Science.gov

Sample records for primary system loca

  1. Interfacing systems LOCAs (Loss of Coolant Accidents) at boiling water reactors

    SciTech Connect

    Chu, Tsong-Lun; Fitzpatrick, R.; Stoyanov, S.

    1987-01-01

    The work presented in this paper was performed by Brookhaven National Laboratory (BNL) in support of Nuclear Regulatory Commission's (NRC) effort towards the resolution of Generic Issue 105 ''Interfacing System Loss of Coolant Accidents (LOCAs) at Boiling Water Reactors (BWRs).'' For BWRs, intersystem LOCA have typically either not been considered in probabilistic risk analyses, or if considered, were judged to contribute little to the risk estimates because of their perceived low frequency of occurrence. However, recent operating experience indicates that the pressure isolation valves (PIVs) in BWRs may not adequately protect against overpressurization of low pressure systems. The objective of this paper is to present the results of a study which analyzed interfacing system LOCA at several BWRs. The BWRs were selected to best represent a spectrum of BWRs in service using industry operating event experience and plant-specific information/configurations. The results presented here include some possible changes in test requirements/practices as well as an evaluation of their reduction potential in terms of core damage frequency (CDF).

  2. Continuation and bifurcation analysis of large-scale dynamical systems with LOCA.

    SciTech Connect

    Salinger, Andrew Gerhard; Phipps, Eric Todd; Pawlowski, Roger Patrick

    2010-06-01

    Dynamical systems theory provides a powerful framework for understanding the behavior of complex evolving systems. However applying these ideas to large-scale dynamical systems such as discretizations of multi-dimensional PDEs is challenging. Such systems can easily give rise to problems with billions of dynamical variables, requiring specialized numerical algorithms implemented on high performance computing architectures with thousands of processors. This talk will describe LOCA, the Library of Continuation Algorithms, a suite of scalable continuation and bifurcation tools optimized for these types of systems that is part of the Trilinos software collection. In particular, we will describe continuation and bifurcation analysis techniques designed for large-scale dynamical systems that are based on specialized parallel linear algebra methods for solving augmented linear systems. We will also discuss several other Trilinos tools providing nonlinear solvers (NOX), eigensolvers (Anasazi), iterative linear solvers (AztecOO and Belos), preconditioners (Ifpack, ML, Amesos) and parallel linear algebra data structures (Epetra and Tpetra) that LOCA can leverage for efficient and scalable analysis of large-scale dynamical systems.

  3. Interfacing systems LOCA (loss-of-coolant accidents): Pressurized water reactors

    SciTech Connect

    Bozoki, G.; Kohut, P.; Fitzpatrick, R.

    1989-02-01

    This report summarizes a study performed by Brookhaven National Laboratory for the Office of Nuclear Regulatory Research, Reactor and Plant Safety Issues Branch, Division of Reactor and Plant Systems, US Nuclear Regulatory Commission. This study was requested by the NRC in order to provide a technical basis for the resolution of Generic Issue 105 ''Interfacing LOCA at LWRs.'' This report deals with pressurized water reactors (PWRs). A parallel report was also accomplished for boiling water reactors. This study focuses on three representative PWRs and extrapolates the plant-specific findings for their generic applicability. In addition, a generic analysis was performed to investigate the cost-benefit aspects of imposing a testing program that would require some minimum level of leak testing of the pressure isolation valves on plants that presently have no such requirements. 28 refs., 31 figs., 64 tabs.

  4. Loss of Coolant Accident (LOCA) / Emergency Core Coolant System (ECCS Evaluation of Risk-Informed Margins Management Strategies for a Representative Pressurized Water Reactor (PWR)

    SciTech Connect

    Szilard, Ronaldo Henriques

    2016-09-01

    A Risk Informed Safety Margin Characterization (RISMC) toolkit and methodology are proposed for investigating nuclear power plant core, fuels design and safety analysis, including postulated Loss-of-Coolant Accident (LOCA) analysis. This toolkit, under an integrated evaluation model framework, is name LOCA toolkit for the US (LOTUS). This demonstration includes coupled analysis of core design, fuel design, thermal hydraulics and systems analysis, using advanced risk analysis tools and methods to investigate a wide range of results.

  5. LOCA analyses for nuclear steam supply systems with upper head injection. [PWR

    SciTech Connect

    Byers, R.K.; Bartel, T.J.

    1980-01-01

    The term Upper Head Injection describes a relatively new addition to a nuclear reactor's emergency cooling system. With this feature, water is delivered directly to the top of the reactor vessel during a loss-of-coolant accident, in addition to the later injection of coolant into the primary operating loops. Established computer programs, with various modifications to models for heat transfer and two-phase flow, were used to analyze a transient following a large break in one of the main coolant loops of a reactor equipped with upper head injection. The flow and heat transfer modifications combined to yield fuel cladding temperatures during blowdown which were as much as 440K (800/sup 0/F) lower than were obtained with standard versions of the codes (for best estimate calculations). The calculations also showed the need for more uniformity of applications of heat transfer models in the computer programs employed.

  6. Geochemical and Hydrologic Controls of Copper-Rich Surface Waters in the Yerba Loca-Mapocho System

    NASA Astrophysics Data System (ADS)

    Pasten, P.; Montecinos, M.; Coquery, M.; Pizarro, G. E.; Abarca, M. I.; Arce, G. J.

    2015-12-01

    Andean watersheds in Northern and Central Chile are naturally enriched with metals, many of them associated to sulfide mineralizations related to copper mining districts. The natural and anthropogenic influx of toxic metals into drinking water sources pose a sustainability challenge for cities that need to provide safe water with the smallest footprint. This work presents our study of the transformations of copper in the Yerba Loca-Mapocho system. Our sampling campaign started from the headwaters at La Paloma Glacier and continues to the inlet of the San Enrique drinking water treatment plant, a system feeding municipalities in the Eastern area of Santiago, Chile. Depending on the season, total copper concentrations go as high as 22 mg/L for the upper sections, which become diluted to <5 mg/L downstream. pH ranged from 3 to 5.6 while suspended solids ranged from <10 to 100 mg/L. We used Geochemist Workbench to assess copper speciation and to evaluate the thermodynamic controls for the formation and dissolution of solid phases. A sediment trap was used to concentrate suspended particulate matter, which was analyzed with ICP-MS, TXRF (total reflection X ray fluorescence) and XRD (X-ray diffraction). Major elements detected in the precipitates were Al (200 g/kg), S (60 g/kg), and Cu (6 g/kg). Likely solid phases include hydrous amorphous phases of aluminum hydroxides and sulfates, and copper hydroxides/carbonates. Efforts are undergoing to find the optimal mixing ratios between the acidic stream and more alkaline streams to maximize attenuation of dissolved copper. The results of this research could be used for enhancing in-stream natural attenuation of copper and reducing treatment needs at the drinking water facility. Acknowledgements to Fondecyt 1130936 and Conicyt Fondap 15110020

  7. Design optimisation of a nanofluid injection system for LOCA events in a nuclear power plant

    NASA Astrophysics Data System (ADS)

    Călimănescu, I.; Stan, L. C.; Velcea, D. D.

    2016-08-01

    The safety issues inside a Nuclear Power Plant (NPP) are encompassing their capacity to ensure the heat sink, meaning the capacity of the systems to release the heat from the rector to the environment. The nanofluids having good heat transfer properties, are recommended to be used in such applications. The paper is solving the following scenario: considering the Safety Injection tank and the Nanofluid injection Tank, and considering the Nanofluid injection Tank filled with a 10% alumina-water nanofluid, how can we select the best design of the connecting point between the pipes of the SIT and the Nanofluid Tank and the pressures inside of any of these tanks in order to have the biggest density of nanoparticles leaving the tanks toward the cold leg. In conclusion the biggest influence over the rate of disposal of the nanofluid inside ECCS is that of the pressure inside the SIT followed in order by the injection pipe diameter and the pressure inside the nanofluid tank. The optimum balance of these three design parameters may be reached following the procedure shown in this paper.

  8. Preliminary LOCA analysis of the westinghouse small modular reactor using the WCOBRA/TRAC-TF2 thermal-hydraulics code

    SciTech Connect

    Liao, J.; Kucukboyaci, V. N.; Nguyen, L.; Frepoli, C.

    2012-07-01

    The Westinghouse Small Modular Reactor (SMR) is an 800 MWt (> 225 MWe) integral pressurized water reactor (iPWR) with all primary components, including the steam generator and the pressurizer located inside the reactor vessel. The reactor core is based on a partial-height 17x17 fuel assembly design used in the AP1000{sup R} reactor core. The Westinghouse SMR utilizes passive safety systems and proven components from the AP1000 plant design with a compact containment that houses the integral reactor vessel and the passive safety systems. A preliminary loss of coolant accident (LOCA) analysis of the Westinghouse SMR has been performed using the WCOBRA/TRAC-TF2 code, simulating a transient caused by a double ended guillotine (DEG) break in the direct vessel injection (DVI) line. WCOBRA/TRAC-TF2 is a new generation Westinghouse LOCA thermal-hydraulics code evolving from the US NRC licensed WCOBRA/TRAC code. It is designed to simulate PWR LOCA events from the smallest break size to the largest break size (DEG cold leg). A significant number of fluid dynamics models and heat transfer models were developed or improved in WCOBRA/TRAC-TF2. A large number of separate effects and integral effects tests were performed for a rigorous code assessment and validation. WCOBRA/TRAC-TF2 was introduced into the Westinghouse SMR design phase to assist a quick and robust passive cooling system design and to identify thermal-hydraulic phenomena for the development of the SMR Phenomena Identification Ranking Table (PIRT). The LOCA analysis of the Westinghouse SMR demonstrates that the DEG DVI break LOCA is mitigated by the injection and venting from the Westinghouse SMR passive safety systems without core heat up, achieving long term core cooling. (authors)

  9. APT Blanket System Loss-of-Coolant Accident (LOCA) Based on Initial Conceptual Design - Case 2: with Beam Shutdown Only

    SciTech Connect

    Hamm, L.L.

    1998-10-07

    This report is one of a series of reports that document normal operation and accident simulations for the Accelerator Production of Tritium (APT) blanket heat removal system. These simulations were performed for the Preliminary Safety Analysis Report. This report documents the results of simulations of a Loss-of-Flow Accident (LOFA) where power is lost to all of the pumps that circulate water in the blanket region, the accelerator beam is shut off and neither the residual heat removal nor cavity flood systems operate.

  10. Results of small break LOCA experiments in the LOFT reactor system with comparison to code calculations. [PWR

    SciTech Connect

    Adams, J.P.; Linebarger, J.H.; Leach, L.P.

    1980-01-01

    The results are presented of three small break loss-of-coolant experiments performed in the LOFT Pressurized Water Reactor (PWR) system. Experiment L3-0, performed without reactor power, represented a loss of coolant from the power operated relief valve on the top of the pressurizer. Experiments L3-1 and L3-2 were initiated with the reactor at full power (maximum linear heat generation rate approximately 52 kW/m) and represented 4-in and 1-in diameter breaks, respectively, in the reactor inlet piping of a commercial PWR. Comparisons of data to analytical model calculations with a number of different models indicate that most major phenomena were correctly calculated, but that improvements in modeling small break behavior are necessary.

  11. RELAP4 calculations of small break LOCAS in PWRs equipped with upper-head injection

    SciTech Connect

    LaChance, J.L.; Berman, M.

    1981-01-01

    The Upper Head Injection (UHI) System is designed to inject directly into the upper head region of the reactor at 1300 psi during a postulated Loss-of-Coolant Accident (LOCA). Recently, some small break LOCA analyses were performed with specially modified versions of RELAP4/MOD5 created to evaluate large break LOCAs in UHI plants. This paper compares some of the small break RELAP4 results with results from similar Westinghouse calculations performed with the WFLASH code. The effects of the special models installed in RELAP4/MOD5 on UHI plant small break LOCA analyses are also evaluated. The calculations simulated 4- and 6-inch diameter cold leg breaks and a break in one of the 4-inch diameter UHI injection lines.

  12. Analysis of LOCA Scenarios in the NIST Research Reactor Before and After Fuel Conversion

    SciTech Connect

    Baek, J. S.; Cheng, L. Y.; Diamond, D.

    2015-08-30

    An analysis has been done of hypothetical loss-of-coolant-accidents (LOCAs) in the research reactor (NBSR) at the National Institute of Standards and Technology (NIST). The purpose of the analysis is to determine if the peak clad temperature remains below the Safety Limit, which is the blister temperature for the fuel. The configuration of the NBSR considered in the analysis is that projected for the future when changes will be made so that shutdown pumps do not operate when a LOCA signal is detected. The analysis was done for the present core with high-enriched uranium (HEU) fuel and with the proposed low-enriched uranium (LEU) fuel that would be used when the NBSR is converted from one to the other. The analysis consists of two parts. The first examines how the water would drain from the primary system following a break and the possibility for the loss of coolant from within the fuel element flow channels. This work is performed using the TRACE system thermal-hydraulic code. The second looks at the fuel clad temperature as a function of time given that the water may have drained from many of the flow channels and the water in the vessel is in a quasi-equilibrium state. The temperature behavior is investigated using the three-dimensional heat conduction code HEATING7.3. The results in all scenarios considered for both HEU and LEU fuel show that the peak clad temperature remains below the blister temperature.

  13. The behavior of ANGRA 2 nuclear power plant core for a small break LOCA simulated with RELAP5 code

    SciTech Connect

    Sabundjian, Gaiane; Andrade, Delvonei A.; Belchior, Antonio Jr.; Silva Rocha, Marcelo da; Conti, Thadeu N.; Torres, Walmir M.; Macedo, Luiz A.; Umbehaun, Pedro E.; Mesquita, Roberto N.; Masotti, Paulo H. F.; Souza Lima, Ana Cecilia de

    2013-05-06

    This work discusses the behavior of Angra 2 nuclear power plant core, for a postulate Loss of Coolant Accident (LOCA) in the primary circuit for Small Break Loss Of Coolant Accident (SBLOCA). A pipe break of the hot leg Emergency Core Cooling System (ECCS) was simulated with RELAP 5 code. The considered rupture area is 380 cm{sup 2}, which represents 100% of the ECCS pipe flow area. Results showed that the cooling is enough to guarantee the integrity of the reactor core.

  14. PWR representative behavior during a LOCA

    SciTech Connect

    Allison, C.M.

    1981-01-01

    To date, there has been substantial analytical and experimental effort to define the margins between design basis loss-of-coolant accident (LOCA) behavior and regulatory limits on maximum fuel rod cladding temperature and deformation. As a result, there is extensive documentation on the modeling of fuel rod behavior in test reactors and design basis LOCA's. However, modeling of that behavior using representative, non-conservative, operating histories is not nearly as well documented in the public literature. Therefore, the objective of this paper is (a) to present calculations of LOCA induced behavior for Pressurized Water Reactor (PWR) core representative fuel rods, and (b) to discuss the variability in those calculations given the variability in fuel rod condition at the initiation of the LOCA. This analysis was limited to the study of changes in fuel rod behavior due to different power operating histories. The other two important parameters which affect that behavior, initial fuel rod design and LOCA coolant conditions were held invarient for all of the representative rods analyzed.

  15. Spatializing Sexuality in Jaime Hernandez's "Locas"

    ERIC Educational Resources Information Center

    Jones, Jessica E.

    2009-01-01

    Focusing on Jaime Hernandez's "Locas: The Maggie and Hopey Stories," part of the "Love and Rockets" comic series, I argue that the graphic landscape of this understudied comic offers an illustration of the theories of space in relation to race, gender, and sexuality that have been critical to understandings of Chicana…

  16. Spatializing Sexuality in Jaime Hernandez's "Locas"

    ERIC Educational Resources Information Center

    Jones, Jessica E.

    2009-01-01

    Focusing on Jaime Hernandez's "Locas: The Maggie and Hopey Stories," part of the "Love and Rockets" comic series, I argue that the graphic landscape of this understudied comic offers an illustration of the theories of space in relation to race, gender, and sexuality that have been critical to understandings of Chicana…

  17. Overview of the M5{sup R} Alloy behavior under RIA and LOCA Conditions

    SciTech Connect

    Mardon, J.P.; Dunn, B.

    2007-07-01

    Experience from irradiation in PWRs has confirmed the M5{sup R} possesses all the properties required for upgraded operation including new fuel management approaches and high duty reactor operation. In this paper accident behavior is demonstrated through a comparison of M5{sup R} and Zircaloy-4 cladding behavior under RIA (Reactivity Insertion Accident) and LOCA (Loss Of Coolant Accident) conditions. AREVA NP supports a significant experimental program of analytical and full -scale tests along with comprehensive analyses on both M5{sup R} and SRA low-tin Zircaloy-4. A key presumption in the conduct of such tests is that, for all Zirconium alloys, the primary effects of high burn-up on cladding thermal-mechanical properties arise from the accumulation of hydrogen within the cladding during operation. This hypothesis is supported through a summarisation of the results of the main RIA and LOCA tests performed on virgin, pre-hydrided, and irradiated M5{sup R} and SRA low-tin Zircaloy-4 cladding. The first part of the paper presents the results of recent Room Temperature (RT) and High Temperature High Pressure (HTHP) integral RIA tests, mainly from the NSRR and CABRI programs, and separate effects mechanical properties tests on high burn-up M5{sup R} and Zircaloy- 4 irradiated claddings. In the second part of this paper, studies of cladding performance under LOCA conditions are presented.. The discussion includes high temperature oxidation kinetics, quench behaviour and post quenched mechanical behaviour of virgin, pre-hydrided and irradiated M5{sup R} and Zircaloy-4 cladding tubes after oxidation at LOCA temperatures and various quenching scenarios. The hydrogen concentrations studied are alloy dependent. Included are mechanical tests and in-depth metallurgical investigations developed to understand the failure mechanisms with the differing alloys and hydrogen concentrations. The result is a confirmation that the effect of hydrogen uptake dominates on the RIA and LOCA

  18. Aging and loss-of-coolant accident (LOCA) testing of electrical connections

    SciTech Connect

    Nelson, C.F.

    1998-01-01

    This report presents the results of an experimental program to determine the aging and loss-of-coolant accident (LOCA) behavior of electrical connections in order to obtain an initial scoping of their performance. Ten types of connections commonly used in nuclear power plants were tested. These included 3 types of conduit seals, 2 types of cable-to-device connectors, 3 types of cable-to-cable connectors, and 2 types of in-line splices. The connections were aged for 6 months under simultaneous thermal (99 C) and radiation (46 Gy/hr) conditions. A simulated LOCA consisting of sequential high dose-rate irradiation (3 kGy/hr) and high-temperature steam exposures followed the aging. Connection functionality was monitored using insulation resistance measurements during the aging and LOCA exposures. Because only 5 of the 10 connection types passed a post-LOCA, submerged dielectric withstand test, further detailed investigation of electrical connections and the effects of cable jacket integrity on the cable-connection system is warranted.

  19. Effect of spray parameter on containment depressurization during LOCA in KAPP 3 and 4, 700 MWE IPHWR

    SciTech Connect

    Sharma, S. K.; Bhartia, D. K.; Mohan, N.; Malhotra, P. K.; Ghadge, S. G.

    2012-07-01

    KAPP 3 and 4 is an Indian Pressurized Heavy Water Reactor (IPHWR) of 700 MWe capacities. It is a pressure tube type reactor with heavy water as moderator and coolant and natural Uranium Dioxide as fuel. It consists of 392 horizontal fuel channel assemblies and surrounded by three separate water systems i.e. primary coolant, moderator and calandria vault water system. Containment of Indian PHWR is an ultimate barrier, which is designed to envelope whole reactor systems, to prevent the spread of active air-borne fission products in accident condition. Containment Spray System has been provided for energy as well as activity removal from the Containment system. This paper discusses about the studies done to assess the effect of spray parameters such as spray flow rate, droplets diameter and height of fall on containment peak pressure and temperature, long term containment depressurization and energy removal from the containment during Loss of Coolant Accident (LOCA). The spray flow rate and droplets diameter play an important role in removing residual energy from containment atmosphere, which influences depressurization of containment. It is obvious that faster depressurization of containment during postulated LOCA helps in limiting radiological consequences. From radiological considerations, droplets diameter is required to be kept to the lowest practically possible value and flow rate of spray should be high. Spray water droplets fall height governs the exposure time of droplets, which is the direct indication of energy removal rate. However, it is observed from the sensitivity studies that for a height of spray droplet fall more than 16.5 m, for the range of spray water flow rate and droplets sizes considered in the analyses, there is no significant change in heat removal. (authors)

  20. APT Blanket System Loss-of-Coolant Accident (LOCA) Based on Initial Conceptual Design - Case 4: External Pressurizer Surge Line Break Near Inlet Header

    SciTech Connect

    Hamm, L.L.

    1998-10-07

    This report is one of a series of reports documenting accident scenario simulations for the Accelerator Production of Tritium (APT) blanket heat removal systems. The simulations were performed in support of the Preliminary Safety Analysis Report (PSAR) for the APT.

  1. APT Blanket System Loss-of-Coolant Accident (LOCA) Analysis Based on Initial Conceptual Design - Case 3: External HR Break at Pump Outlet without Pump Trip

    SciTech Connect

    Hamm, L.L.

    1998-10-07

    This report is one of a series of reports that document normal operation and accident simulations for the Accelerator Production of Tritium (APT) blanket heat removal (HR) system. These simulations were performed for the Preliminary Safety Analysis Report.

  2. APT Blanket System Loss-of-Coolant Accident (LOCA) Based on Initial Conceptual Design - Case 1: External HR Break Near Inlet Header

    SciTech Connect

    Hamm, L.L.

    1998-10-07

    The APT blanket system has about 57 MW of thermal energy deposited within the blanket region under normal operating conditions from the release of neutrons and the interaction of the High energy particles with the blanket materials. This corresponds to about 48 percent of total thermal energy deposited in the APT target/blanket system. The deposited thermal energy under normal operation conditions is an important input parameter used in the thermal-hydraulic design and accident analysis.

  3. A simplified time-dependent recovery model as applied to RCP seal LOCAs

    SciTech Connect

    Kohut, P.; Bozoki, G.; Fitzpatrick, R. )

    1991-01-01

    In Westinghouse-designed reactors, the reactor coolant pump (RCP) seals constantly require a modest amount of cooling. This cooling function depends on the service water (SW) system. Upon the loss of the cooling function due to the unavailability of the SW, component cooling water system or electrical power (station blackout), the RCP seals may degrade, resulting in a loss-of-coolant accident (LOCA). Recent studies indicate that the frequency of the loss of SW initiating events is higher than previously thought. This change significantly increases the core damage frequency contribution from RCP seal failure. The most critical/dominant element in the loss of SW events was found to be the SW-induced RCP seal failure. For these potential accident scenarios, there are large uncertainties regarding the actual frequency of RCP seal LOCA, the resulting leakage rate, and time-dependent behavior. The roles of various recovery options based on the time evolution of the seal LOCA have been identified and taken into account in recent NUREG-1150 probabilistic risk assessment PRA analyses. In this paper, a consistent time-dependent recovery model is described that takes into account the effects of various recovery actions based on explicit considerations given to a spectrum of time- and flow-rate dependencies. The model represents a simplified approach but is especially useful when extensive seal leak rate and core uncovery information is unavailable.

  4. TRANSPORT CHARACTERISTICS OF SELECTED PWR LOCA GENERATED DEBRIS.

    SciTech Connect

    A. K. MAJI; B. MARSHALL; ET AL

    2000-10-01

    In the unlikely event of a Loss of Coolant Accident (LOCA) in a pressurized water reactor (PWR), break jet impingement would dislodge thermal insulation from nearby piping, as well as other materials within the containment, such as paint chips, concrete dust, and fire barrier materials. Steam/water flows induced by the break and by the containment sprays would transport debris to the containment floor. Subsequently, debris would likely transport to and accumulate on the suction sump screens of the emergency core cooling system (ECCS) pumps, thereby potentially degrading ECCS performance and possibly even failing the ECCS. In 1998, the U. S. Nuclear Regulatory Commission (NRC) initiated a generic study (Generic Safety Issue-191) to evaluate the potential for the accumulation of LOCA related debris on the PWR sump screen and the consequent loss of ECCS pump net positive suction head (NPSH). Los Alamos National Laboratory (LANL), supporting the resolution of GSI-191, was tasked with developing a method for estimating debris transport in PWR containments to estimate the quantity of debris that would accumulate on the sump screen for use in plant specific evaluations. The analytical method proposed by LANL, to predict debris transport within the water that would accumulate on the containment floor, is to use computational fluid dynamics (CFD) combined with experimental debris transport data to predict debris transport and accumulation on the screen. CFD simulations of actual plant containment designs would provide flow data for a postulated accident in that plant, e.g., three-dimensional patterns of flow velocities and flow turbulence. Small-scale experiments would determine parameters defining the debris transport characteristics for each type of debris. The containment floor transport methodology will merge debris transport characteristics with CFD results to provide a reasonable and conservative estimate of debris transport within the containment floor pool and

  5. Review and evaluation of the RELAP5YA computer code and the Vermont Yankee LOCA (Loss-of-Coolant Accident) licensing analysis model for use in small and large break BWR (Boiling Water Reactor) LOCAS

    SciTech Connect

    Jones, J.L.

    1987-01-01

    A review has been completed of the RELAP5YA computer code to determine its acceptability for performing licensing analyses. The review was limited to Boiling Water Reactor (BWR) reactor applications. In addition, a Loss-Of-Coolant Accident (LOCA) licensing analysis method, using the RELAP5YA computer code, has been reviewed. This method is applicable to the Vermont Yankee Nuclear Power Station to perform full break spectra LOCA and fuel cycle independent analyses. The review of the RELAP5YA code consisted of an evaluation of all Yankee Atomic Electric Company (YAEC) incorporated modifications to the RELAP5/MOD1 Cycle 18 computer code from which the licensing version of the code originated. Qualifying separate and integral effects assessment calculations were reviewed to evaluate the validity and proper implementation of the various added models. The LOCA licensing method was assessed by reviewing two RELAP5YA system input models and evaluating several small and large break qualifying transient calculations. A review of the RELAP5YA code modifications and their assessments, as well as the submitted LOCA licensing method, is given and the results of the review are provided.

  6. Vermont Yankee simulator qualification: large-break LOCA

    SciTech Connect

    Loomis, J.N.; Fernandez, R.T.

    1987-01-01

    Yankee Atomic Electric Company (YAEC) has developed simulator benchmark capabilities for the Seabrook, Maine Yankee, and Vermont Yankee Nuclear Power Station (VYNPS) simulators. The goal is to establish that each simulator has a satisfactory real-time response for different scenarios that will enhance operator training. Vermont Yankee purchased a full-scope plane simulator for the VYNPS, a four-unit boiling water reactor with a Mark-I containment. The following seven benchmark cases were selected by YAEC and VYNPC to supplement the Simulator Acceptance Test Program: (1) control rod swap; (2) partial reactor scram; (3) recirculation pump trip; (4) main steam isolation valve (MSIV) closure without scram, (5) main steamline break, (6) small-break loss-of-coolant accident (LOCA), and (7) large-break LOCA. Five simulator benchmark sessions have been completed. Each session identified simulator capabilities and limitations that needed correction. This paper discusses results from the latest large-break LOCA case.

  7. LOCA with consequential or delayed LOOP accidents: Unique issues, plant vulnerability, and CDF contributions

    SciTech Connect

    Martinez-Guridi, G.; Samanta, P.; Chu, L.; Yang, J.

    1998-08-01

    A loss-of-coolant accident (LOCA) can cause a loss-of-offsite power (LOOP) wherein the LOOP is usually delayed by few seconds or longer. Such an accident is called LOCA with consequential LOOP, or LOCA with delayed LOOP (here, abbreviated as LOCA/LOOP). This paper analyzes the unique conditions that are associated with a LOCA/LOOP, presents a model, and quantifies its contribution to core damage frequency (CDF). The results show that the CDF contribution can be a dominant contributor to risk for certain plant designs, although boiling water reactors (BWRs) are less vulnerable than pressurized water reactors (PWRs).

  8. Viking orbiter system primary mission

    NASA Technical Reports Server (NTRS)

    Goudy, J. R.

    1977-01-01

    An overview of Viking Orbiter (VO) system and subsystem performances during the primary mission (the time period from VO-1 launch on August 20, 1975, through November 15, 1976) is presented. Brief descriptions, key design requirements, pertinent historical information, unique applications or situations, and predicted versus actual performances are included for all VO-1 and VO-2 subsystems, both individually and as an integrated system.

  9. MELCOR code analysis of a severe accident LOCA at Peach Bottom Plant

    SciTech Connect

    Carbajo, J.J. )

    1993-01-01

    A design-basis loss-of-coolant accident (LOCA) concurrent with complete loss of the emergency core cooling systems (ECCSs) has been analyzed for the Peach Bottom atomic station unit 2 using the MELCOR code, version 1.8.1. The purpose of this analysis is to calculate best-estimate times for the important events of this accident sequence and best-estimate source terms. Calculated pressures and temperatures at the beginning of the transient have been compared to results from the Peach Bottom final safety analysis report (FSAR). MELCOR-calculated source terms have been compared to source terms reported in the NUREG-1465 draft.

  10. SPACE code simulation of cold leg small break LOCA in the ATLAS integral test

    SciTech Connect

    Kim, B. J.; Kim, H. T.; Kim, J.; Kim, K. D.

    2012-07-01

    SPACE code is a system analysis code for pressurized water reactors. This code uses a two-fluid and three-field model. For a few years, intensive validations have been performed to secure the prediction accuracy of models and correlations for two-phase flow and heat transfer. Recently, the code version 1.0 was released. This study is to see how well SPACE code predicts thermal hydraulic phenomena of an integral effect test. The target experiment is a cold leg small break LOCA in the ATLAS facility, which has the same two-loop features as APR1400. Predicted parameters were compared with experimental observations. (authors)

  11. LOCA feasibility study of Almaraz NPP 110% power up-rate

    SciTech Connect

    Orive, Raul; Gallego, Ines; Garcia, Pablo; Concejal, Alberto; Martinez-Murillo, Juan-Carlos

    2006-07-01

    Knowledge about accidents and fuel response in extreme conditions has progressed in parallel with the simulation tools development and consequently results are today highly satisfactory. This fact allows nuclear power plants (NPP) to carry out optimization processes of its operation and yield improvements due to the development of new methodologies and tools. Power up-rates open a demand in areas like the analyses of Loss Of Coolant Accidents (LOCA's), which impact on plant design may limit the maximum operation power in a nuclear power plant. TRAC-PF1 is a thermal-hydraulic calculation code that allows the complete treatment of two-phase flows in balance, combining a three dimensional vessel, that simulates in detail the accident phenomena, with one dimensional components. TRAC-PF1 code capacities in the reproduction of experiments, transients and accidents have been widely proved. IBERINCO has modified the original code to develop a conservative model applicable to a 3-loop Westinghouse NPP. These circumstances have allowed Almaraz NPP to get deeper in the study of the plant behaviour during a LOCA, after a hypothetical Power Up-rate. The scope of the study includes the development of the plant model and the reproduction of several accidents with loss of coolant. These accidents have been simulated with the improved option and the conservative version of the modified code (TRAC-PF1/IBER). The limiting case at the current power is analyzed in 110% Power Up-rate conditions and different sensitivity studies are performed, focused in impact of axial power distribution, discharge coefficients and emergency core cooling system availability. These studies allow to verify the effectiveness of Almaraz NPP safety systems in LOCA scenarios to guarantee the required safety margins. (authors)

  12. Decay heat removal during SB LOCA with loss of all feedwater

    SciTech Connect

    Prosek, A.; Mavko, B.; Petelin, S.

    1994-12-31

    The aim of this research was to investigate decay heat removal during SB LOCA with simultaneous loss of all feedwater in a two loop PWR plant. Following a SB LOCA, the major concern is to keep the core covered assuring decay heat removal from the core thereby preventing cladding damage. Analysis was performed based on the data for Krsko NPP in Slovenia. The spectrum of break sizes in the cold leg was analyzed using the RELAP5/MOD2 code. The results indicate that when the break diameter is lower than 2.5 cm, the steam generators will dry out and the primary side bleed and feed procedure should be initiated. For break diameters between 2.5 cm to 5.1 cm the decay heat can be removed by the break flow and by relieving the steam through the steam generator relief valves. For break diameters greater than 5.1 cm the break flow is sufficient to remove all dissipated decay heat.

  13. Estimate of LOCA-FI plenum pressure uncertainty for a five-ring RELAP5 production reactor model

    SciTech Connect

    Griggs, D.P.

    1993-03-01

    The RELAP5/MOD2.5 code (RELAP5) is used to perform best-estimate analyses of certain postulated Design Basis Accidents (DBAs) in SRS production reactors. Currently, the most limiting DBA in terms of reactor power level is an instantaneous double-ended guillotine break (DEGB) loss of coolant accident (LOCA). A six-loop RELAP5 K Reactor model is used to analyze the reactor system behavior dozing the Flow Instability (FI) phase of the LOCA, which comprises only the first 5 seconds following the DEGB. The RELAP5 K Reactor model includes tank and plenum nodalizations having five radial rings and six azimuthal sectors. The reactor system analysis provides time-dependent plenum and tank bottom pressures for use as boundary conditions in the FLOWTRAN code, which models a single fuel assembly in detail. RELAP5 also performs the system analysis for the latter phase of the LOCA, denoted the Emergency Cooling System (ECS) phase. Results from the RELAP analysis are used to provide boundary conditions to the FLOWTRAN-TF code, which is an advanced two-phase version of FLOWTRAN. The RELAP5 K Reactor model has been tested for LOCA-FI and Loss-of-Pumping Accident analyses and the results compared with equivalent analyses performed with the TRAC-PF1/MOD1 code (TRAC). An equivalent RELAP5 six-loop, five-ring, six-sector L Reactor model has been benchmarked against qualified single-phase system data from the 1989 L-Area In-Reactor Test Program. The RELAP5 K and L Reactor models have also been subjected to an independent Quality Assurance verification.

  14. Primary Atomic Clock Reference System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    An artist's concept of the Primary Atomic Clock Reference System (PARCS) plarned to fly on the International Space Station (ISS). PARCS will make even more accurate atomic time available to everyone, from physicists testing Einstein's Theory of Relativity, to hikers using the Global Positioning System to find their way. In ground-based atomic clocks, lasers are used to cool and nearly stop atoms of cesium whose vibrations are used as the time base. The microgravity of space will allow the atoms to be suspended in the clock rather than circulated in an atomic fountain, as required on Earth. PARCS is being developed by the Jet Propulsion Laboratory with principal investigators at the National Institutes of Standards and Technology and the University of Colorado, Boulder. See also No. 0103191

  15. Primary Atomic Clock Reference System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    An artist's concept of the Primary Atomic Clock Reference System (PARCS) plarned to fly on the International Space Station (ISS). PARCS will make even more accurate atomic time available to everyone, from physicists testing Einstein's Theory of Relativity, to hikers using the Global Positioning System to find their way. In ground-based atomic clocks, lasers are used to cool and nearly stop atoms of cesium whose vibrations are used as the time base. The microgravity of space will allow the atoms to be suspended in the clock rather than circulated in an atomic fountain, as required on Earth. PARCS is being developed by the Jet Propulsion Laboratory with principal investigators at the National Institutes of Standards and Technology and the University of Colorado, Boulder. See also No. 0100120.

  16. Primary Atomic Clock Reference System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    An artist's concept of the Primary Atomic Clock Reference System (PARCS) plarned to fly on the International Space Station (ISS). PARCS will make even more accurate atomic time available to everyone, from physicists testing Einstein's Theory of Relativity, to hikers using the Global Positioning System to find their way. In ground-based atomic clocks, lasers are used to cool and nearly stop atoms of cesium whose vibrations are used as the time base. The microgravity of space will allow the atoms to be suspended in the clock rather than circulated in an atomic fountain, as required on Earth. PARCS is being developed by the Jet Propulsion Laboratory with principal investigators at the National Institutes of Standards and Technology and the University of Colorado, Boulder. See also No. 0103191

  17. Primary Atomic Clock Reference System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    An artist's concept of the Primary Atomic Clock Reference System (PARCS) plarned to fly on the International Space Station (ISS). PARCS will make even more accurate atomic time available to everyone, from physicists testing Einstein's Theory of Relativity, to hikers using the Global Positioning System to find their way. In ground-based atomic clocks, lasers are used to cool and nearly stop atoms of cesium whose vibrations are used as the time base. The microgravity of space will allow the atoms to be suspended in the clock rather than circulated in an atomic fountain, as required on Earth. PARCS is being developed by the Jet Propulsion Laboratory with principal investigators at the National Institutes of Standards and Technology and the University of Colorado, Boulder. See also No. 0100120.

  18. A Demonstration of Advanced Safety Analysis Tools and Methods Applied to Large Break LOCA and Fuel Analysis for PWRs

    SciTech Connect

    Szilard, Ronaldo Henriques; Smith, Curtis Lee; Martineau, Richard Charles

    2016-03-01

    The U.S. Nuclear Regulatory Commission (NRC) is currently proposing a rulemaking designated as 10 CFR 50.46c to revise the loss-of-coolant accident (LOCA)/emergency core cooling system acceptance criteria to include the effects of higher burnup on fuel/cladding performance. We propose a demonstration problem of a representative four-loop PWR plant to study the impact of this new rule in the US nuclear fleet. Within the scope of evaluation for the 10 CFR 50.46c rule, aspects of safety, operations, and economics are considered in the industry application demonstration presented in this paper. An advanced safety analysis approach is used, by integrating the probabilistic element with deterministic methods for LOCA analysis, a novel approach to solving these types of multi-physics, multi-scale problems.

  19. Hydrogen motion in Zircaloy-4 cladding during a LOCA transient

    NASA Astrophysics Data System (ADS)

    Elodie, T.; Jean, D.; Séverine, G.; M-Christine, B.; Michel, C.; Berger, P.; Martine, B.; Antoine, A.

    2016-04-01

    Hydrogen and oxygen are key elements influencing the embrittlement of zirconium-based nuclear fuel cladding during the quench phase following a Loss Of Coolant Accident (LOCA). The understanding of the mechanisms influencing the motion of these two chemical elements in the metal is required to fully describe the material embrittlement. High temperature steam oxidation tests were performed on pre-hydrided Zircaloy-4 samples with hydrogen contents ranging between 11 and 400 wppm prior to LOCA transient. Thanks to the use of both Electron Probe Micro-Analysis (EPMA) and Elastic Recoil Detection Analysis (μ-ERDA), the chemical elements partitioning has been systematically quantified inside the prior-β phase. Image analysis and metallographic examinations were combined to provide an average oxygen profile as well as hydrogen profile within the cladding thickness after LOCA transient. The measured hydrogen profile is far from homogeneous. Experimental distributions are compared to those predicted numerically using calculations derived from a finite difference thermo-diffusion code (DIFFOX) developed at IRSN.

  20. Modelling of LOCA Tests with the BISON Fuel Performance Code

    SciTech Connect

    Williamson, Richard L; Pastore, Giovanni; Novascone, Stephen Rhead; Spencer, Benjamin Whiting; Hales, Jason Dean

    2016-05-01

    BISON is a modern finite-element based, multidimensional nuclear fuel performance code that is under development at Idaho National Laboratory (USA). Recent advances of BISON include the extension of the code to the analysis of LWR fuel rod behaviour during loss-of-coolant accidents (LOCAs). In this work, BISON models for the phenomena relevant to LWR cladding behaviour during LOCAs are described, followed by presentation of code results for the simulation of LOCA tests. Analysed experiments include separate effects tests of cladding ballooning and burst, as well as the Halden IFA-650.2 fuel rod test. Two-dimensional modelling of the experiments is performed, and calculations are compared to available experimental data. Comparisons include cladding burst pressure and temperature in separate effects tests, as well as the evolution of fuel rod inner pressure during ballooning and time to cladding burst. Furthermore, BISON three-dimensional simulations of separate effects tests are performed, which demonstrate the capability to reproduce the effect of azimuthal temperature variations in the cladding. The work has been carried out in the frame of the collaboration between Idaho National Laboratory and Halden Reactor Project, and the IAEA Coordinated Research Project FUMAC.

  1. French investigations of high burnup effect on LOCA thermomechanical behavior: Part 1. Experimental programmes in support of LOCA design methodologies

    SciTech Connect

    Waeckel, N.; Cauvin, R.; Lebuffe, C.

    1997-01-01

    Within the framework of Burn-Up extension request, EDF, FRAMATOME, CEA and IPSN have carried out experimental programmes in order to provide the design of fuel rods under LOCA conditions with relevant data. The design methods used in France for LOCA are based on standard Appendix K methodology updated to take into account some penalties related to the actual conditions of the Nuclear Power Plant. Best-Estimate assessments are used as well. Experimental programmes concern plastic deformation and burst behavior of advanced claddings (EDGAR) and thermal shock quenching behavior of highly irradiated claddings (TAGCIR). The former reveals the important role played by the {alpha}/{beta} transformation kinetics related to advanced alloys (Niobium alloys) and the latter the significative impact of hydrogen charged during in-reactor corrosion on oxidation kinetics and failure behavior in terms of cooling rates.

  2. TREAT source-term experiment STEP-1 simulating a PWR LOCA

    SciTech Connect

    Simms, R.; Baker, L. Jr.; Blomquist, C.A.; Ritzman, R.L.

    1986-01-01

    In a hypothetical pressurized water reactor (PWR) large-break loss-of-coolant accident (LOCA) in which the emergency core cooling system fails, fission product decay heating causes water boil-off and reduced heat removal. Zircaloy cladding is oxidized by the steam. The noble gases and volatile fission products such as cesium and iodine that constitute a principal part of the source term will be released from the damaged fuel at or shortly after the time of cladding failure. TREAT test STEP-1 simulated the LOCA environment when the volatile fission products would be released using four fuel elements from the Belgonucleaire BR3 reactor. The principal objective was to collect a portion of the releases carried by the flow stream in a region as close as possible to the test zone. In this paper, the test is described and the results of an analysis of the thermal and steam/hydrogen environment are compared with the test measurements in order to provide a characterization for analysis of fission product releases and aerosol formation. The results of extensive sample examinations are reported separately.

  3. Primary central nervous system lymphoma.

    PubMed

    Pels, Hendrik; Schlegel, Uwe

    2006-07-01

    There is no class I evidence for any therapeutic option in primary central nervous system lymphoma (PCNSL). When possible, patients should be included in clinical trials. The role of surgery is restricted to stereotactic biopsy in order to gain material for histopathologic diagnosis. Radiotherapy alone is associated with a median survival of no more than 1.5 years; cure is exceptional. However, in patients aged younger than 60 years, cure is the therapeutic aim. Polychemotherapy based on high-dose methotrexate with deferred radiation results in long-term survival in most of these patients and possibly cure in a substantial fraction of these patients. With regard to chemotherapy in PCNSL, the following must be considered: 1) the most efficient drug in PCNSL is methotrexate at a dosage of at least 1.5 g/m(2) per single dose; 2) methotrexate alone will lead to complete remission in only some patients, whereas the combination of methotrexate with other drugs is more efficient; and 3) the value of additional intraventricular chemotherapy and the necessity of "consolidation" radiotherapy after response to chemotherapy are not yet defined. For patients aged older than 60 years, no curative regimen with acceptable toxicity has yet been established. The combination of radiotherapy with methotrexate-based chemotherapy leads to severe long-term neurotoxic sequelae, ie, cognitive dysfunction, in most older patients and in some patients aged younger than 60 years.

  4. RELAP5 simulation of SB LOCA in a VVER 440 model

    SciTech Connect

    Parzer, I.; Mavko, B.; Petelin, S.

    1992-01-01

    The VVER-440-type plants differ considerably from western-type pressurized water reactors (PWR). The two main distinguishing characteristics are horizontal steam generators and loop seals in both hot and cold legs, which are lately a great safety concern worldwide. In 1987, the International Atomic Energy Agency (IAEA) organized and sponsored one of the tests performed on the Hungarian PMK-NVH test facility and called it IAEA-SPE-2. The test was chosen from a wider test matrix performed to investigate emergency core cooling system capability in VVER-440 plants for a small-break loss-of-coolant accident (SB LOCA). PMK-NVA is a one-loop, full-height, full-pressure model of the Hungarian Paks nuclear power plant, type VVER-440, Soviet production. The facility power level is 100%, according to the 1:2070 scaling factor.

  5. TRAC-PF1/MOD1 US/Japanese PWR conservative LOCA prediction

    SciTech Connect

    Gruen, G E; Fisher, J E

    1987-11-01

    This report documents the results of a 200%, double-ended, cold-leg-break, loss-of-coolant-accident (LOCA) calculation using the TRAC-PF1/MOD1 computer code. The reactor system represented a typical United States/Japanese pressurized water reactor with a 15 x 15 fuel bundle arrangement 12-ft long, four loops, and cold-leg Emergency Core Cooling (ECC) Systems. Conservation boundary and initial conditions were used. Reactor power was 102% of the 3250 MWt rated power, decay heat was set to 120% of American Nuclear Society Standard 5.1, highest core lifetime values for power peaking and fuel stored energy were used, and the LOCA occurred simultaneously with a loss of offsite power. Best estimate assumptions were used for the break flow model, fuel rod heat transfer and metal-water reaction correlations, and steady-state fuel temperature profiles. A flow blockage model, having the capability to account for the effects of cladding ballooning or rupturing, was not used. Except for these best estimate assumptions, the boundary and initial conditions were consistent with those used in licensing calculations. Maximum fuel rod temperatures were 1380 K (2020/sup 0/F) and 1040 K (1410/sup 0/F) on the hottest evaluation model rod and hottest best estimate rod, respectively. The high reported values or fuel cladding temperature were a direct consequence of the conservative boundary and initial conditions used for the calculation, primarily the 2% overpower condition, the core decay heat assumption, and the degraded ECCS. The calculation demonstrated successful core reflooding before 1478 K (2200/sup 0/F) cladding temperature was exceeded on any fuel rod. 7 refs., 47 figs., 5 tabs.

  6. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  7. Radiological dose in Muria peninsula from SB-LOCA event

    NASA Astrophysics Data System (ADS)

    Sunarko; Suud, Zaki

    2017-01-01

    Dose assessment for accident condition is performed for Muria Peninsula region using source-term from Three-Mile Island unit 2 SB-LOCA accident. Xe-133, Kr-88, 1-131 and Cs-137 isotopes are considered in the calculation. The effluent is assumed to be released from a 50 m stack. Lagrangian particle dispersion method (LPDM) employing non-Gaussian dispersion coefficient in 3-dimensional mass-consistent wind-field is employed to obtain periodic surface-level concentration which is then time-integrated to obtain spatial distribution of ground-level dose. In 1-hour simulation, segmented plumes with 60 seconds duration with a total of 18.000 particles involved. Simulations using 6-hour worst-case meteorological data from Muria peninsula results in a peak external dose of around 1.668 mSv for low scenario and 6.892 mSv for high scenario in dry condition. In wet condition with 5 mm/hour and 10 mm/hour rain for the whole duration of the simulation provides only minor effect to dose. The peak external dose is below the regulatory limit of 50 mSv for effective skin dose from external gamma exposure.

  8. Primary systemic amyloidosis presenting as constrictive pericarditis.

    PubMed

    Singh, Vikas; Fishman, Joel E; Alfonso, Carlos E

    2011-01-01

    The most frequent presentation of cardiac amyloidosis is with endomyocardial deposition, and resultant restrictive cardiomyopathy. We present a case of primary systemic amyloidosis causing constrictive pericarditis (CP) and congestive heart failure without clinical evidence of endomyocardial deposition. A comprehensive evaluation by noninvasive and invasive studies facilitated the differentiation of CP from restrictive cardiomyopathy and the patient was effectively treated with pericardectomy. To our knowledge, this is the first documented case of primary systemic amyloidosis causing selective CP with successful antemortem diagnosis and treatment in a young man.

  9. Project Design Concept Primary Ventilation System

    SciTech Connect

    MCGREW, D.L.

    2000-10-02

    Tank Farm Restoration and Safe Operation (TFRSO), Project W-3 14 was established to provide upgrades that would improve the reliability and extend the system life of portions of the waste transfer, electrical, ventilation, instrumentation and control systems for the Hanford Site Tank Farms. An assessment of the tank farm system was conducted and the results are documented in system assessment reports. Based on the deficiencies identified in the tank farm system assessment reports, and additional requirements analysis performed in support of the River Protection Project (RPP), an approved scope for the TFRSO effort was developed and documented in the Upgrade Scope Summary Report (USSR), WHC-SD-W314-RPT-003, Rev. 4. The USSR establishes the need for the upgrades and identifies the specific equipment to be addressed by this project. This Project Design Concept (PDC) is in support of the Phase 2 upgrades and provides an overall description of the operations concept for the W-314 Primary Ventilation Systems. Actual specifications, test requirements, and procedures are not included in this PDC. The PDC is a ''living'' document, which will be updated throughout the design development process to provide a progressively more detailed description of the W-314 Primary Ventilation Systems design. The Phase 2 upgrades to the Primary Ventilation Systems shall ensure that the applicable current requirements are met for: Regulatory Compliance; Safety; Mission Requirements; Reliability; and Operational Requirements.

  10. Challenging mimickers of primary systemic vasculitis.

    PubMed

    Miloslavsky, Eli M; Stone, John H; Unizony, Sebastian H

    2015-01-01

    The need to distinguish true primary systemic vasculitis from its multiple potential mimickers is one of the most challenging diagnostic conundrums in clinical medicine. This article reviews 9 challenging vasculitis mimickers: fibromuscular dysplasia, calciphylaxis, segmental arterial mediolysis, antiphospholipid syndrome, hypereosinophilic syndrome, lymphomatoid granulomatosis, malignant atrophic papulosis, livedoid vasculopathy, and immunoglobulin G4-related disease.

  11. ACHILLES: Heat Transfer in PWR Core During LOCA Reflood Phase

    SciTech Connect

    2013-11-01

    1. NAME AND TITLE OF DATA LIBRARY ACHILLES -Heat Transfer in PWR Core During LOCA Reflood Phase. 2. NAME AND TITLE OF DATA RETRIEVAL PROGRAMS N/A 3. CONTRIBUTOR AEA Technology, Winfrith Technology Centre, Dorchester DT2 8DH United Kingdom through the OECD Nuclear Energy Agency Data Bank, Issy-les-Moulineaux, France. 4. DESCRIPTION OF TEST FACILITY The most important features of the Achilles rig were the shroud vessel, which contained the test section, and the downcomer. These may be thought of as representing the core barrel and the annular downcomer in the reactor pressure vessel. The test section comprises a cluster of 69 rods in a square array within a circular shroud vessel. The rod diameter and pitch (9.5 mm and 12.6 mm) were typical of PWR dimensions. The internal diameter of the shroud vessel was 128 mm. Each rod was electrically heated over a length of 3.66 m, which is typical of the nuclear heated length in a PWR fuel rod, and each contained 6 internal thermocouples. These were arranged in one of 8 groupings which concentrated the thermocouples in different axial zones. The spacer grids were at prototypic PWR locations. Each grid had two thermocouples attached to its trailing edge at radial locations. The axial power profile along the rods was an 11 step approximation to a "chopped cosine". The shroud vessel had 5 heating zones whose power could be independently controlled. 5. DESCRIPTION OF TESTS The Achilles experiments investigated the heat transfer in the core of a Pressurized Water Reactor during the re-flood phase of a postulated large break loss of coolant accident. The results provided data to validate codes and to improve modeling. Different types of experiments were carried out which included single phase cooling, re-flood under low flow conditions, level swell and re-flood under high flow conditions. Three series of experiments were performed. The first and the third used the same test section but the second used another test section, similar in

  12. [Transforming health systems based on primary care].

    PubMed

    Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia

    2012-01-01

    Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.

  13. Cobalt-60 simulation of LOCA (loss of coolant accident) radiation effects

    SciTech Connect

    Buckalew, W.H.

    1989-07-01

    The consequences of simulating nuclear reactor loss of coolant accident (LOCA) radiation effects with Cobalt-60 gamma ray irradiators have been investigated. Based on radiation induced damage in polymer base materials, it was demonstrated that electron/photon induced radiation damage could be related on the basis of average absorbed radiation dose. This result was used to estimate the relative effectiveness of the mixed beta/gamma LOCA and Cobalt-60 radiation environments to damage both bare and jacketed polymer base electrical insulation materials. From the results obtained, it is concluded that present simulation techniques are a conservative method for simulating LOCA radiation effects and that the practices have probably substantially overstressed both bare and jacketed materials during qualification testing. 9 refs., 8 figs., 5 tabs.

  14. Considerations for Probabilistic Analyses to Assess Potential Changes to Large-Break LOCA Definition for ECCS Requirements

    SciTech Connect

    Wilkowski, G.; Rudland, D.; Wolterman, R.; Krishnaswamy, P.; Scott, P.; Rahman, S.; Fairbanks, C.

    2002-07-01

    The U.S.NRC has undertaken a study to explore changes to the body of Part 50 of the U.S. Federal Code of Regulations, to incorporate risk-informed attributes. One of the regulations selected for this study is 10 CFR 50.46, {sup A}cceptance Criteria for Emergency Core Cooling Systems for Light-Water Nuclear Power Reactors{sup .} These changes will potentially enhance safety and reduce unnecessary burden on utilities. Specific attention is being paid to redefining the maximum pipe break size for LB-LOCA by determining the spectrum of pipe diameter (or equivalent opening area) versus failure probabilities. In this regard, it is necessary to ensure that all contributors to probabilistic failures are accounted for when redefining ECCS requirements. This paper describes initial efforts being conducted for the U.S.NRC on redefining the LB-LOCA requirements. Consideration of the major contributors to probabilistic failure, and deterministic aspects for modeling them, are being addressed. At this time three major contributors to probabilistic failures are being considered. These include: (1) Analyses of the failure probability from cracking mechanisms that could involve rupture or large opening areas from either through-wall or surface flaws, whether the pipe system was approved for leak-before-break (LBB) or not. (2) Future degradation mechanisms, such as recent occurrence of PWSCC in PWR piping need to be included. This degradation mechanism was not recognized as being an issue when LBB was approved for many plants or when the initial risk-informed inspection plans were developed. (3) Other indirect causes of loss of pressure-boundary integrity than from cracks in the pipe system also should be included. The failure probability from probabilistic fracture mechanics will not account for these other indirect causes that could result in a large opening in the pressure boundary: i.e., failure of bolts on a steam generator manway, flanges, and valves; outside force damage from

  15. Transport Characteristics of Selected Pressurized Water Reactor LOCA-Generated Debris

    SciTech Connect

    Maji, Arup K.; Rao, Daseri V.; Letellier, Bruce; Bartlein, Luke; Marshall, Brooke

    2002-08-15

    In the unlikely event of a loss-of-coolant accident (LOCA) in a pressurized water reactor, break jet impingement would dislodge thermal insulation from nearby piping, as well as other materials within the containment, such as paint chips, concrete dust, and fire barrier materials. Steam/water flows induced by the break and by the containment sprays would transport debris to the containment floor. Subsequently, debris would likely transport to and accumulate on the suction sump screens of the emergency core cooling system (ECCS) pumps, thereby potentially degrading ECCS performance and possibly even failing the ECCS.A systematic study was conducted on various types of fibrous and metallic foil debris to determine their transport in water. Test results reported include incipient movement, bulk movement, accumulation on a screen, the ability of debris to jump over 5-cm (2-in.) and 15-cm (6-in.) curbs, and the effects of accelerating flow and turbulence. These data are currently being used in conjunction with computational fluid dynamics modeling to determine the potential for each debris type to reach the suction screen.

  16. Realization of a primary spectrophotometric system

    NASA Astrophysics Data System (ADS)

    Škerović, V.; Vukadin, P.; Zarubica, V.; Zeković, Lj

    2008-08-01

    The first step in establishing measurement uniformity in spectrophotometry is the realization of a versatile, fully evaluated and documented measurement system, which may, after metrological validation, be upheld as the primary spectrophotometric standard. In this paper, the development and realization of the spectrophotometer—primary standard in the Laboratory for Photometry of Bureau of Measures and Precious Metals—are presented. The construction of the system, as well as its metrological characterization, is shown. Evaluation of systematic errors due to various influential quantities and physical effects, such as light beam geometry effects, inter-reflections, nonlinearities and others, is presented. The results of measurements of spectral transmittance made with neutral optical filters and the evaluation of total measurement uncertainty are presented. Validation of the results was preformed according to National Institute for Standards and Technologies (NIST) certified standards of spectral transmittance.

  17. Systemic primary carnitine deficiency with hypoglycemic encephalopathy

    PubMed Central

    Jun, Jae Sung; Lee, Eun Joo; Park, Hyung Doo

    2016-01-01

    Acute hypoglycemia in children is not an uncommon disease that can be encountered in the Emergency Department. Most cases of childhood hypoglycemia are caused by ketotic hypoglycemia due to missed meals. Often, hypoketotic hypoglycemia can also occur, which suggests hyperinsulinemia or a defect in fatty acid oxidation. Carnitine is essential for long chain fatty acids transfer into mitochondria for oxidation. We present a case of systemic primary carnitine deficiency who presented with seizures due to hypoketotic hypoglycemia. PMID:28164076

  18. Outlier Benchmark Systems With Gaia Primaries

    NASA Astrophysics Data System (ADS)

    Marocco, Federico; Pinfield, David J.; Montes, David; Zapatero Osorio, Maria Rosa; Smart, Richard L.; Cook, Neil J.; Caballero, José A.; Jones, Hugh, R. A.; Lucas, Phil W.

    2016-07-01

    Benchmark systems are critical to assisting sub-stellar physics. While the known population of benchmarks hasincreased significantly in recent years, large portions of the age-metallicity parameter space remain unexplored.Gaia will expand enormously the pool of well characterized primary stars, and our simulations show that we couldpotentially have access to more than 6000 benchmark systems out to 300 pc, allowing us to whittle down thesenbsp;systems into a large sample with outlier properties that will reveal the nature of ultra-cool dwarfs in rare parameternbsp;space. In this contribution we present the preliminary results from our effort to identify and characterize ultra-coolnbsp;companions to Gaia-imaged stars with unusual values of metallicity. Since these systems are intrinsically rare, wenbsp;expand the volume probed by targeting faint, low-proper motion systems.nbsp;/p>

  19. Large-break LOCA, in-reactor fuel bundle Materials Test MT-6A

    SciTech Connect

    Wilson, C.L.; Hesson, G.M.; Pilger, J.P.; King, L.L.; Panisko, F.E.

    1993-09-01

    This is a report on one of a series of experiments to simulates a loss-of-coolant accident (LOCA) using full-length fuel rods for pressurized water reactors (PWR). The experiments were conducted by Pacific Northwest Laboratory (PNL) under the LOCA simulation Program sponsored by the US Nuclear Regulatory Commission (NRC). The major objective of this program was causing the maximum possible expansion of the cladding on the fuel rods from a short-term adiabatic temperature transient to 1200 K (1700 F) leading to the rupture of the cladding; and second, by reflooding the fuel rods to determine the rate at which the fuel bundle is cooled.

  20. Primary Care Providers and a System Problem

    PubMed Central

    Wiener, Renda Soylemez; Sullivan, Donald; Ganzini, Linda; Slatore, Christopher G.

    2015-01-01

    BACKGROUND: As lung cancer screening with low-dose CT scanning is implemented, an increasing number of people will be diagnosed with pulmonary nodules. Primary care clinicians care for the vast majority of these patients, but their experiences with communication and managing distress in this population are not well understood. METHODS: We conducted qualitative interviews of 15 primary care providers (PCPs) at two academic medical centers who care for patients with pulmonary nodules. We used qualitative description analysis, focusing on clinicians’ information exchange and other communication behaviors. RESULTS: Most PCPs believed they had inadequate information to counsel patients regarding lung nodules, although this information is desired. PCPs were concerned patients could “fall through the cracks” but did not have access to a reliable system to ensure follow-up adherence. They were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specific risk a nodule was lung cancer, in part because they did not have ready access to this information. PCPs believed most patients did not have substantial distress as a result of nodule detection. Most PCPs did not include patients when making decisions about the follow-up plan. CONCLUSIONS: PCPs often lack systemic resources to optimize patient-centered approaches when discussing incidental pulmonary nodules with patients. With the advent of lung cancer screening, pulmonologists can assist primary care colleagues by providing accurate information to counsel patients and assisting in managing conversations about the risk of cancer. Pulmonologists should support efforts to implement reliable systems to ensure adherence to follow-up. PMID:25790082

  1. REPOSITORY SURFACE FACILITIES PRIMARY SYSTEM CRANE DATA

    SciTech Connect

    K. Schwartztrauber

    2005-03-14

    The purpose of this calculation is to compile crane design data for the mechanical primary structures, systems, and components (SSCs) required for the repository Waste Handling Building (WHB) and Carrier Preparation Building (CPB). The work presented in this document has been prepared in accordance with Office of Civilian Radioactive Waste Management approved program document AP-3.12Q, Calculations. This calculation has been developed to supplement information previously prepared using the development plan for ''WHB/WTB Space Program Analysis for Site Recommendation'' (Reference 5), which concentrates on the primary, primary support, facility support, and miscellaneous building support areas located in the WHB and Waste Treatment Building (WTB). The development plan was completed in accordance with AP-2.13Q, ''Technical Product Development Planning''. The work in this calculation is a continuance of the work described in the previous development plan; therefore, in accordance with AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities'', a new Technical Work Plan is not required.

  2. Uncertainties in TRAC plenum pressures for the FI phase of a DEGB LOCA

    SciTech Connect

    Griggs, D.P.

    1991-05-01

    The TRAC-PF1/MOD1 code (TRAC) is used to perform best-estimate analyses of certain postulated Design Basis Accidents (DBAs) in SRS production reactors. Currently, the most limiting DBA in terms of reactor power level is an instantaneous double-ended guillotine break (DEGB) loss of coolant accident (LOCA). For this accident, TRAC is used to analyze only the first 5 seconds following the DEGB, which encompasses the Flow Instability (FI) phase of the DBA. The TRAC analysis provides time-dependent plenum and tank bottom pressures for use as boundary conditions in the FLOWTRAN code. The quantification of uncertainty is an important element of determining safe operating power levels for SRS reactors. A detailed methodology for the determination of uncertainty for the FI phase of a DEGB LOCA has been developed. This report presents estimates of the uncertainty in the time-dependent plenum pressures for the DEGB LOCA calculated by TRAC. The plenum pressure uncertainty was estimated by means of comparing TRAC results with steady-state data measured in L Reactor, and confirmed by comparisons with transient LOCA results calculated by an independent group with the RELAP5 code. An overview of the limits methodology is given and discusses the L Reactor data. The methodology for estimating the plenum pressure uncertainty is presented along with the results.

  3. Downscaling humidity with Localized Constructed Analogs (LOCA) over the conterminous United States

    NASA Astrophysics Data System (ADS)

    Pierce, D. W.; Cayan, D. R.

    2016-07-01

    Humidity is important to climate impacts in hydrology, agriculture, ecology, energy demand, and human health and comfort. Nonetheless humidity is not available in some widely-used archives of statistically downscaled climate projections for the western U.S. In this work the Localized Constructed Analogs (LOCA) statistical downscaling method is used to downscale specific humidity to a 1°/16° grid over the conterminous U.S. and the results compared to observations. LOCA reproduces observed monthly climatological values with a mean error of ~0.5 % and RMS error of ~2 %. Extreme (1-day in 1- and 20-years) maximum values (relevant to human health and energy demand) are within ~5 % of observed, while extreme minimum values (relevant to agriculture and wildfire) are within ~15 %. The asymmetry between extreme maximum and minimum errors is largely due to residual errors in the bias correction of extreme minimum values. The temporal standard deviations of downscaled daily specific humidity values have a mean error of ~1 % and RMS error of ~3 %. LOCA increases spatial coherence in the final downscaled field by ~13 %, but the downscaled coherence depends on the spatial coherence in the data being downscaled, which is not addressed by bias correction. Temporal correlations between daily, monthly, and annual time series of the original and downscaled data typically yield values >0.98. LOCA captures the observed correlations between temperature and specific humidity even when the two are downscaled independently.

  4. Large break LOCA calculations for the AP600 design

    SciTech Connect

    Fisher, J.E.

    1992-08-01

    This paper presents the application of RELAP5 to the calculation of a Large Break (200% doubled-ended rupture) Loss-of-Colant-Accident (LBLOCA) at the reactor vessel inlet for the proposed Westinghouse AP600 design. A parametric calculation was also performed to determine effects of loss of a complete Emergency Core Cooling system (ECCS) train. These calculations were performed over the core blowdown, refill, and reflood phases of the LBLOCA and did not address long term cooling. RELAP5 was shown to be adequate for system response calculation over the period of interest. The passive safety systems were predicted to effectively mitigate the consequences of LBLOCAs; the calculations showed less severe thermal responses than for a current generation Pressurized Water Reactor (PWR) plant. The two primary differences between the AP600 design and a current generation plant that affect LBLOCA response are the lower core thermal power, which results in lower temperatures during the blowdown phase, and the long duration accumulator injection, which provides ample core inventory makeup for final quenching.

  5. Large break LOCA calculations for the AP600 design

    SciTech Connect

    Fisher, J.E.

    1992-01-01

    This paper presents the application of RELAP5 to the calculation of a Large Break (200% doubled-ended rupture) Loss-of-Colant-Accident (LBLOCA) at the reactor vessel inlet for the proposed Westinghouse AP600 design. A parametric calculation was also performed to determine effects of loss of a complete Emergency Core Cooling system (ECCS) train. These calculations were performed over the core blowdown, refill, and reflood phases of the LBLOCA and did not address long term cooling. RELAP5 was shown to be adequate for system response calculation over the period of interest. The passive safety systems were predicted to effectively mitigate the consequences of LBLOCAs; the calculations showed less severe thermal responses than for a current generation Pressurized Water Reactor (PWR) plant. The two primary differences between the AP600 design and a current generation plant that affect LBLOCA response are the lower core thermal power, which results in lower temperatures during the blowdown phase, and the long duration accumulator injection, which provides ample core inventory makeup for final quenching.

  6. Primary helium heater for propellant pressurization systems

    NASA Technical Reports Server (NTRS)

    Reichmuth, D. M.; Nguyen, T. V.; Pieper, J. L.

    1991-01-01

    The primary helium heater is a unique design that provides direct heating of pressurant gas for large pressure fed propulsion systems. It has been conceptually designed to supply a heated (800-1000 R) pressurization gas to both a liquid oxygen and an RP-1 propellant tank. This pressurization gas is generated within the heater by mixing super critical helium (40-300 R and 3000-1600 psi) with an appropriate amount of combustion products from a 4:1 throttling stoichiometric LO2/LH2 combustor. This simple, low cost and reliable mixer utilizes the large quantity of helium to provide stoichiometric combustor cooling, extend the throttling limits and enhance the combustion stability margin. Preliminary combustion, thermal, and CFD analyses confirm that this low-pressure-drop direct helium heater can provide the constant-temperature pressurant suitable for tank pressurization of both fuel and oxidizer tanks of large pressure fed vehicles.

  7. Primary reflector for solar energy collection systems

    NASA Technical Reports Server (NTRS)

    Miller, C. G. (Inventor); Stephens, J. B.

    1978-01-01

    A fixed, linear, ground-based primary reflector is disclosed which has an extended curved sawtooth-contoured surface covered with a metalized polymeric reflecting material. The device reflects solar energy to a movably supported collector that is kept at the concentrated line focus of the reflector primary. The primary reflector may be constructed by a process utilizing well-known freeway paving machinery.

  8. Generic Safety Issue (GSI) 171 -- Engineered Safety Feature (ESF) failure from a loop subsequent to LOCA: Assessment of plant vulnerability and CDF contributions

    SciTech Connect

    Martinez-Guridi, G.; Samanta, P.; Chu, L.; Yang, J.

    1998-03-01

    Generic Safety Issue 171 (GSI-171), Engineered Safety Feature (ESF) from a Loss Of Offsite Power (LOOP) subsequent to a Loss Of Coolant Accident (LOCA), deals with an accident sequence in which a LOCA is followed by a LOOP. This issue was later broadened to include a LOOP followed by a LOCA. Plants are designed to handle a simultaneous LOCA and LOOP. In this paper, the authors address the unique issues that are involved i LOCA with delayed LOOP (LOCA/LOOP) and LOOP with delayed LOCA (LOOP/LOCA) accident sequences. LOCA/LOOP accidents are analyzed further by developing event-tree/fault-tree models to quantify their contributions to core-damage frequency (CDF) in a pressurized water reactor and a boiling water reactor (PWR and a BWR). Engineering evaluation and judgments are used during quantification to estimate the unique conditions that arise in a LOCA/LOOP accident. The results show that the CDF contribution of such an accident can be a dominant contributor to plant risk, although BWRs are less vulnerable than PWRs.

  9. Primary central nervous system posttransplant lymphoproliferative disorders.

    PubMed

    Castellano-Sanchez, Amilcar A; Li, Shiyong; Qian, Jiang; Lagoo, Anand; Weir, Edward; Brat, Daniel J

    2004-02-01

    Posttransplant lymphoproliferative disorders (PTLDs) represent a spectrum ranging from Epstein-Barr virus (EBV)-driven polyclonal lymphoid proliferations to EBV+ or EBV- malignant lymphomas. Central nervous system (CNS) PTLDs have not been characterized fully. We reviewed the clinical, radiologic, and pathologic features of 12 primary CNS PTLDs to define them more precisely. Patients included 10 males and 2 females (median age, 43.4 years) who were recipients of kidney (n = 5), liver (n = 2), heart (n = 2), peripheral blood stem cells (n = 2), or bone marrow (n = 1). All received immunosuppressive therapy. CNS symptoms developed 3 to 131 months (mean, 31 months) after transplantation. By neuroimaging, most showed multiple (3 to 9) intra-axial, contrast-enhancing lesions. Histologic sections showed marked expansion of perivascular spaces by large, cytologically malignant lymphoid cells that were CD45+, CD20+, EBV+ and showed light chain restriction or immunoglobulin gene rearrangement. In distinction to PTLDs in other organ systems, CNS PTLDs were uniformly high-grade lymphomas that fulfilled the World Health Organization criteria for monomorphic PTLDs. Extremely short survival periods were noted for each CNS PTLD that followed peripheral blood stem cell transplantation. Survival of others with CNS PTLD varied; some lived more than 2 years.

  10. Pediatric primary care as a component of systems of care.

    PubMed

    Brown, Jonathan D

    2010-02-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of care is defined as serving only children and youth with serious emotional disturbance and their families and does not fully embrace the concept of primary prevention. Although similarities in the definitions of primary care and systems of care may provide a theoretical foundation for including primary care within the systems of care framework, a definition of systems of care that incorporates the idea of prevention and takes into account the broad population served in primary care would provide communities with a definition that can be used to further the work of integrating primary care into systems of care.

  11. Development of Educational Management System in Small Primary School

    ERIC Educational Resources Information Center

    Alsammarry, Yupayao; Sirisuthi, Chaiyuth; Duangcharthom, Surat

    2016-01-01

    The purposes of the research were: (1) to study the factors of Educational Management System in Small Primary School; (2) to investigate current situations problems and guidelines of developing educational management in small primary school; (3) to develop Educational Management System in Small Primary School; and (4) to examine the results of…

  12. Effect of LOCA simulation procedures on ethylene propylene rubber's mechanical and electrical properties

    SciTech Connect

    Bustard, L.D.

    1983-10-01

    Electrical and mechanical properties of several commercial ethylene-propylene rubber (EPR) materials, typically used as electrical cable insulation, have been monitored during three simulations of nuclear power plant aging and accident stresses. For one set of cables and separate tensile specimens we did a sequential test. We first performed accelerated thermal aging, then irradiated the samples to the combined aging and LOCA total dose. Finally we applied a steam exposure. For a second and third set of cables and separate tensile specimens we used simultaneous applications of elevated temperature and radiation stresses to preaccident age our specimens. We followed these aging exposures by simultaneous radiation and steam exposures to simulate a LOCA environment. Our measurement parameters during these tests included: dc insulation resistance, ac leakage current, ultimate tensile strength, ultimate tensile elongation, percentage dimensional changes, and percentage moisture absorption. We present test results for nine EPR materials. The implications of our research results for future cable qualification testing efforts is discussed.

  13. Effect of LOCA simulation procedures on cross-linked polyolefin cable's performance

    SciTech Connect

    Bustard, L.D.

    1984-04-01

    Electrical and mechanical properties of three commercial cross-linked polyolefin (XLPO) materials, typically used as electrical cable insulation, have been monitored during these simulations of nuclear power plant aging and accident stresses. For one XLPO cable accelerated thermal aging is performed, then the samples are irradiated to the combined aging and LOCA total dose. Finally, a steam exposure is applied. For a second and third set of XLPO cables simultaneous applications of elevated temperature and radiation stresses are used to preaccident age specimens. These aging exposures are followed by simultaneous and steam exposures to simulate a LOCA environment. The measurement parameters during these tests included: dc insulation resistance, ac leakage current, ultimate tensile strength, ultimate tensile elongation, percentage dimensional changes, and percentage moisture absorption. Test results for three XLPO materials are presented.

  14. Assessment of CONTAIN and MELCOR for performing LOCA and LOVA analyses in ITER

    SciTech Connect

    Merrill, B.J.; Hagrman, D.L.; Gaeta, M.J.; Petti, D.A.

    1994-09-01

    This report describes the results of an assessment of the CONTAIN and MELCOR computer codes for ITER LOCA and LOVA applications. As part of the assessment, the results of running a test problem that describes an ITER LOCA are presented. It is concluded that the MELCOR code should be the preferred code for ITER severe accident thermal hydraulic analyses. This code will require the least modification to be appropriate for calculating thermal hydraulic behavior in ITER relevant conditions that include vacuum, cryogenics, ITER temperatures, and the presence of a liquid metal test module. The assessment of the aerosol transport models in these codes concludes that several modifications would have to be made to CONTAIN and/or MELCOR to make them applicable to the aerosol transport part of severe accident analysis in ITER.

  15. Effect of aging on EPR cable electrical performance during LOCA simulations. [Ethylene propylene rubber

    SciTech Connect

    Bustard, L.D.

    1984-01-01

    When exposed to a LOCA environment, some ethylene propylene rubber (EPR) cable materials experience substantial moisture absorption and dimensional changes. These phenomena may contribute to mechanical damage of the cable insulation resulting in electrical degradation. Recent experiments illustrate that the extent of moisture absorption and dimensional changes during an accident simulation are dependent on the EPR product, the accelerated age, and the aging technique employed to achieve that age. Results for several commercial EPR materials are summarized.

  16. A sustainable primary care system: lessons from the Netherlands.

    PubMed

    Faber, Marjan J; Burgers, Jako S; Westert, Gert P

    2012-01-01

    The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.

  17. Experimental investigation on the causes for pellet fragmentation under LOCA conditions

    NASA Astrophysics Data System (ADS)

    Bianco, A.; Vitanza, C.; Seidl, M.; Wensauer, A.; Faber, W.; Macián-Juan, R.

    2015-10-01

    This paper addresses a separate effect experiment performed with irradiated fuel to study fuel fragmentation and fission gas release during a loss of coolant accident (LOCA). The paper presents a qualitative and quantitative investigation of the effects of the removal of the geometrical constraint provided by the cladding and the removal of the constraint given by the rod internal pressure in determining the extent of fuel fragmentation and fission gas release during a LOCA for fuel segments with a burnup of approximately 52 MWd/kgU. A review of previous LOCA tests was the starting point for the identification of these constraints and for the selection of the fuel rod burnup, the experiment's procedure and the boundary conditions. An out-of-pile test was considered representative for the scope, and the experiment was performed at the Halden Reactor Project hot cell in Kjeller (Norway) with heat provided by an electric oven. Three fuel rod segments were studied: 1) a fuel segment that experienced only ballooning without burst, 2) a fuel segment that experienced ballooning and burst and 3) a fuel segment that experienced neither ballooning nor burst. The neutron radiography and fuel fragment sifting showed that both cladding constraint and internal pressure play a role in the formation of fuel cracks and fragmentation, and the study of the fission gas release during the transient showed that removing the cladding constraint or the internal pressure increased the amount of fission gas release.

  18. Experimental investigation of sedimentation of LOCA - generated fibrous debris and sludge in BWR suppression pools

    SciTech Connect

    Souto, F.J.; Rao, D.V.

    1995-12-01

    Several tests were conducted in a 1:2.4 scale model of a Mark I suppression pool to investigate the behavior of fibrous insulation and sludge debris under LOCA conditions. NUKON{trademark} shreds, manually cut and tore up in a leaf shredder, and iron oxide particles were used to simulate fibrous and sludge debris, respectively. The suppression pool model included four downcomers fitted with pistons to simulate the steam-water oscillations during chugging expected during a LOCA. The study was conducted to provide debris settling velocity data for the models used in the BLOCKAGE computer code, developed to estimate the ECCS pump head loss due to clogging of the strainers with LOCA generated debris. The tests showed that the debris, both fibrous and particulate, remains fully mixed during chugging; they also showed that, during chugging, the fibrous debris underwent fragmentation into smaller sizes, including individual fibers. Measured concentrations showed that fibrous debris settled slower than the sludge, and that the settling behavior of each material is independent of the presence of the other material. Finally, these tests showed that the assumption of considering uniform debris concentration during strainer calculations is reasonable. The tests did not consider the effects of the operation of the ECCS on the transport of debris in the suppression pool.

  19. Long-term aging and loss-of-coolant accident (LOCA) testing of electrical cables

    SciTech Connect

    Nelson, C.F.; Gauthier, G.; Carlin, F.

    1996-10-01

    Experiments were performed to assess the aging degradation and loss-of-coolant accident (LOCA) behavior of electrical cables subjected to long-term aging exposures. Four different cable types were tested in both the U.S. and France: (1) U.S. 2 conductor with ethylene propylene rubber (EPR) insulation and a Hypalon jacket. (2) U.S. 3 conductor with cross-linked polyethylene (XLPE) insulation and a Hypalon jacket. (3) French 3 conductor with EPR insulation and a Hypalon jacket. (4) French coaxial with polyethylene (PE) insulation and a PE jacket. The data represent up to 5 years of simultaneous aging where the cables were exposed to identical aging radiation doses at either 40{degrees}C or 70{degrees}C; however, the dose rate used for the aging irradiation was varied over a wide range (2-100 Gy/hr). Aging was followed by exposure to simulated French LOCA conditions. Several mechanical, electrical, and physical-chemical condition monitoring techniques were used to investigate the degradation behavior of the cables. All the cables, except for the French PE cable, performed acceptably during the aging and LOCA simulations. In general, cable degradation at a given dose was highest for the lowest dose rate, and the amount of degradation decreased as the dose rate was increased.

  20. Teachers' Performance Motivation System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Pasathang, Sarojn; Tesaputa, Kowat; Sataphonwong, Pattananusron

    2016-01-01

    This research aims to: 1) study the present conditions and desirable condition of the motivation systems as well as how to find methods for motivating the performance of teachers in primary schools, 2) develop a motivation system for the performance of teachers in primary schools, 3) study the effects of using the motivation system for compliance…

  1. Pediatric Primary Care as a Component of Systems of Care

    ERIC Educational Resources Information Center

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  2. Pediatric Primary Care as a Component of Systems of Care

    ERIC Educational Resources Information Center

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  3. [Primary central nervous system lymphoma: report of one case].

    PubMed

    Zhao, Peng; Su, Rong-Gang

    2002-04-01

    One case of primary central nervous system lymphoma was reported. The patient received comprehensive therapy, mainly the surgical treatment, with the survival time 12 months, and local recurrence was considered as the major cause of death. The pathology, imagine examination, diagnosis and treatment of primary central nervous system lymphoma were discussed.

  4. Primary healthcare system and practice characteristics in Singapore.

    PubMed

    Khoo, Hwee Sing; Lim, Yee Wei; Vrijhoef, Hubertus Jm

    2014-01-01

    It is crucial to adapt and improve the (primary) health care systems of countries to prepare for future patient profiles and their related needs. The main aim of this study was to acquire a comprehensive overview of the perceptions of primary care experts in Singapore about the state of primary care in Singapore, and to compare this with the state of primary care in other countries. Notwithstanding ranked 2(nd) in terms of efficiency of health care, Singapore is facing significant health care challenges. Emails were sent to 85 experts, where they were asked to rate Singapore's primary care system based on nine internationally adopted health system characteristics and six practice characteristics (response rate = 29%). The primary care system in Singapore received an average of 10.9 out of 30 possible points. Lowest ratings were given to: earnings of primary care physicians compared to specialists, requirement for 24 hr accessibility of primary care services, standard of family medicine in academic departments, reflection of community served by practices in patient lists, and the access to specialists without needing to be referred by primary care physicians. Singapore was categorized as a 'low' primary care country according to the experts.

  5. French investigations of high burnup effect on LOCA thermomecanical behavior. Part two. Oxidation and quenching experiments under simulated LOCA conditions with high burnup clad material

    SciTech Connect

    GrandJean, C.; Cauvin, R.; Lebuffe, C.

    1997-01-01

    In the frame of the high burnup fuel studies to support a possible extension of the current discharge burnup limit, experimental programs have been undertaken, jointly by EDF and IPSN in order to study the thermal-shock behavior of high burnup fuel claddings under typical LOCA conditions. The TAGUS program used unirradiated cladding samples, bare or bearing a pre-corrosion state simulating the end-of-life state of high burnup fuel claddings: the TAGCIR program used actually irradiated cladding samples taken from high burnup rods irradiated over 5 cycles in a commercial EDF PWR and having reached a rod burnup close to 60 GWd/tU. The thermal-shock failure tests consisted in oxidizing the cladding samples under steam flow, on both inner and outer faces or on the outer face alone, and subjecting them to a final water quench. The heating was provided by an inductive furnace the power of which being regulated through monitoring of the sample surface temperature with use of a single-wave optical pyrometer. Analysis of the irradiated tests (TAGCIR series) evidenced an increased oxidation rate as compared to similar tests on unirradiated samples. Results of the quenching tests series on unirradiated and irradiated samples are plotted under the usual presentation of failure maps relative to the oxidation parameters ECR (equivalent cladding reacted) or e{sub {beta}} (thickness of the remaining beta phase layer) as a function of the oxidation temperature. Comparison of the failure limits for irradiated specimens to those for unirradiated specimens indicates a lower brittleness under two side oxidation and possibly the opposite under one-side oxidation. The tentative analysis of the oxidation and quenching tests results on irradiated samples reveals the important role played by the hydrogen charged during in-reactor corrosion on the oxidation kinetics and the failure bearing capability of the cladding under LOCA transient conditions.

  6. Numerical simulation of PWR response to a small break LOCA (loss-of-coolant accident) with reactor coolant pumps operating

    SciTech Connect

    Adams, J.P.; Dobbe, C.A.; Bayless, P.D.

    1986-01-01

    Calculations have been made of the response of pressurized water reactors (PWRs) during a small-break, loss-of-coolant accident with the reactor coolant pumps (RCPs) operating. This study was conducted, as part of a comprehensive project, to assess the relationship between measurable RCP parameters, such as motor power or current, and fluid density, both local (at the RCP inlet) and global (average reactor coolant system). Additionally, the efficacy of using these RCP parameters, together with fluid temperature, to identify an off-nominal transient as either a LOCA, a heatup transient, or a cooldown transient and to follow recovery from the transient was assessed. The RELAP4 and RELAP5 computer codes were used with three independent sets of RCP, two-phase degradation multipliers. These multipliers were based on data obtained in two-phase flow conditions for the Semiscale, LOFT, and Creare/Combustion Engineering (CE)/Electric Power Research Institute (EPRI) pumps, respectively. Two reference PWRs were used in this study: Zion, a four-loop, 1100-MWe, Westinghouse plant operated by Commonwealth Edison Co. in Zion, Illinois and Bellefonte, a two-by-four loop, 1213 MWe, Babcock and Wilcox designed plant being built by the Tennessee Valley Authority in Scottsboro, Alabama. The results from this study showed that RCP operation resulted in an approximately homogeneous reactor coolant system and that this result was independent of reference plant, computer code, or two-phase RCP head degradation multiplier used in the calculation.

  7. Characteristics of primary electric propulsion systems. [conferences

    NASA Technical Reports Server (NTRS)

    Byers, D. C.

    1979-01-01

    The use of advanced electric propulsion systems is expected to provide cost and performance benefits for future energetic space missions. A methodology to predict the characteristics of advanced electric propulsion systems was developed and programmed for computer calculations to allow evaluation of a broad set of technology and mission assumptions. The impact on overall thrust system characteristics was assessed for variations of propellant type, total accelerating voltage, thruster area, specific impulse, and power system approach. The data may be used both to provide direction to technology emphasis and allow for preliminary estimates of electric propulsion system properties for a wide variety of applications.

  8. R&D Plan for RISMC Industry Application #1: ECCS/LOCA Cladding Acceptance Criteria

    SciTech Connect

    Szilard, Ronaldo Henriques; Zhang, Hongbin; Epiney, Aaron Simon; Tu, Lei

    2016-04-01

    The Nuclear Regulatory Commission (NRC) is finalizing a rulemaking change that would revise the requirements in 10 CFR 50.46. In the proposed new rulemaking, designated as 10 CFR 50.46c, the NRC proposes a fuel performance-based equivalent cladding reacted (ECR) criterion as a function of cladding hydrogen content before the accident (pre-transient) in order to include the effects of higher burnup on cladding performance as well as to address other technical issues. A loss of operational margin may result due to the more restrictive cladding embrittlement criteria. Initial and future compliance with the rule may significantly increase vendor workload and licensee costs as a spectrum of fuel rod initial burnup states may need to be analyzed to demonstrate compliance. The Idaho National Laboratory (INL) has initiated a project, as part of the DOE Light Water Reactor Sustainability Program (LWRS), to develop analytical capabilities to support the industry in the transition to the new rule. This project is called the Industry Application 1 (IA1) within the Risk-Informed Safety Margin Characterization (RISMC) Pathway of LWRS. The general idea behind the initiative is the development of an Integrated Evaluation Model (IEM). The motivation is to develop a multiphysics framework to analyze how uncertainties are propagated across the stream of physical disciplines and data involved, as well as how risks are evaluated in a LOCA safety analysis as regulated under 10 CFR 50.46c. This IEM is called LOTUS which stands for LOCA Toolkit for US, and it represents the LWRS Program’s response to the proposed new rule making. The focus of this report is to complete an R&D plan to describe the demonstration of the LOCA/ECCS RISMC Industry Application # 1 using the advanced RISMC Toolkit and methodologies. This report includes the description and development plan for a RISMC LOCA tool that fully couples advanced MOOSE tools already in development in order to characterize and optimize

  9. Best-estimate LOCA radiation signature for equipment qualification. [PWR; BWR

    SciTech Connect

    Lurie, N.A.; Bonzon, L.L.

    1980-01-01

    The radiation aspect of reactor equipment qualification depends on a knowledge of the appropriate source term. An attempt has been made to define a realistic radiation source corresponding to the loss-of-coolant accident. This best-estimate source is based on available fission product release data from damaged fuel during an unterminated LOCA as described in the Reactor Safety Study (WASH-1400). Energy release rates as a function of time have been calculated for both betas and gamma rays. The results are significantly different from the sources specified in Regulatory Guide 1.89. Spectra corresponding to the best-estimate source have also been computed at selected cooling times.

  10. School Management Information Systems in Primary Schools

    ERIC Educational Resources Information Center

    Demir, Kamile

    2006-01-01

    Developments in information technologies have been impacting upon educational organizations. Principals have been using management information systems to improve the efficiency of administrative services. The aim of this research is to explore principals' perceptions about management information systems and how school management information…

  11. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  12. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  13. Developing Primary Science Teacher Expertise: Thinking about the System

    ERIC Educational Resources Information Center

    Bull, Ally

    2016-01-01

    This report comes from an exploratory project looking at professional learning and development for primary science teachers. In recent years there has been increased interest in science in New Zealand for social and economic reasons. However, there has been concern that the primary school system is not preparing students as well as it could in…

  14. Primary care training and the evolving healthcare system.

    PubMed

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians.

  15. [Comprehensive primary care and segmented health systems in South America].

    PubMed

    Giovanella, Ligia; Almeida, Patty Fidelis de

    2017-10-02

    The article analyzes recent reforms in primary health care in the South American countries, discussing the scope and challenges for establishing comprehensive primary health care in the region's health systems. The data sources were case studies conducted in 12 countries, and the analytical lines were the strategic components in the design and implementation of primary health care: national policy approaches, characteristics of financing, organization and provision, and the workforce in primary health care. The crosscutting analysis from a comparative perspective provides an overview of primary health care in the region's countries and highlights convergences and asymmetries. A common trait is the recovery of the expanded definition of primary health care with family and community components, a territorial base, multidisciplinary team, incorporation of community health workers, and social participation. Implementation revealed heterogeneities in the advances and contradictions in the models. Insufficient supply of physicians, difficulties in provision and physician retention in remote and peripheral areas, as well as in primary health care itself, precarious employment relations, and absence of career plans are common problems, and there have been recent initiatives in government intervention to direct the workforce to the public system. Segmentation of the supply of primary health care converges with the segmentation of social protection in the various countries, through maintenance of social insurance or selective and targeted insurance or coverage by private health insurance, and persistent exclusion of populations from the right to health. The article argues that implementation of comprehensive primary health care is conditioned by the prevailing modalities of social protection in health.

  16. Primary Health Care in Canada: Systems in Motion

    PubMed Central

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-01-01

    Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Conclusions: Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. PMID:21676023

  17. Aging, Loss-of-Coolant Accident (LOCA), and high potential testing of damaged cables

    SciTech Connect

    Vigil, R.A.; Jacobus, M.J.

    1994-04-01

    Experiments were conducted to assess the effects of high potential testing of cables and to assess the survivability of aged and damaged cables under Loss-of-Coolant Accident (LOCA) conditions. High potential testing at 240 Vdc/mil on undamaged cables suggested that no damage was incurred on the selected virgin cables. During aging and LOCA testing, Okonite ethylene propylene rubber (EPR) cables with a bonded jacket experienced unexpected failures. The failures appear to be primarily related to the level of thermal aging and the presence of a bonded jacket that ages more rapidly than the insulation. For Brand Rex crosslinked polyolefin (XLPO) cables, the results suggest that 7 mils of insulation remaining should give the cables a high probability of surviving accident exposure following aging. The voltage necessary to detect when 7 mils of insulation remain on unaged Brand Rex cables is approximately 35 kVdc. This voltage level would almost certainly be unacceptable to a utility for use as a damage assessment tool. However, additional tests indicated that a 35 kvdc voltage application would not damage virgin Brand Rex cables when tested in water. Although two damaged Rockbestos silicone rubber cables also failed during the accident test, no correlation between failures and level of damage was apparent.

  18. Potential for boron dilution during small-break LOCAs in PWRs

    SciTech Connect

    Nourbakhsh, H.P.; Cheng, Z.

    1995-11-01

    This paper documents the results of a scoping study of boron dilution and mixing phenomena during small break loss of coolant accidents (LOCAs) in pressurized water reactors (PWRs). Boron free condensate can accumulate in the cold leg loop seals when the reactor is operating in a reflux/boiler condenser mode. A problem may occur when the subsequent change in flow conditions such as loop seal clearing or re-establishment of natural circulation flow drive the diluted water in the loop seals into the reactor core without sufficient mixing with the highly borated water in the reactor downcomer and lower plenum. The resulting low boron concentration coolant entering the core may cause a power excursion leading to fuel failure. The mixing processes associated with a slow moving stream of diluted water through the loop seal to the core were examined in this report. A bounding evaluation of the range of boron concentration entering the core during a small break LOCA in a typical Westinghouse-designed, four-loop plant is also presented in this report.

  19. [Experimental systemic enzyme therapy of gouty and primary glomerulonephritis].

    PubMed

    Mukhin, I V; Nikolenko, V Iu

    2003-01-01

    The influence of a systemic enzymotherapy on the morphological, biochemical, and functional manifestations of the kidney damage during the experimental gouty and primary glomerulonephritis is described in comparison to the results obtained by traditional methods.

  20. The stabilization system of primary oscillation for a micromechanical gyroscope

    NASA Astrophysics Data System (ADS)

    Baranov, Pavel; Nesterenko, Tamara; Tsimbalist, Edvard; Vtorushin, Sergey

    2017-06-01

    The mode of primary oscillations of a micromechanical gyroscope (MMG) sensor is provided by an electrostatic comb-drive actuator in which the interaction between the micromechanical structures and electronics occurs by means of a single or differential capacitive sensor. Two pairs of capacitive sensors are traditionally used for frequency stabilization of MMG primary oscillations. The first pair of capacitive sensors excites primary oscillations, while the second measures the amplitude of primary oscillations. The stabilization system provides a continuous frequency tuning of primary oscillations that increases the duration of transition processes, the time of operational readiness, and the instability of the output signal from the secondary oscillation channel of the MMGs. This paper presents a new approach to the primary oscillation control system of the two-component MMG. The method of calculating the natural resonant frequency is based on measurements of the total current passing through the comb-driver actuator capacitances, and a lock-in detection is suggested. This paper consists of the results of the numerical analysis, the description of the proposed approach to the frequency control of the primary MMG oscillations, and the Simulink model of the behaviour of the MMG stabilization system, depending on its mechanical-and-physical properties with regard to a 2% shift of the natural resonant frequency. The frequency control of the primary oscillations at 2% frequency detuning is performed within 0.11 s.

  1. Risk-Informed Margin Management (RIMM) Industry Applications IA1 - Integrated Cladding ECCS/LOCA Performance Analysis - Problem Statement

    SciTech Connect

    Szilard, Ronaldo Henriques; Youngblood, Robert; Frepoli, Cesare; Yurko, Joseph P.; Swindlehurst, Gregg; Zhang, Hongbin; Zhao, Haihua; Bayless, Paul D.; Rabiti, Cristian; Alfonsi, Andrea; Smith, Curtis L.

    2015-04-01

    The U. S. NRC is currently proposing rulemaking designated as “10 CFR 50.46c” to revise the LOCA/ECCS acceptance criteria to include the effects of higher burnup on cladding performance as well as to address some other issues. The NRC is also currently resolving the public comments with the final rule expected to be issued in the summer of 2016. The impact of the final 50.46c rule on the industry will involve updating of fuel vendor LOCA evaluation models, NRC review and approval, and licensee submittal of new LOCA evaluations or reanalyses and associated technical specification revisions for NRC review and approval. The rule implementation process, both industry and NRC activities, is expected to take 5-10 years following the rule effective date. The need to use advanced cladding designs is expected. A loss of operational margin will result due to the more restrictive cladding embrittlement criteria. Initial and future compliance with the rule may significantly increase vendor workload and licensee cost as a spectrum of fuel rod initial burnup states may need to be analyzed to demonstrate compliance. Consequently there will be an increased focus on licensee decision making related to LOCA analysis to minimize cost and impact, and to manage margin.

  2. Viking 75 project: Viking lander system primary mission performance report

    NASA Technical Reports Server (NTRS)

    Cooley, C. G.

    1977-01-01

    Viking Lander hardware performance during launch, interplanetary cruise, Mars orbit insertion, preseparation, separation through landing, and the primary landed mission, with primary emphasis on Lander engineering and science hardware operations, the as-flown mission are described with respect to Lander system performance and anomalies during the various mission phases. The extended mission and predicted Lander performance is discussed along with a summary of Viking goals, mission plans, and description of the Lander, and its subsystem definitions.

  3. Oxidation of SiC cladding under Loss of Coolant Accident (LOCA) conditions in LWRs

    SciTech Connect

    Lee, Y.; Yue, C.; Arnold, R. P.; McKrell, T. J.; Kazimi, M. S.

    2012-07-01

    An experimental assessment of Silicon Carbide (SiC) cladding oxidation rate in steam under conditions representative of Loss of Coolant Accidents (LOCA) in light water reactors (LWRs) was conducted. SiC oxidation tests were performed with monolithic alpha phase tubular samples in a vertical quartz tube at a steam temperature of 1140 deg. C and steam velocity range of 1 to 10 m/sec, at atmospheric pressure. Linear weight loss of SiC samples due to boundary layer controlled reaction of silica scale (SiO{sub 2} volatilization) was experimentally observed. The weight loss rate increased with increasing steam flow rate. Over the range of test conditions, SiC oxidation rates were shown to be about 3 orders of magnitude lower than the oxidation rates of zircaloy 4. A SiC volatilization correlation for developing laminar flow in a vertical channel is formulated. (authors)

  4. Ethylene propylene cable degradation during LOCA research tests: tensile properties at the completion of accelerated aging

    SciTech Connect

    Bustard, L.D.

    1982-05-01

    Six ethylene-propylene rubber (EPR) insulation materials were aged at elevated temperature and radiation stress exposures common in cable LOCA qualification tests. Material samples were subjected to various simultaneous and sequential aging simulations in preparation for accident environmental exposures. Tensile properties subsequent to the aging exposure sequences are reported. The tensile properties of some, but not all, specimens were sensitive to the order of radiation and elevated temperature stress exposure. Other specimens showed more severe degradation when simultaneously exposed to radiation and elevated temperature as opposed to the sequential exposure to the same stresses. Results illustrate the difficulty in defining a single test procedure for nuclear safety-related qualification of EPR elastomers. A common worst-case sequential aging sequence could not be identified.

  5. Effect of bundle size on cladding deformation in LOCA simulation tests. [PWR; BWR

    SciTech Connect

    Chapman, R.H.; Crowley, J.L.; Longest, A.W.

    1982-01-01

    Two LOCA simulation tests were conducted to investigate the effects of temperature uniformity and radial restraint boundary conditions on Zircaloy cladding deformation. In one of the tests (B-5), boundary conditions typical of a large array were imposed on an inner 4 x 4 square array by two concentric rings of interacting guard fuel pin simulators. In the other test (B-3), the boundary conditions were imposed on a 4 x 4 square array by a non-interacting heated shroud. Test parameters conducive to large deformation were selected in order to favor rod-to-rod interactions. The tests showed that rod-to-rod interactions play an important role in the deformation process.

  6. Modeling of Zr alloy burst cladding internal oxidation and secondary hydriding under LOCA conditions

    NASA Astrophysics Data System (ADS)

    Veshchunov, M. S.; Shestak, V. E.

    2015-06-01

    The recently developed mechanistic model for Zr alloy cladding hydriding has been implemented in the single-rod SVECHA/QUENCH (S/Q) code. The mass transfer in a fuel rod after ballooning and burst opening have been modeled in the modified code that allowed calculating hydrogen and oxygen pickup by the cladding inner-metal surface. The code predicts with a good accuracy the typical distributions of oxygen and hydrogen in the Zr alloy cladding that were observed in the JAERI (Japan Atomic Energy Research Institute) and ANL (Argonne National Laboratory) single-rod tests and KIT (Karlsruhe Institute of Technology) bundle tests under postulated loss-of-coolant accident (LOCA) conditions.

  7. LOCA simulation in NRU program: data report for the fourth materials experiment (MT-4)

    SciTech Connect

    Wilson, C.L.; Mohr, C.L.; Hesson, G.M.; Wildung, N.J.; Russcher, G.E.; Webb, B.J.; Freshley, M.D.

    1983-07-01

    A series of in-reactor experiments were conducted using full-length 32-rod pressurized water reactor (PWR) fuel bundles as part of the Loss-of-Coolant Accident (LOCA) Simulation Program by Pacific Northwest Laboratory (PNL). This experiment (MT-4) was funded by the US Nuclear Regulatory Commission (NRC) to evaluate ballooning and rupture during adiabatic heatup in the temperature range of 1033 to 1200K (1400 to 1700/sup 0/F). The 12 rest rods in the center of the 32-rod bundle were initially pressurized to 4.62 MPa (670 psia) to insure rupture in the correct temperature range. All 12 test rods ruptured with an average strain of 43.7% at the maximum flow blockage elevation of 2.68 m (105.4 in.). Experimental data for the MT-4 transient experiment and post-test measurements and photographs of the fuel are presented in this report.

  8. Validation of the Deterministic Realistic Method Applied to CATHARE on LB LOCA Experiments

    SciTech Connect

    Sauvage, Jean-Yves; Laroche, Stephane

    2002-07-01

    Framatome-ANP and EDF have defined a generic approach for using a best-estimate code in design basis accident studies called Deterministic Realistic Method (DRM). It has been applied to elaborate a LB LOCA ECCS evaluation model based on the CATHARE code. From a prior statistical analysis of uncertainties, the DRM derives a conservative deterministic model, preserving the realistic nature of the simulation, to be used in the further applications. The conservatism of the penalized model is demonstrated comparing penalized calculations with relevant experimental data. The DRM proved to be a highly flexible tool and has been applied successfully to meet the specific French and specific Belgian requirements of Safety Authorities. (authors)

  9. The BWR lower head response during a large-break LOCA with core damage

    SciTech Connect

    Alammar, M.A.

    1996-12-31

    Some of the important issues in severe accident management guidelines development deal with estimating the time to lower head vessel failure after core damage and the time window available for water injection that would prevent vessel failure. These issues are obviously scenario dependent, but bounding estimates are needed. The scenario chosen for this purpose was a design-basis accident (DBA) loss-of-coolant accident (LOCA) because it was one of the contributors to the Oyster Creek containment failure frequency. Oyster Creek is a 1930-MW(thermal) boiling water reactor (BWR)-2. The lower head response models have improved since the Three Mile Island unit 2 (TMI-2) vessel investigation project (VIP) results became known, specifically the addition of rapid- and slow-cooling models. These mechanisms were found to have taken place in the TMI-2 lower head during debris cooldown and were important contributors in preventing vessel failure.

  10. TRAC-PF1 LOCA calculations using fine-node and coarse-node input models

    SciTech Connect

    Dobranich, D.; Buxton, L.D.; Wong, C.N.C.

    1985-05-01

    TRAC-PF1 calculations of a 200% cold-leg break LOCA have been completed for a UHI (upper head injection accumulator) plant using both fine-node (with 776 mesh cells) and coarse-node (with 320 mesh cells) input models. This study was performed to determine the effect of noding on predicted results and on computer running time. It was found that the overall sequence of events and the important trends of the transient were predicted to be nearly the same with both the fine-node and coarse-node models. There were differences in the time-dependent behavior of the cold-leg accumulator injection, and the predicted PCT for the coarse-node calculation was about 75 K less than that for the fine-node calculation. The higher PCT of the fine-node calculation is attributed primarily to three-dimensional flow effects in the core. The complete (steady state plus transient) coarse-node calculation required 13.5 hours of CYBER 76 computer time compared to 68.3 hours for the fine node calculation, yielding an overall factor of five decrease in running time. Thus, we conclude that for any large break LOCA analyses in which only the overall trends are of concern, the loss of accuracy resulting from use of such a coarse-node model will normally be inconsequential compared to the savings in resources that are realized. However, if the objective of the analyses is the investigation of the effects of multi-dimensional flows on clad temperatures, then a detailed model is required.

  11. The 747 primary flight control systems reliability and maintenance study

    NASA Technical Reports Server (NTRS)

    1979-01-01

    The major operational characteristics of the 747 Primary Flight Control Systems (PFCS) are described. Results of reliability analysis for separate control functions are presented. The analysis makes use of a NASA computer program which calculates reliability of redundant systems. Costs for maintaining the 747 PFCS in airline service are assessed. The reliabilities and cost will provide a baseline for use in trade studies of future flight control system design.

  12. 78 FR 28896 - Design Limits and Loading Combinations for Metal Primary Reactor Containment System Components

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ... COMMISSION Design Limits and Loading Combinations for Metal Primary Reactor Containment System Components... Combinations for Metal Primary Reactor Containment System Components,'' in which there are no substantive... loading combinations for metal primary reactor containment system components. ADDRESSES: Please refer...

  13. Primary electric power generation systems for advanced-technology engines

    NASA Technical Reports Server (NTRS)

    Cronin, M. J.

    1983-01-01

    The advantages of the all electric airplane are discussed. In the all electric airplane the generator is the sole source of electric power; it powers the primary and secondary flight controls, the environmentals, and the landing gear. Five candidates for all electric power systems are discussed and compared. Cost benefits of the all electric airplane are discussed.

  14. An Exploratory Study on How Primary Pupils Approach Systems

    ERIC Educational Resources Information Center

    Koski, Marja-Ilona; de Vries, Marc

    2013-01-01

    This paper presents a study of systems thinking among 27 primary pupils (8-10 years old) and their teacher. The study included a pre-test for the teacher and the pupils, lesson planning, the actual lesson and a post-test for the pupils. The research focused on finding an answer to three questions: (1) do pupils see a system as a structure…

  15. [Primary central nervous system lymphoma: pathogenesis and histomorphology].

    PubMed

    Méhes, Gábor

    2017-03-08

    Lymphoproliferative diseases of the central nervous system are rare, diagnostics and treatment are accordingly challenging. Since the introduction of the 2008 WHO lymphoma classification, primary CNS DLBCL - also covering the associated primary ocular (vitreoretinal) lymphoma - is a separate entity. The special localization is related with a series of newly recognized genetic, genomic and immunologic features directing to the strong interaction between transformed lymphoma cells, neural tissue components and the local immune response. Histological differentiation is frequently disabled by the limited sampling opportunities and requires the application of all available hematopathologic technologies including immunohistochemistry, cytology, liquor serology, flow cytometry, fluorescence in situ hybridization and polymerase chain reaction with sequencing.

  16. [Validation of an adverse event reporting system in primary care].

    PubMed

    de Lourdes Rojas-Armadillo, María; Jiménez-Báez, María Valeria; Chávez-Hernández, María Margarita; González-Fondón, Araceli

    2016-01-01

    Patient safety is a priority issue in health systems, due to the damage costs, institutional weakening, lack of credibility, and frustration on those who committed an error that resulted in an adverse event. There is no standardized instrument for recording, reporting, and analyzing sentinel or adverse events (AE) in primary care. Our aim was to design and validate a surveillance system for recording sentinel events, adverse events and near miss incidents in primary care. We made a review of systems for recording and reporting adverse events in primary care. Then, we proposed an instrument to record these events, and register faults in the structure and process, in primary health care units in the Instituto Mexicano del Seguro Social. We showed VENCER-MF format to 35 subjects. Out of them, 100% identified a failure in care process, 90% recorded a sentinel event, 85% identified the cause of this event, 75% of them suggested some measures for avoiding the recurrence of adverse events. We used a Cronbach's alpha of 0.6, p=0.03. The instrument VENCER-MF has a good consistency for the identification of adverse events.

  17. Implementation of non-condensable gases condensation suppression model into the WCOBRA/TRAC-TF2 LOCA safety evaluation code

    SciTech Connect

    Liao, J.; Cao, L.; Ohkawa, K.; Frepoli, C.

    2012-07-01

    The non-condensable gases condensation suppression model is important for a realistic LOCA safety analysis code. A condensation suppression model for direct contact condensation was previously developed by Westinghouse using first principles. The model is believed to be an accurate description of the direct contact condensation process in the presence of non-condensable gases. The Westinghouse condensation suppression model is further revised by applying a more physical model. The revised condensation suppression model is thus implemented into the WCOBRA/TRAC-TF2 LOCA safety evaluation code for both 3-D module (COBRA-TF) and 1-D module (TRAC-PF1). Parametric study using the revised Westinghouse condensation suppression model is conducted. Additionally, the performance of non-condensable gases condensation suppression model is examined in the ACHILLES (ISP-25) separate effects test and LOFT L2-5 (ISP-13) integral effects test. (authors)

  18. Parametric study of the potential for BWR ECCS strainer blockage due to LOCA generated debris. Final report

    SciTech Connect

    Zigler, G.; Brideau, J.; Rao, D.V.; Shaffer, C.; Souto, F.; Thomas, W.

    1995-10-01

    This report documents a plant-specific study for a BWR/4 with a Mark I containment that evaluated the potential for LOCA generated debris and the probability of losing long term recirculation capability due ECCS pump suction strainer blockage. The major elements of this study were: (1) acquisition of detailed piping layouts and installed insulation details for a reference BWR; (2) analysis of plant specific piping weld failure probabilities to estimate the LOCA frequency; (3) development of an insulation and other debris generation and drywell transport models for the reference BWR; (4) modeling of debris transport in the suppression pool; (5) development of strainer blockage head loss models for estimating loss of NPSH margin; (6) estimation of core damage frequency attributable to loss of ECCS recirculation capability following a LOCA. Elements 2 through 5 were combined into a computer code, BLOCKAGE 2.3. A point estimate of overall DEGB pipe break frequency (per Rx-year) of 1.59E-04 was calculated for the reference plant, with a corresponding overall ECCS loss of NPSH frequency (per Rx-year) of 1.58E-04. The calculated point estimate of core damage frequency (per Rx-year) due to blockage related accident sequences for the reference BWR ranged from 4.2E-06 to 2.5E-05. The results of this study show that unacceptable strainer blockage and loss of NPSH margin can occur within the first few minutes after ECCS pumps achieve maximum flows when the ECCS strainers are exposed to LOCA generated fibrous debris in the presence of particulates (sludge, paint chips, concrete dust). Generic or unconditional extrapolation of these reference plant calculated results should not be undertaken.

  19. Using systems science for population health management in primary care.

    PubMed

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years. Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  20. Notes on the Implementation of Non-Parametric Statistics within the Westinghouse Realistic Large Break LOCA Evaluation Model (ASTRUM)

    SciTech Connect

    Frepoli, Cesare; Oriani, Luca

    2006-07-01

    In recent years, non-parametric or order statistics methods have been widely used to assess the impact of the uncertainties within Best-Estimate LOCA evaluation models. The bounding of the uncertainties is achieved with a direct Monte Carlo sampling of the uncertainty attributes, with the minimum trial number selected to 'stabilize' the estimation of the critical output values (peak cladding temperature (PCT), local maximum oxidation (LMO), and core-wide oxidation (CWO A non-parametric order statistics uncertainty analysis was recently implemented within the Westinghouse Realistic Large Break LOCA evaluation model, also referred to as 'Automated Statistical Treatment of Uncertainty Method' (ASTRUM). The implementation or interpretation of order statistics in safety analysis is not fully consistent within the industry. This has led to an extensive public debate among regulators and researchers which can be found in the open literature. The USNRC-approved Westinghouse method follows a rigorous implementation of the order statistics theory, which leads to the execution of 124 simulations within a Large Break LOCA analysis. This is a solid approach which guarantees that a bounding value (at 95% probability) of the 95{sup th} percentile for each of the three 10 CFR 50.46 ECCS design acceptance criteria (PCT, LMO and CWO) is obtained. The objective of this paper is to provide additional insights on the ASTRUM statistical approach, with a more in-depth analysis of pros and cons of the order statistics and of the Westinghouse approach in the implementation of this statistical methodology. (authors)

  1. Assessment of Environmental Qualification Practices and Condition Monitoring Techniques for Low-Voltage Electric Cables: LOCA Test Results

    SciTech Connect

    Lofaro, R.; Grove, E.; Villaran, M.; Soo, P.; Hsu, F.

    2001-02-01

    This report documents the results of a research program addressing issues related to the qualification process for low-voltage instrumentation and control (I&C) electric cables used in commercial nuclear power plants. Three commonly used types of I&C cable were tested: Cross-Linked Polyethylene (XLPE) insulation with a Neoprene® jacket, Ethylene Propylene Rubber (EPR) insulation with an unbonded Hypalon® jacket, and EPR with a bonded Hypalon® jacket. Each cable type received accelerated aging to simulate 20, 40, and 60 years of qualified life. In addition, naturally aged cables of the same types were obtained from decommissioned nuclear power plants and tested. The cables were subjected to simulated loss-of-coolant-accident (LOCA) conditions, which included the sequential application of LOCA radiation followed by exposure to steam at high temperature and pressure, as well as to chemical spray. Periodic condition monitoring (CM) was performed using nine different techniques to obtain data on the condition of the cable, as well as to evaluate the effectiveness of those CM techniques for in situ monitoring of cables. Volume 1 of this report presents the results of the LOCA tests, and Volume 2 discusses the results of the condition monitoring tests.

  2. Primary Exhaust Cooler at the Propulsion Systems Laboratory

    NASA Image and Video Library

    1952-09-21

    One of the two primary coolers at the Propulsion Systems Laboratory at the National Advisory Committee for Aeronautics (NACA) Lewis Flight Propulsion Laboratory. Engines could be run in simulated altitude conditions inside the facility’s two 14-foot-diameter and 24-foot-long test chambers. The Propulsion Systems Laboratory was the nation’s only facility that could run large full-size engine systems in controlled altitude conditions. At the time of this photograph, construction of the facility had recently been completed. Although not a wind tunnel, the Propulsion Systems Laboratory generated high-speed airflow through the interior of the engine. The air flow was pushed through the system by large compressors, adjusted by heating or refrigerating equipment, and de-moisturized by air dryers. The exhaust system served two roles: reducing the density of the air in the test chambers to simulate high altitudes and removing hot gases exhausted by the engines being tested. It was necessary to reduce the temperature of the extremely hot engine exhaust before the air reached the exhauster equipment. As the air flow exited through exhaust section of the test chamber, it entered into the giant primary cooler seen in this photograph. Narrow fins or vanes inside the cooler were filled with water. As the air flow passed between the vanes, its heat was transferred to the cooling water. The cooling water was cycled out of the system, carrying with it much of the exhaust heat.

  3. Targetable genetic features of primary testicular and primary central nervous system lymphomas

    PubMed Central

    Chapuy, Bjoern; Roemer, Margaretha G. M.; Stewart, Chip; Tan, Yuxiang; Abo, Ryan P.; Zhang, Liye; Dunford, Andrew J.; Meredith, David M.; Thorner, Aaron R.; Jordanova, Ekaterina S.; Liu, Gang; Feuerhake, Friedrich; Ducar, Matthew D.; Illerhaus, Gerald; Gusenleitner, Daniel; Linden, Erica A.; Sun, Heather H.; Homer, Heather; Aono, Miyuki; Pinkus, Geraldine S.; Ligon, Azra H.; Ligon, Keith L.; Ferry, Judith A.; Freeman, Gordon J.; van Hummelen, Paul; Golub, Todd R.; Getz, Gad; Rodig, Scott J.; de Jong, Daphne; Monti, Stefano

    2016-01-01

    Primary central nervous system lymphomas (PCNSLs) and primary testicular lymphomas (PTLs) are extranodal large B-cell lymphomas (LBCLs) with inferior responses to current empiric treatment regimens. To identify targetable genetic features of PCNSL and PTL, we characterized their recurrent somatic mutations, chromosomal rearrangements, copy number alterations (CNAs), and associated driver genes, and compared these comprehensive genetic signatures to those of diffuse LBCL and primary mediastinal large B-cell lymphoma (PMBL). These studies identify unique combinations of genetic alterations in discrete LBCL subtypes and subtype-selective bases for targeted therapy. PCNSLs and PTLs frequently exhibit genomic instability, and near-uniform, often biallelic, CDKN2A loss with rare TP53 mutations. PCNSLs and PTLs also use multiple genetic mechanisms to target key genes and pathways and exhibit near-uniform oncogenic Toll-like receptor signaling as a result of MYD88 mutation and/or NFKBIZ amplification, frequent concurrent B-cell receptor pathway activation, and deregulation of BCL6. Of great interest, PCNSLs and PTLs also have frequent 9p24.1/PD-L1/PD-L2 CNAs and additional translocations of these loci, structural bases of immune evasion that are shared with PMBL. PMID:26702065

  4. Targetable genetic features of primary testicular and primary central nervous system lymphomas.

    PubMed

    Chapuy, Bjoern; Roemer, Margaretha G M; Stewart, Chip; Tan, Yuxiang; Abo, Ryan P; Zhang, Liye; Dunford, Andrew J; Meredith, David M; Thorner, Aaron R; Jordanova, Ekaterina S; Liu, Gang; Feuerhake, Friedrich; Ducar, Matthew D; Illerhaus, Gerald; Gusenleitner, Daniel; Linden, Erica A; Sun, Heather H; Homer, Heather; Aono, Miyuki; Pinkus, Geraldine S; Ligon, Azra H; Ligon, Keith L; Ferry, Judith A; Freeman, Gordon J; van Hummelen, Paul; Golub, Todd R; Getz, Gad; Rodig, Scott J; de Jong, Daphne; Monti, Stefano; Shipp, Margaret A

    2016-02-18

    Primary central nervous system lymphomas (PCNSLs) and primary testicular lymphomas (PTLs) are extranodal large B-cell lymphomas (LBCLs) with inferior responses to current empiric treatment regimens. To identify targetable genetic features of PCNSL and PTL, we characterized their recurrent somatic mutations, chromosomal rearrangements, copy number alterations (CNAs), and associated driver genes, and compared these comprehensive genetic signatures to those of diffuse LBCL and primary mediastinal large B-cell lymphoma (PMBL). These studies identify unique combinations of genetic alterations in discrete LBCL subtypes and subtype-selective bases for targeted therapy. PCNSLs and PTLs frequently exhibit genomic instability, and near-uniform, often biallelic, CDKN2A loss with rare TP53 mutations. PCNSLs and PTLs also use multiple genetic mechanisms to target key genes and pathways and exhibit near-uniform oncogenic Toll-like receptor signaling as a result of MYD88 mutation and/or NFKBIZ amplification, frequent concurrent B-cell receptor pathway activation, and deregulation of BCL6. Of great interest, PCNSLs and PTLs also have frequent 9p24.1/PD-L1/PD-L2 CNAs and additional translocations of these loci, structural bases of immune evasion that are shared with PMBL. © 2016 by The American Society of Hematology.

  5. A primary mirror metrology system for the GMT

    NASA Astrophysics Data System (ADS)

    Rakich, A.

    2016-07-01

    The Giant Magellan Telescope (GMT)1 is a 25 m "doubly segmented" telescope composed of seven 8.4 m "unit Gregorian telescopes", on a common mount. Each primary and secondary mirror segment will ideally lie on the geometrical surface of the corresponding rotationally symmetrical full aperture optical element. Therefore, each primary and conjugated secondary mirror segment will feed a common instrument interface, their focal planes co-aligned and cophased. First light with a subset of four unit telescopes is currently scheduled for 2022. The project is currently considering an important aspect of the assembly, integration and verification (AIV) phase of the project. This paper will discuss a dedicated system to directly characterize the on-sky performance of the M1 segments, independently of the M2 subsystem. A Primary Mirror Metrology System (PMS) is proposed. The main purpose of this system will be to he4lp determine the rotation axis of an instrument rotator (the Gregorian Instrument Rotator or GIR in this case) and then to characterize the deflections and deformations of the M1 segments with respect to this axis as a function of gravity and temperature. The metrology system will incorporate a small (180 mm diameter largest element) prime focus corrector (PFC) that simultaneously feeds a <60" square acquisition and guiding camera field, and a Shack Hartmann wavefront sensor. The PMS is seen as a significant factor in risk reduction during AIV; it allows an on-sky characterization of the primary mirror segments and cells, without the complications of other optical elements. The PMS enables a very useful alignment strategy that constrains each primary mirror segments' optical axes to follow the GIR axis to within a few arc seconds. An additional attractive feature of the incorporation of the PMS into the AIV plan, is that it allows first on-sky telescope operations to occur with a system of considerably less optical and control complexity than the final doubly

  6. RELAP5 MODEL OF THE DIVERTOR PRIMARY HEAT TRANSFER SYSTEM

    SciTech Connect

    Popov, Emilian L; Yoder Jr, Graydon L; Kim, Seokho H

    2010-08-01

    This report describes the RELAP5 model that has been developed for the divertor primary heat transfer system (PHTS). The model is intended to be used to examine the transient performance of the divertor PHTS and evaluate control schemes necessary to maintain parameters within acceptable limits during transients. Some preliminary results are presented to show the maturity of the model and examine general divertor PHTS transient behavior. The model can be used as a starting point for developing transient modeling capability, including control system modeling, safety evaluations, etc., and is not intended to represent the final divertor PHTS design. Preliminary calculations using the models indicate that during normal pulsed operation, present pressurizer controls may not be sufficient to keep system pressures within their desired range. Additional divertor PHTS and control system design efforts may be required to ensure system pressure fluctuation during normal operation remains within specified limits.

  7. Preoperational test report, primary ventilation condenser cooling system

    SciTech Connect

    Clifton, F.T.

    1997-10-29

    This represents the preoperational test report for the Primary Ventilation Condenser Cooling System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system uses a closed chilled water piping loop to provide offgas effluent cooling for tanks AY101, AY102, AZ1O1, AZ102; the offgas is cooled from a nominal 100 F to 40 F. Resulting condensation removes tritiated vapor from the exhaust stack stream. The piping system includes a package outdoor air-cooled water chiller with parallel redundant circulating pumps; the condenser coil is located inside a shielded ventilation equipment cell. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  8. Behavior modification in primary care: the pressure system model.

    PubMed

    Katz, D L

    2001-01-01

    The leading causes of death in the United States are predominantly attributable to modifiable behaviors. Patients with behavioral risk factors for premature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehi cle use patterns; and tobacco, alcohol, and illicit sub stance use, are seen far more consistently by primary care providers than by mental health specialists. Yet models of behavior modification are reported, debated, and revised almost exclusively in the psychology literature. While the Stages of Change Model, or Transtheo retical Model, has won application in a broadening array of clinical settings, its application in the primary care setting is apparently quite limited despite evidence of its utility [Prochaska J, Velicer W. Am J Health Promot 1997;12:38-48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public health goals specified in the Healthy People objectives and in the reports of the U.S. Preventive Services Task Force. The Pressure System Model reported here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome evaluation, is encouraged as part of an effort to advance public health.

  9. Attitude-referenced radiometer study. Part 2: Primary calibration system

    NASA Technical Reports Server (NTRS)

    Williamson, W. R.; Otte, A. A.

    1971-01-01

    A primary calibration system, PCS, for infrared radiometers has been developed, built, and tested. The system allows radiometers to be calibrated with less than 1 percent error for use in earth coverage horizon measurements, earth resources surveys, and synoptic meteorological measurement. The final design, fabrication and test of the PCS are reported. A detailed description of the PCS construction is presented, along with the results of a complete series of functional tests. Test to verify the source thermal characteristics, collimator reflectance, and output beam characteristics are described and their results presented.

  10. 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.

  11. Estimation of ring tensile properties of steam oxidized Zircaloy-4 fuel cladding under simulated LOCA condition

    NASA Astrophysics Data System (ADS)

    Shriwastaw, R. S.; Sawarn, Tapan K.; Banerjee, Suparna; Rath, B. N.; Dubey, J. S.; Kumar, Sunil; Singh, J. L.; Bhasin, Vivek

    2017-09-01

    The present study involves the estimation of ring tensile properties of Indian Pressurised Heavy Water Reactor (IPHWR) fuel cladding made of Zircaloy-4, subjected to experiments under a simulated loss-of-coolant-accident (LOCA) condition. Isothermal steam oxidation experiments were conducted on clad tube specimens at temperatures ranging from 900 to 1200 °C at an interval of 50 °C for different soaking periods with subsequent quenching in water at ambient temperature. The specimens, which survived quenching, were then subjected to ambient temperature ring tension test (RTT). The microstructure was correlated with the mechanical properties. The yield strength (YS) and ultimate tensile strength (UTS) increased initially with rise in oxidation temperature and time duration but then decreased with further increase in oxidation. Ductility is adversely affected with rising oxidation temperature and longer holding time. A higher fraction of load bearing phase and lower oxygen content in it ensures higher residual ductility. Cladding shows almost zero ductility behavior in RIT when load bearing phase fraction is less than 0.72 and its average oxygen concentration is greater than 0.58 wt%.

  12. New roles for astrocytes: the nightlife of an 'astrocyte'. La vida loca!

    PubMed

    Horner, Philip J; Palmer, Theo D

    2003-11-01

    Like a newly popular nightspot, the biology of adult stem cells has emerged from obscurity to become one of the most lively new disciplines of the decade. The neurosciences have not escaped this trendy pastime and, from amid the noise and excitement, the astrocyte emerges as a beguiling companion to the adult neural stem cell. A once receding partner to neurons and oligodendrocytes, the astrocyte even takes on an alter ego of the stem cell itself (S. Goldman, this issue of TINS). Putting ego aside, the 'astrocyte' is also (and perhaps more importantly) an integral component of neural progenitor hotspots, where the craziness or 'la vida loca' of the nightlife might not be so wild when compared with our traditional understanding of the astrocyte. Here, astrocytes contribute to the instructive confluence of location, atmosphere and cellular neighbors that define the daily 'vida local' or everyday local life of an adult stem cell. This review discusses astrocytes as influential components in the local stem cell niche.

  13. Use of Fuzzy Logic Systems for Assessment of Primary Faults

    NASA Astrophysics Data System (ADS)

    Petrović, Ivica; Jozsa, Lajos; Baus, Zoran

    2015-09-01

    In electric power systems, grid elements are often subjected to very complex and demanding disturbances or dangerous operating conditions. Determining initial fault or cause of those states is a difficult task. When fault occurs, often it is an imperative to disconnect affected grid element from the grid. This paper contains an overview of possibilities for using fuzzy logic in an assessment of primary faults in the transmission grid. The tool for this task is SCADA system, which is based on information of currents, voltages, events of protection devices and status of circuit breakers in the grid. The function model described with the membership function and fuzzy logic systems will be presented in the paper. For input data, diagnostics system uses information of protection devices tripping, states of circuit breakers and measurements of currents and voltages before and after faults.

  14. Seasonal regulation of primary production in eastern boundary upwelling systems

    NASA Astrophysics Data System (ADS)

    Messié, Monique; Chavez, Francisco P.

    2015-05-01

    The regulation of seasonal satellite-derived primary production (PP) was investigated within a 150 km coastal box in four eastern boundary upwelling systems (EBUS): California, Peru, Northwest Africa and Benguela. The following regulating factors were considered: (1) wind-driven nitrate supply; (2) iron supply inferred from proxies (shelf mud belt width, modeled atmospheric iron deposition, river discharge); (3) temperature; (4) light and (5) physical export consisting of offshore export, eddy-driven and wind-driven subduction. The ratio of potential new production (carbon-equivalent of nitrate supply) to primary production, termed the N-ratio, is shown to be an indicator of PP limitation by nitrate supply (low N-ratios) vs. inhibition by other factors (high N-ratios). The factors regulating PP were assessed by analyzing the N-ratios and computing spatial correlations between PP and each factor each month. The regulation of primary production was found to vary spatially, seasonally and from one EBUS to another. Macronutrient supply is shown to be the dominant regulating factor off Northwest Africa and during some seasons and locations in other systems. Light regulation within the mixed layer occurs in all EBUS in winter but may only inhibit PP (high N-ratios) off Peru and Benguela. Evidence for iron limitation was found in each EBUS (except Northwest Africa) at varying levels and was greatest off Peru during austral winter when iron demand by phytoplankton increases due to low light levels. Rapid offshore advection combined with wind-driven and/or eddy-driven subduction may inhibit PP off California. A simple generalization regarding the regulation of primary production in EBUS is not forthcoming.

  15. EVALUATION OF THE TEMPORARY TENT COVER TRUSS SYSTEM AP PRIMARY VENT SYSTEM

    SciTech Connect

    HAQ MA

    2009-12-31

    The purpose of this calculation is to evaluate a temporary ten cover truss system. This system will be used to provide weather protection to the workers during replacement of the filter for the Primary Ventilation System in AP Tank Farm. The truss system has been fabricated utilizing tubes and couplers, which are normally used for scaffoldings.

  16. Development of a primary angular shock calibration system

    NASA Astrophysics Data System (ADS)

    Peng, Jun

    2008-06-01

    Primary angular shock calibration system is developed by Changcheng Institute of Metrology & Measurement (CIMM). It uses brushless servo motor driving the air bearing system to generate rotational angle, angular velocity and angular acceleration. Both grating and heterodyne laser interferometer with diffraction grating is used to measure the angular movement, which are traceable to the International System of Units (SI). It can be used to calibrate angular transducers, i.e. angular accelerometer, angular velocity transducer, and rotational angle transducer to obtain sensitivity by angular shock or other kinds of excitation. Heterodyne laser interferometer with diffraction grating is successfully used in the measurement of angular acceleration. The method of using grating and scanning heads measure angular acceleration is developed. One characteristic of this system is that it could generate different kind of excitation signals, which include half sine, trapezoidal, sinusoidal, etc. and it can work as a high performance rate table to generate constant angular velocity. The preliminary test shows the uncertainty in calibrating angular accelerometer should be better than 2%. This paper introduces the mechanic system, control system and measurement system of the angular shock calibration system.

  17. COBRA/TRAC simulation of a semiscale small break LOCA. [PWR

    SciTech Connect

    Bian, S.H.; Thurgood, M.J.; Kelley, J.M.

    1983-06-01

    The COBRA/TRAC computer program has been developed to predict the thermal-hydraulic response of nuclear reactor primary coolant systems to small and large break loss-of-coolant accidents and other anticipated transients. The code solves the compressible three-dimensional, two-fluid, three-field equations for two-phase flow in the reactor vessel. The three fields are the vapor field, the continuous liquid field, and the liquid drop field. A five-equation drift flux model is used to model fluid flow in the primary system piping, pressurizer, pumps, and accumulator. In the code modeling of Semiscale Test S-UT-2, the intact and broken loops, and the upper head injection (UHI) systems are represented by one-dimensional components,. The pressure vessel and two steam generators are modeled using the three-dimensional VESSEL component. The results from the COBRA/TRAC calculation give a reasonable match with the measured data.

  18. Primary central nervous system lymphoma mimicking pituitary apoplexy: case report.

    PubMed

    Quintero Wolfe, Stacey; Hood, Brian; Barker, Jennifer; Benveniste, Ronald J

    2009-01-01

    Lymphoma involving the pituitary gland is very rare and usually results from metastatic spread of systemic lymphoma. We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third nerve palsy and bitemporal hemianopsia. Imaging suggested a pituitary macroadenoma, with spontaneous necrosis, extending into the suprasellar region, compressing the optic chiasm and invading the right cavernous sinus. The patient underwent transsphenoidal resection which revealed a vascular, firm tumor. An aggressive decompression of the optic chiasm was performed with complete resolution of both visual fields and third nerve palsy. Final pathology showed B cell lymphoma. Systemic work-up including bone marrow aspiration and CSF studies showed no other foci of lymphoma, and the patient was HIV-negative. Chemotherapy with methotrexate, vincristine, procarbazine, and dexamethasone was administered for primary CNS lymphoma. This is an uncommon diagnosis of which the clinician should be aware in order to tailor surgical intervention and provide early institution of proper therapy.

  19. A Computerized Decision Support System for Depression in Primary Care

    PubMed Central

    Kurian, Benji T.; Trivedi, Madhukar H.; Grannemann, Bruce D.; Claassen, Cynthia A.; Daly, Ella J.; Sunderajan, Prabha

    2009-01-01

    Objective: In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. Method: This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS17) evaluated by an independent rater. Results: Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS17, than patients treated with usual care (P < .001). Conclusions: The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT00551083 PMID:19750065

  20. Development of an allergy management support system in primary care

    PubMed Central

    Flokstra - de Blok, Bertine MJ; van der Molen, Thys; Christoffers, Wianda A; Kocks, Janwillem WH; Oei, Richard L; Oude Elberink, Joanne NG; Roerdink, Emmy M; Schuttelaar, Marie Louise; van der Velde, Jantina L; Brakel, Thecla M; Dubois, Anthony EJ

    2017-01-01

    Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients. PMID:28352197

  1. Primary propulsion/large space system interaction study

    NASA Technical Reports Server (NTRS)

    Coyner, J. V.; Dergance, R. H.; Robertson, R. I.; Wiggins, J. V.

    1981-01-01

    An interaction study was conducted between propulsion systems and large space structures to determine the effect of low thrust primary propulsion system characteristics on the mass, area, and orbit transfer characteristics of large space systems (LSS). The LSS which were considered would be deployed from the space shuttle orbiter bay in low Earth orbit, then transferred to geosynchronous equatorial orbit by their own propulsion systems. The types of structures studied were the expandable box truss, hoop and column, and wrap radial rib each with various surface mesh densities. The impact of the acceleration forces on system sizing was determined and the effects of single point, multipoint, and transient thrust applications were examined. Orbit transfer strategies were analyzed to determine the required velocity increment, burn time, trip time, and payload capability over a range of final acceleration levels. Variables considered were number of perigee burns, delivered specific impulse, and constant thrust and constant acceleration modes of propulsion. Propulsion stages were sized for four propellant combinations; oxygen/hydrogen, oxygen/methane, oxygen/kerosene, and nitrogen tetroxide/monomethylhydrazine, for pump fed and pressure fed engine systems. Two types of tankage configurations were evaluated, minimum length to maximize available payload volume and maximum performance to maximize available payload mass.

  2. Fiber optic signal collection system for primary flight control applications

    NASA Astrophysics Data System (ADS)

    Harper, Sandy L.

    1994-10-01

    The FOPMN is a fiber-optic signal collection system for primary flight control applications. An avionics bay protected electro-optic interface unit transmits light down fiber optic cable to an optical sensor housed in the harsh environment of a hydraulic actuator. The interface unit also receives the sensor's reflected pattern and calculates independent positions from the multiplexed signals. This paper discusses the FOPMN method for fiber-optically sensing and multiplexing two channels of position of a TEF actuator's main ram cylinder. Currently installed in NASA Dryden's SRA F/A-18, the FOPMN has accumulated approximately 15 hours of flight time. A performance comparison is made between the FOPMN positions and the flight control computer's feedback mechanism (the actuator LVDTs). Included is a discussion of some of the lessons learned as a result of testing the FOPMN in the lab and in flight. The FOPMN is well on its way to proving itself as a robust fiber optic system with the ability to multiplex numerous optical sensors for primary flight control. The success of the FOPMN leads to the second phase of the project--optical loop closure. Our goal for this phase is to have four FOPMN sensor channels on the main ram and/or the main control valve of the actuator to serve as the quad redundant feedback mechanism for flight control.

  3. Primary Emotional Systems and Personality: An Evolutionary Perspective

    PubMed Central

    Montag, Christian; Panksepp, Jaak

    2017-01-01

    The present article highlights important concepts of personality including stability issues from the perspective of situational demands and stability over the life-course. Following this more introductory section, we argue why individual differences in primary emotional systems may represent the phylogenetically oldest parts of human personality. Our argumentation leads to the need to increasingly consider individual differences in the raw affects/emotions of people to understand human personality in a bottom–up fashion, which can be coordinated with top–down perspectives. In support of this idea, we also review existing evidence linking individual differences in primal emotions as assessed with the Affective Neuroscience Personality Scales and the widely accepted Big Five Model of Personality. In this context, we provide additional evidence on the link between primal emotions and personality in German and Chinese sample populations. In short, this article addresses evolutionary perspectives in the evaluation of human personality, highlighting some of the ancestral emotional urges that probably still control variations in the construction of human personality structures. Moreover, we address how individual differences in primary emotional systems can illuminate linkages to major human psychopathologies and the potential advantages and disadvantages of carrying a certain personality trait within certain cultural/environmental niches. PMID:28443039

  4. Fission Product Migration in Primary System and Containment

    SciTech Connect

    2015-04-01

    Version 00 ART MOD2 aims at a comprehensive analysis for the FP behaviour in primary system and in containment during severe accidents and therefore the code considers the removal of radio-nuclides of up to 60 materials including chemical compounds by natural deposition and by the engineered safety features (ESF) such as spray systems. As for the natural deposition of radio-nuclides, the code can consider the phenomena such as gravitational settling, thermophoresis, diffusiophoresis, Brownian diffusion, diffusion under laminar or turbulent flows, resuspension, condensation, chemisorption and revaporization. The code also models the aerosol growth by agglomeration of aerosols and condensation/evaporation of volatile material at the aerosol surface. Recently, the models for iodine chemistry in containment sump water was incorporated into ART MOD2 ART MOD2 was modified in January 2015 to correct coding errors and improve the vibration of the calculation result of water (H2O) vapor.

  5. An evaluation of four telemedicine systems for primary care.

    PubMed Central

    Dunn, E V; Conrath, D W; Bloor, W G; Tranquada, B

    1977-01-01

    In an evaluation of the efficacy of four two-way telecommunication systems for use in primary care, more than 1,000 patients seeking care at a community health center received an additional remote examination by use of either color television, black and white television, still-frame black and white television, or hands-free telephone. The diagnosis, clinical tests and X rays requested, and proposed patient management were compared to the actual care received by the patients at the health center. There were no significant differences between any of the modes in relation to diagnostic accuracy, time for the diagnostic interview, tests requested, or referral rates. Furthermore, patient attitudes did not vary significantly. Thus the relatively inexpensive telephone proved to be as efficient and effective a means for delivery of remote physician care as did any of the visual communication systems. PMID:873812

  6. Optimized Battery-Type Reactor Primary System Design Utilizing Lead

    SciTech Connect

    Yu, Yong H.; Son, Hyoung M.; Lee, Il S.; Suh, Kune Y.

    2006-07-01

    A number of small and medium size reactors are being developed worldwide as well as large electricity generation reactors for co-generation, district heating or desalination. The Seoul National University has started to develop 23 MWth BORIS (Battery Optimized Reactor Integral System) as a multi-purpose reactor. BORIS is an integral-type optimized fast reactor with an ultra long life core. BORIS is being designed to meet the Generation IV nuclear energy system goals of sustainability, safety, reliability and economics. Major features of BORIS include 20 consecutive years of operation without refueling; elimination of an intermediate heat transport loop and main coolant pump; open core without individual subassemblies; inherent negative reactivity feedback; and inherent load following capability. Its one mission is to provide incremental electricity generation to match the needs of developing nations and especially remote communities without major electrical grid connections. BORIS consists of a reactor module, heat exchanger, coolant module, guard vessel, reactor vessel auxiliary cooling system (RVACS), secondary system, containment and the seismic isolation. BORIS is designed to generate 10 MWe with the resulting thermal efficiency of 45 %. BORIS uses lead as the primary system coolant because of the inherent safety of the material. BORIS is coupled with a supercritical carbon dioxide Brayton cycle as the secondary system to gain a high cycle efficiency in the range of 45 %. The reference core consists of 757 fuel rods without assembly with an active core height of 0.8 m. The BORIS core consists of single enrichment zone composed of a Pu-MA (minor actinides)-U-N fuel and a ferritic-martensitic stainless steel clad. This study is intended to set up appropriate reactor vessel geometry by performing thermal hydraulic analysis on RVACS using computational fluid dynamics codes; to examine the liquid metal coolant behavior along the subchannels; to find out whether the

  7. Shuttle primary reaction control system engine exhaust plume contamination effects

    NASA Technical Reports Server (NTRS)

    Koontz, Steve; Ehlers, Horst; Pedley, Mike; Cross, John; Hakes, Charles

    1993-01-01

    Space Shuttle proximity operations constitute an important part of the SSF induced external environment. The impingement of primary reaction control system (PRCS) engine plumes on SSF functional surfaces during docking or berthing and separation leads to concerns about molecular contamination and high speed particle impact. The Shuttle Plume Impingement flight Experiment (SPIE) was designed to provide a direct measure of both the molecular contamination and particle impact rates produced by Shuttle PRCS engines in the LEO environment. The measured permanent deposition produced by PRCS engine firings was less than that assumed in current SSF programatic assessments. Only two to three possible high velocity particle impact pits were observed on the RMS end effector hardware.

  8. Shuttle primary reaction control system engine exhaust plume contamination effects

    NASA Technical Reports Server (NTRS)

    Koontz, Steve; Ehlers, Horst; Pedley, Mike; Cross, John; Hakes, Charles

    1993-01-01

    Space Shuttle proximity operations constitute an important part of the SSF induced external environment. The impingement of primary reaction control system (PRCS) engine plumes on SSF functional surfaces during docking or berthing and separation leads to concerns about molecular contamination and high speed particle impact. The Shuttle Plume Impingement flight Experiment (SPIE) was designed to provide a direct measure of both the molecular contamination and particle impact rates produced by Shuttle PRCS engines in the LEO environment. The measured permanent deposition produced by PRCS engine firings was less than that assumed in current SSF programatic assessments. Only two to three possible high velocity particle impact pits were observed on the RMS end effector hardware.

  9. Primary large-cell lymphoma of the central nervous system

    SciTech Connect

    Amendola, B.E.; McClatchey, K.D.; Amendola, M.A.; Gebarski, S.S.

    1986-06-01

    Primary non-Hodgkin's lymphoma of the central nervous system (CNS) is a rare disease. Seven patients were seen and treated at the University of Michigan Medical Center between January 1969 and December 1983. All patients had histologically proven diagnoses of large cell lymphoma with clinical and radiologic evidence of involvement limited to the CNS. Five of seven patients received postoperative radiation therapy, two of whom have had apparent local control at 1- and 2-year follow-up. The two patients without postoperative radiation died of local recurrence 2 and 3 months following subtotal resection. These poor results suggest that adjuvant therapy may be required for improved control of this type of extranodal lymphoma.

  10. Neuropsychological profile of patients with primary systemic hypertension.

    PubMed

    Ostrosky-Solis, F; Mendoza, V U; Ardila, A

    2001-01-01

    Arterial hypertension represents a risk factor for cerebrovascular disease. It has been hypothesized that chronic hypertension may eventually result in small subcortical infarcts associated with some cognitive impairments. One hundred fourteen patients with primary systemic hypertension (PSH) and 114 matched subjects were selected. PSH patients were further divided in four groups depending upon the hypertension severity. In addition to the medical and laboratory exams, a neuropsychological evaluation was administered. The NEUROPSI neuropsychological test battery was used. An association between level of hypertension and cognitive impairment was observed. Most significant differences were observed in the following domains: Reading, executive functioning, constructional, and memory-recall. No differences were observed in orientation, memory-recognition, and language. Some neuropsychological functions appeared impaired even in the PSH group with the least risk factors. Cognitive evaluation may be important in cases of PSH not only to determine early subtle cognitive changes, but also for follow-up purposes, and to assess the efficacy of different therapeutic procedures.

  11. 49 CFR 214.529 - In-service failure of primary braking system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false In-service failure of primary braking system. 214... Maintenance Machines and Hi-Rail Vehicles § 214.529 In-service failure of primary braking system. (a) In the event of a total in-service failure of its primary braking system, an on-track roadway...

  12. 49 CFR 214.529 - In-service failure of primary braking system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false In-service failure of primary braking system. 214... Maintenance Machines and Hi-Rail Vehicles § 214.529 In-service failure of primary braking system. (a) In the event of a total in-service failure of its primary braking system, an on-track roadway...

  13. 49 CFR 214.529 - In-service failure of primary braking system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false In-service failure of primary braking system. 214... Maintenance Machines and Hi-Rail Vehicles § 214.529 In-service failure of primary braking system. (a) In the event of a total in-service failure of its primary braking system, an on-track roadway...

  14. 49 CFR 214.529 - In-service failure of primary braking system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false In-service failure of primary braking system. 214... Maintenance Machines and Hi-Rail Vehicles § 214.529 In-service failure of primary braking system. (a) In the event of a total in-service failure of its primary braking system, an on-track roadway...

  15. Comparison of computer codes (CE-THERM, FRAP-T5, GT3-FLECHT, and TRUMP-FLECHT) with data from the NRU-LOCA thermal hydraulic tests

    SciTech Connect

    Mohr, C.L.; Rausch, W.N.; Hesson, G.M.

    1981-07-01

    The LOCA Simulation Program in the NRU reactor is the first set of experiments to provide data on the behavior of full-length, nuclear-heated PWR fuel bundles during the heatup, reflood, and quench phases of a loss-of-coolant accident (LOCA). This paper compares the temperature time histories of 4 experimental test cases with 4 computer codes: CE-THERM, FRAP-T5, GT3-FLECHT, and TRUMP-FLECHT. The preliminary comparisons between prediction and experiment show that the state-of-the art fuel codes have large uncertainties and are not necessarily conservative in predicting peak temperatures, turn around times, and bundle quench times.

  16. Chromosomal Imbalances in Primary Lymphomas of the Central Nervous System

    PubMed Central

    Rickert, Christian H.; Dockhorn-Dworniczak, Barbara; Simon, Ronald; Paulus, Werner

    1999-01-01

    Twenty-two primary central nervous system lymphomas of immunocompetent adults were studied by comparative genomic hybridization. All were high-grade diffuse large B cell lymphomas. Comparative genomic hybridization revealed an average of 5.5 chromosomal changes per tumor, with gains being more common than losses (3.5 vs. 2.0). The most frequent DNA copy number changes were gains on chromosomes 1, 12, 18 (41% each), 7 (23%), and 11 (18%) and losses involving chromosomes 6 (59%), 18, and 20 (18% each). Commonly involved regions were +12q (41%), +18q (36%), +1q (32%), and +7q (23%), as well as −6q (50%), −6p (18%), −17p, and −18p (14% each). High-level gains were found on 7 chromosomes, mainly involving chromosomes 18q (23%), 12q (18%), and 1q (14%). Minimal common regions of over- and underrepresentation were found on +1q25–31, −6q16–21, +7q11.2, +12p11.2–13, +12q12–14, +12q22–24.1, and +18q12.2–21.3. A significant correlation between loss of DNA copy numbers on chromosome 6q and shorter survival could be established (10.2 vs. 22.3 months; P < 0.05). Our findings suggest that chromosomal imbalances of primary central nervous system lymphomas are similar to those of diffuse large B cell lymphomas at other locations and are probably not related to cerebral presentation; however, they may be prognostically relevant. PMID:10550299

  17. Chemotherapy in newly diagnosed primary central nervous system lymphoma

    PubMed Central

    Hashemi-Sadraei, Nooshin; Peereboom, David M.

    2010-01-01

    Primary central nervous system lymphoma (PCNSL) accounts for only 3% of brain tumors. It can involve the brain parenchyma, leptomeninges, eyes and the spinal cord. Unlike systemic lymphoma, durable remissions remain uncommon. Although phase III trials in this rare disease are difficult to perform, many phase II trials have attempted to define standards of care. Treatment modalities for patients with newly diagnosed PCNSL include radiation and/or chemotherapy. While the role of radiation therapy for initial management of PCNSL is controversial, clinical trials will attempt to improve the therapeutic index of this modality. Routes of chemotherapy administration include intravenous, intraocular, intraventricular or intra-arterial. Multiple trials have outlined different methotrexate-based chemotherapy regimens and have used local techniques to improve drug delivery. A major challenge in the management of patients with PCNSL remains the delivery of aggressive treatment with preservation of neurocognitive function. Because PCNSL is rare, it is important to perform multicenter clinical trials and to incorporate detailed measurements of long-term toxicities. In this review we focus on different chemotherapeutic approaches for immunocompetent patients with newly diagnosed PCNSL and discuss the role of local drug delivery in addition to systemic therapy. We also address the neurocognitive toxicity of treatment. PMID:21789140

  18. A concept of JAERI passive safety light water reactor system (JPSR)

    SciTech Connect

    Murao, Y.; Araya, F.; Iwamura, T.

    1995-09-01

    The Japan Atomic Energy Research Institute (JAERI) proposed a passive safety reactor system concept, JPSR, which was developed for reducing manpower in operation and maintenance and influence of human errors on reactor safety. In the concept the system was extremely simplified. The inherent matching nature of core generation and heat removal rate within a small volume change of the primary coolant is introduced by eliminating chemical shim and adopting in-vessel control rod drive mechanism units, a low power density core and once-through steam generators. In order to simplify the system, a large pressurizer, canned pumps, passive engineered-safety-features-system (residual heat removal system and coolant injection system) are adopted and the total system can be significantly simplified. The residual heat removal system is completely passively actuated in non-LOCAs and is also used for depressurization of the primary coolant system to actuate accumulators in small break LOCAs and reactor shutdown cooling system in normal operation. All of systems for nuclear steam supply system are built in the containment except for the air coolers as a the final heat sink of the passive residual heat removal system. Accordingly the reliability of the safety system and the normal operation system is improved, since most of residual heat removal system is always working and a heat sink for normal operation system is {open_quotes}safety class{close_quotes}. In the passive coolant injection system, depressurization of the primary cooling system by residual heat removal system initiates injection from accumulators designed for the MS-600 in medium pressure and initiates injection from the gravity driven coolant injection pool at low pressure. Analysis with RETRAN-02/MOD3 code demonstrated the capability of passive load-following, self-power-controllability, cooling and depressurization.

  19. Mixed-oxide fuel decay heat analysis for BWR LOCA safety evaluation

    SciTech Connect

    Chiang, R. T.

    2013-07-01

    The mixed-oxide (MOX) fuel decay heat behavior is analyzed for Boiling Water Reactor (BWR) Loss of Coolant Accident (LOCA) safety evaluation. The physical reasoning on why the decay heat power fractions of MOX fuel fission product (FP) are significantly lower than the corresponding decay heat power fractions of uranium-oxide (UOX) fuel FP is illustrated. This is primarily due to the following physical phenomena. -The recoverable energies per fission of plutonium (Pu)-239 and Pu-241 are significantly higher than those of uranium (U)-235 and U-238. Consequently, the fission rate required to produce the same amount of power in MOX fuel is significantly lower than that in UOX fuel, which leads to lower subsequent FP generation rate and associated decay heat power in MOX fuel than those in UOX fuel. - The effective FP decay energy per fission of Pu-239 is significantly lower than the corresponding effective FP decay energy per fission of U-235, e.g., Pu-239's 10.63 Mega-electron-Volt (MeV) vs. U-235's 12.81 MeV at the cooling time 0.2 second. This also leads to lower decay heat power in MOX fuel than that in UOX fuel. The FP decay heat is shown to account for more than 90% of the total decay heat immediately after shutdown. The FP decay heat results based on the American National Standard Institute (ANSI)/American Nuclear Society (ANS)-5.1-1979 standard method are shown very close to the corresponding FP decay heat results based on the ANSI/ANS-5.1-2005 standard method. The FP decay heat results based on the ANSI/ANS-5.1-1979 simplified method are shown very close to but mostly slightly lower than the corresponding FP decay heat results based on the ANSI/ANS-5.1-1971 method. The FP decay heat results based on the ANSI/ANS-5.1-1979 simplified method or the ANSI/ANS-5.1-1971 method are shown significantly larger than the corresponding FP decay heat results based on the ANSI/ANS-5.1-1979 standard method or the ANSI/ANS-5.1-2005 standard method. (authors)

  20. Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal.

    PubMed

    Acharya, Bibhav; Tenpa, Jasmine; Thapa, Poshan; Gauchan, Bikash; Citrin, David; Ekstrand, Maria

    2016-09-19

    Globally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation. We conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program. Participants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist. Primary care providers in rural Nepal reported the failure of the current system of referral, which

  1. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system.

  2. Primary Central Nervous System Anaplastic Large T-cell Lymphoma

    PubMed Central

    Splavski, Bruno; Muzevic, Dario; Ladenhauser-Palijan, Tatjana; Jr, Brano Splavski

    2016-01-01

    Introduction: Primary central nervous system lymphoma (PCNSL) of T-cell origin is an exceptionally rare, highly malignant intracranial neoplasm. Although such a tumor typically presents with a focal mass lesion. Case report: Past medical history of a 26-year-old male patient with a PCNS lymphoma of T-cell origin was not suggestive of intracranial pathology or any disorder of other organs and organic systems. To achieve a gross total tumor resection, surgery was performed via osteoplastic craniotomy using the left frontal transcortical transventricular approach. Histological and immunohistochemical analyses of the tissue removed described tumor as anaplastic large cell lymphoma of T-cells (T-ALCL). Postoperative and neurological recovery was complete, while control imaging of the brain showed no signs of residual tumor at a six-month follow-up. The patient, who did not appear immunocompromized, was referred to a hematologist and an oncologist where corticosteroids, the particular chemotherapeutic protocol and irradiation therapy were applied. Conclusion: Since PCNS lymphoma is a potentially curable brain tumor, we believe that proper selection of the management options, including early radical tumor resection for solitary PCNS lymphoma, may be proposed as a major treatment of such a tumor in selected patients, resulting in a satisfactory outcome. PMID:27703297

  3. Probabilistic analysis and operational data in response to NUREG-0737, Item II. K. 3. 2 for Westinghouse NSSS plants. [Modifications to reduce LOCA due to stuck-open power-operated relief valve

    SciTech Connect

    Wood, D.C.; Gottshall, C.L.

    1981-02-01

    This report describes various modifications to Westinghouse plants since TMI and, using probabilistic analysis via event trees, estimates the effect of the post-TMI changes, including an automatic (PORV) (power operated relief valve) isolation concept identified in NUREG-0731 item II.K.3.1. The requested safety valve operational data is included as an appendix. A significant reduction in the frequency of a small break LOCA, due to a stuck open PORV has already been achieved by the modifications made subsequent to TMI. Domestic Westinghouse operating plant data (based on 181 reactor years of operation) has been collected and evaluated. An auto block valve closure system has been evaluated. The analysis is generally applicable to all Westinghouse plants which have incorporated the post-TMI hardware and procedural changes relative to stuck-open PORVs.

  4. Pressure suppression system

    DOEpatents

    Gluntz, D.M.

    1994-10-04

    A pressure suppression system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and an enclosed gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel. The GDCS pool includes a plenum for receiving through an inlet the non-condensable gas carried with steam from the drywell following a loss-of-coolant accident (LOCA). A condenser is disposed in the GDCS plenum for condensing the steam channeled therein and to trap the non-condensable gas therein. A method of operation includes draining the GDCS pool following the LOCA and channeling steam released into the drywell following the LOCA into the GDCS plenum for cooling along with the non-condensable gas carried therewith for trapping the gas therein. 3 figs.

  5. Pressure suppression containment system

    DOEpatents

    Gluntz, D.M.; Townsend, H.E.

    1994-03-15

    A pressure suppression containment system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and a gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel. The wetwell pool includes a plenum for receiving the non-condensable gas carried with steam from the drywell following a loss-of-coolant-accident (LOCA). The wetwell plenum is vented to a plenum above the GDCS pool following the LOCA for suppressing pressure rise within the containment vessel. A method of operation includes channeling steam released into the drywell following the LOCA into the wetwell pool for cooling along with the non-condensable gas carried therewith. The GDCS pool is then drained by gravity, and the wetwell plenum is vented into the GDCS plenum for channeling the non-condensable gas thereto. 6 figures.

  6. Pressure suppression system

    DOEpatents

    Gluntz, Douglas M.

    1994-01-01

    A pressure suppression system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and an enclosed gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel. The GDCS pool includes a plenum for receiving through an inlet the non-condensable gas carried with steam from the drywell following a loss-of-coolant accident (LOCA). A condenser is disposed in the GDCS plenum for condensing the steam channeled therein and to trap the non-condensable gas therein. A method of operation includes draining the GDCS pool following the LOCA and channeling steam released into the drywell following the LOCA into the GDCS plenum for cooling along with the non-condensable gas carried therewith for trapping the gas therein.

  7. Pressure suppression containment system

    DOEpatents

    Gluntz, Douglas M.; Townsend, Harold E.

    1994-03-15

    A pressure suppression containment system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and a gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel. The wetwell pool includes a plenum for receiving the non-condensable gas carried with steam from the drywell following a loss-of coolant-accident (LOCA). The wetwell plenum is vented to a plenum above the GDCS pool following the LOCA for suppressing pressure rise within the containment vessel. A method of operation includes channeling steam released into the drywell following the LOCA into the wetwell pool for cooling along with the non-condensable gas carried therewith. The GDCS pool is then drained by gravity, and the wetwell plenum is vented into the GDCS plenum for channeling the non-condensable gas thereto.

  8. Pathway analysis of primary central nervous system lymphoma.

    PubMed

    Tun, Han W; Personett, David; Baskerville, Karen A; Menke, David M; Jaeckle, Kurt A; Kreinest, Pamela; Edenfield, Brandy; Zubair, Abba C; O'Neill, Brian P; Lai, Weil R; Park, Peter J; McKinney, Michael

    2008-03-15

    Primary central nervous system (CNS) lymphoma (PCNSL) is a diffuse large B-cell lymphoma (DLBCL) confined to the CNS. A genome-wide gene expression comparison between PCNSL and non-CNS DLBCL was performed, the latter consisting of both nodal and extranodal DLBCL (nDLBCL and enDLBCL), to identify a "CNS signature." Pathway analysis with the program SigPathway revealed that PCNSL is characterized notably by significant differential expression of multiple extracellular matrix (ECM) and adhesion-related pathways. The most significantly up-regulated gene is the ECM-related osteopontin (SPP1). Expression at the protein level of ECM-related SPP1 and CHI3L1 in PCNSL cells was demonstrated by immunohistochemistry. The alterations in gene expression can be interpreted within several biologic contexts with implications for PCNSL, including CNS tropism (ECM and adhesion-related pathways, SPP1, DDR1), B-cell migration (CXCL13, SPP1), activated B-cell subtype (MUM1), lymphoproliferation (SPP1, TCL1A, CHI3L1), aggressive clinical behavior (SPP1, CHI3L1, MUM1), and aggressive metastatic cancer phenotype (SPP1, CHI3L1). The gene expression signature discovered in our study may represent a true "CNS signature" because we contrasted PCNSL with wide-spectrum non-CNS DLBCL on a genomic scale and performed an in-depth bioinformatic analysis.

  9. Reversible Ammonia Sorption for the Primary Life Support System (PLSS)

    NASA Technical Reports Server (NTRS)

    Wojtowicz, Marek A.; Cosgrove, Joseph E.; Serio, Michael A.; Jennings, Mallory A.

    2012-01-01

    Results are presented on the development of regenerable trace-contaminant (TC) sorbent for use in Extravehicular Activities (EVAs), and more specifically in the Primary Life Support System (PLSS). Since ammonia is the most important TC to be captured, data presented in this paper are limited to ammonia sorption, with results relevant to other TCs to be reported at a later time. The currently available TC-control technology involves the use of a packed bed of acid-impregnated granular charcoal. The sorbent is non-regenerable, and its use is associated with appreciable pressure drop, i.e. power consumption. The objective of this work is to demonstrate the feasibility of using vacuum-regenerable sorbents for PLSS application. In this study, several carbon sorbent monoliths were fabricated and tested. Multiple adsorption/vacuum-regeneration cycles were demonstrated at room temperature, as well as carbon surface conditioning that enhances ammonia sorption without impairing sorbent regeneration. Depending on sorbent monolith geometry, the reduction in pressure drop with respect to granular sorbent was found to be between 50% and two orders of magnitude. Resistive heating of the carbon sorbent monolith was demonstrated by applying voltage to the opposite ends of the monolith.

  10. Mutational analysis of primary central nervous system lymphoma.

    PubMed

    Bruno, Aurélie; Boisselier, Blandine; Labreche, Karim; Marie, Yannick; Polivka, Marc; Jouvet, Anne; Adam, Clovis; Figarella-Branger, Dominique; Miquel, Catherine; Eimer, Sandrine; Houillier, Caroline; Soussain, Carole; Mokhtari, Karima; Daveau, Romain; Hoang-Xuan, Khê

    2014-07-15

    Little is known about the genomic basis of primary central nervous system lymphoma (PCNSL) tumorigenesis. To investigate the mutational profile of PCNSL, we analyzed nine paired tumor and germline DNA samples from PCNSL patients by high throughput exome sequencing. Eight genes of interest have been further investigated by focused resequencing in 28 additional PCNSL tumors to better estimate their incidence. Our study identified recurrent somatic mutations in 37 genes, some involved in key signaling pathways such as NFKB, B cell differentiation and cell cycle control. Focused resequencing in the larger cohort revealed high mutation rates for genes already described as mutated in PCNSL such as MYD88 (38%), CD79B (30%), PIM1 (22%) and TBL1XR1 (19%) and for genes not previously reported to be involved in PCNSL tumorigenesis such as ETV6 (16%), IRF4 (14%), IRF2BP2 (11%) and EBF1 (11%). Of note, only 3 somatically acquired SNVs were annotated in the COSMIC database. Our results demonstrate a high genetic heterogeneity of PCNSL and mutational pattern similarities with extracerebral diffuse large B cell lymphomas, particularly of the activated B-cell (ABC) subtype, suggesting shared underlying biological mechanisms. The present study provides new insights into the mutational profile of PCNSL and potential targets for therapeutic strategies.

  11. Primary expert system applied in design of electron-optical system

    NASA Astrophysics Data System (ADS)

    Lei, Wei; Tong, Linsu

    1995-09-01

    It is well known that the structure of electron optical system is complicated, so many factors, such as magnification, geometrical aberrations, and space charge effect must be taken into account in the design. At present, the main work of electron optical system CAD is solving equations and calculating numerical values. However, the designs perhaps need more inference and expertise than numerical calculations. In this paper, a primary expert system which is applied in design of electron optical system is established. This expert system is combined with the simulation software SEU-3D program to design some practical electron optical systems. Although the knowledge base is small and rules are not abundant, this paper has used this system to obtain some very useful results. The initial success with this system suggests that further work need to be done whether more rules and knowledge will be added to extend the ability of expert system.

  12. Development of Effective Academic Affairs Administration System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Thongnoi, Niratchakorn; Srisa-ard, Boonchom; Sri-ampai, Anan

    2013-01-01

    This research aimed to: 1) study current situations and problems of academic affairs administration system in Primary Schools. 2) develop an effective academic affairs administration system, and 3) evaluate the implementation of the developed system in the primary school, Thailand. Research and Development (R&D) was employed which consisted of…

  13. Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system.

    PubMed

    Pasarín, M Isabel; Berra, Silvina; González, Angelina; Segura, Andreu; Tebé, Cristian; García-Altés, Anna; Vallverdú, Inma; Starfield, Barbara

    2013-01-01

    To obtain versions of the Primary Care Assessment Tools (PCAT)-Facility version to evaluate primary care (PC) in the Spanish context, and to analyze its feasibility, reliability and validity. Cultural adaptation was performed through the use of forward and backward translations into Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews with target users (PC team managers). A pilot phase was carried out in a sample of 130 managers of PC teams in Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in the Barcelona health region. Analysis of metric properties included: 1) description of items and verification of Likert assumptions, since domain scores are obtained by summing item scores; 2) reliability analysis (Cronbach's alpha coefficient, Pearson's correlation coefficient, test-retest analysis); and 3) validity analysis (expert panel, cognitive interviews, and convergent and discriminant validity). Substantial adaptation was required for the accessory section of the questionnaire, but less was required in PC domain measurements. Items were added to the comprehensiveness domain to reflect services usually available in Spain. The lowest Cronbach's alpha scores were found for Access (0.62) and Coordination (0.59 and 0.65), while values were >0.70 for the remaining domains. The Spanish version of the PCAT-Facility questionnaire is now available and shows adequate reliability and validity. The Spanish PCAT version will facilitate national and international comparisons of PC and analysis of the determinants of quality of service provision. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  14. Prevalence of primary hyperaldosteronism in a systemic arterial hypertension league.

    PubMed

    Ribeiro, Maria Jacqueline Silva; Figueiredo Neto, José Albuquerque de; Memória, Edson Viriato; Lopes, Maíra de Castro; Faria, Manuel dos Santos; Salgado Filho, Natalino; Oliveira, Thiara Castro de

    2009-01-01

    Until recently, primary hyperaldosteronism was considered a rare cause of secondary hypertension. However, in recent years, many studies have suggested that this disease can affect up to 20% of hypertensive individuals. To determine the prevalence of primary hyperaldosteronism in hypertensive patients treated at the hypertension league of a university hospital. Serum aldosterone and plasma renin activity levels were measured in 105 patients while they were undergoing standard antihypertensive treatment, with the exception of those using betablockers and spironolactone, in fasting condition and after rest in the supine position for 20 minutes. Those with an aldosterone/plasma renin activity ratio > 25 were submitted to the saline suppression test and, after the confirmation of the autonomy of aldosterone secretion, a computed tomography of the adrenals was performed. The results are presented as percentages and means and standard deviations. Of the 105 patients, 6.54% presented refractory hypertension. Nine presented an aldosterone/plasma renin activity ratio > 25 (8.5% of the total). Of these, 08 were submitted to the saline suppression test and 01 (with refractory hypertension) had the diagnosis of primary hyperaldosteronism confirmed (0.96% of the total). A computed tomography of the adrenals was performed, which showed normal results. The prevalence of primary hyperaldosteronism in the studied sample was 0.96% of the total. However, when only the patients with refractory hypertension were evaluated, the prevalence was 14.3%.

  15. Primary Nocturnal Enuresis: A Structural and Strategic Family Systems Approach.

    ERIC Educational Resources Information Center

    Fletcher, Teresa B.

    2000-01-01

    Exploration of the literature regarding primary nocturnal enuresis suggests there are various causes including genetic, biological, physiological, and psychological explanations. Treatments typically consist of medication and behavioral intervention. However, it was believed that this enuretic case was caused by psychological trauma. A series of…

  16. Fluidic emergency roll control system. [for emergency aircraft control following failure of primary roll control system

    NASA Technical Reports Server (NTRS)

    Haefner, K. B.; Honda, T. S.

    1973-01-01

    A fluidic emergency roll control system for aircraft stabilization in the event of primary flight control failure was evaluated. The fluidic roll control units were designed to provide roll torque proportional to an electrical command as operated by two diametrically opposed thrust nozzles located in the wing tips. The control package consists of a solid propellant gas generator, two diametrically opposed vortex valve modulated thrust nozzles, and an electromagnetic torque motor. The procedures for the design, development, and performance testing of the system are described.

  17. A Computerized System for In-Service Formative Evaluation in Primary Care Residencies

    PubMed Central

    Beaujon, H. Jan

    1980-01-01

    A computerized system for in-service formative evaluation in primary care residencies is described. Used by three primary care residency programs at the Medical University of South Carolina, the system includes among its applications: ongoing evaluations of and by residents (rotations, monitoring, chart audits), annual in-service examinations, annual faculty and resident evaluations, and alumni surveys.

  18. Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

    PubMed Central

    2013-01-01

    Background Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Methods Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). Results These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to

  19. Cathode for use in high energy primary thionyl chloride cell systems and high energy primary thionyl chloride cell systems including the cathode

    NASA Astrophysics Data System (ADS)

    Walker, C. W., Jr.; Wade, W. L., Jr.; Binder, M.; Gilman, S.

    1985-08-01

    A cathode is provided for use in high energy primary lithium-thionyl chloride cell systems or calcium-thionyl chloride cell systems. The cathode comprises an expanded metallic current collector screen into which has been pasted a mixture of a low surface area conductive carbon black and a high surface area conductive carbon black previously mixed with a binder.

  20. Description of the primary flight display and flight guidance system logic in the NASA B-737 transport systems research vehicle

    NASA Technical Reports Server (NTRS)

    Knox, Charles E.

    1990-01-01

    A primary flight display format was integrated with the flight guidance and control system logic in support of various flight tests conducted with the NASA Transport Systems Research Vehicle B-737-100 airplane. The functional operation of the flight guidance mode control panel and the corresponding primary flight display formats are presented.

  1. Optimization design for the supporting system of 5m collimator primary mirror

    NASA Astrophysics Data System (ADS)

    Guan, Shaohua; Ma, Tianmeng; Zhang, Ming

    2016-10-01

    Primary mirror is an important component of collimator. The surface figure error of primary mirror is a critical factor affecting the imaging quality of collimator. Besides, the support system of primary mirror of collimator must be steady, while collimator need be moved safely as an elementary optical measuring tool. The support system of the primary mirror is composed of axial support and lateral support. Due to the axis of the primary mirror is horizontal when collimator working, the lateral support of the primary mirror has a far greater impact on the figure error of the primary mirror. In this paper, static structure analysis with finite element method is carried out for a 5m collimator primary mirror with V-block support under gravity load. With the analysis, the relationship between the structure parameters in primary mirror V-block support and the deformation of the primary mirror is built. With this relationship, the optimization parameters are found out to reduce the gravity deformation of the primary mirror.

  2. Determination of the bias in LOFT fuel peak cladding temperature data from the blowdown phase of large-break LOCA experiments

    SciTech Connect

    Berta, V.T.; Hanson, R.G.; Johnsen, G.W.; Schultz, R.R.

    1993-05-01

    Data from the Loss-of-Fluid Test (LOFT) Program help quantify the margin of safety inherent in pressurized water reactors during postulated loss-of-coolant accidents (LOCAs). As early as 1979, questions arose concerning the accuracy of LOFT fuel rod cladding temperature data during several large-break LOCA experiments. This report analyzes how well externally-mounted fuel rod cladding thermocouples in LOFT accurately reflected actual cladding surface temperature during large-break LOCA experiments. In particular, the validity of the apparent core-wide fuel rod cladding quench exhibited during blowdown in LOFT Experiments L2-2 and L2-3 is studied. Also addressed is the question of whether the externally-mounted thermocouples might have influenced cladding temperature. The analysis makes use of data and information from several sources, including later, similar LOFT Experiments in which fuel centerline temperature measurements were made, experiments in other facilities, and results from a detailed FRAP-T6 model of the LOFT fuel rod. The analysis shows that there can be a significant difference (referred to as bias) between the surface-mounted thermocouple reading and the actual cladding temperature, and that the magnitude of this bias depends on the rate of heat transfer between the fuel rod cladding and coolant. The results of the analysis demonstrate clearly that a core-wide cladding quench did occur in Experiments L2-2 and L2-3. Further, it is shown that, in terms of peak cladding temperature recording during LOFT large-break LOCA experiments, the mean bias is 11.4 {plus_minus} 16.2K (20.5 {plus_minus} 29.2{degrees} F). The best-estimate value of peak cladding temperature for LOFT LP-02-6 is 1,104.8 K. The best-estimate peak cladding temperature for LOFT LP-LB-1 is 1284.0 K.

  3. Workforce requirements for a primary oral health care system.

    PubMed

    van Palenstein Helderman, W; Mikx, F; Truin, G J; Hoang, T H; Pham, H L

    2000-12-01

    To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam.

  4. The W. M. Keck Telescope segmented primary mirror active control system

    SciTech Connect

    Jared, R.C.; Arthur, A.A.; Andreae, S.; Biocca, A.; Cohen, R.W.; Fuertes, J.M.; Franck, J.; Gabor, G.; Llacer, J.; Mast, T.; Meng, J.; Merrick, T.; Minor, R.; Nelson, J.; Orayani, M.; Salz, P.; Schaefer, B.; Witebsky, C.

    1989-07-01

    The ten meter diameter primary mirror of the W. M. Keck Telescope is a mosaic of thirty-six hexagonal mirrors. An active control system stabilizes the primary mirror. The active control system uses 168 measurements of the relative positions of adjacent mirror segments and 3 measurements of the primary mirror position in the telescope structure to control the 108 degrees of freedom needed to stabilize the figure and position of the primary mirror. The components of the active control system are relative position sensors, electronics, computers, actuators that position the mirrors, and software. The software algorithms control the primary mirror, perform star image stacking, emulate the segments, store and fit calibration data, and locate hardware defects. We give an overview of the active control system, its functional requirements and test measurements. 12 refs.

  5. LOFA (loss of flow accident) and LOCA (loss of coolant accident) in the TIBER-II engineering test reactor: Appendix A-4

    SciTech Connect

    Sviatoslavsky, I.N.; Attaya, H.M.; Corradini, M.L.; Lomperski, S.

    1987-01-01

    This paper describes the preliminary analysis of LOFA (loss of flow accident) and LOCA (loss of coolant accident) in the TIBER-II engineering test reactor breeding shield. TIBER-II is a compact reactor with a major radius of 3 m and thus requires a thin, high efficiency shield on the inboard side. The use of tungsten in the inboard shield implies a rather high rate of afterheat upon plasma shutdown, which must be dissipated in a controlled manner to avoid the possibility of radioactivity release or threatening the investment. Because the shield is cooled with an aqueous solution, LOFA does not pose a problem as long as natural convection can be established. LOCA, however, has more serious consequences, particularly on the inboard side. Circulation of air by natural convection is proposed as a means for dissipating the inboard shield decay heat. The safety and environmental implications of such a scheme are evaluated. It is shown that the inboard shield temperature never exceeds 510/sup 0/C following LOCA posing no hazard to reactor personnel and not threatening the investment. 7 refs., 6 figs.

  6. An ion thruster module for primary propulsion systems.

    NASA Technical Reports Server (NTRS)

    King, H. J.; Poeschel, R. L.

    1972-01-01

    The development of a 30 cm thruster module having the operational characteristics, weight, and structural integrity consistent with flight hardware is described. Elements of the program discussed in this paper are selection of an ion optical system design, development of the discharge chamber and its control, and the results of extensive performance mapping tests. The thruster system operates at 2750 sec specific impulse at 69% over-all efficiency and can be throttled from 2.0 A to 0.16 A beam current with a control system requiring a single electrical input. The 1 kV ion beam is formed by a high perveance, two grid ion optical system.

  7. Control System Modeling for the Thirty Meter Telescope Primary Mirror

    NASA Technical Reports Server (NTRS)

    MacMynowski, Douglas G.; Thompson, Peter M.; Shelton, J. Chris; Roberts, Lewis C., Jr.; Colavita, M. Mark; Sirota, Mark J.

    2011-01-01

    The Thirty Meter Telescope primary mirror is composed of 492 segments that are controlled to high precision in the presence of wind and vibration disturbances, despite the interaction with structural dynamics. The higher bandwidth and larger number of segments compared with the Keck telescopes requires greater attention to modeling to ensure success. We focus here on the development and validation of a suite of quasi-static and dynamic modeling tools required to support the design process, including robustness verification, performance estimation, and requirements flowdown. Models are used to predict the dynamic response due to wind and vibration disturbances, estimate achievable bandwidth in the presence of control-structure-interaction (CSI) and uncertainty in the interaction matrix, and simulate and analyze control algorithms and strategies, e.g. for control of focus-mode, and sensor calibration. Representative results illustrate TMT performance scaling with parameters, but the emphasis is on the modeling framework itself.

  8. Contribution of polymers to classical primary insulation of distribution system

    SciTech Connect

    Shwehdi, M.H.; Al-Rawi, A.

    1996-12-31

    Insulation composites used on present distribution lines frequently consist of several types of materials such as wood, porcelain, polymers and fiberglass reinforced plastics (FRP) connected in series. A study included the laboratory determination of the critical flashover voltage (CFO) of 17 single component and 90 combinations of two components were conducted. The acquired data were used to develop methods of predicting CFO levels of various multiple series electrical insulations. This paper illustrates the results and analyses of the classical primary insulation (porcelain), and of the modern-day insulation of polymers. It also presents the result of whether polymers may add or supplement insulation strength to the two dielectric combination using statistical methods. The paper also presents advantages and guidelines for the use of polymers to either replace or complement porcelain. This may help optimize the choice of dielectrics on distribution lines.

  9. Primary lymphoma of the central nervous system: a case report.

    PubMed

    Mackenzie, R A; Braye, S G

    1979-01-01

    A 46-year-old female presented with a 1-week history of mental change, confusion and headaches. Investigations revealed evidence of sterile meningitis. CAT scanning of the brain demonstrated marked contrast enhancement around the ependyma, and later examinations showed extension of the process deep into the white matter, Cerebral biopsies were non-diagnostic and, despite ventricular drainage and treatment with antibiotics and high dose steriods, the patent died. At postmortem there was extensive tumour tissue distributed in a butterfly shape around the ventricles, and microscopy revealed typical apperances of primary CNS lymphoma. On the basis of the experience of this case and a review of recent literature, it is suggested that the CAT scan appearances of this tumour are quite typical, and that cranial irradiation may be justified in the absence of specific histological diagnosis.

  10. Measurement of cold challenge responses in primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis.

    PubMed Central

    O'Reilly, D; Taylor, L; el-Hadidy, K; Jayson, M I

    1992-01-01

    Using computed thermography continuous temperature recordings were made before and after cold challenge of the fingers of control subjects and patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis. Basal skin temperature measurements (Tpre) were significantly lower in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in the controls. Temperatures immediately after cold challenge (T0) were significantly lower in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in controls. The lag phase before the start of temperature recovery (Tlag) was significantly greater in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in control subjects. The maximum recovery index (R%) was significantly less in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in controls. The maximum rate of change of temperature during the rapid phase of rewarming (Gmax) was significantly greater in controls than in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis. Discriminant analysis showed that the dynamic parameters of rewarming (Tlag, Gmax, and R%) showed greater variation between the patients with primary Raynaud's phenomenon and those with Raynaud's phenomenon associated with systemic sclerosis than did Tpre or T0. This method of analysis of cold challenge will be used in studies of the effects of treatment of Raynaud's phenomenon. PMID:1466594

  11. Primary-secondary pumping conversion: Retrofit of an existing campus chilled water distribution system

    SciTech Connect

    Sczomak, D.P.; Nguyen, P.N.

    1996-08-01

    The chilled water distribution system within an existing 8,300 ton (29,200 kW) capacity regional chilled water plant at Michigan State University (MSU) is being converted from a primary pumping arrangement to a primary-secondary arrangement. The plant presently provides chilled water for air conditioning to twelve remote buildings. In the future, MSU plans to increase the plant`s capacity to 10,800 tons (38,000 kW) in order to serve seven more buildings. The addition of buildings to the distribution system has caused the existing primary pumps to be incapable of producing enough pressure to offset system losses at design flow rates. The existing system has become unable to concurrently provide adequate flow, design supply water temperature and efficient chiller operation due to the distribution system deficiencies. The primary-secondary pumping conversion will include modifications to the distribution piping, the addition of five variable speed secondary pumps, additions and modifications to the control systems, the trimming of impellers on six of the existing primary pumps and replacement of two primary pumps. The campus central control system will be utilized to provide automatic chiller staging, interface with the packaged secondary pump control systems, and control of the building interconnections. The total construction cost is approximately $1,400,000 and is scheduled for completion prior to the 1996 cooling season. Provisions have been made for two additional secondary pumps to accommodate the connection of additional buildings to the distribution system in the future.

  12. Degradation and Failure Characteristics of NPP Containment Protective Coating Systems

    SciTech Connect

    Sindelar, R.L.

    2001-04-10

    Nuclear power plants (NPPs) must ensure that the emergency core cooling system (ECCS) or safety-related containment spray system (CSS) remains capable of performing its design safety function throughout the life of the plant. This requires ensuring that long-term core cooling can be maintained following a postulated loss-of-coolant accident (LOCA). Adequate safety operation can be impaired if the protective coatings which have been applied to the concrete and steel structures within the primary containment fail, producing transportable debris which could then accumulate on BWR ECCS suction strainers or PWR ECCS sump debris screens located within the containment. This document will present the data collected during the investigation of coating specimens from plants.

  13. Intention and Usage of Computer Based Information Systems in Primary Health Centers

    ERIC Educational Resources Information Center

    Hosizah; Kuntoro; Basuki N., Hari

    2016-01-01

    The computer-based information system (CBIS) is adopted by almost all of in health care setting, including the primary health center in East Java Province Indonesia. Some of softwares available were SIMPUS, SIMPUSTRONIK, SIKDA Generik, e-puskesmas. Unfortunately they were most of the primary health center did not successfully implemented. This…

  14. Current Management of Primary Central Nervous System Lymphoma

    SciTech Connect

    Schultz, Christopher J.; Bovi, Joseph

    2010-03-01

    Primary central nervous cell lymphoma (PCNSL) is an uncommon neoplasm of the brain, leptomeninges, and rarely the spinal cord. Initially thought to be characteristically associated with congenital, iatrogenic, or acquired immunosuppression, PCNSL is now recognized with increasing frequency in immunocompetent individuals. The role of surgery is limited to establishing diagnosis, as PCNSL is often multifocal with a propensity to involve the subarachnoid space. A whole-brain radiation volume has empirically been used to adequately address the multifocal tumor frequently encountered at the time of PCNSL diagnosis. Despite high rates of response after whole-brain radiotherapy (WBRT), rapid recurrence is common and long-term survival is the exception. Chemotherapy alone or in combination with WBRT has more recently become the treatment of choice. Most effective regimens contain high-dose methotrexate and or other agents that are capable of penetrating the blood-brain barrier. High response rates and improved survival with the use of chemotherapy has led to treatment strategies that defer or eliminate WBRT in hopes of lessening the risk of neurotoxicity attributed to WBRT. Unfortunately, elimination of WBRT is also associated with a higher rate of relapse. Combined chemotherapy and WBRT regimens are now being explored that use lower total doses of radiation and altered fractionation schedules with the aim of maintaining high rates of tumor control while minimizing neurotoxicity. Pretreatment, multifactor prognostic indices have recently been described that may allow selection of treatment regimens that strike an appropriate balance of risk and benefit for the individual PCNSL patient.

  15. CATHARE2 calculation of SPE-3 test small break loca on PMK facility

    SciTech Connect

    Laugier, E.; Radet, J.

    1995-09-01

    Bind and post test calculations with CATHARE2 have been performed concerning the SPE-4 exercise organized under the auspices of IAEA on the hungarian PMK-2 facility, a one loop scaled model of VVER 440/213 Nuclear Power Plant. The SPE-4 test is a cold leg SBLOCA associated to a {open_quotes}bleed and feed{close_quotes} procedure applied in the secondary circuit. The present paper is devoted to the analysis of the post test calculation. For the first part of the transient (until the end of the SIT activations), the primary and secondary pressures are rather well predicted, leading to a good agreement with the experimental trips, as scram, flow coast down, SIT beginning and end of activation. Nevertheless, some discrepancy with the experiment may be due to an over prediction of the thermal exchanges from the primary to the secondary circuits. For the second part of the transient, the predicted primary circuit repressurization is shifted after the SITs are off, while in the experiment this event immediately follows the end of SIT activation. The delay in the calculation leads to underpredict primary and secondary pressures, thus anticipating the timing of events, such as LPIS and emergency feedwater activation.

  16. Assessing & Developing Primary Care for Children: Reforms in Health Systems.

    ERIC Educational Resources Information Center

    Grason, Holly Allen, Ed.; Guyer, Bernard, Ed.

    This publication is a compilation of papers presented at an April 1994 workshop sponsored by the National Center for Education in Maternal and Child Health and the Bureau-funded Johns Hopkins Child and Adolescent Health Policy Center (CAHPC). The papers are as follows: (1) "Defining the Issues and Planning for Change: Health Care Systems,…

  17. Progress in systemic chemotherapy of primary breast cancer: an overview.

    PubMed

    Hortobagyi, G N

    2001-01-01

    Substantial progress has been made in the multidisciplinary management of primary breast cancer during the last 30 years. Adjuvant chemotherapy has been shown to significantly reduce the annual risk of cancer recurrence and mortality, and these effects persist even 15 years after diagnosis. Combination chemotherapy is superior to single-agent therapy and anthracycline-containing regimens. Those that combine an anthracycline with 5-fluorouracil and cyclophosphamide are more effective than regimens without an anthracycline. Six cycles of a single regimen appear to provide optimal benefit. Dose reductions below the standard range are associated with inferior results. Dose increases that require growth factor or hematopoietic stem cell support are under investigation; at this time, the existing results provide no compelling reason to use this strategy outside a clinical trial. Regimens using fixed crossover designs with two non-cross-resistant regimens are being evaluated. The addition of a taxane to anthracycline-containing regimens is currently under intense scrutiny, and preliminary analysis of the first three clinical trials has shown encouraging, albeit not compelling, results. For patients with estrogen receptor-positive breast cancer, the sequential administration of chemotherapy and 5 years of tamoxifen therapy provides additive benefits. No compelling evidence exists to combine ovarian ablation with chemotherapy. Most side effects and toxic effects are self-limited, although premature menopause requires monitoring and preventive interventions to preserve bone mineral density. The small risk of acute leukemia is of concern, and additional research to develop safer regimens is clearly indicated. The overall effect of optimal local/regional treatment combined with an anthracycline-containing adjuvant chemotherapy and a taxane (and, for patients with estrogen receptor-positive tumors, 5 years of tamoxifen therapy) is a greater than 50% reduction in annual risks of

  18. The development process for the space shuttle primary avionics software system

    NASA Technical Reports Server (NTRS)

    Keller, T. W.

    1987-01-01

    Primary avionics software system; software development approach; user support and problem diagnosis; software releases and configuration; quality/productivity programs; and software development/production facilities are addressed. Also examined are the external evaluations of the IBM process.

  19. Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.

    PubMed

    Tamaki, Hiromichi; Khasnis, Atul

    2015-08-01

    Venous thromboembolism (VTE) is a prevalent multifactorial health condition associated with significant morbidity and mortality. Population-based epidemiological studies have revealed an association between systemic autoimmune diseases and deep venous thrombosis (DVT)/VTE. The etiopathogenesis of increased risk of VTE in systemic autoimmune diseases is not entirely clear but multiple contributors have been explored, especially in the context of systemic inflammation and disordered thrombogenesis. Epidemiologic data on increased risk of VTE in patients with primary systemic vasculitides (PSV) have accumulated in recent years and some of these studies suggest the increased risk while patients have active diseases. This could lead us to hypothesize that venous vascular inflammation has a role to play in this phenomenon, but this is unproven. The role of immunosuppressive agents in modulating the risk of VTE in patients with PSV is not yet clear except for Behçet's disease, where most of the studies are retrospective. Sensitizing physicians to this complication has implications for prevention and optimal management of patients with these complex diseases. This review will focus on the epidemiology and available evidence regarding pathogenesis, and will attempt to summarize the best available data regarding evaluation and treatment of these patients.

  20. A novel primary system for compressible flow calibration uncertainty analysis for the preliminary design

    SciTech Connect

    Kegel, T.

    1995-08-01

    The operation of a primary system for compressible flow calibration is typically based on either a gravimetric or volumetric method of mass determination. The gravimetric method provides direct determination of mass while the volumetric method utilizes measurements of density and volume. This paper describes the preliminary design of a primary system that features both gravimetric and volumetric mass determination. The emphasis is on the presentation of an uncertainty analysis procedure to be used for preliminary design decisions.

  1. Peripheral neuropathy in primary HIV infection associates with systemic and central nervous system immune activation.

    PubMed

    Wang, Samantha X Y; Ho, Emily L; Grill, Marie; Lee, Evelyn; Peterson, Julia; Robertson, Kevin; Fuchs, Dietmar; Sinclair, Elizabeth; Price, Richard W; Spudich, Serena

    2014-07-01

    Peripheral neuropathy (PN) is a frequent complication of chronic HIV infection. We prospectively studied individuals with primary HIV infection (<1 year after transmission) to assess the presence of and laboratory associations with PN in this early stage. Standardized examination and analysis of blood and cerebrospinal fluid (CSF) was performed in participants with laboratory-confirmed primary HIV infection. PN was defined as ≥1 of the following unilateral or bilateral signs: decreased distal limb position, vibration, or temperature sense or hyporeflexia; symptomatic PN (SPN) was defined as the presence of these signs with symptoms. Analysis used nonparametric statistics. Overall, 20 (35%) of 58 antiretroviral-naive male subjects without diabetes evaluated at a median of 107 days post HIV transmission met criteria for PN. Thirteen (65%) of 20 PN subjects met criteria for SPN; 6 (30%) of 20 had bilateral findings. PN subjects and no PN subjects (NPN) did not differ in median age, days post HIV transmission, blood CD4 or CD8 counts, CSF or plasma HIV RNA levels, CSF white blood cell counts, or CSF to blood albumin ratio. PN and SPN subjects had elevated CSF neopterin (P = 0.003 and P = 0.0005), CSF monocyte chemoattractant protein-1 (P = 0.006 and P = 0.01), and blood neopterin (P = 0.006 and P = 0.009) compared with NPN subjects. PN subjects had a higher percentage of activated phenotype CSF CD8 T lymphocytes than NPN subjects (P = 0.009). Signs of PN were detected by detailed neurologic examination in 35% of men enrolled in a neurological study at a median of 3.5 months after HIV transmission. PN during this early period may be mediated by systemic and nervous system immune responses to HIV.

  2. Space Shuttle Program Primary Avionics Software System (PASS) Success Legacy - Quality and Reliability Date

    NASA Technical Reports Server (NTRS)

    Orr, James K.; Peltier, Daryl

    2010-01-01

    Thsi slide presentation reviews the avionics software system on board the space shuttle, with particular emphasis on the quality and reliability. The Primary Avionics Software System (PASS) provides automatic and fly-by-wire control of critical shuttle systems which executes in redundant computers. Charts given show the number of space shuttle flights vs time, PASS's development history, and other charts that point to the reliability of the system's development. The reliability of the system is also compared to predicted reliability.

  3. Reliability model of fault-tolerant data processing system with primary and backup nodes

    NASA Astrophysics Data System (ADS)

    Rahman, P. A.; Bobkova, E. Yu

    2016-04-01

    This paper deals with the fault-tolerant data processing systems, which are widely used in modern world of information technologies and have acceptable overhead expenses in hardware implementation. A simplified reliability model for duplex systems and the offered by authors advanced model for data processing systems with primary and backup nodes based on a three-state model of recoverable elements, which takes into consideration different failure rates of passive and active nodes and finite time of node activation, are also given. A calculation formula for the availability factor of the dual-node data processing system with primary and backup nodes and calculation examples are also provided.

  4. Evaluation of primary stability of innovated orthodontic miniscrew system (STS): An ex-vivo study

    PubMed Central

    Seifi, Massoud

    2016-01-01

    Background Stability is determined as one of the requirements in use of Temporary Anchorage Devices (TAD) in orthodontics. Miniscrew has been a widely used Bone Anchor. Compared with mini-implant that necessitates osseointegration; mechanical retention is a determining factor for primary stability of miniscrew. Studies investigated various ways to increase primary stability. The aim of this study is to introduce a new configuration of miniscrew system which is believed to obtain more primary stability. Material and Methods Freshly ovine mandibles were cut in blocks. Twenty-seven miniscrews (diameter 1.6 × 8 mm; G2, Dual Top Anchor System, Jeil Medical, Seoul, Korea) were inserted in the blocks and divided in 2 experimental groups: single miniscrew and the innovated design “Seifi Twin Screw (STS)”. Primary stability was evaluated by Periotest “M”® device. Results Independent t-test showed a significant difference between 2 experimental groups in periotest evaluation (p< 0.05). STS demonstrated higher primary stability due to its mechanical configuration and design. Conclusions The STS provides higher primary stability and was found to be effective in increased success rate of miniscrew systems from the standpoint of primary stability. Key words:Anchorage procedures, anchorage techniques, orthodontic anchorage procedures, miniscrews, temporary anchorage device. PMID:27398174

  5. 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...

  6. 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... 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...

  7. 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...

  8. 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...

  9. 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...

  10. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

    PubMed Central

    2013-01-01

    Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices

  11. Patient-perceived responsiveness of primary care systems across Europe and the relationship with the health expenditure and remuneration systems of primary care doctors.

    PubMed

    Murante, Anna Maria; Seghieri, Chiara; Vainieri, Milena; Schäfer, Willemijn L A

    2017-08-01

    Health systems are expected to be responsive, that is to provide services that are user-oriented and respectful of people. Several surveys have tried to measure all or some of the dimensions of the responsiveness (e.g. autonomy, choice, clarity of communication, confidentiality, dignity, prompt attention, quality of basic amenities, and access to family and community support), however there is little evidence regarding the level of responsiveness of primary care (PC) systems. This work analyses the capacity of primary care systems to be responsive. Data collected from 32 PC systems were used to investigate whether a relationship exists between the responsiveness of PC systems and the PC doctor remuneration systems and domestic health expenditure. There appears to be a higher responsiveness of PC when doctors are paid via capitation than when they only receive a fee for services or a mixed payment method. In addition, countries that spend more on health services are associated with higher levels of dignity and autonomy. Quality, as measured from the patient's perspective, does not necessarily overlap with PC performance based on structure and process indicators. The results could also stimulate a new debate on the role of economic resources and PC workforce payment mechanisms in the achievement of quality goals, in this case related to the capacity of PC systems to be responsive. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Developing a patient safety incident classification system for primary care. A literature review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care.

    PubMed

    Klemp, Kerstin; Dovey, Susan; Valderas, Jose M; Rohe, Julia; Godycki-Cwirko, Maciek; Elliott, Phillip; Beyer, Martin; Gerlach, Ferdin M; Hoffmann, Barbara

    2015-09-01

    Despite awareness that comparative analysis of patient safety data from several data sources would promote risk reduction, there has been little effort to establish an incident classification system that is generally applicable to patient safety data in European primary care. To describe the development of a patient safety incident classification system for primary care. A systematic review was followed by an expert group discussion and a modified Delphi survey, to provide consensus statements. We developed a classification system providing a mechanism for classifying patient safety incidents across Europe, taking into account the varying organizational arrangements that exist for primary care. It takes into account organizational processes and outcomes related to patient safety incidents and can supplement existing classification systems. Classification systems are key tools in the analysis of patient safety incidents. A system that has relevance for primary care is now available.

  13. Photovoltaic Systems for Government Agencies

    DTIC Science & Technology

    1994-02-01

    i -- • • ;__ S• .... S,<, - Loca ted in the Adirondacks this photovoltaic system powers a facility offering visitors a clean, odorless, and...current depends on type of metal, composition of the soil, salinity of water, and surface area of metal to be protected. Historically, cathodic

  14. Preparation of gaseous CRMs from the primary system for (222)Rn activity measurement.

    PubMed

    Kim, B J; Kim, B C; Lee, K B; Lee, J M; Park, T S

    2016-03-01

    For disseminating the gaseous radon standard traceable to the KRISS primary system based on the defined solid angle counting method, two kinds of radon CRM (a glass ampule type and a stainless steel cylinder type) were developed. The activity of the CRM was certified by subtracting a residual activity from the measured activity by the primary system. After certification, the ampule CRM was used to calibrate a radon-monitoring instrument and the cylinder CRM to calibrate an HPGe system. We also improved the measurement procedure of the radon primary system. In a typical radon energy spectrum, the radon peak overlaps with the polonium peak. For more reliable and accurate measurement of radon activity, a fitting method was adopted for the evaluation of radon area in the alpha energy spectrum. The result of radon activity evaluated by using the fitting method is in good agreement with that by the previous integration method. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Role for primary cilia as flow detectors in the cardiovascular system.

    PubMed

    Van der Heiden, Kim; Egorova, Anastasia D; Poelmann, Robert E; Wentzel, Jolanda J; Hierck, Beerend P

    2011-01-01

    The cardiovascular system is exposed to biochemical and biomechanical signals. Various sensors for these signals have been described and they contribute to cardiovascular development, maintenance of vessel integrity during adult life, and to pathogenesis. In the past 10years, primary cilia, membrane-covered, rod-like cellular protrusions, were discovered on multiple cell types of the cardiovascular system. Primary cilia are sensory organelles involved in several key (developmental) signaling pathways and in chemo- and mechanosensing on a myriad of cell types. In the embryonic and adult cardiovascular system, they have been demonstrated to function as shear stress sensors on endothelial cells and could act as strain sensors on smooth muscle cells and cardiomyocytes and as chemosensors on fibroblasts. This review will cover their occurrence and elaborate on established and possible functions of primary cilia in the cardiovascular system.

  16. Central nervous system involvement in primary Sjogren`s syndrome manifesting as multiple sclerosis.

    PubMed

    Liu, Jing-Yao; Zhao, Teng; Zhou, Chun-Kui

    2014-04-01

    Central nervous system symptoms in patients with primary Sjogren`s syndrome are rare. They can present as extraglandular manifestations and require a differential diagnosis from multiple sclerosis. Due to a variety of presentations, Sjogren`s syndrome with neurologic involvement may be difficult to diagnose. Here, we report a case of a 75-year-old woman who was first diagnosed with multiple sclerosis in 2010, but who was subsequently diagnosed with primary Sjogren`s syndrome 2 years later after showing signs of atypical neurologic manifestations. Therefore, primary Sjogren`s syndrome should be suspected in patients who present with atypical clinical and radiologic neurologic manifestations.

  17. Implementation of coulometric titration system at constant current for developing of certified materials as primary standards

    NASA Astrophysics Data System (ADS)

    Suarez, H.; Cristancho, R.; Peralta, F.; Torres, H.

    2017-01-01

    Coulometry is a primary method for measuring high purity substances. This is used to certify the primary reference materials required in a chemical analysis process. This paper describes the coulometric titration system developed by the National Metrology Institute (NMI) of Colombia for the certification of hydrochloric acid 0.1mol/kg reference materials. In addition, it also shows preliminary studies for future development of potassium chloride (KCl) and ethylenediaminetetraacetic acid disodium salt (EDTA-Na2) certification.

  18. Gender Differences in the Primary Representational System according to Neurolinguistic Programming.

    ERIC Educational Resources Information Center

    Cassiere, M. F.; And Others

    Neurolinguistic Programming (NLP) is a currently popular therapeutic modality in which individuals organize information through three basic sensory systems, one of which is the Primary Representational System (PRS). This study was designed to investigate gender differences in PRS according to the predicate preference method. It was expected that…

  19. Childhood primary angiitis of the central nervous system: two biopsy-proven cases.

    PubMed

    Yaari, Roy; Anselm, Irina A; Szer, Ilona S; Malicki, Denise M; Nespeca, Mark P; Gleeson, Joseph G

    2004-11-01

    Primary angiitis of the central nervous system is a rare idiopathic vasculitis predominantly affecting the central nervous system. The literature includes 10 histologically confirmed cases in childhood. We identify two additional cases, one presenting with both uveitis and cerebrospinal fluid neutrophilic pleocytosis, which has not been reported previously, and demonstrate the importance of biopsy in suspected cases.

  20. Gender Differences in the Primary Representational System according to Neurolinguistic Programming.

    ERIC Educational Resources Information Center

    Cassiere, M. F.; And Others

    Neurolinguistic Programming (NLP) is a currently popular therapeutic modality in which individuals organize information through three basic sensory systems, one of which is the Primary Representational System (PRS). This study was designed to investigate gender differences in PRS according to the predicate preference method. It was expected that…

  1. Relationships between Digestive, Circulatory, and Urinary Systems in Portuguese Primary Textbooks

    ERIC Educational Resources Information Center

    Carvalho, Graça S.; Clèment, Pierre

    2007-01-01

    In this study, 63 Portuguese primary schoolbooks (1920-2005) were analyzed. The analysis focused on text information (reference to blood absorption and association of the digestive system to other human systems) and on information from images (presence or absence of image "confusion" (when the sequence of the digestive tract is not…

  2. 49 CFR 214.529 - In-service failure of primary braking system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Maintenance Machines and Hi-Rail Vehicles § 214.529 In-service failure of primary braking system. (a) In the... machine may be operated for the remainder of its tour of duty with the use of a secondary braking system or by coupling to another machine, if such operations may be done safely. (b) If the total...

  3. Evaluation of combustible gas concentration in a multi-compartment containment after a LOCA

    SciTech Connect

    Goodwin, E.F.

    1995-12-31

    The General Electric Company`s Simplified Boiling Water Reactor (SBWR) is an advanced reactor and containment design relying on passive safety features. The containment is a pressure suppression type containment with heat removed from the containment by a Passive Containment Cooling System. This paper reports on an analysis using the GOTHIC code to investigate the distribution of non-condensable gases within the containment system. The goal of the analysis was to determine areas in the containment that may collect combustible mixtures following an accident. The SBWR`s Flammability Control System, using Passive Autocatalytic Recombiners, is not modeled in this analysis. The analysis is useful for demonstrating basic design requirements of the Flammability Control System.

  4. The Place of Creativity in Pakistani Primary Education System: An Investigation into the Factors Enhancing and Inhibiting Primary School Children's Creativity

    ERIC Educational Resources Information Center

    Shaheen, Robina

    2011-01-01

    The study presented in this book provides a baseline analysis of the extent to which the primary education system in Pakistan is capable of enhancing or inhibiting children's creativity. It involved 1008 primary schools who participated in a survey, 154 children who took the Torrance Tests of Creative Thinking, and classroom observation in 16…

  5. Thermodynamics of greenhouse systems for the northern latitudes: analysis, evaluation and prospects for primary energy saving.

    PubMed

    Bronchart, Filip; De Paepe, Michel; Dewulf, Jo; Schrevens, Eddie; Demeyer, Peter

    2013-04-15

    In Flanders and the Netherlands greenhouse production systems produce economically important quantities of vegetables, fruit and ornamentals. Indoor environmental control has resulted in high primary energy use. Until now, the research on saving primary energy in greenhouse systems has been mainly based on analysis of energy balances. However, according to the thermodynamic theory, an analysis based on the concept of exergy (free energy) and energy can result in new insights and primary energy savings. Therefore in this paper, we analyse the exergy and energy of various processes, inputs and outputs of a general greenhouse system. Also a total system analysis is then performed by linking the exergy analysis with a dynamic greenhouse climate growth simulation model. The exergy analysis indicates that some processes ("Sources") lie at the origin of several other processes, both destroying the exergy of primary energy inputs. The exergy destruction of these Sources is caused primarily by heat and vapour loss. Their impact can be compensated by exergy input from heating, solar radiation, or both. If the exergy destruction of these Sources is reduced, the necessary compensation can also be reduced. This can be accomplished through insulating the greenhouse and making the building more airtight. Other necessary Sources, namely transpiration and loss of CO2, have a low exergy destruction compared to the other Sources. They are therefore the best candidate for "pump" technologies ("vapour heat pump" and "CO2 pump") designed to have a low primary energy use. The combination of these proposed technologies results in an exergy efficient greenhouse with the highest primary energy savings. It can be concluded that exergy analyses add additional information compared to only energy analyses and it supports the development of primary energy efficient greenhouse systems.

  6. Comparison of the Mismatch Repair System between Primary and Metastatic Colorectal Cancers Using Immunohistochemistry

    PubMed Central

    Jung, Jiyoon; Kang, Youngjin; Lee, Yoo Jin; Kim, Eojin; Ahn, Bokyung; Lee, Eunjung; Kim, Joo Young; Lee, Jeong Hyeon; Lee, Youngseok; Kim, Chul Hwan; Chae, Yang-Seok

    2017-01-01

    Background Colorectal cancer (CRC) is one of the most common malignancies worldwide. Approximately 10%–15% of the CRC cases have defective DNA mismatch repair (MMR) genes. Although the high level of microsatellite instability status is a predictor of favorable outcome in primary CRC, little is known about its frequency and importance in secondary CRC. Immunohistochemical staining (IHC) for MMR proteins (e.g., MLH1, MSH2, MSH6, and PMS2) has emerged as a useful technique to complement polymerase chain reaction (PCR) analyses. Methods In this study, comparison between the MMR system of primary CRCs and paired liver and lung metastatic lesions was done using IHC and the correlation with clinical outcomes was also examined. Results Based on IHC, 7/61 primary tumors (11.4%) showed deficient MMR systems, while 13/61 secondary tumors (21.3%) showed deficiencies. In total, 44 cases showed proficient expression in both the primary and metastatic lesions. Three cases showed deficiencies in both the primary and paired metastatic lesions. In 10 cases, proficient expression was found only in the primary lesions, and not in the corresponding metastatic lesions. In four cases, proficient expression was detected in the secondary tumor, but not in the primary tumor. Conclusions Although each IHC result and the likely defective genes were not exactly matched between the primary and the metastatic tumors, identical results for primary and metastatic lesions were obtained in 77% of the cases (47/61). These data are in agreement with the previous microsatellite detection studies that used PCR and IHC. PMID:28192899

  7. Integration of Oral Health into Primary Health Care System: Views of Primary Health Care Workers in Lagos State, Nigeria

    PubMed Central

    Ogunbodede, Eyitope; Adeniyi, Abiola

    2014-01-01

    The limited access to oral health care in developing countries can be greatly improved by integrating oral health into the Primary Health Care (PHC) system. This study was designed to assess the views of PHC workers on integrating oral health care into the PHC system. A self-administered questionnaire survey was conducted in two selected local government areas of Lagos State. The instrument contained three sections assessing sociodemographic features, knowledge of common oral diseases and views on integration of oral health into PHC respectively. The mean knowledge score was 7.75 (SD=±1.81), while 60.4% of the respondents had average knowledge scores. Educational status (P=0.018) and designation (P=0.033) were significantly related to the mean knowledge scores. There was no significant difference in the oral health knowledge of the various cadres (P=0.393). Majority (85.4%) of the respondents were willing to include oral health education in their job schedule and 82% believed they needed more training on oral health. The knowledge of the respondents on the causes of the common oral diseases was deficient. Oral health education should be included in the future curriculum of these personnel. PMID:28299117

  8. The range and diversity of providers' viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology.

    PubMed

    Shabila, Nazar P; Al-Tawil, Namir G; Al-Hadithi, Tariq S; Sondorp, Egbert

    2013-03-21

    The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system. This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from "disagree most" to "agree most". By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors. Analysis of the participants' Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system. This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that

  9. [Primary malignant melanoma of the central nervous system: A diagnostic challenge].

    PubMed

    Quillo-Olvera, Javier; Uribe-Olalde, Juan Salvador; Alcántara-Gómez, Leopoldo Alberto; Rejón-Pérez, Jorge Dax; Palomera-Gómez, Héctor Guillermo

    2015-01-01

    The rare incidence of primary malignant melanoma of the central nervous system and its ability to mimic other melanocytic tumors on images makes it a diagnostic challenge for the neurosurgeon. A 51-year-old patient, with a tumor located in the right forniceal callosum area. Total surgical excision was performed. Histopathological result was consistent with the diagnosis of primary malignant melanoma of the central nervous system, after ruling out extra cranial and extra spinal melanocytic lesions. The primary malignant melanoma of the central nervous system is extremely rare. There are features in magnetic resonance imaging that increase the diagnostic suspicion; nevertheless there are other tumors with more prevalence that share some of these features through image. Since there is not an established therapeutic standard its prognosis is discouraging. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  10. APR: A geographic information system based primary router for underground residential distribution design

    SciTech Connect

    Yeh, E.C.; Sumic, Z. |; Venkata, S.S.

    1995-02-01

    This paper presents an automated tool for optimizing the routing of primary cables in underground residential distribution systems (URD). Although initially developed as one of the modules in Puget Sound Power and Light Co.`s automated electrical plant design program, Automated Primary Router (APR) can also be used in standalone mode. APR, implemented in a Geographic Information System (GIS)-based environment, is capable of efficiently accessing and manipulating geographically referenced data from a facilities management system database. It also provides a full-fledged Graphic User Interface, along with on-line visualization and accurate cost estimation to facilitate the design process. APR employs a heuristic search algorithm to find the best primary cable routes either for new residential developments, or for existing URD systems as part of the ongoing cable replacement program. Based on the test results, APR shows significant stability and efficiency in finding the optimal solution for primary cable routing. With this performance, APR can help distribution engineers improve the quality of URD design, producing standardized and economically justifiable primary cable routes. Because geographically referenced design data are digitally stored in the GIS database, APR further increases the reusability and accessibility of the URD design information.

  11. APR: A geographic information system based primary router for underground residential distribution design

    SciTech Connect

    Yeh, E.C.; Sumic, Z. |; Venkata, S.S.

    1994-12-31

    This paper presents an automated tool for optimizing the routing of primary cables in underground residential distribution systems (URD). Although initially developed as on of the modules in Puget Sound Power and Light Co.`s automated electrical plant design program, Automated Primary Router (APR) can also be used in standalone mode. APR, implemented in a Geographic Information System (GIS)-based environment, is capable of efficiently accessing and manipulating geographically referenced data from a facilities management system database. It also provides a full-fledged Graphic User Interface, along with on-line visualization and accurate cost estimation to facilitate the design process. APR employs a heuristic search algorithm to find the best primary cable routes whether for new residential developments, or for existing URD systems as part of the ongoing cable replacement program. Based on the test results, APR shows significant stability and efficiency in finding the optimal solution for primary cable routing. With this performance, APR can help distribution engineers improve the quality of URD design, producing standardized and economically justifiable primary cable routes. Because geographically referenced design data are digitally stored in the GIS database, APR further increases the reusability and accessibility of the URD design information.

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. A human factors systems approach to understanding team-based primary care: a qualitative analysis.

    PubMed

    Mundt, Marlon P; Swedlund, Matthew P

    2016-12-01

    Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Apotopes and innate immune system: novel players in the primary biliary cirrhosis scenario.

    PubMed

    Lleo, Ana; Invernizzi, Pietro

    2013-08-01

    Our understanding of primary biliary cirrhosis has been rapidly growing over the past decade and the disease is now regarded as a model for other female-predominant, organ-specific autoimmune conditions. Primary biliary cirrhosis ensues from a multi-lineage loss of tolerance to the E2 component of the pyruvate dehydrogenase complex. One of the major unanswered questions in the pathogenesis of primary biliary cirrhosis is the specificity of small intrahepatic bile ducts attack while PDC-E2 is present in mitochondria of all nucleated cells. Recent findings suggest that the uniqueness of the primary target tissue, biliary epithelium, may be of considerable importance for understanding primary biliary cirrhosis and that the biliary epithelial cell is more than an innocent victim. Rather, it attracts an immune attack by virtue of the unique apoptotic mechanisms and by the way it handles PDC-E2. Moreover, recent evidence suggests that apoptotic bodies of biliary epithelial cell are able to activate the innate immune system in the presence of anti-mitochondrial antibodies. This review article is intended to provide a critical overview of the role of apoptosis in biliary epithelial cells, the activation of the innate immune system, and its biological and clinical significance in primary biliary cirrhosis.

  18. Comparison of Carbon and Hi-Z Primary Collimators for the LHC Phase II Collimation System

    SciTech Connect

    Keller, Lewis; Markiewicz, Thomas; Smith, Jeffrey; Assmann, Ralph; Bracco, Chiara; Weiler, Thomas; /Karlsruhe, Inst. Technol.

    2011-10-31

    A current issue with the LHC collimation system is single-diffractive, off-energy protons from the primary collimators that pass completely through the secondary collimation system and are absorbed immediately downbeam in the cold magnets of the dispersion suppressor section. Simulations suggest that the high impact rate could result in quenching of these magnets. We have studied replacing the 60 cm primary graphite collimators, which remove halo mainly by inelastic strong interactions, with 5.25 mm tungsten, which remove halo mainly by multiple coulomb scattering and thereby reduce the rate of single-diffractive interactions that cause losses in the dispersion suppressor.

  19. Primary Systemic Amyloidosis and High Levels of Angiotensin-Converting Enzyme: Two Case Reports

    PubMed Central

    Praena-Segovia, J.; Sanchez-Gastaldo, A.; Bernabeu-Wittel, M.; Ocete-Pérez, R.; Ávila-Polo, R.; Martino, M. L.

    2013-01-01

    Infiltrative heart diseases are caused by a heterogeneous group of disorders; amyloidosis and sarcoidosis are two frequent causes of myocardial infiltration, which differ in clinical and biological outcome and treatment issues. The presence of high levels of angiotensin-converting enzyme (ACE) in a patient with infiltrative heart disease may increase suspicion of sarcoidosis. Nevertheless, no mention about increased ACE levels in extracerebral primary systemic amyloidosis is available. We present two cases of primary systemic amyloidosis, which are cardiac involvement and elevated ACE levels. PMID:24826302

  20. Office systems for promoting screening mammography. A survey of primary care practices.

    PubMed

    Melville, S K; Luckmann, R; Coghlin, J; Gann, P

    1993-12-01

    Office tracking, scheduling, and reminder systems have been shown to improve utilization of screening mammography, but little is known about the use of these systems by primary care physicians. We surveyed 132 primary care and obstetrics and gynecology practices affiliated with an independent practice association model health maintenance organization in central Massachusetts to determine their use of reminder, scheduling, and follow-up systems, and education and counseling services aimed at increasing screening mammography rates. The use of chart flags to remind physicians of a patient's need for mammography screening was reported by 30% of practices. Thirty-one percent reported the use of flow sheets, and 27% reported the use of mail or telephone patient reminders. At least one of these three systems was used by 57% of the practices, whereas 43% reported having none of these three systems. Variations in the use of these office systems were related to specialty type, physician number, and clinical staffing. The majority of practices (77%) reported using written educational materials, and 42% offered prevention counseling with nonphysician staff. Very few offices (8%) reported using mail or telephone reminders for previously scheduled appointments. Despite the proven effectiveness of reminder systems for screening mammography, many practices do not have a system in place. Promotion of reminder systems in primary care practices could have a substantial impact on mammography utilization.

  1. Central nervous system compromise in primary Sjögren's syndrome.

    PubMed

    Anaya, Juan-Manuel; Villa, Luis A; Restrepo, Lucas; Molina, Jose F; Mantilla, Rubén D; Vargas, Sergio

    2002-08-01

    Central nervous system (CNS) involvement in primary Sjögren's syndrome (SS) is poorly understood, and its frequency as well as its manifestations are subjects of controversy. The current study was undertaken to determine the prevalence and the clinical and immunogenetic characteristics of CNS compromise in a well defined group of patients with primary SS. In this retrospective study, patients fulfilled the European classification criteria. Among 120 patients with primary SS, 3 (2.5%) had CNS compromise (multiple sclerosis-like illness, complicated migraine, and optic neuritis with epilepsy). The CNS involvement coincided with the onset of sicca symptoms in 1 case. All 3 patients carried the human leukocyte antigen (HLA) DQB1*0303 allele and tested positive for anti-Ro antibodies, but not for anti-cardiolipin antibodies. Although rare, CNS compromise in primary SS can be the presenting manifestation of the disease in a few cases, and may be severe and varied.

  2. [Differences and similarities of primary care in the German and Spanish health care systems].

    PubMed

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor

    2016-02-01

    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  3. Scaling for integral simulation of thermal-hydraulic phenomena in SBWR during LOCA

    SciTech Connect

    Ishii, M.; Revankar, S.T.; Dowlati, R

    1995-09-01

    A scaling study has been conducted for simulation of thermal-hydraulic phenomena in the Simplified Boiling Water Reactor (SBWR) during a loss of coolant accident. The scaling method consists of a three-level scaling approach. The integral system scaling (global scaling or top down approach) consists of two levels, the integral response function scaling which forms the first level, and the control volume and boundary flow scaling which forms the second level. The bottom up approach is carried out by local phenomena scaling which forms the third level scaling. Based on this scaling study the design of the model facility called Purdue University Multi-Dimensional Integral Test Assembly (PUMA) has been carried out. The PUMA facility has 1/4 height and 1/100 area ratio scaling, corresponding to the volume scaling of 1/400. The PUMA power scaling based on the integral scaling is 1/200. The present scaling method predicts that PUMA time scale will be one-half that of the SBWR. The system pressure for PUMA is full scale, therefore, a prototypic pressure is maintained. PUMA is designed to operate at and below 1.03 MPa (150 psi), which allows it to simulate the prototypic SBWR accident conditions below 1.03 MPa (150 psi). The facility includes models for all components of importance.

  4. Long-term survival with favorable cognitive outcome after chemotherapy in primary central nervous system lymphoma.

    PubMed

    Juergens, Annika; Pels, Hendrik; Rogowski, Sabine; Fliessbach, Klaus; Glasmacher, Axel; Engert, Andreas; Reiser, Marcel; Diehl, Volker; Vogt-Schaden, Marlies; Egerer, Gerlinde; Schackert, Gabriele; Reichmann, Heinz; Kroschinsky, Frank; Bode, Udo; Herrlinger, Ulrich; Linnebank, Michael; Deckert, Martina; Fimmers, Rolf; Schmidt-Wolf, Ingo G H; Schlegel, Uwe

    2010-02-01

    To evaluate long-term progression-free survival and overall survival, quality of life, and cognitive function in primary central nervous system lymphoma after systemic and intraventricular chemotherapy without radiotherapy. A long-term follow-up was conducted on surviving primary central nervous system lymphoma patients having been enrolled in a pilot/phase II trial between September 1995 and December 2001. Initially, 65 patients (median age, 62 years) had been treated with systemic and intraventricular chemotherapy without radiotherapy. All living patients were contacted, and a neurological examination, comprehensive neuropsychological testing, quality-of-life assessment, and imaging were performed. Twenty-one of all 65 patients (32 %) and 17 of 30 patients 60 years or younger (57%), respectively, were still alive at median follow-up of 100 months (range, 77-149 months). Nineteen of 21 patients completed all investigations; 1 was lost to follow-up. In three patients, an exclusively extraneural relapse of a high-grade non-Hodgkin's lymphoma was diagnosed after 9, 31, and 40 months, respectively. All of them experienced complete remission to high dose. Neither late neurotoxicity nor compromise of quality of life was found in any of the patients examined. Primary polychemotherapy based on high-dose methotrexate (MTX) and cytarabine (Ara-C) is highly efficient in treatment of primary central nervous system lymphoma. About half of patients 60 years or younger can obviously be cured with this regimen without long-term neurotoxic sequelae or quality-of-life compromise.

  5. A systems-based partnership learning model for strengthening primary healthcare

    PubMed Central

    2013-01-01

    Background Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems. Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research. Discussion IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM. Summary This paper draws together

  6. Vapor/Mist Used to Lubricate Gears After Loss of Primary Lubrication System

    NASA Technical Reports Server (NTRS)

    Handschuh, Robert F.; Morales, Wilfredo

    2001-01-01

    Loss of lubrication in rotorcraft drive systems is a demanding requirement placed on drive system manufacturers. The drive system must operate for at least 30 minutes once the primary lubrication system has failed. This test is a military requirement that must be passed prior to certification of the aircraft. As new aircraft engines, operating at higher speeds, are fielded, the requirements for the drive system become increasingly more difficult. Also, the drive system must be lightweight, which minimizes the opportunity to use the gear bodies to absorb the tremendous amount of heating that takes place. In many cases, the amount of heat generated because of the high speed and load requires an emergency lubrication system that negatively impacts the aircraft's weight, complexity, and cost. A single mesh spur gear test rig is being used at the NASA Glenn Research Center to investigate possible emergency lubrication system improvements that will minimize the impact of having these systems onboard rotorcraft. A technique currently being investigated uses a vapor/mist system to lubricate the contacting surfaces after the primary lubrication system has been shut down. A number of tests were conducted in which the vapor/mist used the same lubricant as the primary system, but at a greatly reduced flow rate. Each test was initiated with the primary lubrication system operational and at steady-state conditions for a given speed and load. Then the primary lubrication system was shut down, and the vapor/mist lubrication system was initiated. An example of the tests conducted is shown in the figures. These preliminary tests have uncovered a mechanism that provides a lubricious, carbonaceous solid on the surface that actually reduces the surface temperature of the meshing gear teeth during operation. Surface analysis of the carbonaceous solid revealed it was graphitic. This mechanism is the synthetic lubricant "coking" on the active profile of the gears, which reduces the

  7. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System.

    PubMed

    Dobmeyer, Anne C; Hunter, Christopher L; Corso, Meghan L; Nielsen, Matthew K; Corso, Kent A; Polizzi, Nicholas C; Earles, Jay E

    2016-09-01

    The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

  8. A continuous hyperspatial monitoring system of evapotranspiration and gross primary productivity from Unmanned Aerial Systems

    NASA Astrophysics Data System (ADS)

    Wang, Sheng; Bandini, Filippo; Jakobsen, Jakob; Zarco-Tejada, Pablo J.; Köppl, Christian Josef; Haugård Olesen, Daniel; Ibrom, Andreas; Bauer-Gottwein, Peter; Garcia, Monica

    2017-04-01

    Unmanned Aerial Systems (UAS) can collect optical and thermal hyperspatial (<1m) imagery with low cost and flexible revisit times regardless of cloudy conditions. The reflectance and radiometric temperature signatures of the land surface, closely linked with the vegetation structure and functioning, are already part of models to predict Evapotranspiration (ET) and Gross Primary Productivity (GPP) from satellites. However, there remain challenges for an operational monitoring using UAS compared to satellites: the payload capacity of most commercial UAS is less than 2 kg, but miniaturized sensors have low signal to noise ratios and small field of view requires mosaicking hundreds of images and accurate orthorectification. In addition, wind gusts and lower platform stability require appropriate geometric and radiometric corrections. Finally, modeling fluxes on days without images is still an issue for both satellite and UAS applications. This study focuses on designing an operational UAS-based monitoring system including payload design, sensor calibration, based on routine collection of optical and thermal images in a Danish willow field to perform a joint monitoring of ET and GPP dynamics over continuous time at daily time steps. The payload (<2 kg) consists of a multispectral camera (Tetra Mini-MCA6), a thermal infrared camera (FLIR Tau 2), a digital camera (Sony RX-100) used to retrieve accurate digital elevation models (DEMs) for multispectral and thermal image orthorectification, and a standard GNSS single frequency receiver (UBlox) or a real time kinematic double frequency system (Novatel Inc. flexpack6+OEM628). Geometric calibration of the digital and multispectral cameras was conducted to recover intrinsic camera parameters. After geometric calibration, accurate DEMs with vertical errors about 10cm could be retrieved. Radiometric calibration for the multispectral camera was conducted with an integrating sphere (Labsphere CSTM-USS-2000C) and the laboratory

  9. Primary healthcare in transition--a qualitative study of how managers perceived a system change.

    PubMed

    Maun, Andy; Nilsson, Kerstin; Furåker, Carina; Thorn, Jörgen

    2013-10-03

    Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for

  10. Primary healthcare in transition – a qualitative study of how managers perceived a system change

    PubMed Central

    2013-01-01

    Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager

  11. Building the foundation for health system transformation: Oregon's Patient-Centered Primary Care Home program.

    PubMed

    Rissi, Jill Jamison; Gelmon, Sherril; Saulino, Evan; Merrithew, Nicole; Baker, Robin; Hatcher, Paige

    2015-01-01

    Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregon's Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers. We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process. Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships. This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in

  12. Fission product release during a LOCA in VVER-440/213-type reactor

    SciTech Connect

    Sdouz, G. )

    1991-01-01

    In 1988, Austria initiated a research program to investigate the source term behavior of VVER-type reactors. Mainly, there are three design categories for VVER-type reactors. The first standardized 440-MW(electric) nuclear power plant was designated as VVER-440/MW(electric) nuclear power plant was designated as VVER-440/230. A somewhat more advanced model was designated as model V213. These reactors have six loops, isolation valves on each loop, horizontal steam generators, and hexagonal fuel assemblies. To prevent the release of fission products, the concept of local area compartmentalization is applied. The main difference between the two models is the existence of an emergency core cooling system (ECCS) and a bubbler-condenser tower in the newer model. In the 1970s, a 1000-MW(electric) reactor was designed and designated as VVER-1000. This unit has four loops housed in a containment-type structure with spray-type steam suppression. The Austrian program started with source term calculations for the VVEr-1000-type reactor. A TMLB{prime} and a S{sub 1}B accident sequence were calculated using the Source Term Code Package (STCP). In 1990, the source term analyses were extended to both models of the VVER-440-type reactors. In this paper, the results of the thermohydraulic part of the calculation for the VVER-440/213 reactor are presented.

  13. A new classification system for primary lymphatic dysplasias based on phenotype.

    PubMed

    Connell, F; Brice, G; Jeffery, S; Keeley, V; Mortimer, P; Mansour, S

    2010-05-01

    Traditional classification systems for lymphoedema are of limited use for the diagnosis of specific forms of primary lymphoedema. The understanding of primary lymphoedema has been impeded by confusing terminology and a tendency to simply divide patients into three categories based on the age of onset: lymphoedema congenita manifests at or shortly after birth, lymphoedema praecox is apparent before the age of 35 years and lymphoedema tarda manifests thereafter. The clinical presentation in the spectrum of primary lymphoedema disorders is very variable; the phenotypes of primary lymphoedema conditions vary in the age of onset, site of the oedema, inheritance patterns, associated features and genetic causes. Different inheritance patterns are recognised and there are numerous associated anomalies. Some subgroups, such as Milroy disease and Lymphoedema distichiasis, are well characterised, but others are not. A new clinical classification for primary lymphoedema has been developed as a diagnostic algorithm. Its use is demonstrated on 333 probands referred to our lymphoedema clinic. Grouping patients by accurate phenotyping facilitates molecular investigations, understanding of inheritance patterns, and the natural history of different types of primary lymphoedema. Descriptions of the diagnostic categories, some of which have not been previously clearly defined as distinct clinical entities, are illustrated by clinical cases.

  14. Release and systemic accumulation of heavy metals from preformed crowns used in restoration of primary teeth.

    PubMed

    Kodaira, Hiroe; Ohno, Kohachiro; Fukase, Naoko; Kuroda, Midori; Adachi, Shiki; Kikuchi, Motohiro; Asada, Yoshinobu

    2013-01-01

    Preformed crowns for restoration of primary teeth are used in various treatments and are essential for restoring the crowns of primary molars. However, there are concerns that mechanical, chemical, and thermal stimulation may cause release of components of such crowns. We examined systemic accumulation of heavy metals associated with preformed crowns (3M Stainless Steel Primary Molar Crowns) used in primary tooth restoration. The participants were 37 children who had visited the Pediatric Dental Clinic of Tsurumi University Dental Hospital. They were divided into two groups: 22 participants without a history of being fitted with a preformed crown for primary tooth restoration (controls), and 15 participants with preformed crowns for primary tooth restoration. Analysis of hair samples showed a significant difference in the level of the trace element Cr - an important component of the preformed crowns - between children with and without preformed crowns, but no significant differences in Fe or Ni levels. Levels of the trace elements Ni, Cr, and Fe were within allowable ranges, indicating that these minerals were not likely to be harmful.

  15. Mammaglobin-A Immunohistochemistry in Primary Central Nervous System Neoplasms and Intracranial Metastatic Breast Carcinoma

    PubMed Central

    Cimino, Patrick J.; Perrin, Richard J.

    2014-01-01

    Metastases represent the most common type of intracranial neoplasm. In women, 30% of such tumors derive from breast carcinoma. In neurosurgical cases with ambiguous cellular morphology and/or limited biopsy material, immunohistochemistry (IHC) is often performed to distinguish metastases from primary central nervous system (CNS) neoplasms. IHC for mammaglobin-A (MGA), a protein expressed in a majority of breast carcinomas, is commonly applied in this setting, but its utility for distinguishing primary CNS neoplasms from metastatic breast carcinoma is unknown; the reactivity of MGA in primary and metastatic CNS neoplasms has never been described. Here, we describe the frequency and patterns of IHC reactivity for MGA in metastatic and primary CNS neoplasms from patients with well-documented histories of breast carcinoma. Following a published protocol previously applied to non-CNS neoplasms, MGA staining of moderate to strong intensity within 5% or more of a neoplasm was considered positive. Based on these criteria, 3 of 12 (25.0%) glioblastomas, 1 of 10 (10.0%) meningiomas, and 47 of 95 (49.5%) metastases were positive. Importantly, the cytoarchitectural staining characteristics among all four MGA positive primary CNS neoplasms (cytoplasmic and nuclear) differed from those of the metastases (cytoplasmic and membranous). These findings suggest that MGA IHC staining intensity and distribution can distinguish metastases from primary CNS neoplasms (**P=0.0086) in women with a history of breast carcinoma but also indicate that cytological staining patterns must be interpreted for more accurate tumor classification. PMID:23958549

  16. Mammaglobin-A immunohistochemistry in primary central nervous system neoplasms and intracranial metastatic breast carcinoma.

    PubMed

    Cimino, Patrick J; Perrin, Richard J

    2014-07-01

    Metastases represent the most common type of intracranial neoplasm. In women, 30% of such tumors derive from breast carcinoma. In neurosurgical cases with ambiguous cellular morphology and/or limited biopsy material, immunohistochemistry (IHC) is often performed to distinguish metastases from primary central nervous system (CNS) neoplasms. IHC for mammaglobin-A (MGA), a protein expressed in a majority of breast carcinomas, is commonly applied in this setting, but its utility for distinguishing primary CNS neoplasms from metastatic breast carcinoma is unknown; the reactivity of MGA in primary and metastatic CNS neoplasms has never been described. Here, we describe the frequency and patterns of IHC reactivity for MGA in metastatic and primary CNS neoplasms from patients with well-documented histories of breast carcinoma. Following a published protocol previously applied to non-CNS neoplasms, MGA staining of moderate to strong intensity within 5% or more of a neoplasm was considered positive. On the basis of these criteria, 3 of 12 (25.0%) glioblastomas, 1 of 10 (10.0%) meningiomas, and 47 of 95 (49.5%) metastases were positive. Importantly, the cytoarchitectural staining characteristics among all 4 MGA-positive primary CNS neoplasms (cytoplasmic and nuclear) differed from those of the metastases (cytoplasmic and membranous). These findings suggest that MGA IHC staining intensity and distribution can distinguish metastases from primary CNS neoplasms (P=0.0086) in women with a history of breast carcinoma but also indicate that cytologic staining patterns must be interpreted for more accurate tumor classification.

  17. Office Systems and Their Influence on Mammography Use in Rural and Urban Primary Care

    ERIC Educational Resources Information Center

    Engelman, Kimberly K.; Ellerbeck, Edward F.; Perpich, Denise; Nazir, Niaman; McCarter, Kevin; Ahluwalia, Jasjit S.

    2004-01-01

    Breast cancer screening rates are lower in rural communities. Although studies have addressed barriers to mammography for rural residents, physician practice barriers have received less attention. Purpose: Controlled clinical trials have shown that the use of office reminder systems in primary care practices is related to increased clinical care…

  18. Space shuttle/food system study. Volume 2, Appendix F: Flight food and primary packaging

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The analysis and selection of food items and primary packaging, the development of menus, the nutritional analysis of diet, and the analyses of alternate food mixes and contingency foods is reported in terms of the overall food system design for space shuttle flight. Stowage weights and cubic volumes associated with each alternate mix were also evaluated.

  19. Using a Learning Management System to Personalise Learning for Primary School Students

    ERIC Educational Resources Information Center

    Edmunds, Bronwyn; Hartnett, Maggie

    2014-01-01

    This paper reports on one aspect of a descriptive multiple-case study which set out to explore the role of a learning management system (LMS) in personalising learning for students from the perspective of three teachers in one primary school in New Zealand. The intention was to provide insight into the role the LMS could play in classrooms when…

  20. Investigating Nigerian Primary School Teachers' Preparedness to Adopt Personal Response System in ESL Classroom

    ERIC Educational Resources Information Center

    Agbatogun, Alaba Olaoluwakotansibe

    2012-01-01

    This study investigated the extent to which computer literacy dimensions (computer general knowledge, documents and documentations, communication and surfing as well as data inquiry), computer use and academic qualification as independent variables predicted primary school teachers' attitude towards the integration of Personal Response System in…

  1. Assessment of Primary Representational Systems with Neurolinguistic Programming: Examination of Preliminary Literature.

    ERIC Educational Resources Information Center

    Dorn, Fred J.; And Others

    1983-01-01

    Reviews the inconsistent findings of studies on neurolinguistic programing and recommends some areas that should be examined to verify various claims. Discusses methods of assessing client's primary representational systems, including predicate usage and eye movements, and suggests that more reliable methods of assessing PRS must be found. (JAC)

  2. Assessing Primary Representational System (PRS) Preference for Neurolinguistic Programming (NLP) Using Three Methods.

    ERIC Educational Resources Information Center

    Dorn, Fred J.

    1983-01-01

    Considered three methods of identifying Primary Representational System (PRS)--an interview, a word list, and a self-report--in a study of 120 college students. Results suggested the three methods offer little to counselors either collectively or individually. Results did not validate the PRS construct, suggesting the need for further research.…

  3. Development of Quality Assurance System in Culture and Nation Character Education in Primary Education in Indonesia

    ERIC Educational Resources Information Center

    Susilana, Rudi; Asra

    2013-01-01

    The purpose of national education is to develop skills and build dignified national character and civilization in educating nation life (Act No. 20, 2003). The paper describes a system of quality assurance in culture and character education in primary education. This study employs the six sigma model which consists of the formula DMAIC (Define,…

  4. Office Systems and Their Influence on Mammography Use in Rural and Urban Primary Care

    ERIC Educational Resources Information Center

    Engelman, Kimberly K.; Ellerbeck, Edward F.; Perpich, Denise; Nazir, Niaman; McCarter, Kevin; Ahluwalia, Jasjit S.

    2004-01-01

    Breast cancer screening rates are lower in rural communities. Although studies have addressed barriers to mammography for rural residents, physician practice barriers have received less attention. Purpose: Controlled clinical trials have shown that the use of office reminder systems in primary care practices is related to increased clinical care…

  5. Job Realities of Primary School Principals in Greece: Similarities and Variations in a Highly Centralized System

    ERIC Educational Resources Information Center

    Dimopoulos, Kostas; Dalkavouki, Katerina; Koulaidis, Vasilis

    2015-01-01

    This study aims at investigating primary school principals' work on a daily basis in order to understand the ways in which the centralized educational system affects their practices. Four typical cases of principals were selected and asked to keep daily records for a period of four months. Data from logs were complemented with data collected…

  6. Job Realities of Primary School Principals in Greece: Similarities and Variations in a Highly Centralized System

    ERIC Educational Resources Information Center

    Dimopoulos, Kostas; Dalkavouki, Katerina; Koulaidis, Vasilis

    2015-01-01

    This study aims at investigating primary school principals' work on a daily basis in order to understand the ways in which the centralized educational system affects their practices. Four typical cases of principals were selected and asked to keep daily records for a period of four months. Data from logs were complemented with data collected…

  7. Assessing Primary Representational System (PRS) Preference for Neurolinguistic Programming (NLP) Using Three Methods.

    ERIC Educational Resources Information Center

    Dorn, Fred J.

    1983-01-01

    Considered three methods of identifying Primary Representational System (PRS)--an interview, a word list, and a self-report--in a study of 120 college students. Results suggested the three methods offer little to counselors either collectively or individually. Results did not validate the PRS construct, suggesting the need for further research.…

  8. Assessment of Primary Representational Systems with Neurolinguistic Programming: Examination of Preliminary Literature.

    ERIC Educational Resources Information Center

    Dorn, Fred J.; And Others

    1983-01-01

    Reviews the inconsistent findings of studies on neurolinguistic programing and recommends some areas that should be examined to verify various claims. Discusses methods of assessing client's primary representational systems, including predicate usage and eye movements, and suggests that more reliable methods of assessing PRS must be found. (JAC)

  9. Post-transplantation primary central nervous system lymphoma in a patient with systemic lupus erythematosus and prolonged use of immunosuppressant.

    PubMed

    Tse, Teresa P K; Chan, Allan N L; Chan, Tony K T; Po, Y C

    2014-12-01

    Post-transplantation primary central nervous system lymphoma is an uncommon and fatal post-transplant lymphoproliferative disorder. Such lymphomas have been described in only a few case series in the literature. The incidence of this condition is rising with improved survival after organ transplantation. A case of post-transplantation primary central nervous system lymphoma in a young Chinese woman with systemic lupus erythematosus is described here. She presented with right-sided weakness and memory loss after tooth extraction 2 weeks before admission. Contrast computed tomography of the brain demonstrated a contrast rim-enhancing lesion over the left frontal lobe. With a history of recent dental procedure, long-term immunosuppressive therapy and computed tomography findings, cerebral abscess was highly suspected. Emergency operation was performed. Histopathology showed post-transplantation primary central nervous system lymphoma, with cells positive for B-cell marker CD20. Immunosuppressant was stopped and she was treated with radiotherapy and rituximab (anti-CD20 monoclonal antibody). She remained disease-free at 16 months. Post-transplantation primary central nervous system lymphoma is rare with variable presentation and radiological features. We believe rituximab may have a role in the treatment of such lymphomas.

  10. Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

    PubMed Central

    Welton, William E.; Kantner, Theodore A.; Katz, Sheila Moriber

    1997-01-01

    As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health. PMID:9184684

  11. Investigating Power System Primary and Secondary Reserve Interaction under High Wind Power Penetration

    SciTech Connect

    Zhang, Yingchen; Tan, Jin; Krad, Ibrahim; Yang, Rui; Gevorgian, Vahan; Ela, Erik

    2016-12-01

    Power system frequency needs to be maintained close to its nominal value at all times to successfully balance load and generation and maintain system reliability. Adequate primary frequency response and secondary frequency response are the primary forces to correct an energy imbalance at the second-to-minute level. As wind energy becomes a larger portion of the world's energy portfolio, there is an increased need for wind to provide frequency response. This paper addresses one of the major concerns about using wind for frequency regulation: the unknown factor of the interaction between primary and secondary reserves. The lack of a commercially available tool to model this has limited the energy industry's understanding of when the depletion of primary reserves will impact the performance of secondary response or vice versa. This paper investigates the issue by developing a multi-area frequency response integration tool with combined primary and secondary capabilities. The simulation is conducted in close coordination with economical energy scheduling scenarios to ensure credible simulation results.

  12. Classification of lymphatic-system malformations in primary lymphoedema based on MR lymphangiography.

    PubMed

    Liu, N F; Yan, Z X; Wu, X F

    2012-09-01

    The study aims to investigate lymphatic-system malformations and proposes a classification of primary lymphoedema based on comprehensive imaging data of both lymph vessel- and lymph-node abnormalities. A total of 378 patients with primary lymphoedema of the lower extremity were examined with magnetic resonance lymphangiography (MRL) using gadobenate dimeglumine as contrast agent. Lymph vessels and drainage lymph nodes were evaluated, leading to the proposal of the classification of primary lymphoedema and the relative proportions. A total of 63 (17%) patients exhibited defects of the inguinal lymph nodes with mild or moderate dilatation of afferent lymph vessels. A total of 123 (32%) patients exhibited lymphatic anomalies as lymphatic aplasia, hypoplasia or hyperplasia with no obvious defect of the drainage lymph nodes. The involvement of both lymph vessel- and lymph-node abnormalities in the affected limb was found in 192 (51%) patients. The primary lymphoedema was classified as three major types as: (1) lymph nodes affected only; (2) lymph vessel affected only with three subtypes and (3) both lymph vessel and lymph node affected with subgroups. A comprehensive classification of lymphatic-system malformation in primary lymphoedema is proposed, which clearly defines the location and pathologic characteristics of both lymphatics and lymph node and may lead to further study of the aetiology as well as rational treatment of the disease. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  13. A safety incident reporting system for primary care. A systematic literature review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

    PubMed Central

    Klemp, Kerstin; Zwart, Dorien; Hansen, Jørgen; Hellebek, Torben; Luettel, Dagmar; Verstappen, Wim; Beyer, Martin; Gerlach, Ferdin M.; Hoffmann, Barbara; Esmail, Aneez

    2015-01-01

    Background: Incident reporting is widely used in both patient safety improvement programmes, and in research on patient safety. Objective: To identify the key requirements for incident reporting systems in primary care; to develop an Internet-based incident reporting and learning system for primary care. Methods: A literature review looking at the purpose, design and requirements of an incident reporting system (IRS) was used to update an existing incident reporting system, widely used in Germany. Then, an international expert panel with knowledge on IRS developed the criteria for the design of a new web-based incident reporting system for European primary care. A small demonstration project was used to create a web-based reporting system, to be made freely available for practitioners and researchers. The expert group compiled recommendations regarding the desirable features of an incident reporting system for European primary care. These features covered the purpose of reporting, who should be involved in reporting, the mode of reporting, design considerations, feedback mechanisms and preconditions necessary for the implementation of an IRS. Results: A freely available web-based reporting form was developed, based on these criteria. It can be modified for local contexts. Practitioners and researchers can use this system as a means of recording patient safety incidents in their locality and use it as a basis for learning from errors. Conclusion: The LINNEAUS collaboration has provided a freely available incident reporting system that can be modified for a local context and used throughout Europe. PMID:26339835

  14. Patient-centered primary health care: synergy potential for health systems strengthening.

    PubMed

    Stender, S C; Christensen, A

    2013-10-01

    The ultimate goal of government health systems is to provide highly effective equitable services that save lives and reduce morbidity and mortality. The pressure to conform to duplicative global and donor initiatives compounds existing challenges to health systems strengthening such as shortages of human resources for health, weak supply chains, inadequate laboratory services and parallel data management systems. This article illustrates how primary health care, as the point of entry into the health care system for the majority of individuals in sub-Saharan Africa, should be strengthened to ensure that individuals and their communities receive essential, holistic care.

  15. Structural and contextual dimensions of Iranian primary health care system at local level.

    PubMed

    Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

    2015-01-01

    In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions. Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

  16. Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

    PubMed Central

    Zanganeh Baygi, Mehdi; Seyedin, Hesam; Salehi, Masoud; Jafari Sirizi, Mehdi

    2014-01-01

    Background: In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago. Objectives: This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests. Results: Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions. Conclusions: Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system. PMID:25763257

  17. Development of a handheld computer documentation system to enhance an integrated primary care clerkship.

    PubMed

    Pipas, Catherine F; Carney, Patricia A; Eliassen, M Scottie; Mengshol, Sarah C; Fall, Leslie H; Olson, Ardis L; Schifferdecker, Karen E; Russell, Margaret T; Peltier, Deborah A; Nierenberg, David W

    2002-07-01

    Documentation systems are used by medical schools and residency programs to record the clinical experiences of their learners. The authors developed a system for their school's (Dartmouth's) multidisciplinary primary care clerkship (family medicine, internal medicine, pediatrics) that documents students' clinical and educational experiences and provides feedback designed to enhance clinical training utilizing a timely data-reporting system. The five critical components of the system are (1) a valid, reliable and feasible data-collection instrument; (2) orientation of and ongoing support for student and faculty users; (3) generation and distribution of timely feedback reports to students, preceptors, and clerkship directors; (4) adequate financial and technical support; and (5) a database design that allows for overall evaluation of educational outcomes. The system, whose development began in 1997, generated and distributed approximately 150 peer-comparison reports of clinical teaching experiences to students, preceptors, and course directors during 2001, in formats that are easy to interpret and use to individualize learning. The authors present report formats and annual cost estimate comparisons of paper- and computer-based system development and maintenance, which range from $35,935 to $53,780 for the paper-based system and from $46,820 to $109,308 for the computer-based system. They mention ongoing challenges in components of the system. They conclude that a comprehensive documentation and feedback system provides an essential infrastructure for the evaluation and enhancement of community-based teaching and learning in primary care ambulatory clerkships, whether separate or integrated.

  18. [The primary research and development of software oversampling mapping system for electrocardiogram].

    PubMed

    Zhou, Yu; Ren, Jie

    2011-04-01

    We put forward a new concept of software oversampling mapping system for electrocardiogram (ECG) to assist the research of the ECG inverse problem to improve the generality of mapping system and the quality of mapping signals. We then developed a conceptual system based on the traditional ECG detecting circuit, Labview and DAQ card produced by National Instruments, and at the same time combined the newly-developed oversampling method into the system. The results indicated that the system could map ECG signals accurately and the quality of the signals was good. The improvement of hardware and enhancement of software made the system suitable for mapping in different situations. So the primary development of the software for oversampling mapping system was successful and further research and development can make the system a powerful tool for researching ECG inverse problem.

  19. Micro-tensile bond strength of adhesive systems applied on occlusal primary enamel.

    PubMed

    Ramires-Romito, Ana Cláudia; Reis, Alessandra; Loguercio, Alessandro Dourado; de Góes, Mario Fernando; Grande, Rosa Helena Miranda

    2004-01-01

    The aim of this study was to evaluate the micro-tensile bond strength of adhesive systems (OptiBond Solo, Kerr; Prime & Bond NT, Dentsply) on occlusal surface of primary molars. The adhesives were tested under manufacturers' specifications and after contamination of the bonding site with saliva. Hourglass cylindrical-shaped samples were obtained and subjected to a tensile force. No significant difference was observed among the groups. OptiBond Solo and Prime & Bond NT showed similar values of bond strengths when applied on occlusal enamel of primary molar under either saliva contamination or not.

  20. Primary lymphomas of the central nervous system: patterns of failure and factors that influence survival

    SciTech Connect

    Loeffler, J.S.; Ervin, T.J.; Mauch, P.; Skarin, A.; Weinstein, H.J.; Canellos, G.; Cassady, J.R.

    1985-04-01

    Primary lymphomas of the CNS are rare tumors accounting for less than 2% of all extranodal non-Hodgkin's lymphomas. The treatment for this disease has been disappointing. Radiation therapy and surgery have produced consistently poor control of this disease, with a median survival of 15 months. A review of ten cases of primary lymphoma of the CNS treated at the Joint Center for Radiation Therapy or Dana-Farber Cancer Institute (Boston) from 1968 to 1981 is presented. All patients had biopsy- proven CNS lymphomas without systemic disease at presentation. In this series, control of CNS lymphoma was seen only in patients receiving craniospinal radiation or CNS-penetrating chemotherapy.

  1. Concomitant diagnosis of primary Sjögren's syndrome and systemic AL amyloidosis.

    PubMed

    Delèvaux, I; André, M; Amoura, Z; Kémény, J L; Piette, J C; Aumaître, O

    2001-07-01

    A 48 year old woman was referred to hospital for buccal discomfort. Physical examination showed a macroglossia and features of xerostomia. She was diagnosed as having primary Sjögren's syndrome according to the criteria proposed by the European Community study group in 1993. Furthermore, a lower lip salivary gland biopsy showed amyloid deposits that were also seen in the stomach and in the bone marrow. Echocardiography was consistent with cardiac amyloidosis. Serum immunofixation identified a monoclonal IgGlambda. As far as is known, this is the first report of systemic primary amyloidosis associated with Sjögren's syndrome. The relation between these two disorders is discussed.

  2. Health system factors affecting communication with pediatricians: gendered work culture in primary care.

    PubMed

    Lynch, Sean

    2011-01-01

    This qualitative study examined the roles that practice setting, education level, and gender may play in social workers' communication satisfaction with pediatricians. Taking an ethnographic approach, the researcher interviewed social workers and pediatricians who worked together to provide mental health services in primary care. The results suggested that gender at the health system level may be an issue and that gendered work culture in primary care was a factor in communication. In particular, reimbursement, an aspect of the gendered work culture, was a substantial communication barrier, and the implications for Medicaid billing are discussed.

  3. Microleakage of adhesive resin systems in the primary and permanent dentitions.

    PubMed

    Schmitt, Donald C; Lee, Jacob

    2002-01-01

    The purpose of this study was to compare the in vitro microleakage of fourth-generation filled and unfilled adhesive resin systems with fifth-generation filled and unfilled adhesive resin systems in both primary and permanent teeth. Eighty extracted or exfoliated human noncarious teeth (40 primary and 40 permanent) were assigned to each of 8 groups. Groups 1, 3, 5 and 7 were primary teeth, and groups 2, 4, 6 and 8 contained permanent teeth. Groups 1 and 2 were bonded with Optibond Fl (Kerr), groups 3 and 4 with Scotchbond Multipurpose (3M), groups 5 and 6 with Optibond Solo Plus (Kerr) and groups 7 and 8 with Single Bond (3M). All teeth received a Class V cavity preparation, and the cavosurface margins were placed entirely in enamel. They were then restored with TPH Spectrum Shade Al (Dentsply Caulk). All teeth were thermocycled, stained with basic fuchsin, sectioned and viewed under the microscope. Measurements were recorded in absolute millimeters and relative grades as judged by 2 evaluators. No significant difference in microleakage was observed between fourth- and fifth-generation adhesive resin systems, whether filled or unfilled, or applied on primary or permanent teeth. Significant differences were found in the amount of microleakage at the gingival and occlusal surfaces in all groups. One-bottle, fifth-generation adhesive resin systems permit easier application with the same effectives as the 2-bottle, fourth-generation systems. One-bottle, fifth-generation adhesive resin systems permit easier application with the same effectiveness as the 2-bottle, fourth-gerenration systems.

  4. Comparing the Asthma APGAR system and the Asthma Control Test™ in a multicenter primary care sample.

    PubMed

    Rank, Matthew A; Bertram, Susan; Wollan, Peter; Yawn, Roy A; Yawn, Barbara P

    2014-07-01

    To compare asthma control assessment using the Asthma APGAR system, a tool developed by primary care clinicians, in a multicenter primary care sample with the Asthma Control Test (ACT™)/Childhood Asthma Control Test (CACT™), a tool developed by asthma specialists. This is a substudy of a multicenter, randomized, controlled pragmatic trial that tests the effectiveness of the Asthma APGAR system in primary care practices. As part of the study, enrolled patients completed both the ACT™/CACT™ and the Asthma APGAR system between March 1, 2011, and December 31, 2011. Kappa and McNemar statistics were used to compare the results of questionnaires. Of the 468 patients in our sample, 306 (65%) were classified as not controlled by the ACT™/CACT™ or the Asthma APGAR system. The overall agreement was 84.4%, with a kappa value of .68 (substantial agreement) and a McNemar test P value of .35 (suggesting no significant difference in the direction of disagreement). Of those with poor control as defined by the Asthma APGAR system, 23.8% (73) had no controller medications and 76.5% (234) were seldom or sometimes able to avoid identified triggers for their asthma. Of those who stated that they had been prescribed controller medications, 116 of 332 (35%) stated that they did not use the controller medication on a daily basis. The Asthma APGAR system and the ACT™/CACT™ similarly assess asthma control in a multicenter primary care-based sample. The Asthma APGAR system identified an "actionable item" in more than 75% (234) of the individuals with poor asthma control, thus linking an assessment of poor asthma control with a management strategy. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  5. System factors affect the recognition and management of posttraumatic stress disorder by primary care clinicians.

    PubMed

    Meredith, Lisa S; Eisenman, David P; Green, Bonnie L; Basurto-Dávila, Ricardo; Cassells, Andrea; Tobin, Jonathan

    2009-06-01

    Posttraumatic stress disorder (PTSD) is common with an estimated prevalence of 8% in the general population and up to 17% in primary care patients. Yet, little is known about what determines primary care clinician's (PCC's) provision of PTSD care. To describe PCC's reported recognition and management of PTSD and identify how system factors affect the likelihood of performing clinical actions with regard to patients with PTSD or "PTSD treatment proclivity." Linked cross-sectional surveys of medical directors and PCCs. Forty-six medical directors and 154 PCCs in community health centers (CHCs) within a practice-based research network in New York and New Jersey. Two system factors (degree of integration between primary care and mental health services, and existence of linkages with other community, social, and legal services) as reported by medical directors, and PCC reports of self-confidence, perceived barriers, and PTSD treatment proclivity. Surveys from 47 (of 58) medical directors (81% response rate) and 154 PCCs (86% response rate). PCCs from CHCs with better mental health integration reported greater confidence, fewer barriers, and higher PTSD treatment proclivity (all P < 0.05). The PCCs in CHCs with better community linkages reported greater confidence, fewer barriers, higher PTSD treatment proclivity, and lower proclivity to refer patients to mental health specialists or to use a "watch and wait" approach (all P < 0.05). System factors play an important role in PCC PTSD management. Interventions are needed that restructure primary care practices by making mental health services more integrated and community linkages stronger.

  6. A PCA3 gene-based transcriptional amplification system targeting primary prostate cancer.

    PubMed

    Neveu, Bertrand; Jain, Pallavi; Têtu, Bernard; Wu, Lily; Fradet, Yves; Pouliot, Frédéric

    2016-01-12

    Targeting specifically primary prostate cancer (PCa) cells for immune therapy, gene therapy or molecular imaging is of high importance. The PCA3 long non-coding RNA is a unique PCa biomarker and oncogene that has been widely studied. This gene has been mainly exploited as an accurate diagnostic urine biomarker for PCa detection. In this study, the PCA3 promoter was introduced into a new transcriptional amplification system named the 3-Step Transcriptional Amplification System (PCA3-3STA) and cloned into type 5 adenovirus. PCA3-3STA activity was highly specific for PCa cells, ranging between 98.7- and 108.0-fold higher than that for benign primary prostate epithelial or non-PCa cells, respectively. In human PCa xenografts, PCA3-3STA displayed robust bioluminescent signals at levels that are sufficient to translate to positron emission tomography (PET)-based reporter imaging. Remarkably, when freshly isolated benign or cancerous prostate biopsies were infected with PCA3-3STA, the optical signal produced from primary PCa biopsies was significantly higher than from benign prostate biopsies (4.4-fold, p < 0.0001). PCA3-3STA therefore represents a PCa-specific expression system with the potential to target, with high accuracy, primary or metastatic PCa epithelial cells for imaging, vaccines, or gene therapy.

  7. Perceived role of primary care physicians in Nova Scotia's reformed health care system. Qualitative study.

    PubMed Central

    Sangster, L. M.; McGuire, D. P.

    1999-01-01

    OBJECTIVE: To determine primary care physicians' perceptions of their role in a reformed health system. DESIGN: Qualitative study using in-depth interviews. SETTING: Province of Nova Scotia. PARTICIPANTS: Purposefully selected sample of 14 practising primary care physicians. MAIN OUTCOME FINDINGS: Participants identified seven aspects of their role: primarily, diagnosis and treatment of patient's medical problems; then coordination, counseling, education, advocacy, disease prevention, and gatekeeping. The range of activities and degree of responsibility assumed by participants, however, varied. Factors affecting role perception fell into three categories: philosophical view of health and medicine, willingness to collaborate, and practical realities. Participants differed in their understanding of primary health care and their overall vision of the health system. Remuneration policies and concerns about sharing accountability were factors preventing an integrated, collaborative approach to care. Personal, patient, and structural realities also limited physicians' roles. CONCLUSIONS: This sample of primary care physicians had diverse perceptions of their role. Results of this study could provide information for identifying issues that need to be addressed to facilitate changes taking place in the health care system. PMID:10889862

  8. The optical metrology system for cryogenic testing of the JWST primary mirror segments

    NASA Astrophysics Data System (ADS)

    Hadaway, James B.; Chaney, David M.; Carey, Larkin B.

    2011-09-01

    The James Webb Space Telescope (JWST) primary mirror is 6.6 m in diameter and consists of 18 hexagonal mirror segments each approximately 1.5 m point-to-point. Each primary mirror segment assembly (PMSA) is constructed from a lightweight beryllium substrate with both a radius-of-curvature actuation system and a six degree-of-freedom hexapod actuation system. With the JWST being a near to mid-infrared observatory, the nominal operational temperature of a PMSA is 45 K. Each PMSA must be optically tested at 45 K twice, first to measure the change in the surface figure & radius-of-curvature between ambient & cryogenic temperatures and then to verify performance at cryo following final polishing. This testing is conducted at Marshall Space Flight Center's (MSFC's) X-Ray & Cryogenic Facility (XRCF). The chamber & metrology system can accommodate up to six PMSAs per cryo test. This paper will describe the optical metrology system used during PMSA cryogenic testing. This system evolved from systems used during the JWST mirror technology development program. The main components include a high-speed interferometer, a computer-generated holographic null, an absolute distance meter, a tiltable window, and an imaging system for alignment. The optical metrology system is used to measure surface figure error, radius-of-curvature, conic constant, prescription alignment, clear aperture, and the range & resolution of the PMSA actuation systems.

  9. Payment systems and incentives in primary care: implications of recent reforms in Estonia and Romania.

    PubMed

    Dan, Sorin; Savi, Riin

    2015-01-01

    Since the early 1990s, major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than 20 years after, reform in healthcare still draws much interest from policy makers and academics alike. One of the dynamic components of reform has been the reform of payment systems in primary care. This article looks at recent developments in payment systems and financial incentives in Estonia and Romania. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is no easy solution for healthcare policy makers who need to carefully weigh in the advantages and inherent problems of various payment arrangements. In a transitional, rapidly changing healthcare system and society, and a context of financial stringency, the theoretical effects of payment mechanisms may be more difficult to predict and manage than it is expected.

  10. Randomized Clinical Trial of Composite Restorations in Primary Teeth: Effect of Adhesive System after Three Years

    PubMed Central

    Donmez, Secil Bektaş; Uysal, Serdar; Ozdemir, Pinar; Tekcicek, Meryem; Zimmerli, Brigitte; Lussi, Adrian

    2016-01-01

    The purpose of this study was to assess the clinical performance of composite restorations placed with different adhesive systems in primary teeth. In 32 patients, 128 composite restorations were placed using a split-mouth design as follows (4 groups/patient): three-step etch-and-rinse (Group 1), two-step etch-and-rinse (Group 2), two-step self-etch (Group 3), and one-step self-etch (Group 4). The restorations were clinically evaluated at baseline and at 6, 18, and 36 months according to the FDI criteria. There was no significant difference between the adhesive systems in retention of the restorations (p > 0.05). Over time, there was a statistically significant decrease in marginal adaptation in all groups, whereas surface and marginal staining significantly increased in Groups 3 and 4 (p < 0.05). The etch-and-rinse adhesive systems resulted in better marginal adaptation than the self-etch adhesive systems (p < 0.05). It was concluded that preetching of the primary enamel might help improve the clinical performance of the self-etch adhesive systems in primary teeth. PMID:27833917

  11. Implementing a gatekeeper system to strengthen primary care in Egypt: pilot study.

    PubMed

    Ward, T R

    2010-06-01

    Overuse of hospital outpatient clinics in Egypt, due to lack of an effective gatekeeper system, has threatened the sustainability of improved primary care services. In this pilot project in Menoufia in the Nile delta region, the price of direct hospital outpatient visits was increased, encouraging patients to attend primary care clinics first. As a result, direct hospital outpatient utilization decreased by 63% in the project area compared with a 4% increase in a control district. The majority of this reduction was accounted for by patients attending either public primary care clinics or private clinics. Increasing the price of direct hospital outpatient visits was an effective way to establish a gatekeeper role for family health clinics.

  12. Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System.

    PubMed

    Godoy, Leandra; Long, Melissa; Marschall, Donna; Hodgkinson, Stacy; Bokor, Brooke; Rhodes, Hope; Crumpton, Howard; Weissman, Mark; Beers, Lee

    2017-09-19

    Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.

  13. Equity in primary health care delivery: an examination of the cohesiveness of strategies relating to the primary healthcare system, the health workforce and hepatitis C.

    PubMed

    Scarborough, Jane; Eliott, Jaklin; Miller, Emma; Aylward, Paul

    2015-04-01

    To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.

  14. Advising potential recipients on the use of organs from donors with primary central nervous system tumors.

    PubMed

    Warrens, Anthony N; Birch, Rhiannon; Collett, David; Daraktchiev, Maren; Dark, John H; Galea, George; Gronow, Katie; Neuberger, James; Hilton, David; Whittle, Ian R; Watson, Christopher J E

    2012-02-27

    Deciding to use an organ from a donor with a primary central nervous system (CNS) tumor necessitates offsetting the risk of tumor transmission with the chances of survival if the patient waits for another offer of a transplant. Published data vary in the quoted risk of tumor transmission. We used data obtained by reviewing 246 UK recipients of organs taken from donors with CNS tumors and found no evidence of a difference in overall patient mortality for recipients of a kidney, liver, or cardiothoracic organ, compared with recipients of organs from donors without a CNS tumor. Recent publication of the UK experience of transplanting organs from CNS tumor donors found no transmission in 448 recipients of organs from 177 donors with a primary CNS tumor (Watson et al., Am J Transplant 2010; 10: 1437). This 0% transmission rate is associated with an upper 95% confidence interval limit of 1.5%. Using a series of assumptions of risk, we compared the risks of dying as a result of the transmission of a primary brain tumor with the risks of dying if not transplanted. On this basis, the use of kidneys from a donor with a primary CNS tumor provides a further 8 years of life over someone who waited for a donor who did not have a primary CNS tumor, in addition to the life years gained by the transplant itself. The benefits for the recipients of livers and cardiothoracic organs were less, but there was no disadvantage in the impact on life expectancy.

  15. Investigating Power System Primary and Secondary Reserve Interaction under High Wind Penetration Using Frequency Response Model

    SciTech Connect

    Tan, Jin; Zhang, Yingchen; Krad, Ibrahim; Gevorgian, Vahan; Ela, Erik

    2015-10-12

    Power system frequency needs to be maintained close to its nominal value at all times to avoid machine damage, under-frequency load-shedding and even blackouts. Adequate primary frequency response and secondary frequency response are the primary forces to correct an energy imbalance at the second to minute level. As wind energy becomes a larger portion of the world's energy portfolio, there are greater oppotunities for wind to provide frequency response services. This paper addresses one area of frequency control that has been missing in previous work - the reliabilty impacts and interactions between primary and secondary frequency control. The lack of a commercially available tools to simulate the interaction of these two responses has limited the energy industry's understanding of when the depletion of primary control reserve will impact the performance of secondary conrol response or vice versa. To investigate this issue, in this paper we develop a multi-area frequency response integration model with combined primary and secondary frequency control capabilities.

  16. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    PubMed Central

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

  17. Primary production and sinking export during fall in the Hudson Bay system, Canada

    NASA Astrophysics Data System (ADS)

    Lapoussière, Amandine; Michel, Christine; Gosselin, Michel; Poulin, Michel; Martin, Johannie; Tremblay, Jean-Éric

    2013-01-01

    Primary production and organic material sinking export were investigated in the Hudson Bay system (i.e., Hudson Bay, Hudson Strait and Foxe Basin) under ice-free conditions during early fall 2005, using the 14C-uptake method and short-term free-drifting particle interceptor traps deployed below the euphotic zone at 50 m. Principal component analysis revealed spatial patterns of primary production and chlorophyll a (chl a) biomass in the euphotic zone that were shaped by hydrographic conditions and nutrient concentrations linked to freshwater/seawater influence. Primary production rates varied widely, from 70 to 435 mg C m-2 d-1, while the range of particulate organic carbon (POC) sinking fluxes was narrow, from 50 to 77 mg C m-2 d-1. Consequently, high ratios of POC sinking export to primary production (i.e., export ratios; range of 0.38-0.69) were observed at stations where primary production was low and dominated by small cells, and where heterotrophic protist dominated in biomass. These results show that at short temporal scales neither protist community structure nor biomass or production rates could be used to predict the magnitude of POC sinking export from the euphotic zone.

  18. Effects of Hospital Systems on Medical Home Transformation in Primary Care Residency Training Practices.

    PubMed

    Knierim, Kyle; Hall, Tristen; Fernald, Douglas; Staff, Thomas J; Buscaj, Emilie; Allen, Jessica Cornett; Onysko, Mary; Dickinson, W Perry

    2016-11-23

    Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.

  19. Health policy and the policymaking system: A case study of primary care in Ireland.

    PubMed

    Kelly, Niall; Garvey, John; Palcic, Dónal

    2016-08-01

    In 2001 the Irish government published a reforming policy intended to modernise and expand the delivery of primary care in Ireland. Fifteen years later, the Irish health system remains beset by problems indicative of a fragmented and underdeveloped primary care system. This case study examines the formation and implementation of the 2001 primary care policy and identifies key risk categories within the policymaking process itself that inhibited the timely achievement of policy objectives. Our methodology includes a directed content analysis of the policy formation and implementation documents and the influencing academic literature, as well as semi-structured interviews with key personnel involved in the process. We identify three broad risk categories - power, resources and capability - within the policymaking process that strongly influenced policy formation and implementation. We additionally show that the disjoint between policy formation and policy implementation was a contested issue among those involved in the policy process and provided space for these risks to critically undermine Ireland's primary care policy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Effect of adhesive systems and bevel on enamel margin integrity in primary and permanent teeth.

    PubMed

    Swanson, T K; Feigal, R J; Tantbirojn, D; Hodges, J S

    2008-01-01

    This study compared the effectiveness of self-etch and total-etch adhesive systems in bonding to the beveled and nonbeveled margins of primary and permanent teeth. This in vitro, factorial-designed study allowed evaluation of 3 factors: (1) tooth type; (2) presence of a bevel; and (3) adhesive type. Two preparations, each including a beveled and nonbeveled margin, were completed on buccal surfaces of 60 extracted molars (30 primary and 30 permanent). Preparations were randomly assigned to self-etch or a total-etch adhesive system and restored with resin composite. After thermocycling, teeth were stained with silver nitrate, sectioned, and measured for microleakage. Statistical analysis used a repeated measures analysis of variance. Beveled margins had less microleakage than nonbeveled margins for primary and permanent teeth (P < .001). Total-etch had less microleakage than self-etch adhesives on primary (53% less, P < .001) and on permanent teeth (22% less, P = .01). Self-etch had considerably more microleakage when enamel margins were not beveled. Comparably less microleakage, however, was found for total-etch and self-etch in restorations with beveled margins. Total-etch adhesive and beveled margins resulted in the least microleakage. Margin beveling has a greater effect in minimizing microleakage than the type of adhesive used.

  1. Increased light-use efficiency sustains net primary productivity of shaded coffee plants in agroforestry system.

    PubMed

    Charbonnier, Fabien; Roupsard, Olivier; le Maire, Guerric; Guillemot, Joannès; Casanoves, Fernando; Lacointe, André; Vaast, Philippe; Allinne, Clémentine; Audebert, Louise; Cambou, Aurélie; Clément-Vidal, Anne; Defrenet, Elsa; Duursma, Remko A; Jarri, Laura; Jourdan, Christophe; Khac, Emmanuelle; Leandro, Patricia; Medlyn, Belinda E; Saint-André, Laurent; Thaler, Philippe; Van Den Meersche, Karel; Barquero Aguilar, Alejandra; Lehner, Peter; Dreyer, Erwin

    2017-08-01

    In agroforestry systems, shade trees strongly affect the physiology of the undergrown crop. However, a major paradigm is that the reduction in absorbed photosynthetically active radiation is, to a certain extent, compensated by an increase in light-use efficiency, thereby reducing the difference in net primary productivity between shaded and non-shaded plants. Due to the large spatial heterogeneity in agroforestry systems and the lack of appropriate tools, the combined effects of such variables have seldom been analysed, even though they may help understand physiological processes underlying yield dynamics. In this study, we monitored net primary productivity, during two years, on scales ranging from individual coffee plants to the entire plot. Absorbed radiation was mapped with a 3D model (MAESPA). Light-use efficiency and net assimilation rate were derived for each coffee plant individually. We found that although irradiance was reduced by 60% below crowns of shade trees, coffee light-use efficiency increased by 50%, leaving net primary productivity fairly stable across all shade levels. Variability of aboveground net primary productivity of coffee plants was caused primarily by the age of the plants and by intraspecific competition among them (drivers usually overlooked in the agroforestry literature) rather than by the presence of shade trees. © 2017 John Wiley & Sons Ltd.

  2. Primary reaction control system/remote manipulator system interaction with loaded arm. Space shuttle engineering and operations support

    NASA Technical Reports Server (NTRS)

    Taylor, E. C.; Davis, J. D.

    1978-01-01

    A study of the interaction between the orbiter primary reaction control system (PRCS) and the remote manipulator system (RMS) with a loaded arm is documented. This analysis was performed with the Payload Deployment and Retrieval Systems Simulation (PDRSS) program with the passive arm bending option. The passive-arm model simulates the arm as massless elastic links with locked joints. The study was divided into two parts. The first part was the evaluation of the response of the arm to step inputs (i.e. constant jet torques) about each of the orbiter body axes. The second part of the study was the evaluation of the response of the arm to minimum impulse primary RCS jet firings with both single pulse and pulse train inputs.

  3. Primary health care and public health: foundations of universal health systems.

    PubMed

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable.

  4. INTEGRATED DRILLING SYSTEM USING MUD ACTUATED DOWN HOLE HAMMER AS PRIMARY ENGINE

    SciTech Connect

    John V. Fernandez; David S. Pixton

    2005-12-01

    A history and project summary of the development of an integrated drilling system using a mud-actuated down-hole hammer as its primary engine are given. The summary includes laboratory test results, including atmospheric tests of component parts and simulated borehole tests of the hammer system. Several remaining technical hurdles are enumerated. A brief explanation of commercialization potential is included. The primary conclusion for this work is that a mud actuated hammer can yield substantial improvements to drilling rate in overbalanced, hard rock formations. A secondary conclusion is that the down-hole mud actuated hammer can serve to provide other useful down-hole functions including generation of high pressure mud jets, generation of seismic and sonic signals, and generation of diagnostic information based on hammer velocity profiles.

  5. Primary angiitis of the central nervous system mimicking tumor-like lesion--case report.

    PubMed

    Tanei, Takafumi; Nakahara, Norimoto; Takebayashi, Shigenori; Ito, Masafumi; Hashizume, Yoshio; Wakabayashi, Toshihiko

    2011-01-01

    A 60-year-old man presented with a rare case of primary angiitis of the central nervous system mimicking a tumor-like lesion and manifesting as slight disorientation, left hemiparesis, and motor aphasia. Computed tomography showed multiple low density lesions in the left frontal lobe, brain stem, and right parietal lobe. Magnetic resonance images revealed a slightly enhanced mass lesion in the right parietal lobe with surrounding brain edema. Serum, cerebrospinal fluid, and other image examinations did not show any abnormal findings, so surgical removal of the right parietal mass was performed. Histological examination revealed that the mass consisted of hemorrhagic infarction without cellular atypia. Proliferations of endothelial cells in small and medium arteries, and infiltration of macrophages in the perivascular space were detected in the infarction tissues. The histological diagnosis was primary angiitis of the central nervous system.

  6. Oil-air mist lubrication as an emergency system and as a primary lubrication system. [for helicopter engines

    NASA Technical Reports Server (NTRS)

    Loomis, W. R.

    1976-01-01

    The feasibility of an emergency aspirator once-through lubrication system was demonstrated as a viable survivability concept for Army helicopter mainshaft engine bearings for periods as long as 30 minutes. It was also shown in an experimental study using a 46-mm bore bearing test machine that an oil-air mist once-through system with auxiliary air cooling is an effective primary lubrication system at speeds up to 2,500,000 DN for extended operating periods of at least 50 hours.

  7. Modeling PWR systems for monitoring primary-to-secondary leakage using tritium tracer

    SciTech Connect

    Peiffer, D.G. )

    1992-02-01

    This paper discusses several techniques available for monitoring primary to secondary leakage, focusing on the advantages and disadvantages of each. A mathematical model of Millstone 2 describes the behavior of tritium activity in the secondary plant water when a leak exists. Real data from Millstone 2 illustrate the accuracy and reliability of the model and use of the model to measure the mass of water in the secondary system.

  8. [Correction of spectral interferences by ICP-AES primary expert system].

    PubMed

    Ying, H; Yang, P; Wang, X; Huang, B

    1998-12-01

    A subpackage for spectral interference correction has been set up in ICP-AES primary expert system. Some numerical recipes have been applied in this subpackage, such as curve smoothing, derivative spectrum, FFT technique, spectral resolving etc. A comprehensive method for spectral interference correction is presented. All these numeric recipes have been tested with simulated data and also utilized in several typical examples of real spectra. Results are satisfactory.

  9. Validation of Systemic Lupus Erythematosus Diagnosis as the Primary Cause of Renal Failure in the US Renal Data System.

    PubMed

    Broder, Anna; Mowrey, Wenzhu B; Izmirly, Peter; Costenbader, Karen H

    2017-04-01

    Using American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria for systemic lupus erythematosus (SLE) classification as gold standards, we determined sensitivity, specificity, positive and negative predictive values (PPV and NPV) of having SLE denoted as the primary cause of end-stage renal disease (ESRD) in the US Renal Data System (USRDS). ESRD patients were identified by International Classification of Diseases, Ninth Revision codes in electronic medical records of 1 large tertiary care center, Montefiore Hospital, from 2006 to 2012. Clinical data were extracted and reviewed to establish SLE diagnosis. Data were linked by social security number, name, and date of birth to the USRDS, where primary causes of ESRD were ascertained. Of 7,396 ESRD patients at Montefiore, 97 met ACR/SLICC SLE criteria, and 86 had SLE by record only. Among the 97 SLE patients, the attributed causes of ESRD in the USRDS were 77 SLE and 12 with other causes (unspecified glomerulonephritis, hypertension, scleroderma), and 8 missing. Sensitivity, specificity, PPV, and NPV for SLE in the USRDS were 79%, 99.9%, 93%, and 99.7%, respectively. Of the 60 patients with biopsy-proven lupus nephritis, 44 (73%) had SLE as primary ESRD cause in the USRDS. Attribution of the primary ESRD causes among SLE patients with ACR/SLICC criteria differed by race, ethnicity, and transplant status. The diagnosis of SLE as the primary cause of ESRD in the USRDS has good sensitivity, and excellent specificity, PPV, and NPV. Nationwide access to medical records and biopsy reports may significantly improve sensitivity of SLE diagnosis. © 2016, American College of Rheumatology.

  10. Sensitivity Analyses in Small Break LOCA with HPI-Failure: Effect of Break-Size in Secondary-Side Depressurization

    NASA Astrophysics Data System (ADS)

    Kinoshita, Ikuo; Torige, Toshihide; Yamada, Minoru

    2014-06-01

    In the case of total failure of the high pressure injection (HPI) system following small break loss of coolant accident (SBLOCA) in pressurized water reactor (PWR), the break size is so small that the primary system does not depressurize to the accumulator (ACC) injection pressure before the core is uncovered extensively. Therefore, steam generator (SG) secondary-side depressurization is necessary as an accident management in order to grant accumulator system actuation and core reflood. A thermal-hydraulic analysis using RELAP5/MOD3 was made on SBLOCA with HPI-failure for Oi Units 3/4 operated by Kansai Electoric Power Co., which are conventional 4 loop PWR plants. The effectiveness of SG secondary-side depressurization procedure was investigated for the real plant design and operational characteristics. The sensitivity analyses using RELAP5/MOD3.2 showed that the accident management was effective for a wide range of break sizes, various orientations and positions. The critical break can be 3 inch cold-leg bottom break.

  11. Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

    PubMed

    Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

    2013-09-30

    Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

  12. Systemically administered PEDF against primary and secondary tumours in a clinically relevant osteosarcoma model

    PubMed Central

    Broadhead, M L; Dass, C R; Choong, P F M

    2011-01-01

    Background: Pigment epithelium-derived factor (PEDF) is an endogenous glycoprotein with a potential role as a therapeutic for osteosarcoma. Animal studies have demonstrated the biological effects of PEDF on osteosarcoma; however, these results are difficult to extrapolate for human use due to the chosen study design and drug delivery methods. Methods: In this study we have attempted to replicate the human presentation and treatment of osteosarcoma using a murine orthotopic model of osteosarcoma. The effects of PEDF on osteosarcoma cell lines were evaluated in vitro prior to animal experimentation. Orthotopic tumours were induced by intra-tibial injection of SaOS-2 osteosarcoma cells. Treatment with PEDF was delayed until after the macroscopic appearance of primary tumours. Pigment epithelium-derived factor was administered systemically via an implanted intraperitoneal micro-osmotic pump. Results: In vitro, PEDF inhibited proliferation, induced apoptosis and inhibited cell cycling of osteosarcoma cells. Pigment epithelium-derived factor promoted adhesion to Collagen I and inhibited invasion through Collagen I. In vivo, treatment with PEDF caused a reduction in both primary tumour volume and burden of pulmonary metastases. Systemic administration of PEDF did not cause toxic effects on normal tissues. Conclusion: Systemically delivered PEDF is effective in suppressing the size of primary and secondary tumours in an orthotopic murine model of osteosarcoma. PMID:21979423

  13. Deployment and Validation of a Smart System for Screening of Language Disorders in Primary Care

    PubMed Central

    Martín-Ruiz, María Luisa; Duboy, Miguel Ángel Valero; de la Cruz, Iván Pau

    2013-01-01

    Neuro-evolutive development from birth until the age of six years is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child's optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases. PMID:23752564

  14. Analysis of N-16 concentration in primary cooling system of AP1000 power reactor

    SciTech Connect

    Rohanda, Anis; Waris, Abdul

    2015-04-16

    Nitrogen-16 (N-16) is one of the radiation safety parameter on the primary reactor system. The activation product, N-16, is the predominant contributor to the activity in the reactor coolant system during reactor operation. N-16 is activation product derived from activation of O-16 with fast neutron based on {sup 16}O(n,p){sup 16}N reaction. Thus study is needed and it performs to determine N-16 concentration in reactor coolant (primary coolant) in supporting radiation safety. One of the way is using analytical methode based on activation and redecay princip to obtain N-16 concentration. The analysis was performed on the configuration basis and operational of Westinghouse AP1000 power reactor in several monitoring points at coolant reactor system. The results of the calculation of N-16 concentration at the core outlet, reactor vessel outlet, pressurizer line, inlet and outlet of steam generators, primary pumps, reactor vessels inlet and core inlet are: 281, 257, 255, 250, 145, 142, 129 and 112 µCi/gram respectively. The results of analysis compared with AP1000 design control document as standard values. The verification showed very high accuracy comparation between analytical results and standard values.

  15. Analysis of N-16 concentration in primary cooling system of AP1000 power reactor

    NASA Astrophysics Data System (ADS)

    Rohanda, Anis; Waris, Abdul

    2015-04-01

    Nitrogen-16 (N-16) is one of the radiation safety parameter on the primary reactor system. The activation product, N-16, is the predominant contributor to the activity in the reactor coolant system during reactor operation. N-16 is activation product derived from activation of O-16 with fast neutron based on 16O(n,p)16N reaction. Thus study is needed and it performs to determine N-16 concentration in reactor coolant (primary coolant) in supporting radiation safety. One of the way is using analytical methode based on activation and redecay princip to obtain N-16 concentration. The analysis was performed on the configuration basis and operational of Westinghouse AP1000 power reactor in several monitoring points at coolant reactor system. The results of the calculation of N-16 concentration at the core outlet, reactor vessel outlet, pressurizer line, inlet and outlet of steam generators, primary pumps, reactor vessels inlet and core inlet are: 281, 257, 255, 250, 145, 142, 129 and 112 µCi/gram respectively. The results of analysis compared with AP1000 design control document as standard values. The verification showed very high accuracy comparation between analytical results and standard values.

  16. Deployment and validation of a smart system for screening of language disorders in primary care.

    PubMed

    Martín-Ruiz, María Luisa; Duboy, Miguel Ángel Valero; de la Cruz, Iván Pau

    2013-06-10

    Neuro-evolutive development from birth until the age of six years is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child's optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases.

  17. International study on low-grade primary central nervous system lymphoma.

    PubMed

    Jahnke, Kristoph; Korfel, Agnieszka; O'Neill, Brian Patrick; Blay, Jean-Yves; Abrey, Lauren E; Martus, Peter; Poortmans, Philip M P; Shenkier, Tamara N; Batchelor, Tracy T; Neuwelt, Edward A; Raizer, Jeffrey J; Schiff, David; Pels, Hendrik; Herrlinger, Ulrich; Stein, Harald; Thiel, Eckhard

    2006-05-01

    The aim of this study was to characterize the clinical presentation, course, and outcome of low-grade primary central nervous system lymphoma. Cases were assessed in a retrospective series collected from 18 cancer centers in 5 countries. Forty patients (18 men, 22 women; median age, 60 years [range, 19-78]) were identified. Involvement of a cerebral hemisphere or deeper brain structures was seen in 37 patients, only leptomeningeal involvement in 2 patients, and spinal cord disease in 1 patient. Chemotherapy/radiotherapy was conducted in 15 patients, radiotherapy alone in 12, chemotherapy alone in 10, and tumor resection alone in 2, whereas 1 patient received no treatment. The median progression-free, disease-specific, and overall survival were 61.5 (range, 0-204), 130 (range, 1-204), and 79 (range, 1-204) months, respectively. Only age 60 years or older was associated with shorter progression-free (p = 0.009), disease-specific (p = 0.015), and overall survival (p = 0.001) in multivariate analysis. Low-grade primary central nervous system lymphoma differs from the high-grade subtype in its pathological, clinical, and radiological features. It has a better long-term outcome than primary central nervous system lymphoma in general with age 60 years or older adversely affecting survival.

  18. Activities and Attributes of Nurse Practitioner Leaders: Lessons from a Primary Care System Change.

    PubMed

    O'Rourke, Tammy; Higuchi, Kathryn Smith

    2016-01-01

    Nurse practitioners (NPs) are being encouraged to practice to the full extent of their skills, and they have a critical role to play in leading health system reform. The evidence in support of NP-led initiatives is growing; however, in spite of the positive outcomes associated with these initiatives, considerable opposition to and debate about the potential for NPs to lead health system change and interprofessional teams continues. To date, we know very little about NP leadership activities, particularly those activities that contribute to primary care system change, and there are very few examples of this type of leadership. The qualitative descriptive study here was part of a larger case study that examined stakeholder participation in a system change led by NPs. The change involved the introduction of a new NP-led model of team-based primary care delivery in Ontario, Canada. Data from participant interviews and public documents were analyzed to describe the activities and attributes (perseverance, risk-taking and effective communication) of two NP leaders who were the drivers of this change. Knowledge of these activities and attributes has the potential to inform NP leadership roles in health system policy planning and implementation. However, to be able to provide effective leadership in system change, NPs need access to educational content about public policy and opportunities to develop and practice the skills required to work with multiple stakeholders, including those who oppose change.

  19. Use of email in communication between the Finnish primary healthcare system and general practitioners.

    PubMed

    Karhula, Tuula; Kauppila, Timo; Elonheimo, Outi; Brommels, Mats

    2011-01-01

    The volume of emails is rising rapidly everywhere. However, there is no data available concerning how primary healthcare physicians feel about the use of email communication between themselves, with their managers and with other people contacting them. The objective of this study was to find out what the attitudes of primary care physicians are towards email at work. The use of email was studied among a convenience sample of primary healthcare physicians. Physicians thought that email was a good instrument for delivering information but not as an instrument for leadership. Physicians in lead positions thought more often than ordinary general practitioners (GPs) that email is good for information. The leaders used email more actively than other GPs. The contents of the emails received by the GPs differed depending on the site of work. The total number of emails was higher in urban areas than in rural areas. Emails relating to administration, educational information and meeting materials were more often sent in rural than in urban primary healthcare settings. Information about daily work arrangements and about social events were more frequently emailed in urban than in rural surroundings. Email was considered important for information inside the system but a somewhat difficult tool for discussing complicated subjects. Generally, it was agreed that there was some unimportant information filtering through this medium to the target GPs. GPs were uncertain whether important data reached everybody who needed it or not. Still, almost everybody used the email system regularly and the use of it was considered relatively easy. GPs were generally prone to adopt advice and instructions given via email and implemented those in their working routines. The use of the email system was related to technical ability to use the system. The easier the GP thought that the email system was the more he used it. Rural GPs were more critical in applying advice shared via email than their

  20. Cooperative Research and Development of Primary Surface Recuperator for Advanced Microturbine Systems

    SciTech Connect

    Escola, George

    2007-01-17

    Recuperators have been identified as key components of advanced gas turbines systems that achieve a measure of improvement in operating efficiency and lead the field in achieving very low emissions. Every gas turbine manufacturer that is studying, developing, or commercializing advanced recuperated gas turbine cycles requests that recuperators operate at higher temperature without a reduction in design life and must cost less. The Solar Cooperative Research and Development of Primary Surface Recuperator for Advanced Microturbine Systems Program is directed towards meeting the future requirements of advanced gas turbine systems by the following: (1) The development of advanced alloys that will allow recuperator inlet exhaust gas temperatures to increase without significant cost increase. (2) Further characterization of the creep and oxidation (dry and humid air) properties of nickel alloy foils (less than 0.13 mm thick) to allow the economical use of these materials. (3) Increasing the use of advanced robotic systems and advanced in-process statistical measurement systems.

  1. 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... REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile § 141.535 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If...

  2. Belgian experience in applying the {open_quotes}leak-before-break{close_quotes} concept to the primary loop piping

    SciTech Connect

    Gerard, R.; Malekian, C.; Meessen, O.

    1997-04-01

    The Leak Before Break (LBB) concept allows to eliminate from the design basis the double-ended guillotine break of the primary loop piping, provided it can be demonstrated by a fracture mechanics analysis that a through-wall flaw, of a size giving rise to a leakage still well detectable by the plant leak detection systems, remains stable even under accident conditions (including the Safe Shutdown Earthquake (SSE)). This concept was successfully applied to the primary loop piping of several Belgian Pressurized Water Reactor (PWR) units, operated by the Utility Electrabel. One of the main benefits is to permit justification of supports in the primary loop and justification of the integrity of the reactor pressure vessel and internals in case of a Loss Of Coolant Accident (LOCA) in stretch-out conditions. For two of the Belgian PWR units, the LBB approach also made it possible to reduce the number of large hydraulic snubbers installed on the primary coolant pumps. Last but not least, the LBB concept also facilitates the steam generator replacement operations, by eliminating the need for some pipe whip restraints located close to the steam generator. In addition to the U.S. regulatory requirements, the Belgian safety authorities impose additional requirements which are described in details in a separate paper. An novel aspect of the studies performed in Belgium is the way in which residual loads in the primary loop are taken into account. Such loads may result from displacements imposed to close the primary loop in a steam generator replacement operation, especially when it is performed using the {open_quote}two cuts{close_quotes} technique. The influence of such residual loads on the LBB margins is discussed in details and typical results are presented.

  3. Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco.

    PubMed

    Oneib, Bouchra; Sabir, Maria; Otheman, Yassine; Abda, Naima; Ouanass, Abderrazzak

    2016-01-01

    The aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. We conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. The prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.

  4. Primary propulsion of electrothermal, ion, and chemical systems for space-based radar orbit transfer

    NASA Technical Reports Server (NTRS)

    Wang, S.-Y.; Staiger, P. J.

    1985-01-01

    An orbit transfer mission concept has been studied for a Space-Based Radar (SBR) where 40 kW required for radar operation is assumed available for orbit transfer propulsion. Arcjet, pulsed electrothermal (PET), ion, and storable chemical systems are considered for the primary propulsion. Transferring two SBR per shuttle flight to 1112 km/60 deg using eiectrical propulsion systems offers an increased payload at the expense of increased trip time, up to 2000 kg each, which may be critical for survivability. Trade offs between payload mass, transfer time, launch site, inclination, and height of parking orbits are presented.

  5. Primary propulsion of electrothermal, ion and chemical systems for space-based radar orbit transfer

    NASA Technical Reports Server (NTRS)

    Wang, S. Y.; Staiger, P. J.

    1985-01-01

    An orbit transfer mission concept has been studied for a Space-Based Radar (SBR) where 40 kW required for radar operation is assumed available for orbit transfer propulsion. Arcjet, pulsed electrothermal (PET), ion, and storable chemical systems are considered for the primary propulsion. Transferring two SBR per shuttle flight to 1112 km/60 deg using electrical propulsion systems offers an increased payload at the expense of increased trip time, up to 2000 kg each, which may be critical for survivability. Trade offs between payload mass, transfer time, launch site, inclination, and height of parking orbits are presented.

  6. Primary propulsion of electrothermal, ion, and chemical systems for space-based radar orbit transfer

    NASA Technical Reports Server (NTRS)

    Wang, S.-Y.; Staiger, P. J.

    1985-01-01

    An orbit transfer mission concept has been studied for a Space-Based Radar (SBR) where 40 kW required for radar operation is assumed available for orbit transfer propulsion. Arcjet, pulsed electrothermal (PET), ion, and storable chemical systems are considered for the primary propulsion. Transferring two SBR per shuttle flight to 1112 km/60 deg using eiectrical propulsion systems offers an increased payload at the expense of increased trip time, up to 2000 kg each, which may be critical for survivability. Trade offs between payload mass, transfer time, launch site, inclination, and height of parking orbits are presented.

  7. Systems and complexity thinking in general practice. Part 2: application in primary care research.

    PubMed

    Sturmberg, Joachim P

    2007-04-01

    Systems organise themselves upward toward larger wholes, and downward toward ever smaller parts. The upward view describes holism or emergence (complexity science view), the downward view reductionism or analysis (Newtonian science view). Both views provide valid and valuable information, one being contextual, the other specific. A systems and complexity view allows a simultaneous understanding of a phenomenon from different perspectives, providing the opportunity to identify potentially different outcomes from a single action. The findings from studies on prescribing antibiotics and continuity of care will demonstrate and draw attention to the potential of this approach for primary care research.

  8. Primary breast lymphoma sequentially relapsed in the peripheral and central nervous system.

    PubMed

    Tang, Tzung-Chih; Chang, Hung; Chuang, Wen-Yu

    2012-09-01

    Primary breast lymphoma (PBL) is an uncommon extranodal type of lymphoma, exhibiting more aggressive behavior and poorer prognosis. Patients with PBL have a higher incidence to relapse in central nervous system (CNS), which is always leading to a dismal outcome even treating with high intensity chemotherapy plus radiotherapy. Lymphoma involving the peripheral nervous system (PNS), either primarily or secondarily, is also rare. But no PBL with PNS relapse has been reported before. Herein, we reported a case of PBL who presented with subsequent relapse in two discrete sites of the PNS followed by the CNS.

  9. [Revitalization of the federal and state efforts to promote community-based primary care systems].

    PubMed

    Carlson, R H

    1990-01-01

    Progress toward a strengthened public health system is clearly emerging in the United States, but still faces a number of financial and functional barriers. There is no question, however, that the importance being placed on primary care systems is making a difference as more and more communities are seeking and implementing effective approaches that bring resources together in ways that work. That, of course, is the ultimate objective; that is, that all public agencies assure their constituents that their needed services are being provided in an affordable way.

  10. Dynamics of the Establishment of Systemic Potyvirus Infection: Independent yet Cumulative Action of Primary Infection Sites

    PubMed Central

    Lafforgue, Guillaume; Tromas, Nicolas; Elena, Santiago F.

    2012-01-01

    In the clinic, farm, or field, for many viruses there is a high prevalence of mixed-genotype infections, indicating that multiple virions have initiated infection and that there can be multiple sites of primary infection within the same host. The dynamic process by which multiple primary infection sites interact with each other and the host is poorly understood, undoubtedly due to its high complexity. In this study, we attempted to unravel the basic interactions underlying this process using a plant RNA virus, as removing the inoculated leaf can instantly and rigorously eliminate all primary infection sites. Effective population size in the inoculated leaf and time of removal of the inoculated leaf were varied in experiments, and it was found that both factors positively influenced if the plant became systemically infected and what proportion of cells in the systemic tissue were infected, as measured by flow cytometry. Fitting of probabilistic models of infection to our data demonstrated that a null model in which the action of each focus is independent of the presence of other foci was better supported than a dependent-action model. The cumulative effect of independently acting foci therefore determined when plants became infected and how many individual cells were infected. There was no evidence for interference between primary infection sites, which is surprising given the planar structure of leaves. By showing that a simple null model is supported, we experimentally confirmed—to our knowledge for the first time—the minimal components that dictate interactions of a conspecific virus population establishing systemic infection. PMID:22993154

  11. Microtensile and Microshear Bond Strength of an Antibacterial Self-Etching System to Primary Tooth Dentin

    PubMed Central

    Yildirim, Sibel; Tosun, Gül; Koyutürk, Alp Erdin; Şener, Yaḡmur; Şengün, Abdulkadir; Özer, Füsun; Imazato, Satoshi

    2008-01-01

    Objectives The aim of this study was to test the hypothesis that the bonding ability of antibacterial bonding system to primary dentin was not different from the parental material which did not contain any antibacterial component. Methods Extracted human non-carious primary molars were ground to expose the coronal dentin, and then randomly divided into two experimental groups: treatment with Clearfil Protect Bond or with Clearfil SE Bond (Kuraray Medical Inc.). Composite-dentin sticks with a cross-sectional area of approximately 0.90 mm2 were prepared and subsequently subjected to microtensile bond strength (μTBS) and microshear bond strength (μSBS) tests. For the μTBS tests, specimens were attached to an Instron testing machine with a cyanoacrylate adhesive. For μSBS testing, the sticks were mechanically fixed to the μSBS testing apparatus. The bonds were stressed in shear or tension at a crosshead speed of 1mm/min until failure occurred. Resin-dentin interfaces produced by each system were examined using SEM. The data were analyzed with Mann-Whitney’s U test. Results The μTBS and μSBS of Clearfil Protect Bond were 30.69±9.71 and 9.94±3.78 MPa, respectively. Clearfil SE Bond showed significantly greater values of 37.31±9.57 and 12.83±3.15 MPa, respectively. SEM analysis demonstrated similar micro-morphological features including the thickness of the hybrid layer for both materials. Conclusions It was showed that antibacterial self-etching system Clearfil Protect Bond showed lower bond strength values compared to primary dentin than that of to Clearfil SE Bond on primary dentin. (Eur J Dent 2008;2:11–17) PMID:19212503

  12. Georeferenced and secure mobile health system for large scale data collection in primary care.

    PubMed

    Sa, Joao H G; Rebelo, Marina S; Brentani, Alexandra; Grisi, Sandra J F E; Iwaya, Leonardo H; Simplicio, Marcos A; Carvalho, Tereza C M B; Gutierrez, Marco A

    2016-10-01

    Mobile health consists in applying mobile devices and communication capabilities for expanding the coverage and improving the effectiveness of health care programs. The technology is particularly promising for developing countries, in which health authorities can take advantage of the flourishing mobile market to provide adequate health care to underprivileged communities, especially primary care. In Brazil, the Primary Care Information System (SIAB) receives primary health care data from all regions of the country, creating a rich database for health-related action planning. Family Health Teams (FHTs) collect this data in periodic visits to families enrolled in governmental programs, following an acquisition procedure that involves filling in paper forms. This procedure compromises the quality of the data provided to health care authorities and slows down the decision-making process. To develop a mobile system (GeoHealth) that should address and overcome the aforementioned problems and deploy the proposed solution in a wide underprivileged metropolitan area of a major city in Brazil. The proposed solution comprises three main components: (a) an Application Server, with a database containing family health conditions; and two clients, (b) a Web Browser running visualization tools for management tasks, and (c) a data-gathering device (smartphone) to register and to georeference the family health data. A data security framework was designed to ensure the security of data, which was stored locally and transmitted over public networks. The system was successfully deployed at six primary care units in the city of Sao Paulo, where a total of 28,324 families/96,061 inhabitants are regularly followed up by government health policies. The health conditions observed from the population covered were: diabetes in 3.40%, hypertension (age >40) in 23.87% and tuberculosis in 0.06%. This estimated prevalence has enabled FHTs to set clinical appointments proactively, with the aim of

  13. Passive containment cooling system

    DOEpatents

    Billig, Paul F.; Cooke, Franklin E.; Fitch, James R.

    1994-01-01

    A passive containment cooling system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and a gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel and is vented to the drywell. An isolation pool is disposed above the GDCS pool and includes an isolation condenser therein. The condenser has an inlet line disposed in flow communication with the drywell for receiving the non-condensable gas along with any steam released therein following a loss-of-coolant accident (LOCA). The condenser also has an outlet line disposed in flow communication with the drywell for returning to the drywell both liquid condensate produced upon cooling of the steam and the non-condensable gas for reducing pressure within the containment vessel following the LOCA.

  14. Passive containment cooling system

    DOEpatents

    Billig, P.F.; Cooke, F.E.; Fitch, J.R.

    1994-01-25

    A passive containment cooling system includes a containment vessel surrounding a reactor pressure vessel and defining a drywell therein containing a non-condensable gas. An enclosed wetwell pool is disposed inside the containment vessel, and a gravity driven cooling system (GDCS) pool is disposed above the wetwell pool in the containment vessel and is vented to the drywell. An isolation pool is disposed above the GDCS pool and includes an isolation condenser therein. The condenser has an inlet line disposed in flow communication with the drywell for receiving the non-condensable gas along with any steam released therein following a loss-of-coolant accident (LOCA). The condenser also has an outlet line disposed in flow communication with the drywell for returning to the drywell both liquid condensate produced upon cooling of the steam and the non-condensable gas for reducing pressure within the containment vessel following the LOCA. 1 figure.

  15. Work system factors influencing physicians' screen sharing behaviors in primary care encounters.

    PubMed

    Asan, Onur; Carayon, Pascale; Beasley, John W; Montague, Enid

    2015-10-01

    While the use of electronic health records (EHRs) in primary care has increased dramatically, its potential benefits need to be considered in light of potential negative impacts on physician-patient interactions and the increase in physician cognitive workload. This study aims to understand work system factors contributing to physicians' use of the EHR as a communication tool during primary-care encounters. We interviewed 14 primary care physicians on their use of EHRs as a communication tool in patient visits. A qualitative content analysis guided by the work system model identified factors influencing physicians' decisions to share or not share the computer screen with their patients. The analysis revealed 26 factors that influenced physicians' decisions to share the screen, most related to the "task" (reviewing lab records), "tools and technology" (using algorithm calculators for risk prediction), or "individual" (patient interest) elements of the work system. The analysis revealed 15 factors that influenced physicians' decisions not to share the screen, most related to the "individual" (patient's acute pain), "organization" (insufficient time), or "task" (documenting embarrassing information) elements of the work system. Eleven physicians made individual decisions to share or not to share the screen in a particular visit based on work-system related factors. Three doctors always shared the screen, based on the idea that it is polite and builds trust. However, several physicians also reported that it was time consuming and caused unnecessary distractions. Understanding these factors is essential to effective EHR redesign and training for improving physician-patient communication. Copyright © 2015. Published by Elsevier Ireland Ltd.

  16. Primary human herpesvirus-6 infection in the central nervous system can cause severe disease.

    PubMed

    Mannonen, Laura; Herrgård, Eila; Valmari, Pekka; Rautiainen, Paula; Uotila, Kari; Aine, Marjo-Riitta; Karttunen-Lewandowski, Pirkko; Sankala, Juhani; Wallden, Tiina; Koskiniemi, Marjaleena

    2007-09-01

    Human herpesvirus-6 (HHV-6) infection is common in infancy, and symptoms are usually mild. However, encephalitis and other neurologic complications have been reported. Primary HHV-6 infection has been rarely confirmed in the central nervous system. We studied 21 children with suspected HHV-6 infection, drawn from a prospective, large-scale study of neurologic infections in Finland. Human herpesvirus-6 polymerase chain reaction was performed on cerebrospinal fluid samples, and antibody tests were performed on serum and cerebrospinal fluid. We identified nine children, aged 3 to 24 months, who had HHV-6-specific nucleic acid in cerebrospinal fluid. Primary infection was confirmed by seroconversion of specific antibodies in six, whereas one had a fourfold increase, and one had a fourfold decrease, in the antibody titer supporting recent infection. Generalized and prolonged seizures appeared in six children, four had a rash, four had ataxia, and four had gastroenteritis. All but two had a high fever. At follow-up, four children had evident neurologic sequelae, ataxia, and developmental disability, and needed special education. Primary HHV-6 infection may invade the central nervous system, and can cause neurologic symptoms and potentially permanent disability in children aged

  17. A microfluidic system to study cytoadhesion of Plasmodium falciparum infected erythrocytes to primary brain microvascularendothelial cells

    PubMed Central

    Herricks, Thurston; Seydel, Karl B.; Turner, George; Molyneux, Malcolm; Heyderman, Robert; Taylor, Terrie; Rathod, Pradipsinh K.

    2013-01-01

    The cellular events leading to severe and complicated malaria in some Plasmodium falciparum infections are poorly understood. Additional tools are required to better understand the pathogenesis of this disease. In this technical report, we describe a microfluidic culture system and image processing algorithms that were developed to observe cytoadhesion interactions of P. falciparum parasitized erythrocytes rolling on primary brain microvascularendothelial cells. We isolated and cultured human primary vascular endothelial cells in a closed loop microfluidic culture system where a peristaltic pump and media reservoirs were integrated onto a microscope stage insert. We developed image processing methods to enhance contrast of rolling parasitized erythrocytes on endothelial cells and to estimate the local wall shear stress. The velocity of parasitized erythrocytes rolling on primary brain microvascularendothelial cells was then measured under physiologically relevant wall shear stresses. Finally, we deployed this method successfully at a field site in Blantyre, Malawi. The method is a promising new tool for the investigation of the pathogenesis of severe malaria. PMID:21743938

  18. Trends in primary production, sea surface temperature and wind in upwelling systems (1998-2007)

    NASA Astrophysics Data System (ADS)

    Demarcq, Hervé

    2009-12-01

    We take advantage of the longest high quality single-sensor global data set of ocean color available today to explore recent trends in the primary productivity of the main eastern boundary upwelling systems (EBUEs): California, Canary, Humboldt and Benguela. The chlorophyll- a concentration is used as a proxy for primary production. SST data from AVHRR and wind speed data from QuikSCAT are used in conjunction with this data set to analyse forcing mechanisms explaining the chlorophyll biomass. Whereas the worldwide primary-production biomass shows on average decreasing trends, as already observed in the stratified part of the worldwide ocean, the productivity of most EBUEs increases during the study period. These contrasting trends are both significant, at least for the mid latitude range of 50°S-50°N, where the data coverage is sufficient for accurate estimation. Probably due to the large scale atmospheric forcing, trends in sea surface temperature (SST) show non-significant relationships with the trends in biomass within upwelling systems, suggesting that SST anomalies cannot be used as an indicator of change in upwelling intensity in a continuous warming context. On the other hand, upwelling favourable equatorward winds show a significant correlation with the observed trends in biomass, suggesting that the trends in the trade winds are probably linked to an increase in the intensity of the Hadley cell circulation observed during the last several decades.

  19. Design and testing of the U.S. Space Station Freedom primary propulsion system

    NASA Technical Reports Server (NTRS)

    Morano, Joseph S.; Delventhal, Rex A.; Chilcot, Kimberly J.

    1992-01-01

    The primary propulsion system (PPS) for the Space Station Freedom is discussed in terms of salient design characteristics and key testing procedures. The rocket engine modules contain reboost and attitude control thrusters, and their designs are illustrated showing the mounting structures, thruster solenoid valves, and thrust chambers. The propellant tank assembly for storing gaseous N pressurant and hydrazine propellant is described as are the system avionics, thruster solenoid valves, and latching isolation valves. PPS testing conducted on the development systems includes the use of a propulsion-module development unit, a development test article, and system qualification testing. Specific test articles include functional heaters, mass/thermal simulated components, flight-quality structures, and software control operations.

  20. A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

    PubMed

    Aldulaimi, Sommer; Mora, Francisco E

    2017-01-01

    Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

  1. Colon Targeted Drug Delivery Systems: A Review on Primary and Novel Approaches

    PubMed Central

    Philip, Anil K.; Philip, Betty

    2010-01-01

    The colon is a site where both local and systemic delivery of drugs can take place. Local delivery allows topical treatment of inflammatory bowel disease. However, treatment can be made effective if the drugs can be targeted directly into the colon, thereby reducing the systemic side effects. This review, mainly compares the primary approaches for CDDS (Colon Specific Drug Delivery) namely prodrugs, pH and time dependent systems, and microbially triggered systems, which achieved limited success and had limitations as compared with newer CDDS namely pressure controlled colonic delivery capsules, CODESTM, and osmotic controlled drug delivery which are unique in terms of achieving in vivo site specificity, and feasibility of manufacturing process. PMID:22125706

  2. Treatment of a primary intracranial germ cell tumor with systemic chemotherapy

    SciTech Connect

    Kirshner, J.J.; Ginsberg, S.J.; Fitzpatrick, A.V.; Comis, R.L.

    1981-01-01

    Primary germ cell neoplasms of the central nervous system (CNS) are rare tumors which generally respond to radiotherapy. Experience is limited in managing the refractory patient. We report a patient whose suprasellar dysgerminoma responded completely to 5,000 rad. Seven years later, disease recurrence was refractory to an additional 4,000 rad. Theorizing that the ''blood-brain barrier'' was no longer intact after extensive radiotherapy and tumor involvement of the ventricular system, the patient was treated with systemic bleomycin, cisplatin, and vinblastine. Pharmacokinetic studies revealed that the bleomycin and cisplatin entered the cerebrospinal fluid. Serial CT scans and CSF levels of beta-HCG confirmed the clinical impression of a partial remission. Subsequent tumor progression was refractory to therapy with intraventricular bleomycin. It is concluded that systemic chemotherapy may be beneficial in certain cases of CNS germ cell neoplasms.

  3. Design and testing of the U.S. Space Station Freedom primary propulsion system

    NASA Technical Reports Server (NTRS)

    Morano, Joseph S.; Delventhal, Rex A.; Chilcot, Kimberly J.

    1992-01-01

    The primary propulsion system (PPS) for the Space Station Freedom is discussed in terms of salient design characteristics and key testing procedures. The rocket engine modules contain reboost and attitude control thrusters, and their designs are illustrated showing the mounting structures, thruster solenoid valves, and thrust chambers. The propellant tank assembly for storing gaseous N pressurant and hydrazine propellant is described as are the system avionics, thruster solenoid valves, and latching isolation valves. PPS testing conducted on the development systems includes the use of a propulsion-module development unit, a development test article, and system qualification testing. Specific test articles include functional heaters, mass/thermal simulated components, flight-quality structures, and software control operations.

  4. Design and testing of the U.S. Space Station Freedom primary propulsion system

    NASA Astrophysics Data System (ADS)

    Morano, Joseph S.; Delventhal, Rex A.; Chilcot, Kimberly J.

    1992-07-01

    The primary propulsion system (PPS) for the Space Station Freedom is discussed in terms of salient design characteristics and key testing procedures. The rocket engine modules contain reboost and attitude control thrusters, and their designs are illustrated showing the mounting structures, thruster solenoid valves, and thrust chambers. The propellant tank assembly for storing gaseous N pressurant and hydrazine propellant is described as are the system avionics, thruster solenoid valves, and latching isolation valves. PPS testing conducted on the development systems includes the use of a propulsion-module development unit, a development test article, and system qualification testing. Specific test articles include functional heaters, mass/thermal simulated components, flight-quality structures, and software control operations.

  5. The panels for primary and secondary mirror reflectors and the Active Surface System for the new Sardinia Radio Telescope

    NASA Astrophysics Data System (ADS)

    Zacchiroli, G.; Fiocchi, F.; Maccaferri, G.; Morsiani, M.; Orfei, A.; Pernechele, C.; Pisanu, T.; Roda, J.; Vargiu, G.

    In this paper we will describe the panels for the primary and secondary mirror reflectors and the active surface system that will be provided on the Sardinia Radio Telescope. The panels for the primary and secondary mirror have been designed to allow an operating frequency up to 100 GHz. The active surface system will be used to overcome the effect of gravity deformation on the antenna gain and to re-shape the primary mirror in a parabolic form, in order to avoid large phase error contribution on the gain for the highest frequencies placed in the primary focus.

  6. Gut mucosal nutritional support--enteral nutrition as primary therapy after multiple system trauma.

    PubMed Central

    Kudsk, K A

    1994-01-01

    Over the past 10 years, several clinical and experimental studies report the potential benefit of enteral nutrition as primary therapy after multiple system trauma. In this study, 98 patients sustaining blunt and penetrating trauma were randomised to receive either enteral or parenteral feeding for 15 days. There were significantly fewer infectious complications in patients randomised to receive enteral feeding with particular benefit shown in the most severely injured patients. Serum protein concentrations correlated with the clinical outcome with an increase in constitutive protein and decrease in acute phase protein concentrations occurring in the enteral group through a decrease in septic complications and possible direct hepatic 'reprioritisation'. Enteral feeding serves as a primary therapy affecting the outcome of critically ill patients. PMID:8125392

  7. Environmental standards for primary and secondary containment systems and transfer stations

    SciTech Connect

    Maguire, D.M.

    1995-04-01

    Environmental Standards for Primary and Secondary Containment Systems and Transfer Stations will supersede all previous requirements for design of dikes, storage tanks, and transfer stations in order to maintain consistency throughout the Y-12 Plant. This document is organized into six distinct sections, each with a specific purpose. Section I outlines the objectives of the document along with its applications and limitations; this section should be of interest to all readers for essential background information. Section II lists all definitions and is consistent with definitions outlined by environmental regulations. Section III discusses primary containment standards. Section IV outlines secondary containment standards; this section contains the actual standards for the diking of storage tanks and storage containers. Section V discusses transfer station standards. Section VI of this document outlines how exemptions may be granted for specific cases.

  8. Optimization of system parameters for modulator design in x-ray scatter correction using primary modulation

    NASA Astrophysics Data System (ADS)

    Gao, Hewei; Zhu, Lei; Fahrig, Rebecca

    2010-04-01

    The impact of the system parameters of the modulator on X-ray scatter correction using primary modulation is studied and an optimization of the modulator design is presented. Recently, a promising scatter correction method for X-ray computed tomography (CT) that uses a checkerboard pattern of attenuating blockers (primary modulator) placed between the X-ray source and the object has been developed and experimentally verified. The blocker size, d, and the blocker transmission factor, α, are critical to the performance of the primary modulation method. In this work, an error caused by aliasing of primary whose magnitude depends on the choices of d and α, and the scanned object, is set as the object function to be minimized, with constraints including the X-ray focal spot, the physical size of the detector element, and the noise level. The optimization is carried out in two steps. In the first step, d is chosen as small as possible but should meet a lower-bound condition. In the second step, α should be selected to balance the error level in the scatter estimation and the noise level in the reconstructed image. The lower bound of d on our tabletop CT system is 0.83 mm. Numerical simulations suggest 0.6 < α < 0.8 is appropriate. Using a Catphan 600 phantom, a copper modulator (d = 0.89 mm, α = 0.70) expectedly outperforms an aluminum modulator (d = 2.83 mm, α = 0.90). With the aluminum modulator, our method reduces the average error of CT number in selected contrast rods from 371.4 to 25.4 Hounsfield units (HU) and enhances the contrast to noise ratio (CNR) from 10.9 to 17.2; when the copper modulator is used, the error is further reduced to 21.9 HU and the CNR is further increased to 19.2.

  9. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk.

    PubMed

    Misra, Durga Prasanna; Shenoy, Sajjan N

    2017-01-01

    Cardiac involvement is common in primary systemic vasculitides and may be due to direct effect of the disease on the heart or due to therapy. We shall review involvement of the heart in the various forms of primary systemic vasculitis. Among anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), eosinophilic granulomatosis with polyangiitis most commonly involves the heart. Involvement of the heart confers poorer prognosis in AAV, which is also complicated by increased risk of cardiovascular events. Kawasaki's disease (KD) is the most common form of medium-vessel vasculitis to affect the heart, with coronary artery aneurysms being the most common manifestation. These predispose patients with KD to develop premature ischemic heart disease. Takayasu's arteritis is the most common large-vessel vasculitis to involve the heart and can result in aortic incompetence, myocarditis, or coronary heart disease. Involvement of the heart in Behcet's disease is usually in the form of intracardiac mass lesions, thrombosis, or endomyocardial fibrosis. Drugs used in the treatment of systemic vasculitis influence the risk of developing cardiovascular events. Corticosteroid therapy has been shown to increase the risk of myocardial infarction, whereas methotrexate, azathioprine, mycophenolate mofetil, rituximab, and anti-tumor necrosis alpha agents favorably modulate the risk of cardiovascular events, predominantly by dampening systemic inflammation. Awareness of cardiac involvement in vasculitis and accelerated cardiovascular risk in these patients should help clinicians to maximize the modulation of modifiable risk factors for heart disease in these individuals.

  10. Frequent involvement of central nervous system in primary Sjögren syndrome.

    PubMed

    Moreira, Isabel; Teixeira, Filipa; Martins Silva, Ana; Vasconcelos, Carlos; Farinha, Fátima; Santos, Ernestina

    2015-02-01

    Primary Sjögren syndrome (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the salivary and tear glands, and autoantibody secretion, in the absence of other systemic autoimmune disorder. Among autoimmune diseases, it is a relatively common disease, but the burden of central nervous system (CNS) involvement is controversial. This retrospective study evaluates the prevalence, clinical patterns and outcomes of CNS involvement in a cohort of patients with primary Sjögren syndrome. We evaluated 93 patients with pSS diagnosed according to American-European Consensus Group criteria. Fourteen patients (15.1 %) had CNS involvement. All were women with an average age of onset of the disease of 42.1 ± 14.7 years (average ± SD) and an average age of onset of neurological involvement of 47.29 ± 16 years. Three had parkinsonian syndrome, two epilepsy, two motor and sensory deficits, two headache with brain magnetic resonance abnormalities, two neuromyelitis optica, two chronic progressive myelitis and one aseptic meningitis. Neurological involvement preceded Sjögren syndrome diagnosis in nine of the patients (64 %), and neurological outcome was good in 11 patients (78.6 %). Central nervous involvement was not as rare as expected, and the frequency was similar to the frequency of peripheral nervous system involvement. In half of the patients, this was the first symptom of the disease, emphasizing the importance of considering this diagnosis, especially in young female with neurological symptoms without other evident cause.

  11. EHR systems in the Spanish Public Health National System: the lack of interoperability between primary and specialty care.

    PubMed

    de la Torre-Díez, Isabel; González, Sandra; López-Coronado, Miguel

    2013-02-01

    One of the problems of the Spanish Public Health National System is the lack of interoperability in the implemented Electronic Health Records (EHRs) systems in primary and specialty care. There is a deficiency in the electronic health systems that store the data of primary care patients, so one of the basic problems that prevent that every hospital and health center working on the same method is that deficiency. In this paper we research on this problem and to give expression to a series of solutions to it. Bibliographic material in this work has been obtained mainly from MEDLINE source. Additionally, due to the lack of information and privacy about the different EHRs systems, we have resorted to making direct contact with the organizations that have implemented those systems and technological providers. Two solutions have been propounded given several aspects for a feasibility study. The first solution is based upon in the execution of backups in different EHRs databases, which implies a huge economical and infrastructure development. The second of these solutions so that due to the creation of protocols by means of Cloud Computing Technologies. It is crucial the need to reach a homogeneity concerning to the storage of patients clinical data. On the results achieved we can emphasize that maybe the main problems are not the economical handicaps or the large technological development needed, but, as for Health each Region manages its own competences, each one governs with independent policies and decisions.

  12. [Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

    PubMed

    Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

    2016-01-01

    To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  13. Predicting length of stay from an electronic patient record system: a primary total knee replacement example.

    PubMed

    Carter, Evelene M; Potts, Henry W W

    2014-04-04

    To investigate whether factors can be identified that significantly affect hospital length of stay from those available in an electronic patient record system, using primary total knee replacements as an example. To investigate whether a model can be produced to predict the length of stay based on these factors to help resource planning and patient expectations on their length of stay. Data were extracted from the electronic patient record system for discharges from primary total knee operations from January 2007 to December 2011 (n=2,130) at one UK hospital and analysed for their effect on length of stay using Mann-Whitney and Kruskal-Wallis tests for discrete data and Spearman's correlation coefficient for continuous data. Models for predicting length of stay for primary total knee replacements were tested using the Poisson regression and the negative binomial modelling techniques. Factors found to have a significant effect on length of stay were age, gender, consultant, discharge destination, deprivation and ethnicity. Applying a negative binomial model to these variables was successful. The model predicted the length of stay of those patients who stayed 4-6 days (~50% of admissions) with 75% accuracy within 2 days (model data). Overall, the model predicted the total days stayed over 5 years to be only 88 days more than actual, a 6.9% uplift (test data). Valuable information can be found about length of stay from the analysis of variables easily extracted from an electronic patient record system. Models can be successfully created to help improve resource planning and from which a simple decision support system can be produced to help patient expectation on their length of stay.

  14. EVALUATION OF BEST AVAILABLE CONTROL TECHNOLOGY FOR TOXICS -TBACT- DOUBLE SHELL TANK FARMS PRIMARY VENTILATION SYSTEMS SUPPORTING WASTE TRANSFER OPERATIONS

    SciTech Connect

    HAAS CC; KOVACH JL; KELLY SE; TURNER DA

    2010-06-24

    This report is an evaluation of Best Available Control Technology for Toxics (tBACT) for installation and operation of the Hanford double shell (DST) tank primary ventilation systems. The DST primary ventilation systems are being modified to support Hanford's waste retrieval, mixing, and delivery of single shell tank (SST) and DST waste through the DST storage system to the Waste Treatment and Immobilizaiton Plant (WTP).

  15. EVALUATION OF BEST AVAILABLE CONTROL TECHNOLOGY FOR TOXICS (TBACT) DOUBLE SHELL TANK FARMS PRIMARY VENTILATION SYSTEM SUPPORTING WASTE TRANSFER OPERATIONS

    SciTech Connect

    KELLY SE; HAASS CC; KOVACH JL; TURNER DA

    2010-06-03

    This report is an evaluation of Best Available Control Technology for Toxics (tBACT) for installation and operation of the Hanford double shell (DST) tank primary ventilation systems. The DST primary ventilation systems are being modified to support Hanford's waste retrieval, mixing, and delivery of single shell tank (SST) and DST waste throught the DST storage system to the Waste Treatment and Immobilization Plant (WTP).

  16. The W. M. Keck Telescope segmented primary mirror active control system software

    SciTech Connect

    Cohen, R.W. California Association for Research in Astronomy, Kamuela, HI ); Andreae, S.; Biocca, A.K.; Jared, R.C.; Llacer, J.; Meng, J.D.; Minor, R.H.; Orayani, M. )

    1989-07-01

    The active control system (ACS) uses both parallel and distributed processing techniques to measure and control the positions of the 36 segments of the Keck Observatory Telescope primary mirror. The main function of the software is to maintain the mirror figure; to accomplish this goal the software uses a predictive, feed-forward'' mechanism which effectively increases the system bandwidth for the most important sources of perturbation. The software executes on a set of twelve 68000-family processors under the supervision of a VAX workstation. An array of nine parallel I/O processors collect and process data from 168 displacement sensors and transmit motion commands to 108 actuators. Three additional processors simultaneously compute actuator commands, monitor system performance, compute sensor control parameters and communicate with other observatory computers. The software is highly optimized for speed. 6 refs., 7 figs.

  17. The Simplest Chronoscope V: A Theory of Dual Primary and Secondary Reaction Time Systems.

    PubMed

    Montare, Alberto

    2016-12-01

    Extending work by Montare, visual simple reaction time, choice reaction time, discriminative reaction time, and overall reaction time scores obtained from college students by the simplest chronoscope (a falling meterstick) method were significantly faster as well as significantly less variable than scores of the same individuals from electromechanical reaction timers (machine method). Results supported the existence of dual reaction time systems: an ancient primary reaction time system theoretically activating the V5 parietal area of the dorsal visual stream that evolved to process significantly faster sensory-motor reactions to sudden stimulations arising from environmental objects in motion, and a secondary reaction time system theoretically activating the V4 temporal area of the ventral visual stream that subsequently evolved to process significantly slower sensory-perceptual-motor reactions to sudden stimulations arising from motionless colored objects.

  18. Heat transfer characteristics of current primary packaging systems for pharmaceutical freeze-drying.

    PubMed

    Hibler, Susanne; Gieseler, Henning

    2012-11-01

    In the field of freeze-drying, the primary packaging material plays an essential role. Here, the packaging system not only contains and protects the drug product during storage and shipping, but it is also directly involved in the freeze-drying process itself. The heat transfer characteristics of the actual container system influence product temperature and therefore product homogeneity and quality as well as process performance. Consequently, knowledge of the container heat transfer characteristics is of vital importance for process optimization. It is the objective of this review article to provide a summary of research focused on heat transfer characteristics of different container systems for pharmaceutical freeze-drying. Besides the common tubing and molded glass vials and metal trays, more recent packaging solutions like polymer vials, LYOGUARD® trays, syringes, and blister packs are discussed. Recent developments in vial manufacturing are also taken into account.

  19. Primary central nervous system lymphoma mimicking recurrent depressive disorder: A case report

    PubMed Central

    LIU, WEIBO; XUE, JING; YU, SHAOHUA; CHEN, QIAOZHEN; LI, XIUZHEN; YU, RISHENG

    2015-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma, which is limited to the central nervous system. Few studies are available reporting psychiatric symptoms as the initial and dominant presentation of PCNSL. The current study reports the case of a PCNSL patient with a history of major depressive disorder and coexisting rheumatoid arthritis (treated with methotrexate), who initially presented with recurrent depressive disorder that showed no response to antidepressant drug therapy. Magnetic resonance imaging revealed multiple mass lesions in the brain, and pathological examination of the biopsy confirmed the diagnosis of diffuse large B cell lymphoma of the central nervous system. The present case demonstrated that PCNSL may affect mood in the early stages of the disease and thus, clinicians must be aware of this manifestation in patients with depressive disorder co-existing with immunosuppressive conditions, as early detection and appropriate treatment are important prognostic factors for PCNSL. PMID:25789049

  20. Not lost in translation: generalization of the primary systems hypothesis to Japanese-specific language processes.

    PubMed

    Ueno, Taiji; Saito, Satoru; Saito, Akie; Tanida, Yuki; Patterson, Karalyn; Lambon Ralph, Matthew A

    2014-02-01

    The emergentist-connectionist approach assumes that language processing reflects interaction between primary neural systems (Primary Systems Hypothesis). This idea offers an overarching framework that generalizes to various kinds of (English) language and nonverbal cognitive activities. The current study advances this approach with respect to language in two new and important ways. The first is the provision of a neuroanatomically constrained implementation of the theory. The second is a test of its ability to generalize to a language other than English (in this case Japanese) and, in particular, to a feature of that language (pitch accent) for which there is no English equivalent. A corpus analysis revealed the presence and distribution of typical and atypical accent forms in Japanese vocabulary, forming a quasiregular domain. Consequently, according to the Primary Systems Hypothesis, there should be a greater semantic impact on the processing of words with an atypical pitch accent. In turn, when word meaning is intrinsically less rich (e.g., abstract words), speakers should be prone to regularization errors of pitch accent. We explored these semantic-phonological interactions, first, in a neuroanatomically constrained, parallel-distributed processing model of spoken language processing. This model captured the accent typicality effect observed in nonword repetition in Japanese adults and children and exhibited the predicted semantic impact on repetition of words with atypical accent patterns. Second, also as predicted, in word repetition and immediate serial recall of spoken words, human participants exhibited reduced pitch-accent accuracy and/or slower RT for low imageability words with atypical accent patterns, and they generated accent errors reflecting the more typical accent patterns found in Japanese.

  1. A population management system for improving colorectal cancer screening in a primary care setting.

    PubMed

    Wu, Charlotte A; Mulder, Amara L; Zai, Adrian H; Hu, Yuanshan; Costa, Manuela; Tishler, Lori Wiviott; Saltzman, John R; Ellner, Andrew L; Bitton, Asaf

    2016-06-01

    Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors. Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines. A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls. Six suites within an academic primary care practice. 5320 adults eligible for CRC screening treated by 70 doctors. In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices. CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months. At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group. A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes. © 2015 John Wiley & Sons, Ltd.

  2. System facilitators and barriers to discussing older driver safety in primary care settings

    PubMed Central

    Betz, Marian E.; Jones, Jacqueline; Carr, David B.

    2015-01-01

    Background Primary care physicians play a leading role in counseling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. Objective To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a program supporting routine conversations. Methods This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. Results From fifteen interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterized their experiences in terms of current and ideal states. Conclusions Physicians have been tasked with assessing older driver safety and guiding older patients through the process of “driving retirement.” Attention to system-level factors such as provider roles, resources, and training can support them in this process. PMID:25617342

  3. Envisioning a Learning Health Care System: The Electronic Primary Care Research Network, A Case Study

    PubMed Central

    Delaney, Brendan C.; Peterson, Kevin A.; Speedie, Stuart; Taweel, Adel; Arvanitis, Theodoros N.; Hobbs, F. D. Richard

    2012-01-01

    PURPOSE The learning health care system refers to the cycle of turning health care data into knowledge, translating that knowledge into practice, and creating new data by means of advanced information technology. The electronic Primary Care Research Network (ePCRN) was a project, funded by the US National Institutes of Health, with the aim to facilitate clinical research using primary care electronic health records (EHRs). METHODS We identified the requirements necessary to deliver clinical studies via a distributed electronic network linked to EHRs. After we explored a variety of informatics solutions, we constructed a functional prototype of the software. We then explored the barriers to adoption of the prototype software within US practice-based research networks. RESULTS We developed a system to assist in the identification of eligible cohorts from EHR data. To preserve privacy, counts and flagging were performed remotely, and no data were transferred out of the EHR. A lack of batch export facilities from EHR systems and ambiguities in the coding of clinical data, such as blood pressure, have so far prevented a full-scale deployment. We created an international consortium and a model for sharing further ePCRN development across a variety of ongoing projects in the United States and Europe. CONCLUSIONS A means of accessing health care data for research is not sufficient in itself to deliver a learning health care system. EHR systems need to use sophisticated tools to capture and preserve rich clinical context in coded data, and business models need to be developed that incentivize all stakeholders from clinicians to vendors to participate in the system. PMID:22230831

  4. Combined systemic and intraventricular chemotherapy in primary CNS lymphoma: a pilot study

    PubMed Central

    Schlegel, U; Pels, H; Glasmacher, A; Kleinschmidt, R; Schmidt-Wolf, I; Helmstaedter, C; Fliessbach, K; Deckert, M; Van Roost, D; Fimmers, R; Bode, U; Klockgether, T

    2001-01-01

    The objective was to evaluate response rate, response duration, and toxicity after systemic and intraventricular chemotherapy in primary CNS lymphoma (PCNSL).
 From September 1995 to September 1998, 20 consecutive patients with PCNSL (median age 64, range 27 to 71 years) were enrolled in a pilot study evaluating chemotherapy without radiotherapy. A high dose methotrexate (MTX) (cycles 1, 2, 4, 5) and cytarabine (ara-C) (cycles 3, 6) based systemic therapy (including dexamethasone, vinca alkaloids, ifosfamide, and cyclophosphamide) was combined with intraventricular MTX, prednisolone, and ara-C.
 Complete response was achieved in 11 and partial remission in two patients; in one response could not be determined. Four patients showed progressive disease and two (70, 71 years) died from treatment related complications. Observation time was 2 to 59 months (median 31.5 months). Kaplan-Meier estimate for median time to treatment failure (TTF) was 20.5 months, and for median survival 54 months. Systemic toxicity was mainly hematological. Ommaya reservoir infection occurred in four patients and acute transient MTX induced encephalopathy in two (subacute in another). Cognitive dysfunction possibly due to treatment was seen in only one patient after relapse and after a total of 12 cycles (six at relapse).
 In conclusion, primary chemotherapy based on high dose MTX and ara-C is highly efficient in PCNSL. Toxicity is manageable in patients younger than 70years.

 PMID:11413277

  5. Peripheral nervous system involvement in primary burning mouth syndrome--results of a pilot study.

    PubMed

    Puhakka, A; Forssell, H; Soinila, S; Virtanen, A; Röyttä, M; Laine, M; Tenovuo, O; Teerijoki-Oksa, T; Jääskeläinen, S K

    2016-05-01

    The pathophysiology of primary burning mouth syndrome (BMS) has remained enigmatic, but recent studies suggest pathology within the nervous system at multiple levels. This study aimed to investigate in detail the contribution of either focal or generalized alterations within the peripheral nervous system (PNS) in the etiopathogenesis of BMS. Intraepithelial nerve fiber density (IENFD) of tongue mucosa was assessed in 10 carefully characterized BMS, and the results were compared to 19 age- and gender-matched cadaver controls, 6 with lifetime diabetes. Extensive neurophysiologic and psychophysical examinations of the trigeminal system and distal extremities were performed to profile PNS function in BMS. Patients with BMS had significantly fewer intraepithelial nerve fibers (0,27, s.e. 0,18 mm(-1); P = 0.0253) than non-diabetic controls (0,92, s.e. 0,15 mm(-1)). In the subepithelial space, the amount of nerve fibers did not differ between the groups. The majority (9/10) of patients with BMS showed neurophysiologic or psychophysical signs of a more generalized PNS dysfunction. Our results in neurophysiologically optimally characterized BMS patients confirm that pure focal small fiber neuropathy of the oral mucosa has a role in the pathophysiology of primary BMS. Furthermore, BMS may be related to a more generalized, yet subclinical peripheral neuropathy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Work stress of primary care physicians in the US, UK and German health care systems.

    PubMed

    Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

    2010-07-01

    Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions.

  7. A Case of Primary Central Nervous System Lymphoma Located at Brain Stem in a Child

    PubMed Central

    Kim, Jinho

    2016-01-01

    Primary central nervous system lymphoma (PCNSL) is an extranodal Non-Hodgkin's lymphoma that is confined to the brain, eyes, and/or leptomeninges without evidence of a systemic primary tumor. Although the tumor can affect all age groups, it is rare in childhood; thus, its incidence and prognosis in children have not been well defined and the best treatment strategy remains unclear. A nine-year old presented at our department with complaints of diplopia, dizziness, dysarthria, and right side hemiparesis. Magnetic resonance image suggested a diffuse brain stem glioma with infiltration into the right cerebellar peduncle. The patient was surgically treated by craniotomy and frameless stereotactic-guided biopsy, and unexpectedly, the histopathology of the mass was consistent with diffuse large B cell lymphoma, and immunohistochemical staining revealed positivity for CD20 and CD79a. Accordingly, we performed a staging work-up for systemic lymphoma, but no evidence of lymphoma elsewhere in the body was obtained. In addition, she had a negative serologic finding for human immunodeficient virus, which confirmed the histopathological diagnosis of PCNSL. She was treated by radiosurgery at 12 Gy and subsequent adjuvant combination chemotherapy based on high dose methotrexate. Unfortunately, 10 months after the tissue-based diagnosis, she succumbed due to an acute hydrocephalic crisis. PMID:27867930

  8. Primary melanocytic tumors of the central nervous system: a review with focus on molecular aspects.

    PubMed

    Küsters-Vandevelde, Heidi V N; Küsters, Benno; van Engen-van Grunsven, Adriana C H; Groenen, Patricia J T A; Wesseling, Pieter; Blokx, Willeke A M

    2015-03-01

    Primary melanocytic tumors of the central nervous system (CNS) represent a spectrum of rare tumors. They can be benign or malignant and occur in adults as well as in children, the latter often in the context of neurocutaneous melanosis. Until recently, the genetic alterations in these tumors were largely unknown. This is in contrast with cutaneous and uveal melanomas, which are known to harbor distinct oncogenic mutations that can be used as targets for treatment with small-molecule inhibitors in the advanced setting. Recently, novel insights in the molecular alterations underlying primary melanocytic tumors of the CNS were obtained, including different oncogenic mutations in tumors in adult patients (especially GNAQ, GNA11) vs. children (especially NRAS). In this review, the focus is on molecular characteristics of primary melanocytic tumors of the CNS. We summarize what is known about their genetic alterations and discuss implications for pathogenesis and differential diagnosis with other pigmented tumors in or around the CNS. Finally, new therapeutic options with targeted therapy are discussed. © 2014 International Society of Neuropathology.

  9. Increasing capacity for innovation in bureaucratic primary care organizations: a whole system participatory action research project.

    PubMed

    Thomas, Paul; McDonnell, Juliet; McCulloch, Janette; While, Alison; Bosanquet, Nick; Ferlie, Ewan

    2005-01-01

    We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs). Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context. Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these "learning spaces"; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits. These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights.

  10. Primary lymphoma of the central nervous system and HTLV-I infection.

    PubMed

    Calderón, Enrique J; Japón, Miguel A; Chinchón, Isidoro; Soriano, Vicente; Capote, Francisco J

    2002-01-01

    Only a few cases of AIDS-related primary lymphomas of the central nervous system (CNS) show a T-cell phenotype. We have recently studied two intravenous drug users with HIV infection who had primary CNS T-cell lymphomas. In both cases, the enzyme immunoassay (EIA) for HTLV gave a positive result. In the first case, study by western-blot (WB) and specific PCR confirmed the human T-cell lymphotropic virus type I (HTLV-I) infection and serological study by EIA for HTLV of his mother was negative. In the second case, analysis of ante-mortem serum samples by two different WBs showed an indeterminate pattern suggestive of HTLV-I infection, but adequate samples for PCR were not available. We speculate about the possibility that the horizontal transmission of HTLV-I infection could have facilitated the devepolment of a primary CNS T-cell lymphoma in these HIV patients, although they cannot be strictly considered as ATLL cases.

  11. Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

    PubMed

    Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

    2015-01-01

    Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

  12. Use of an appendicitis medical information sheet in the pediatric primary care system.

    PubMed

    Oyachi, Noboru; Yagasaki, Hideaki; Suzuki, Takeyuki; Higashida, Kosuke; Komai, Takayuki; Hasuda, Norio; Takano, Kunio; Obana, Kazuko

    2016-10-01

    Accurate and prompt diagnosis is required for the primary evaluation of pediatric appendicitis. Among pediatricians and surgeons working in Yamanashi Prefecture, the pediatric appendicitis medical information (PAMI) sheet was edited in April 2011 to reflect the diagnostic results of the pediatric primary and emergency medical service and used as a referral document for surgical consultation to secondary hospitals. The PAMI sheet consisted of sections for history taking, symptoms, physical signs and laboratory findings without a scoring system. For 32 consecutive months starting in April 2011, 59 patients hospitalized for suspected appendicitis were retrospectively reviewed. In particular, a total of 17 referral patients evaluated with the PAMI sheet were assessed in order to evaluate the utility of the form. The pediatric surgeons were able to easily determine patient condition from the PAMI sheet. In total, 13 of 17 patients had appendicitis. According to the physical findings of the 17 studied patients, the judgment of right lower quadrant tenderness (κ = 0.63) and guarding (κ = 1.00) was consistent between the pediatric surgeons and primary attending pediatricians. The PAMI sheet aids in the collection of detailed history and objective data with a high level of accuracy, and provides useful referral diagnostic information to the secondary-level hospitals. © 2016 Japan Pediatric Society.

  13. Measuring access to primary medical care: some examples of the use of geographical information systems.

    PubMed

    Parker, E B; Campbell, J L

    1998-06-01

    This paper explores the potential for geographical information system technology in defining some variables influencing the use of primary care medical services. Eighteen general practices in Scotland contributed to a study examining the accessibility of their services and their patients' use of the local Accident and Emergency Department. Geo-referencing of information was carried out through analysis of postcode data relating to practices and patients. This information was analyzed using ARC/INFO GIS software in conjunction with the ORACLE relational database and 1991 census information. The results demonstrate that GIS technology has an important role in defining and analyzing the use of health services by the population.

  14. Automated Finite Element Analysis of Complex Dynamics of Primary System Traversed by Oscillatory Subsystem

    NASA Astrophysics Data System (ADS)

    Saleeb, Atef F.; Kumar, Abhimanyu

    2011-07-01

    The extensive literature on a particular dynamics problem, the bridge-vehicle-interaction, has provided insights and understanding of the many complex issues involved, but the mathematical and numerical work reported remained too highly specialized for practicing engineers. In particular, the use of standard FEA packages is virtually nonexistent. To this end, we propose an alternative approach by considering the primary and secondary systems as deformable solids, undergoing large, overall relative sliding motion. This will directly account for important convective accelerations, and the possible contact/separation. The versatility of the proposed strategy has been demonstrated by the solution of an extensive number of benchmark problems.

  15. NOA-03 trial of high-dose methotrexate in primary central nervous system lymphoma: final report.

    PubMed

    Herrlinger, Ulrich; Küker, Wilhelm; Uhl, Martin; Blaicher, Hans-Peter; Karnath, Hans-Otto; Kanz, Lothar; Bamberg, Michael; Weller, Michael

    2005-06-01

    The NOA-03 trial explored high-dose methotrexate alone in 37 patients with primary central nervous system lymphoma. The overall median survival was 25 months. After 4 years, the rate of leukoencephalopathy in patients surviving more than 12 months was 58% with and 10% without whole-brain radiotherapy given at relapse (p = 0.11). Attention deficits were found in all six tested patients, and memory deficits in four patients. Two patients had normal, three had moderately restricted, and one had markedly restricted quality of life. Thus, high-dose methotrexate with deferred radiotherapy had only moderate efficacy and was associated with significant neurotoxicity in long-term surviving patients.

  16. Thermal Analysis of the Divertor Primary Heat Transfer System Piping During the Gas Baking Process

    SciTech Connect

    Yoder Jr, Graydon L; Harvey, Karen; Ferrada, Juan J

    2011-02-01

    A preliminary analysis has been performed examining the temperature distribution in the Divertor Primary Heat Transfer System (PHTS) piping and the divertor itself during the gas baking process. During gas baking, it is required that the divertor reach a temperature of 350 C. Thermal losses in the piping and from the divertor itself require that the gas supply temperature be maintained above that temperature in order to ensure that all of the divertor components reach the required temperature. The analysis described in this report was conducted in order to estimate the required supply temperature from the gas heater.

  17. Feasibility of using a knowledge-based system concept for in-flight primary-flight-display research

    NASA Technical Reports Server (NTRS)

    Ricks, Wendell R.

    1991-01-01

    Flight test results have been obtained which demonstrate the feasibility and desirability of using knowledge-based systems architectures for flight test investigations of primary flight display information management-related issues. LISP-based software was used for real-time operation of the primary flight display. The two integrated knowledge-based systems designed to control the primary flight displays were implemented aboard a NASA-Langley B-737. The programmer is noted to be capable of more easily developing initial systems via the present method than with more conventional techniques.

  18. Embedding effective depression care: using theory for primary care organisational and systems change.

    PubMed

    Gunn, Jane M; Palmer, Victoria J; Dowrick, Christopher F; Herrman, Helen E; Griffiths, Frances E; Kokanovic, Renata; Blashki, Grant A; Hegarty, Kelsey L; Johnson, Caroline L; Potiriadis, Maria; May, Carl R

    2010-08-06

    care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression.

  19. Embedding effective depression care: using theory for primary care organisational and systems change

    PubMed Central

    2010-01-01

    agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. Conclusions Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression. PMID:20687962

  20. Opportunities and Gaps in Primary Care Preventative Health Services for Transgender Patients: A Systemic Review

    PubMed Central

    Edmiston, E. Kale; Donald, Cameron A.; Sattler, Alice Rose; Peebles, J. Klint; Ehrenfeld, Jesse M.; Eckstrand, Kristen Laurel

    2016-01-01

    Abstract Purpose: Transgender people face barriers to accessing healthcare, resulting in population-level disparities in health outcomes. Little research is available to better understand the receipt of primary healthcare among transgender patients or how the rate of receipt of preventive care may differ among transgender populations. Methods: The medical literature regarding U.S. adult transgender primary healthcare was reviewed using a keyword search strategy: transgender OR transsexual OR transvestite OR gender nonconforming for articles published between January 1, 2001 and June 15, 2015. Studies addressing the following topics as assessed by the Behavioral Risk Factor Surveillance System were extracted for qualitative review: colorectal cancer screenings, mammography or chest/breast tissue examinations, cholesterol and blood pressure screenings, tobacco use and smoking cessation, cervical cancer or human papillomavirus (HPV) screenings, human immunodeficiency virus (HIV), annual flu shot, and insurance coverage. Results: The search identified 1304 eligible records, of which 41 discussed transgender primary or preventive care. The majority of studies discussed HIV rates or risk behaviors, while fewer articles addressed pelvic examinations, tobacco use, insurance coverage, and cholesterol screenings. No studies addressed mammography or chest/breast tissue examinations, colorectal screenings, or flu shots. Conclusions: Findings from articles addressing five topics are discussed: HIV, cholesterol screenings, tobacco use, pelvic health, and insurance coverage. Gaps in the extant literature, including the lack of studies of nonbinary people, transgender men of color, and transgender people living outside of large coastal urban centers, are discussed. This review, coincident with other health disparity findings, suggests an urgent need for research that addresses the primary care needs of all transgender and gender nonconforming people. PMID:28861536

  1. Programmed Approach vs. Conventional Approach Using highly Consistent Sound-Symbol System of Reading in Three Primary Grades.

    ERIC Educational Resources Information Center

    Shore, Robert Eugene

    The effects of two primary reading programs using a programed format (with and without audio-supplement) and a conventional format (the program format deprogramed) in a highly consistent sound-symbol system of reading at three primary grade levels were compared, using a pretest, post-test control group design. The degree of suitability of…

  2. [Primary care pediatrics in the public health system of the twenty-first century. SESPAS report 2012].

    PubMed

    Domínguez Aurrecoechea, Begoña; Valdivia Jiménez, Carlos

    2012-03-01

    Today in our country, the primary care pediatrician is the first contact between children and adolescents with the health system, being also a highly resolving specialist that addresses over 90% of the health needs of this population, monitors growth and development and participates in all activities of prevention, health promotion and health education within primary care teams with nurses and family doctors. Witnessing rapid and profound demographic, social, cultural, scientific and technological changes as well as the demands and expectations of health care for citizens, which should enhance the value and response capacity of primary care. These changes also affect infant morbidity and health care priorities in child and adolescent, posing new challenges for primary care practice and reinforce the role of the pediatrician in primary care. Primary care is not only the gateway to the health system. Primary care teams have to take responsibility for the care of people assigned to coordinate the necessary resources and advising citizens on their health problems and his itinerary care by the health system. It identifies the need to foster teamwork within the health department involved nursing staff to take care activities in this age group. It aims to foster a model based on cooperation and complementarity. A recent systematic review recommended maintaining the figure of the pediatrician in primary care teams and strengthen their specific role as first point of contact with the child's health care system, found significant benefits for children. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  3. Bonding of simplified adhesive systems to caries-affected dentin of primary teeth.

    PubMed

    Alves, Fabiana Bucholdz; Lenzi, Tathiane Larissa; Reis, Alessandra; Loguercio, Alessandro D; Carvalho, Thiago Saads; Raggio, Daniela Prócida

    2013-10-01

    To evaluate the bonding of simplified adhesive systems to sound and caries-affected dentin of primary teeth with microtensile (µTBS) and nanoleakage (NL) tests. Occlusal cavities were prepared in 36 sound second primary molars. Half of the specimens were submitted to pH cycling to simulate caries-affected dentin. Teeth were randomly restored with one of three materials: the etch-and-rinse adhesive system Adper Single Bond 2 (SB), the two-step self-etching adhesive system Adper SE Plus (SE), and the one-step self-etching adhesive system Adper Easy One (EASY). After storage for 24 h, specimens with cross-sectional areas of 0.8 mm2 were prepared for microtensile testing (1 mm/min). One stick from each tooth was immersed in silver nitrate solution (24 h) and allowed to develop for 8 h in order to score the nano leakage with SEM. The fracture pattern was evaluated using a stereomicroscope (400X). The µTBS means were analyzed by two-way ANOVA and Tukey's post-hoc test. For NL, the Kruskal- Wallis and Mann-Whitney tests were used (α < 0.05). SB (35.5 ± 3.5) showed the highest µTBS value to sound dentin, followed by EASY (26.3 ± 1.9) and SE (18.2 ± 6.5) (p < 0.05). No difference among materials was observed for caries-affected dentin (SB: 17.8 ± 4.2; SE: 13.9 ± 3.2; EASY: 14.4 ± 4.2, p > 0.05). For all groups, adhesive/mixed fracture prevailed. Caries affected dentin promoted silver nitrate uptake into the adhesive interface; however, with SE, the nano leakage was more pronounced than in the other adhesive systems, even in sound dentin. Caries-affected dentin negatively influences the bond strength and nano leakage of the two-step etch-and-rinse and one-step self-etching adhesive systems tested in primary teeth.

  4. Evaluation of computerized health management information system for primary health care in rural India

    PubMed Central

    2010-01-01

    Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision. PMID:21078203

  5. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    PubMed Central

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  6. Educational potential of a virtual patient system for caring for traumatized patients in primary care

    PubMed Central

    2013-01-01

    Background Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system’s usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on

  7. Development of a computerised decisions support system for renal risk drugs targeting primary healthcare

    PubMed Central

    Helldén, Anders; Al-Aieshy, Fadiea; Bastholm-Rahmner, Pia; Bergman, Ulf; Gustafsson, Lars L; Höök, Hans; Sjöviker, Susanne; Söderström, Anders; Odar-Cederlöf, Ingegerd

    2015-01-01

    Objectives To assess general practitioners (GPs) experience from the implementation and use of a renal computerised decision support system (CDSS) for drug dosing, developed for primary healthcare, integrated into the patient’s electronic health record (EHR), and building on estimation of the patient's creatinine clearance (ClCG). Design Qualitative research design by a questionnaire and a focus group discussion. Setting and participants Eight GPs at two primary healthcare centres (PHCs). Interventions The GP at PHC 1, and the project group, developed and tested the technical solution of the CDSS. Proof-of-concept was tested by seven GPs at PHC 2. They also participated in a group discussion and answered a questionnaire. A web window in the EHR gave drug and dosage in relation to ClCG. Each advice was according to three principles: If? Why? Because. Outcome measures (1) The GPs’ experience of ‘easiness to use’ and ‘perceived usefulness’ at PHC 2, based on loggings of use, answers from a questionnaire using a 5-point Likert scale, and answers from a focus group discussion. (2) The number of patients aged 65 years and older with an estimation of ClCG before and after the implementation of the CDSS. Results The GPs found the CDSS fast, simple and easy to use. They appreciated the automatic presentation of the CICG status on opening the medication list, and the ability to actively look up specific drug recommendations in two steps. The CDSS scored high on the Likert scale. All GPs wanted to continue the use of the CDSS and to recommend it to others. The number of patients with an estimated ClCG increased 1.6-fold. Conclusions Acceptance of the simple graphical interface of this push and pull renal CDSS was high among the primary care physicians evaluating this proof of concept. The graphical model should be useful for further development of renal decision support systems. PMID:26150141

  8. Primary Nonadherence to Overactive Bladder Medications in an Integrated Managed Care Health Care System.

    PubMed

    Rashid, Nazia; Vassilakis, Maria; Lin, Kathy J; Kristy, Rita; Ng, Daniel B

    2017-04-01

    Treatment for overactive bladder (OAB) remains suboptimal, in part because of patient nonadherence to medications. Primary nonadherence is when patients fail to pick up their initial prescriptions. To measure primary nonadherence to OAB medications within 30 days of a first OAB prescription order using electronic medical records from a U.S. managed care health care system METHODS: A retrospective cohort study was conducted using electronic medical records from the Kaiser Permanente Southern California (KPSC) database to identify patients with new OAB prescriptions between January 1, 2007, and December 31, 2013. The index date was defined as the first order of an OAB prescription. Patients had to be aged ≥ 18 years on the index date and were required to have 12 months of continuous membership with drug benefit eligibility before, during, and after the index date. Patients were defined as primary nonadherent if they did not pick up their new OAB prescriptions within 30 days of the order date. Descriptive statistics and a multivariable logistic regression analysis with backward selection were conducted to identify factors associated with patients who were primary nonadherent versus adherent. There were 9,050 patients with a new OAB prescription order; 1,662 (18%) of these were primary nonadherent. Patients with primary nonadherence were younger in age (56.9 [SD ± 16.0] years vs. 63.9 [SD ± 14.8] years; P < 0.001) and more likely to have commercial insurance (65.9% vs. 46.2%; P < 0.001). They also had lower mean Charlson Comorbidity Index (CCI) scores (1.99 vs. 2.70; P < 0.001), fewer OAB-related comorbidities, fewer concomitant medications (P < 0.005), and fewer overall prescriptions dispensed in the previous 12 months (P < 0.001) compared with adherent patients. Significant factors such as commercial insurance (P = 0.013), race other than white (P = 0.020), CCI = 0 versus CCI ≥ 2 (P = 0.001), urinary tract infections (P < 0.001), and falls (P = 0.047) were

  9. Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice.

    PubMed

    Schapira, Marilyn M; Sprague, Brian L; Klabunde, Carrie N; Tosteson, Anna N A; Bitton, Asaf; Chen, Jane S; Beaber, Elisabeth F; Onega, Tracy; MacLean, Charles D; Harris, Kimberly; Howe, Kathleen; Pearson, Loretta; Feldman, Sarah; Brawarsky, Phyllis; Haas, Jennifer S

    2016-10-01

    Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH). Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of

  10. Effect of Fluoride and Simplified Adhesive Systems on the Bond Strength of Primary Molars and Incisors.

    PubMed

    Firoozmand, Leily Macedo; Noleto, Lawanne Ellen Carvalho; Gomes, Isabella Azevedo; Bauer, José Roberto de Oliveira; Ferreira, Meire Coelho

    2015-01-01

    The aim of this study was evaluate in vitro the influence of simplified adhesive systems (etch-and-rinse and self-etching) and 1.23% acidulated phosphate fluoride (APF) on the microshear bond strength (μ-SBS) of composite resins on primary molars and incisors. Forty primary molars and forty incisors vestibular enamel was treated with either the self-etching Clearfil SE Bond (CSE, Kuraray) or etch-and-rinse Adper Single Bond 2 (SB2, 3M/ESPE) adhesive system. Each group was subdivided based on the prior treatment of the enamel with or without the topical application of 1.23% APF. Thereafter, matrices were positioned and filled with composite resin and light cured. After storage in distilled water at 37 ± 1°C for 24 h, the specimens were submitted to μ-SBS in a universal testing machine. Kruskal-Wallis and Mann-Whitney tests (p < 0.05) showed that the prior application of 1.23% APF led to a significant reduction in bond strength. The type of adhesive exerted no significant influence bond strength. In the inter-group analysis, however, significantly bond strength reduction was found for the incisors when CSE was employed with APF. Adhesive failure was the most common type of fracture. The bond strength was affected by the prior application of 1.23% APF and type of tooth.

  11. Modeling and Simulation of the ITER First Wall/Blanket Primary Heat Transfer System

    SciTech Connect

    Ying, Alice; Popov, Emilian L

    2011-01-01

    ITER inductive power operation is modeled and simulated using a thermal-hydraulics system code (RELAP5) integrated with a 3-D CFD (SC-Tetra) code. The Primary Heat Transfer System (PHTS) functions are predicted together with the main parameters operational ranges. The control algorithm strategy and derivation are summarized as well. The First Wall and Blanket modules are the primary components of PHTS, used to remove the major part of the thermal heat from the plasma. The modules represent a set of flow channels in solid metal structure that serve to absorb the radiation heat and nuclear heating from the fusion reactions and to provide shield for the vacuum vessel. The blanket modules are water cooled. The cooling is forced convective with constant blanket inlet temperature and mass flow rate. Three independent water loops supply coolant to the three blanket sectors. The main equipment of each loop consists of a pump, a steam pressurizer and a heat exchanger. A major feature of ITER is the pulsed operation. The plasma does not burn continuously, but on intervals with large periods of no power between them. This specific feature causes design challenges to accommodate the thermal expansion of the coolant during the pulse period and requires active temperature control to maintain a constant blanket inlet temperature.

  12. A Spanish version for the new ERA-EDTA coding system for primary renal disease.

    PubMed

    Zurriaga, Óscar; López-Briones, Carmen; Martín Escobar, Eduardo; Saracho-Rotaeche, Ramón; Moina Eguren, Íñigo; Pallardó Mateu, Luis; Abad Díez, José María; Sánchez Miret, José Ignacio

    2015-01-01

    The European Renal Association and the European Dialysis and Transplant Association (ERA-EDTA) have issued an English-language new coding system for primary kidney disease (PKD) aimed at solving the problems that were identified in the list of "Primary renal diagnoses" that has been in use for over 40 years. In the context of Registro Español de Enfermos Renales (Spanish Registry of Renal Patients, [REER]), the need for a translation and adaptation of terms, definitions and notes for the new ERA-EDTA codes was perceived in order to help those who have Spanish as their working language when using such codes. Bilingual nephrologists contributed a professional translation and were involved in a terminological adaptation process, which included a number of phases to contrast translation outputs. Codes, paragraphs, definitions and diagnostic criteria were reviewed and agreements and disagreements aroused for each term were labelled. Finally, the version that was accepted by a majority of reviewers was agreed. A wide agreement was reached in the first review phase, with only 5 points of discrepancy remaining, which were agreed on in the final phase. Translation and adaptation into Spanish represent an improvement that will help to introduce and use the new coding system for PKD, as it can help reducing the time devoted to coding and also the period of adaptation of health workers to the new codes. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

  13. Isolated primary central nervous system lymphoma arising from the optic chiasm.

    PubMed

    Vassal, F; Pommier, B; Boutet, C; Forest, F; Campolmi, N; Nuti, C

    2014-12-01

    A 58-year-old previously healthy woman rapidly developed progressive bilateral visual loss. Magnetic resonance imaging revealed a bulging appearance of the optic chiasm, with homogeneous enhancement after gadolinium administration, which suggested an optic glioma or inflammatory disease. In the absence of (para)clinical clues for a specific diagnosis despite extensive investigation, a biopsy of one optic nerve was performed, resulting in a diagnosis of non-Hodgkin B-cell lymphoma. There was no evidence of any other ocular or systemic involvement, therefore the conclusion was that this immunocompetent patient had a primary central nervous system lymphoma isolated in the anterior visual pathway. Treatment included two cycles of polychemotherapy (rituximab, methotrexate, carmustine, etoposide, methylprednisolone), followed by autologous peripheral blood stem cell transplantation and rituximab plus cytarabine consolidation therapy. Subsequently, the patient exhibited significant improvement in vision, and was still disease-free at the 1-year follow-up examination. The aim of the present paper was to provide well-documented clinical, radiological, and intraoperative features of isolated primary malignant lymphoma arising from the anterior visual pathway. A better recognition of this rare pathological entity is necessary for clinicians who may encounter similar presentations, as prompt management is crucial for both a visual and vital prognosis.

  14. Magnetic resonance features of primary central nervous system lymphoma in the immunocompetent patient: a pictorial essay.

    PubMed

    Yap, Kelvin K; Sutherland, Tom; Liew, Elaine; Tartaglia, Con J; Pang, Mei; Trost, Nick

    2012-04-01

    Primary central nervous system lymphoma (PCNSL) is an uncommon but important variant of non-Hodgkin lymphoma and represents up to 6% of all primary central nervous system (CNS) malignancies. Recognition of this entity by radiologist on MRI may avoid unnecessary neurosurgical resection and redirect to biopsy. The pretreatment MRI of patients with biopsy proven PCNSL from the last 5 years at our institution was reviewed. Selected examples were used to construct a pictorial essay to illustrate some of the typical and atypical MR features of PCNSL. MRI of other CNS conditions with imaging similarities to PCNSL was included to demonstrate possible mimics. The typical features of PCNSL lymphoma are intra-axial homogenous single or multiple contrast enhancing lesions, with marked surrounding oedema and restricted diffusion, usually contacting a cerebrospinal fluid (CSF) surface. Necrosis, peripheral enhancement, haemorrhage or calcification are unusual and other diagnoses should be considered if any of these features are present. Potential mimics include high grade glioma, infarcts, metastatic disease, demyelination, abscess and secondary lymphoma. Careful assessment of the MR features and correlation with the clinical findings should enable the radiologists to raise the possibility of PCNSL and minimise the risk of unnecessary resection. © 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.

  15. Psychosis in primary angiitis of the central nervous system involving bilateral thalami: a case report.

    PubMed

    Kim, Sangha; Kim, Doh Kwan

    2015-01-01

    To report a case of primary angiitis of the central nervous system (PACNS), a rare inflammatory disease restricted to the central nervous system (CNS), with unusual clinical presentation mimicking schizophrenia. Case report. A 45-year-old male presented with alteration of consciousness and confusion. Brain magnetic resonance imaging (MRI) scan showed a mass-like enhancing lesion involving bilateral thalami, and biopsy revealed findings compatible with PACNS. The patient was treated with corticosteroids. Psychotic symptoms crystallized over the initial 2 months after the diagnosis and persisted for over a year. Severity of his symptoms improved with gradual normalization of the radiologic findings and antipsychotic medication. Our case highlights the importance of considering PACNS as a differential diagnosis of a tumor-like mass lesion in the CNS and the significance of thalamic involvement in the pathogenesis of psychotic symptoms including delusions and hallucinations. Copyright © 2015. Published by Elsevier Inc.

  16. Development of Trace Contaminant Control Prototypes for the Primary Life Support System (PLSS)

    NASA Technical Reports Server (NTRS)

    Wojtowicz, Marek; Cosgrove, Joseph E.; Serio, Michael E.; Nalette, Tim; Guerrero, Sandra V.; Papale, William; Wilburn, Monique S.

    2017-01-01

    Results are presented on the development of Trace Contaminant Control (TCC) Prototypes for use in Extravehicular Activities (EVAs), and more specifically in the Primary Life Support System (PLSS). The current TC-control technology involves the use of a packed bed of acid-impregnated granular charcoal, which is non-regenerable, and the carbon-based sorbent under development in this project can be regenerated by exposure to vacuum at room temperature. Data on sorption and desorption of ammonia and formaldehyde, which are major TCs of concern, as well as pressure-drop calculations were used to design and test 1/6-scale and full-scale trace contaminant control system (TCCS) prototypes. Carbon sorbents were fabricated in both the granular and foam-supported forms. Sorbent performance was tested for ammonia sorption and vacuum regeneration in 1/6-scale, and pressure-drop characteristics were measured at flow rates relevant to the PLSS application.

  17. Distributed Hierarchical Control of Multi-Area Power Systems with Improved Primary Frequency Regulation

    SciTech Connect

    Lian, Jianming; Marinovici, Laurentiu D.; Kalsi, Karanjit; Du, Pengwei; Elizondo, Marcelo A.

    2012-12-12

    The conventional distributed hierarchical control architecture for multi-area power systems is revisited. In this paper, a new distributed hierarchical control architecture is proposed. In the proposed architecture, pilot generators are selected in each area to be equipped with decentralized robust control as a supplementary to the conventional droop speed control. With the improved primary frequency control, the system frequency can be restored to the nominal value without the help of secondary frequency control, which reduces the burden of the automatic generation control for frequency restoration. Moreover, the low frequency inter-area electromechanical oscillations can also be effectively damped. The effectiveness of the proposed distributed hierarchical control architecture is validated through detailed simulations.

  18. WWER Expert System for Fuel Failure Analysis Using Data on Primary Coolant Activity

    SciTech Connect

    Likhanskii, V.V.; Evdokimov, I.A.; Sorokin, A.A.; Khromov, A.G.; Kanukova, V.D.; Apollonova, O.V.; Ugryumov, A.V.

    2007-07-01

    The computer expert system for fuel failure analysis of WWER during operation is presented. The diagnostics is based on the measurement of specific activity of reference nuclides in reactor primary coolant and application of a computer code for the data interpretation. The data analysis includes an evaluation of tramp uranium mass in reactor core, detection of failures by iodine and caesium spikes, evaluation of burnup of defective fuel. Evaluation of defective fuel burnup was carried out by applying the relation of caesium nuclides activity in spikes and relations of activities of gaseous fission products for steady state operational conditions. The method of burnup evaluation of defective fuel by use of fission gas activity is presented in detail. The neural-network analysis is performed for determination of failed fuel rod number and defect size. Results of the expert system application are illustrated for several fuel campaigns on operating WWER NPPs. (authors)

  19. A Highly Practical Copper(I)/TEMPO Catalyst System for Chemoselective Aerobic Oxidation of Primary Alcohols

    PubMed Central

    Hoover, Jessica M.; Stahl, Shannon S.

    2011-01-01

    Aerobic oxidation reactions have been the focus of considerable attention, but their use in mainstream organic chemistry has been constrained by limitations in their synthetic scope and by practical factors, such as the use of pure O2 as the oxidant or complex catalyst synthesis. Here, we report a new (bpy)CuI/TEMPO catalyst system that enables efficient and selective aerobic oxidation of a broad range of primary alcohols, including allylic, benzylic and aliphatic derivatives, to the corresponding aldehydes using readily available reagents, at room temperature with ambient air as the oxidant. The catalyst system is compatible with a wide range of functional groups and the high selectivity for 1° alcohols enables selective oxidation of diols that lack protecting groups. PMID:21861488

  20. Highly practical copper(I)/TEMPO catalyst system for chemoselective aerobic oxidation of primary alcohols.

    PubMed

    Hoover, Jessica M; Stahl, Shannon S

    2011-10-26

    Aerobic oxidation reactions have been the focus of considerable attention, but their use in mainstream organic chemistry has been constrained by limitations in their synthetic scope and by practical factors, such as the use of pure O(2) as the oxidant or complex catalyst synthesis. Here, we report a new (bpy)Cu(I)/TEMPO catalyst system that enables efficient and selective aerobic oxidation of a broad range of primary alcohols, including allylic, benzylic, and aliphatic derivatives, to the corresponding aldehydes using readily available reagents, at room temperature with ambient air as the oxidant. The catalyst system is compatible with a wide range of functional groups and the high selectivity for 1° alcohols enables selective oxidation of diols that lack protecting groups.

  1. Invariant Functions, Symmetries and Primary Branch Solutions of First Order Autonomous Systems

    NASA Astrophysics Data System (ADS)

    Lou, Sen-Yue; Yao, Ruo-Xia

    2017-07-01

    An invariant function (IF) is defined as a multiplier of a symmetry that means a symmetry multiplied by an IF is still a symmetry. Primary branch solutions of arbitrary first order scalar systems can be obtained by means of the IF and its related symmetry approach. Especially, one recursion operator and some sets of infinitely many high order symmetries are also explicitly given for arbitrary (1+1)-dimensional first order autonomous systems. Because of the intrusion of the arbitrary function, various implicit special exact solutions can be found by fixing the arbitrary functions and selecting different seed solutions. Supported by the National Natural Science Foundations of China under Grant Nos. 11435005, 11471004, 11175092, and 11205092, Shanghai Knowledge Service Platform for Trustworthy Internet of Things No. ZF1213 and K. C. Wong Magna Fund in Ningbo University

  2. Primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome.

    PubMed

    Hammad, Tariq A; Hajj-Ali, Rula A

    2013-08-01

    Primary angiitis of the central nervous system (PACNS) is one of the most devastating pathologic processes that affect the central nervous system (CNS). It results in exclusive inflammation and destruction of CNS blood vessels. Progressive debilitating unexplained neurological deficit associated with abnormal cerebrospinal fluid (CSF) analysis findings is the typical picture of the disease. CNS biopsy is the gold standard diagnostic test. Immunosuppressive therapy is the core treatment. Reversible cerebral vasoconstriction syndrome (RCVS) is a main mimic of PACNS. RCVS is characterized clinically by recurrent thunderclap headache with or without neurological deficit and normal CSF analysis findings and angiographically by reversible diffuse segmental vasospasm of intracranial vessels. A stepwise diagnostic approach should be followed to differentiate PACNS from RCVS and exclude the other clinical, radiographic, and angiographic mimics.

  3. [Health situation assessment by primary care workers based on geographic information systems].

    PubMed

    Ritter, Fernando; Rosa, Roger dos Santos; Flores, Rui

    2013-12-01

    Primary healthcare has made little use of information systems to assess the population's health situation due to the difficulty in understanding the reports. Generic definitions of actions are common, based on empirical observations. The current study aimed to evaluate whether the introduction of georeferenced indicators can serve to better identify individuals' health situation, which would help planning actions by health teams. Healthcare workers from eight teams answered a questionnaire at three different moments: the first, before reading the information system's reports; the second after reading; and the third after using georeferencing. The results showed a significant difference in the classification of the health situation using georeferencing when compared to the previous moments (p < 0.05). Georeferencing facilitated analysis of the health situation, fostering better monitoring of work processes. Finally, use of the data points to rationalization of actions and possible upgrading of healthcare. The study suggests the use of georeferencing in the work agenda to become an effective tool for orienting actions.

  4. Systems for the management of respiratory disease in primary care - an international series: Australia.

    PubMed

    Glasgow, Nicholas

    2008-03-01

    Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis. Australia has a high prevalence of asthma. Respiratory-related encounters in general practice, including acute and chronic respiratory illness and influenza immunisations, account for 20.6% of general practice activity. Lung cancer is a rare disease in general practice. Tuberculosis is uncommon and most often found in people born outside of Australia. Aboriginal and Torres Strait Islanders have higher rates of asthma, smoking and tuberculosis. Access to care is positively influenced by substantial public funding underpinning both the private and public sectors through Medicare. Access to general practice care is negatively influenced by workforce shortages, the ongoing demands of acute care, and the incremental way in which system redesign is occurring in general practice. Most general practice operates from privately-owned rooms. The Australian Government requires general practice facilities to be accredited against certain standards in order for the practice to receive income from a number of

  5. [Management problems of improving the quality and efficiency of primary health care system of Georgia].

    PubMed

    Dzhakeli, I V; Edzhibadze, O I; Gerzmava, O Kh

    2009-01-01

    Improving the quality and efficiency of primary health care system is a key challenge. In this regard, problems that have accumulated in the system over the past decade - a weak material base of outpatient-polyclinic institutions, especially in rural areas; a surplus of medical personnel; lack of control by local, regional and central authorities--still remain as serious obstacle. The issue of financing the provided health services, is also particularly important, given the fact that a significant portion of the cost of medical services is covered by the patient directly. And as a consequence, the low level of applications for outpatient-polyclinic assistance due to declining affordability of medical services. In connection with the foregoing, the authors of the paper raise the question of implementing strict, multi-component system of quality control of medical care for patients. In particular, they propose: to base modern organization works on improving the quality of primary health care system on the principles of general management theory; Modern management of service quality should be clearly oriented towards the needs of the population in health care, its structure and dynamics; accessibility, incentives, determined by economic and technological competition characteristic to the market; Modern quality management, regardless of ownership and scale of outpatient-polyclinic establishment should optimally combine the actions, methods and tools that provide, on the one hand--the organization of diagnostic and therapeutic-prophylactic processes meeting the needs of the people, and on the other--the introduction of new methods and means to ensure the modern level of medical care; Schematic diagram of quality control mechanism organically interacts with the market research and includes a block of policy development in terms of quality.

  6. Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients.

    PubMed

    Mahale, Parag; Shiels, Meredith S; Lynch, Charles F; Engels, Eric A

    2017-08-14

    Primary central nervous system lymphoma (PCNSL) risk is greatly increased in immunosuppressed human immunodeficiency virus-infected people. Using data from the US transplant registry linked with 17 cancer registries (1987-2014), we studied PCNSL and systemic non-Hodgkin lymphoma (NHL) in 288 029 solid organ transplant recipients. Transplant recipients had elevated incidence for PCNSL compared with the general population (standardized incidence ratio = 65.1; N = 168), and this elevation was stronger than for systemic NHL (standardized incidence ratio=11.5; N = 2043). Compared to kidney recipients, PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [aIRR] = 0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients (aIRR = 2.45). PCNSL incidence was higher in Asians/Pacific Islanders than non-Hispanic whites (aIRR = 2.09); after induction immunosuppression with alemtuzumab (aIRR = 3.12), monoclonal antibodies (aIRR = 1.83), or polyclonal antibodies (aIRR = 2.03); in recipients who were Epstein-Barr virus-seronegative at the time of transplant and at risk of primary infection (aIRR = 1.95); and within the first 1.5 years after transplant. Compared to other recipients, those with PCNSL had increased risk of death (adjusted hazard ratio [aHR] = 11.79) or graft failure/retransplantation (aHR = 3.24). Recipients with PCNSL also had higher mortality than those with systemic NHL (aHR = 1.48). In conclusion, PCNSL risk is highly elevated among transplant recipients, and it carries a poor prognosis. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  7. Probability of pipe fracture in the primary coolant loop of a PWR plant. Volume 5. Probabilistic fracture mechanics analysis. Load Combination Program Project I final report

    SciTech Connect

    Harris, D.O.; Lim, E.Y.; Dedhia, D.D.

    1981-06-01

    The primary purpose of the Load Combination Program covered in this report is to estimate the probability of a seismic induced LOCA in the primary piping of a commercial pressurized water reactor (PWR). Best estimates, rather than upper bound results are desired. This was accomplished by use of a fracture mechanics model that employs a random distribution of initial cracks in the piping welds. Estimates of the probability of cracks of various sizes initially existing in the welds are combined with fracture mechanics calculations of how these cracks would grow during service. This then leads to direct estimates of the probability of failure as a function of time and location within the piping system. The influence of varying the stress history to which the piping is subjected is easily determined. Seismic events enter into the analysis through the stresses they impose on the pipes. Hence, the influence of various seismic events on the piping failure probability can be determined, thereby providing the desired information.

  8. Genome-wide analysis uncovers novel recurrent alterations in primary central nervous system lymphomas

    PubMed Central

    Braggio, Esteban; Van Wier, Scott; Ojha, Juhi; McPhail, Ellen; Asmann, Yan W.; Egan, Jan; da Silva, Jackline Ayres; Schiff, David; Lopes, M Beatriz; Decker, Paul A; Valdez, Riccardo; Tibes, Raoul; Eckloff, Bruce; Witzig, Thomas E.; Stewart, A Keith; Fonseca, Rafael; O’Neill, Brian Patrick

    2015-01-01

    Purpose Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma confined to the CNS. Whether there is a PCNSL-specific genomic signature and, if so, how it differs from systemic diffuse large B-cell lymphoma (DLBCL) is uncertain. Experimental design We performed a comprehensive genomic study of tumor samples from 19 immunocompetent PCNSL patients. Testing comprised array-comparative genomic hybridization and whole exome sequencing. Results Biallelic inactivation of TOX and PRKCD were recurrently found in PCNSL but not in systemic DLBCL, suggesting a specific role in PCNSL pathogenesis. Additionally, we found a high prevalence of MYD88 mutations (79%) and CDKN2A biallelic loss (60%). Several genes recurrently affected in PCNSL were common with systemic DLBCL, including loss of TNFAIP3, PRDM1, GNA13, TMEM30A, TBL1XR1, B2M, CD58, activating mutations of CD79B, CARD11 and translocations IgH-BCL6. Overall, BCR/TLR/NF-κB pathways were altered in >90% of PNCSL, highlighting its value for targeted therapeutic approaches. Furthermore, integrated analysis showed enrichment of pathways associated with immune response, proliferation, apoptosis, and lymphocyte differentiation. Conclusions In summary, genome-wide analysis uncovered novel recurrent alterations, including TOX and PRKCD, helping to differentiate PCNSL from systemic DLBCL and related lymphomas. PMID:25991819

  9. How Can Primary Health Care System and Community-Based Participatory Research Be Complementary?

    PubMed Central

    Sheikhattari, Payam; Kamangar, Farin

    2010-01-01

    Health statistics leave little doubt that the current health system in Iran, which is mainly based on primary health care (PHC), is a functioning one, and that health in Iran has improved far beyond where it was 40 years ago. However, this system has its limitations too. While PHC is very effective in reducing morbidity and mortality from infectious diseases and other acute conditions, it is far less effective in addressing chronic and multifactorial conditions which are now emerging in Iran. In this article, we review some of the salient features of the current health system in Iran, its strengths and limitations, and then introduce community-based participatory research (CBPR) as a method that could potentially fill some of the gaps in the system. We will discuss the definition and steps needed to implement CBPR, provide some important references, and discuss how this approach may not only improve the health system but it could also lead to improvement in other fields in the society too. PMID:21677760

  10. The Bold Promise Project: a system change in primary care to support cardiovascular risk screening.

    PubMed

    Sinclair, Gary; Kerr, Andrew

    2006-11-17

    To develop a series of system changes in primary care to facilitate cardiovascular risk screening of all eligible patients identified according to the current New Zealand Cardiovascular Guidelines (NZGG), and to provide the ability to measure and track clinical management of high risk patients. Several system changes were developed within primary care practice management software to identify the patient cohort eligible for cardiovascular risk screening, to calculate cardiovascular disease risk (CVR), and to extract the data for reporting on screening outcomes and clinical management indicators in high risk patients. Following a baseline audit, the system changes were piloted over 12 months in three general practices with a combined enrolled patient population of 30,963. A total of 6570 NZGG eligible patients were identified; 20.1% of these were Maori and 19.7% were Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin). Over 12 months, screening rates for cardiovascular risk assessment increased from 4.7% to 53.5% for the cohort. Of the 3516 patients screened, 482 (13.7%) had established cardiovascular disease. A further 230 (6.5%) had diabetes without CVD and 646 (18.4%) had a 5-year CVD risk of > or = to 15% Management data was available in 232 (48.1%) of those with CVD, 74%, 65%, and 79% were on aspirin, statins, and blood pressure-lowering medication, respectively. Fifty-five percent exceeded the low density lipoprotein (LDL) target of 2.5 mmol/L, 62% had a systolic blood pressure (BP) above the target of 130 mmHg, 18% were still smoking, and only 9% met all clinical targets recommended in the guideline. Of 646 with a 5-year CVD risk > or = to 15%, management data was available in 347 (53.7%). Only 34% were prescribed aspirin, 40% were prescribed statins, and 57% were on blood pressure lowering medication. Forty percent of this group had a systolic BP >140 mmHg, 36% an LDL >3.5 mmol/L, with only 7% of patients meeting all the guideline

  11. The activation pattern of macrophages in giant cell (temporal) arteritis and primary angiitis of the central nervous system.

    PubMed

    Mihm, Bernhard; Bergmann, Markus; Brück, Wolfgang; Probst-Cousin, Stefan

    2014-06-01

    To determine if the pattern of macrophage activation reflects differences in the pathogenesis and clinical presentation of giant cell arteritis and primary angiitis of the central nervous system, specimens of 10 patients with giant cell arteritis and five with primary angiitis of the central nervous system were immunohistochemically studied and the expression of the macrophage activation markers 27E10, MRP14, MRP8 and 25F9 was determined in the vasculitic infiltrates. Thus, a partly different expression pattern of macrophage activation markers in giant cell arteritis and primary angiitis of the central nervous system was observed. The group comparison revealed that giant cell arteritis cases had significantly higher numbers of acute activated MRP14-positive macrophages, whereas primary angiitis of the central nervous system is characterized by a tendency toward more MRP8-positive intermediate/late activated macrophages. Furthermore, in giant cell arteritis comparably fewer CD8-positive lymphocytes were observed. These observations suggest, that despite their histopathological similarities, giant cell arteritis and primary angiitis of the central nervous system appear to represent either distinct entities within the spectrum of granulomatous vasculitides or different stages of similar disease processes. Their discrete clinical presentation is reflected by different activation patterns of macrophages, which may characterize giant cell arteritis as a more acute process and primary angiitis of the central nervous system as a more advanced inflammatory process. © 2013 Japanese Society of Neuropathology.

  12. Exploring Online Learning at Primary Schools: Students' Perspectives on Cyber Home Learning System through Video Conferencing (CHLS-VC)

    ERIC Educational Resources Information Center

    Lee, June; Yoon, Seo Young; Lee, Chung Hyun

    2013-01-01

    The purposes of the study are to investigate CHLS (Cyber Home Learning System) in online video conferencing environment in primary school level and to explore the students' responses on CHLS-VC (Cyber Home Learning System through Video Conferencing) in order to explore the possibility of using CHLS-VC as a supportive online learning system. The…

  13. Increasing Capacity for Innovation in Bureaucratic Primary Care Organizations: A Whole System Participatory Action Research Project

    PubMed Central

    Thomas, Paul; McDonnell, Juliet; McCulloch, Janette; While, Alison; Bosanquet, Nick; Ferlie, Ewan

    2005-01-01

    PURPOSE We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs). METHODS Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context. RESULTS Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these “learning spaces”; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits. CONCLUSIONS These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights. PMID:16046563

  14. Clinicopathological and immunohistochemical features of primary central nervous system germ cell tumors: a 24-years experience.

    PubMed

    Gao, Yuping; Jiang, Jiyao; Liu, Qiang

    2014-01-01

    Primary central nervous system (CNS) germ cell tumors (GCTs) are a rare heterogeneous group of lesions, which the clinicopathological features have a marked degree of heterogeneity comparing with that of gonadal GCTs. Accurately diagnosing CNS GCTs might be extremely difficult and requires immunohistochemical verification. This study was to investigate the biological feature of CNS GCTs and diagnostic value of immunohistochemical markers OCT3/4, C-kit, PLAP, and CD30 in CNS GCTs. A retrospective study was performed on 34 patients with CNS germ cell tumors between 1990 and 2014. 34 CNS GCTs account for 9.2% of all primary CNS neoplasms. The sellar region (35.3%) and pineal gland (17.6%) were the most common sites of intracranial GCTs. Hydrocephalus (82.4%) and diplopia (46.9%) were the two most common clinical presentations. The most common histological subtypes were germinoma (67.6%). PLAP, c-kit, OCT3/4 were highly expressed in gernimomas. CD30 and CK AE1/3 stainings were positive in embryonal carcinoma. Yolk sac tumor component showed positive staining for AFP and CK AE1/3. β-HCG staining was positive in choriocarcinoma and STGC. Patients with mature teratomas and germinomas had a better prognosis (a 5-year survival rate) than those with embryonal carcinoma and choriocarcinoma (a 5-year survival rates were 0). Our finding suggest that the incidences of primary CNS GCTs are higher in South China than in the West, but mixed GCTs are uncommon in our study. The judicious use of a panel of selected markers is helpful in diagnosing and predicting the prognosis for CNS GCTs.

  15. A reconsideration of the primary visual system of the turtle Emys orbicularis.

    PubMed

    Hergueta, S; Lemire, M; Ward, R; Rio, J P; Repérant, J

    1992-01-01

    The retinocerebral projections of Emys orbicularis were investigated by means of [3H]-proline or HRP, administered by intraocular injection. Two newly-hatched, two juvenile and seven adult specimens were examined. The results reveal contralateral retinal projections to fifteen sites: two in the hypothalamus (the nuclei suprachiasmaticus and periventricularis), five in the thalamus (the nuclei ovalis, geniculatus lateralis ventralis, geniculatus laleralis dorsalis, dorsolateralis anterior and ventrolateralis), five in the pretectal region (the nuclei geniculatus pretectalis, opticus pretectalis ventrolateralis, lentiformis mesencephali, posterodorsalis and griseus tectalis), two in the optic tectum (the stratum opticum and the stratum fibrosum et griseum superficiale), and one in the tegmentum (the nucleus opticus tegmenti). Ipsilateral projections to nine of these sites at thalamic, pretectal, tectal and tegmental levels, while weak, could be clearly demonstrated. These results differ considerably from those obtained in a previous investigation using a Nauta-paraffin technique; it is suggested that the differences are due to limitations of the latter technique. A review of the existing literature on the Chelonian primary visual system reveals considerable terminological diversity, and a standard nomenclature for the primary visual centres of turtles is proposed.

  16. Patient-centered medical home: an emerging primary care model and the military health system.

    PubMed

    Marshall, Robert C; Doperak, Martin; Milner, Michelle; Motsinger, Charles; Newton, Terry; Padden, Maureen; Pastoor, Sara; Hughes, Cortney L; LeFurgy, Jennifer; Mun, Seong K

    2011-11-01

    The patient-centered medical home (PCMH) is a primary care model that aims to provide quality care that is coordinated, comprehensive, and cost-effective. PCMH is hinged upon building a strong patient-provider relationship and using a team-based approach to care to increase continuity and access. It is anticipated that PCMH can curb the growth of health care costs through better preventative medicine and lower utilization of services. The Navy, Air Force, and Army are implementing versions of PCMH, which includes the use of technologies for improved documentation, better disease management, improved communication between the care teams and patients, and increased access to care. This article examines PCMH in the Military Health System by providing examples of the transition from each of the branches. The authors argue that the military must overcome unique challenges to implement and sustain PCMH that civilian providers may not face because of the deployment of patients and staff, the military's mission of readiness, and the use of both on-base and off-base care by beneficiaries. Our objective is to lay out these considerations and to provide ways that they have been or can be addressed within the transition from traditional primary care to PCMH.

  17. Bronchial Artery and Systemic Artery Embolization in the Management of Primary Lung Cancer Patients with Hemoptysis

    SciTech Connect

    Park, Hong Suk Kim, Young Il; Kim, Hyae Young; Zo, Jae-Ill; Lee, Joo Hyuk; Lee, Jin Soo

    2007-07-15

    Purpose. To assess the safety and effectiveness of arterial embolization in lung cancer patients with hemoptysis. Methods. Nineteen primary lung cancer patients with hemoptysis underwent bronchial artery and systemic artery embolization from April 2002 to March 2005. There were 17 men and 2 women, with a mean age of 59 years. Histologic analysis revealed squamous cell carcinoma in 10 patients and poorly differentiated adenocarcinoma in 9 patients. The amount of hemoptysis was bleeding of 25-50 ml within 24 hr in 8 patients, recurrent blood-tinged sputum in 6, and bleeding of 100 ml or more per 24 hr in 5. Embolization was done with a superselective technique using a microcatheter and polyvinyl alcohol particles to occlude the affected vessels. Results. Arterial embolization was technically successful in all patients and clinically successful in 15 patients (79%). The average number of arteries embolized was 1.2. Bronchial arteriography revealed staining (all patients), dilatation of the artery or hypervascularity (10 patients), and bronchopulmonary shunt (6 patients). The recurrence rate was 33% (5/15) and 11 patients were alive with a mean follow-up time of 148 days (30-349 days). Conclusion. Arterial embolotherapy for hemoptysis in patients with primary lung cancer is an effective, safe therapeutic modality despite the fact the vascular changes are subtle on angiography.

  18. Performance of newly implemented Environmental Management Systems in primary schools in South Africa.

    PubMed

    Hens, Luc; Wiedemann, Torsten; Raath, Schalk; Stone, Riana; Renders, Paul; Craenhals, Eric

    2010-01-01

    Quantitative results from Environmental Management Systems (EMS) at primary schools have rarely been examined in literature. This paper presents the monitoring results of environmental care in 39 primary schools in Northern South Africa. During 2 years, after the EMS was implemented in the curriculum and in the school's management, the progress of environmental performances of the participating schools has been measured, by means of detailed questionnaires, related to four environmental aspects: water, waste, energy and greening. At the beginning of the project, 50% of the schools performed well on water-related environmental actions. Two years later it was 76%. For waste-related activities the improvement was even stronger: from 50% to 100%. The environmental performances of the schools improved also for greening-related actions, from 50% at the start of the project to 64% two years later. Only energy-related activities did not improve significantly with only 24% of all schools performing well at the end of the survey period. In general, the introduction of an EMS succeeded in an improvement of the overall environmental performances of the schools, but cost-intensive activities were less successful than others.

  19. Effect of the Keck telescope`s segmented primary on the performance on the Keck adaptive optics system

    SciTech Connect

    Gavel, D.

    1997-06-01

    The 349 degree of freedom Keck adaptive optics system will be mapped on to the 36 segment Keck primary mirror. Each telescope segment is independently controlled in piston and tilt by an active control system and each segment also has its own set of aberrations. This presents a unique set of problems for the Keck adaptive optics system, not encountered with continuous primaries. To a certain extent the low order segment aberrations, beginning with focus, can be corrected statically by the adaptive optic system. However, the discontinuous surface at the segment edges present special problems in sensing and correcting wavefront with laser guide stars or natural guide stars.

  20. Post-traumatic basal ganglia haemorrhage in a child with primary central nervous system lymphoma.

    PubMed

    Jankowski, Pawel P; Levy, Michael L; Crawford, John Ross

    2013-07-31

    Primary central nervous system lymphoma (PCNSL) is a rare tumour of childhood with 15-20 cases reported yearly in North America. We present a case of a 13-year-old boy diagnosed with PCNSL who presented more than one-and-a-half years post-treatment with high dose cytosine arabinoside and methotrexate with a right-sided basal ganglia haemorrhage on MRI following a concussion while playing organised football against medical advice. There was no evidence of an underlying vascular malformation or recurrent disease by MRI, cerebrospinal fluid analysis or positron emission tomography computed tomography (PET-CT). However, 6 months post-injury he presented with asymptomatic disease recurrence of the frontal lobe. Our case reports an unusual MRI pattern of post-traumatic injury in a child previously treated for PCNSL that would support a recommendation for the avoidance of contact sports in this population.

  1. The Systemic Changes to Improve Efficiency in Polish Primary Health Care

    PubMed Central

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna

    2016-01-01

    Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation. PMID:27468269

  2. A case of primary central nervous system lymphoma presenting diffuse infiltrative leukoencephalopathy.

    PubMed

    Yamamoto, Tatsuya; Kojima, Kazuho; Koibuchi, Katsura; Ito, Shoichi; Higuchi, Yoshinori; Iwadate, Yasuo; Oide, Takashi; Kuwabara, Satoshi

    2012-01-01

    A 58-year-old immunocompetent man gradually developed loss of appetite, cognitive decline, gait disturbances, and personality changes over 4 months. Brain magnetic resonance imaging (MRI) revealed bilateral diffuse leukoencephalopathy without mass formation on admission. His condition progressively deteriorated, and we treated him with intravenous high-dose steroids. His symptoms improved rapidly, but exacerbated when therapy was withdrawn. A brain biopsy was performed, and the diagnosis of primary central nervous system lymphoma (PCNSL) was confirmed. He was successfully treated with high-dose methotrexate therapy. Although it is difficult to diagnose PCNSL without mass formation in the early stages, steroid responsiveness is important and brain biopsy is essential for the correct diagnosis of PCNSL.

  3. Salvage Therapy for Refractory Aids-Related Primary Central Nervous System Lymphoma

    PubMed Central

    Ferro, Hugo; Parino, Eduardo

    2012-01-01

    A 27-year-old male patient presented with speech disorders and multiple brain masses on MRI evaluation. He tested positive for HIV. A sterotactic biopsy diagnosed primary central nervous system lymphoma (diffuse large B-cell lymphoma). After two cycles of high-dose metotrexate (HD-MTX-)-based chemotherapy, the tumor progressed. He underwent whole brain radiotherapy achieving complete response. Six cycles of consolidating immunochemotherapy with rituximab-temozolomide were administered after radiation. Forty-three months after remission, he has not recurred and his neurological status is optimal. Younger HIV patients with refractory PCNSL and preserved immune function can face salvage therapy successfully achieving long term remissions with no remarkable neurotoxicity. PMID:23029628

  4. Salvage therapy for refractory AIDS-related primary central nervous system lymphoma.

    PubMed

    Ferro, Hugo; Parino, Eduardo

    2012-01-01

    A 27-year-old male patient presented with speech disorders and multiple brain masses on MRI evaluation. He tested positive for HIV. A sterotactic biopsy diagnosed primary central nervous system lymphoma (diffuse large B-cell lymphoma). After two cycles of high-dose metotrexate (HD-MTX-)-based chemotherapy, the tumor progressed. He underwent whole brain radiotherapy achieving complete response. Six cycles of consolidating immunochemotherapy with rituximab-temozolomide were administered after radiation. Forty-three months after remission, he has not recurred and his neurological status is optimal. Younger HIV patients with refractory PCNSL and preserved immune function can face salvage therapy successfully achieving long term remissions with no remarkable neurotoxicity.

  5. A Systems Model for Ursodeoxycholic Acid Metabolism in Healthy and Patients With Primary Biliary Cirrhosis

    PubMed Central

    Dobbins, RL; O'Connor‐Semmes, RL; Young, MA

    2016-01-01

    A systems model was developed to describe the metabolism and disposition of ursodeoxycholic acid (UDCA) and its conjugates in healthy subjects based on pharmacokinetic (PK) data from published studies in order to study the distribution of oral UDCA and potential interactions influencing therapeutic effects upon interruption of its enterohepatic recirculation. The base model was empirically adapted to patients with primary biliary cirrhosis (PBC) based on current understanding of disease pathophysiology and clinical measurements. Simulations were performed for patients with PBC under two competing hypotheses: one for inhibition of ileal absorption of both UDCA and conjugates and the other only of conjugates. The simulations predicted distinctly different bile acid distribution patterns in plasma and bile. The UDCA model adapted to patients with PBC provides a platform to investigate a complex therapeutic drug interaction among UDCA, UDCA conjugates, and inhibition of ileal bile acid transport in this rare disease population. PMID:27537780

  6. District nurses' experiences with the free-choice system in Swedish primary care.

    PubMed

    Hollman, Djana; Lennartsson, Sandra; Rosengren, Kristina

    2014-01-01

    This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.

  7. [Characteristics of the cardiovascular system in children with primary arterial hypotension].

    PubMed

    Leont'eva, I V; Akhmetzhanova, Kh M; Belozerov, Iu M; Sipiagina, A E

    1991-01-01

    Overall 120 children aged 12 to 15 years with primary arterial hypotension and different variants of the disease course (grave, of medium gravity or mild) were examined. The control group was made up to 50 normal children. The program of the examination included electrocardiography, echocardiography, tetrapolar chest rheography and bicycle ergometry. It has been established that in children with arterial hypotension, the intracardiac hemodynamics undergoes compensatory adaptive reconstruction characterized by the enhancement of contractile and pump functions of the myocardium combined with the increased relaxation capacity. The central hemodynamics is characterized by the lowering of the general peripheral vascular resistance. The functional potentialities of the cardiovascular system decline, manifesting in the form of a decrease of exercise tolerance in association with energy losses necessary for its performance. The use of bicycle ergometry made it possible to delineate dysadaptation reactions of arterial pressure to exercise, modified by hereditary factors.

  8. Primary central nervous system lymphoma: implication of high-dose chemotherapy followed by auto-SCT

    PubMed Central

    Reddy, N; Savani, BN

    2016-01-01

    Primary central nervous system lymphoma is a rare and distinct subtype of non-Hodgkin's lymphoma that is sensitive to radiation and chemotherapy. Decisions regarding the initial therapeutic approach are influenced by age and risk of therapy-related neurotoxicity. Despite several albeit small phase II studies, and the acknowledged need for larger prospective trials, there is supporting evidence to consider auto-SCT following induction chemotherapy in patients with good performance status. The international extranodal lymphoma study group is conducting a randomized phase II study comparing consolidative radiation therapy to high-dose therapy. Novel therapeutic options including early aggressive approach with upfront auto-SCT and strategies to prevent relapse following transplantation is an area of focus. PMID:22002486

  9. Primary central nervous system lymphoma: implication of high-dose chemotherapy followed by auto-SCT.

    PubMed

    Reddy, N; Savani, B N

    2012-10-01

    Primary central nervous system lymphoma is a rare and distinct subtype of non-Hodgkin's lymphoma that is sensitive to radiation and chemotherapy. Decisions regarding the initial therapeutic approach are influenced by age and risk of therapy-related neurotoxicity. Despite several albeit small phase II studies, and the acknowledged need for larger prospective trials, there is supporting evidence to consider auto-SCT following induction chemotherapy in patients with good performance status. The international extranodal lymphoma study group is conducting a randomized phase II study comparing consolidative radiation therapy to high-dose therapy. Novel therapeutic options including early aggressive approach with upfront auto-SCT and strategies to prevent relapse following transplantation is an area of focus.

  10. Astrocytes As the Main Players in Primary Degenerative Disorders of the Human Central Nervous System

    PubMed Central

    Capani, Francisco; Quarracino, Cecilia; Caccuri, Roberto; Sica, Roberto E. P.

    2016-01-01

    Along the last years it has been demonstrated that non-neural cells play a major role in the pathogenesis of the primary degenerative disorders (PDDs) of the human central nervous system. Among them, astrocytes coordinate and participate in many different and complex metabolic processes, in close interaction with neurons. Moreover, increasing experimental evidence hints an early astrocytic dysfunction in these diseases. In this mini review we summarize the astrocytic behavior in PDDs, with special consideration to the experimental observations where astrocytic pathology precedes the development of neuronal dysfunction. We also suggest a different approach that could be consider in human investigations in Alzheimer’s and Parkinson’s disease. We believe that the study of PDDs with human brain samples may hold the key of a paradigmatic physiopathological process in which astrocytes might be the main players. PMID:26973519

  11. Astrocytes As the Main Players in Primary Degenerative Disorders of the Human Central Nervous System.

    PubMed

    Capani, Francisco; Quarracino, Cecilia; Caccuri, Roberto; Sica, Roberto E P

    2016-01-01

    Along the last years it has been demonstrated that non-neural cells play a major role in the pathogenesis of the primary degenerative disorders (PDDs) of the human central nervous system. Among them, astrocytes coordinate and participate in many different and complex metabolic processes, in close interaction with neurons. Moreover, increasing experimental evidence hints an early astrocytic dysfunction in these diseases. In this mini review we summarize the astrocytic behavior in PDDs, with special consideration to the experimental observations where astrocytic pathology precedes the development of neuronal dysfunction. We also suggest a different approach that could be consider in human investigations in Alzheimer's and Parkinson's disease. We believe that the study of PDDs with human brain samples may hold the key of a paradigmatic physiopathological process in which astrocytes might be the main players.

  12. Dynamic Scheduling Real-Time Task Using Primary-Backup Overloading Strategy for Multiprocessor Systems

    NASA Astrophysics Data System (ADS)

    Sun, Wei; Yu, Chen; Défago, Xavier; Inoguchi, Yasushi

    The scheduling of real-time tasks with fault-tolerant requirements has been an important problem in multiprocessor systems. The primary-backup (PB) approach is often used as a fault-tolerant technique to guarantee the deadlines of tasks despite the presence of faults. In this paper we propose a dynamic PB-based task scheduling approach, wherein an allocation parameter is used to search the available time slots for a newly arriving task, and the previously scheduled tasks can be re-scheduled when there is no available time slot for the newly arriving task. In order to improve the schedulability we also propose an overloading strategy for PB-overloading and Backup-backup (BB) overloading. Our proposed task scheduling algorithm is compared with some existing scheduling algorithms in the literature through simulation studies. The results have shown that the task rejection ratio of our real-time task scheduling algorithm is almost 50% lower than the compared algorithms.

  13. Governance challenges in the Nepalese primary health care system: time to focus on greater community engagement?

    PubMed

    Gurung, Gagan; Derrett, Sarah; Hill, Philip C; Gauld, Robin

    2016-04-01

    Nepal has seen impressive recent health gains through a successful community-based health program. However, governance challenges remain within the Nepalese primary health care system that include under-staffing and absenteeism, limited health facility opening hours, poor supervision and monitoring, and insufficient financial management. We propose that these be addressed through expanded community engagement and a power shift towards local communities, enhancing skills of community representatives in co-managing health facilities and of service providers to effectively engage the community, increased quality of community participation, and improved documentation of the process and impact of engagement on health outcomes. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  14. Systems for the management of respiratory disease in primary care - an international series: Canada.

    PubMed

    Kaplan, Alan

    2008-06-01

    Canada has a universal health care system funded by the government. All people are supposed to have unrestricted access to all essential health care in a timely fashion. Canada has ten provinces and three territories. Health care is funded by each province/territory, with federal payments providing some of the funding. The bulk of the provision of respiratory care in Canada is provided by primary care practitioners. Across the country we have a family physician shortage; thus, in many areas of the country there is insufficient access since patients do not actually have a family physician. This has less effect on acute medical services, which can be available in ER or walk-in settings, but certainly does affect the provision of services for chronic illnesses. While thus far the health care system is 'free', there are some significant limitations; the commonest is waiting times for specialist care and investigations. Other significant deficiencies include the lack of coverage for medications for both acute and chronic conditions and of medical devices. Primary care reforms by local governments have attempted to fix these issues by changing care models. Fee-for-service medicine by physicians is slowly being changed in places to capitation models and other systems such as rewards for managing chronic conditions optimally. Ontario has instituted 'reward systems' for diabetes and smoking cessation. British Columbia has rewards for multiple chronic diseases. In many areas, care in the provinces is regionalised to allow local arrangements to help decide on where and how care is organised. Respiratory diseases (excluding lung cancer) rank fourth in Canada in the total proportion of direct health care costs (behind neuropsychiatric, injury and cardiovascular diseases). A number of studies have shown that respiratory conditions such as asthma and COPD are underdiagnosed and/or undermanaged. Other conditions need treatment by specialists or physicians with a special interest

  15. Prognostic Significance of High Ki-67 Index and Histogenetic Subclassification in Primary Central Nervous System Lymphoma.

    PubMed

    Cho, Uiju; Oh, Woo Jin; Hong, Yong-Kil; Lee, Youn Soo

    2016-08-03

    In diffuse large B-cell lymphoma (DLBCL), the germinal center B-cell (GCB) subtype is associated with a better prognosis compared with the nongerminal center B-cell-like (non-GCB) subtype. However, validity of this immunohistochemical subgrouping in primary DLBCL of the central nervous system is unclear. A total 45 cases of primary central nervous system lymphoma (PCNS)/DLBCL were selected, and immunohistochemistries for CD10, Bcl-6, MUM1, and Ki-67 were performed. Each of the cases was subclassified as either GCB or non-GCB based on its immunoprofile. Among clinical and immunologic markers, patients under 70 years of age and who had methotrexate chemotherapy showed a significantly better overall survival (OS). High Ki-67 (ie, a Ki-67 index ≥90%) was an independent prognostic factor for a poor OS in the whole cohort and in the patients with non-GCB subtype tumors (P=0.017, HR=4.267, 95% CI, 1.3-14.0; P=0.031, HR=3.752, 95% CI, 1.3-12.5). Tumors were dominantly non-GCB subtype (41/45, 91.1%); only 4 (8.9%) were GCB subtype. The 2-year OS rates for these groups were 73% and 100%. There was, however, no statistically significant difference between these groups for OS and progression-free survival. The subclassification of PCNS/DLBCL into GCB and non-GCB subtypes did not seem to have a prognostic value. In non-GCB subtype PCNSL patients, high Ki-67 index was an adverse independent prognostic marker that could be used to stratify patients for more suitable management.

  16. Treatment of central nervous system involvement associated with primary Sjögren's syndrome.

    PubMed

    Ozgocmen, Salih; Gur, Ali

    2008-01-01

    Sjögren's syndrome (SS) is a chronic autoimmune disease that mainly affects the exocrine glands and usually presents with sicca symptoms of the main mucosal surfaces. The prevalence and the type of central nervous system (CNS) tissue damage caused by SS are debatable. The wide spectrum of CNS manifestations, different classification criteria used and unclear inclusion or exclusion criteria pose some difficulty reviewing these studies. Careful examination of the SS patients and to be aware of neurological findings which may be associated with suspicious CNS involvement is highly important. Central nervous system may also hypothetically have a role in the pathophysiology of SS. The wide spectrum of CNS involvement includes focal (sensorial and motor deficits, brain stem, cerebellar lesions, seizure, migraine etc.) or non-focal (encephalomyelitis, aseptic meningitis, neuropsychiatric dysfunctions), spinal cord (myelopathy, transverse myelitis, motor neuron disease etc.) findings or multiple sclerosis-like illness and optic neuritis. Evolving imaging techniques such as single photon emission computed tomography (SPECT), magnetic resonance spectroscopy or magnetization transfer imaging are promising for better understanding the nature of CNS involvement in SS. Treatments usually comprise symptomatic approach in milder cases however, pulse cyclophosphamide and steroids or other immunosuppressants (chlorambucil or azathioprine) are required in cases with progressive symptoms leading to neurological impairment. Anti-TNF agents (infliximab and etanercept) and B cell targeted therapies (rituximab and epratuzumab) are used in primary SS however their efficacy on CNS manifestation is still unclear. Randomized, multicenter studies are warranted to confirm the efficacy of treatment regimes which were reported to be effective in anecdotal reports or in small uncontrolled series. This article reviews the clinical approach to current therapy of CNS involvement in patients with

  17. Geodynamic stability of the primary in the binary asteroid system 65803 Didymos

    NASA Astrophysics Data System (ADS)

    Barnouin, Olivier S.; Maurel, Clara; Richardson, Derek C.; Ballouz, Ronald-Louis; Schwartz, Stephen; Michel, Patrick

    2015-11-01

    The moon of the near-Earth binary asteroid 65803 Didymos is the target of the Asteroid Impact and Deflection Assessment (AIDA) mission. This mission is a joint concept between NASA and ESA to investigate the effectiveness of a kinetic impactor in deflecting an asteroid. The mission is composed of two components: the NASA-led Double Asteroid Redirect Test (DART) that will impact the Didymos moon, and the ESA-led Asteroid Impact Monitoring (AIM) mission that will characterize the Didymos system. In order to provide AIDA constraints on the physical character of the both objects in this binary system, we undertook preliminary numerical investigations to evaluate the stability of the shape of the primary using its rapid 2.26 h rotation. We modeled the primary as a rubble pile. Each model consisted of thousands of uniform rigid spheres collapsed together under their own gravity to form a spherical pile that was then carved to match the current radar-derived shape model of the primary, as well as other comparable shapes (e.g. asteroid 1999 KW4, spheres) that were scaled to match best estimates of the size of Didymos. Each model was given a starting rotation period of 6 h with the spin axis aligned to the pole. At each timestep the spin rate was increased by a small amount so that after about 1 million timesteps the spin would match the observed rotation of 2.26 h. We tested a range of bulk densities spanning the current observational uncertainty (mean 2.4 g/cc) using "gravel"-like material parameters that provide significant resistance to sliding and rolling. We find that at the upper range of the density uncertainty it is possible for Didymos to hold its shape and not lose mass at its nominal rotation period, without the need for cohesive forces. At lower densities or with smoother particles, significant shape change occurs and mass loss is possible. We conclude that based on the radar shape available at the time of this writing, Didymos is marginally stable as a rubble

  18. Patients' perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa.

    PubMed

    Adeniji, Adeloye A; Mash, Bob

    2016-06-17

    In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Gugulethu Community Health Centre, Cape Town. A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened.

  19. Mechanism for the primary transformation of acetaminophen in a soil/water system.

    PubMed

    Liang, Chuanzhou; Lan, Zhonghui; Zhang, Xu; Liu, Yingbao

    2016-07-01

    The transformation of acetaminophen (APAP) in a soil/water system was systematically investigated by a combination of kinetic studies and a quantitative analysis of the reaction intermediates. Biotransformation was the predominant pathway for the elimination of APAP, whereas hydrolysis or other chemical transformation, and adsorption processes made almost no contribution to the transformation under a dark incubation. Bacillus aryabhattai strain 1-Sj-5-2-5-M, Klebsiella pneumoniae strain S001, and Bacillus subtilis strain HJ5 were the main bacteria identified in the biotransformation of APAP. The soil-to-water ratio and soil preincubation were able to alter the transformation kinetic pattern. Light irradiation promoted the overall transformation kinetics through enhanced biotransformation and extra photosensitized chemical reactions. The transformation pathways were strongly dependent on the initial concentration of APAP. The main primary transformation products were APAP oligomers and p-aminophenol, with the initial addition of 26.5 and 530 μM APAP, respectively. APAP oligomers accounted for more than 95% of transformed APAP, indicating that almost no bound residues were generated through the transformation of APAP in the soil/water system. The potential environmental risks of APAP could increase following the transformation of APAP in the soil/water system because of the higher toxicity of the transformation intermediates. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    PubMed Central

    Adeniji, Adeloye Amoo

    2016-01-01

    Background In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting Gugulethu Community Health Centre, Cape Town. Methods A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. PMID:27380788

  1. Radiotherapy in the treatment of primary central nervous system lymphoma (PCNSL).

    PubMed

    Nelson, D F

    1999-07-01

    The use of radiotherapy alone to treat primary central nervous system lymphoma (PCNSL) does not produce the high local control and survival rates that it does in limited extranodal non-Hodgkin's lymphoma outside the central nervous system (CNS). Even with doses of whole brain radiation therapy (WBRT) to 40+20 Gy boost, the Radiation Therapy Oncology Group (RTOG) reported a local control rate of 39%. Seventy-nine percent of recurrences were in the 60 Gy region. The median survival was 11.6 months. This response to local radiotherapy is quite different from the response of non-CNS Diffuse Large Cell Lymphoma where doses of 30-40 and >40 Gy have a 75-90% local control rate. Neither systemic lymphoma nor PCNSL have a classic radiotherapy dose response. For PCNSL there appears to be a threshold dose that ranges in the literature between 30 and > 50 Gy with a median of 40 Gy. Therefore, when radiotherapy is combined with chemotherapy that crosses the BBB, WBRT and/or boost doses may be able to be decreased, especially in patients achieving a complete response. Promising data from the Centre Leon Berard suggest that this is possible. When such chemotherapy was combined with intrathecal chemotherapy and 20 Gy WBRT, they obtained a 56% actuarial 5 year survival rate. Confirmation of single institution reports of favorable results such as these are needed. Cooperative group and intergroup trials are needed to define optimal therapy.

  2. Changes in functional connectivity of pain modulatory systems in women with primary dysmenorrhea.

    PubMed

    Wei, Shyh-Yuh; Chao, Hsiang-Tai; Tu, Cheng-Hao; Li, Wei-Chi; Low, Intan; Chuang, Chih-Ying; Chen, Li-Fen; Hsieh, Jen-Chuen

    2016-01-01

    Menstrual pain is the most prevalent gynecological complaint, and is usually without organic cause (termed primary dysmenorrhea, PDM). The high comorbidity in the later life of PDM with many functional pain disorders (associated with central dysfunction of pain inhibition, eg, fibromyalgia) suggests possible maladaptive functionality of pain modulatory systems already occurred in young PDM women, making them vulnerable to functional pain disorders. Periaqueductal gray (PAG) matter functions as a critical hub in the neuraxis of pain modulatory systems; therefore, we investigated the functional connectivity of PAG in PDM. Forty-six PDM subjects and 49 controls received resting-state functional magnetic resonance imaging during menstruation and periovulatory phases. The PAG of PDM subjects exhibited adaptive/reactive hyperconnectivity with the sensorimotor cortex during painful menstruation, whereas it exhibited maladaptive hypoconnectivity with the dorsolateral prefrontal cortex and default mode network (involving the ventromedial prefrontal cortex, posterior cingulate cortex, or posterior parietal cortex) during menstruation or periovulatory phase. We propose that the maladaptive descending pain modulatory systems in PDM may underpin the central susceptibility to subsequent development of various functional disorders later in life. This hypothesis is corroborated by the growing body of evidence that hypoconnectivity between PAG and default mode network is a coterminal to many functional pain disorders.

  3. Neurologic complications after intrathecal liposomal cytarabine in combination with systemic polychemotherapy in primary CNS lymphoma.

    PubMed

    Ostermann, Kathrin; Pels, Hendrik; Kowoll, Annika; Kuhnhenn, Jan; Schlegel, Uwe

    2011-07-01

    Intrathecal application of liposomal cytarabine (Ara-C) (DepoCyte(®)) has been associated with neurotoxicity when applied as part of a polychemotherapy regimen. Patients with primary central nervous system lymphoma treated with high-dose systemic methotrexate (MTX)- and Ara-C-based polychemotherapy including six cycles of liposomal Ara-C (50 mg intrathecally every 3 weeks) were prospectively monitored for neurotoxic side-effects. Between November 2005 and February 2009, 149 intrathecal applications of liposomal cytarabine (DepoCyte(®)) were carried out in 33 patients, 7 (21%) of whom developed an incomplete conus medullaris/cauda equina syndrome with incontinence for bladder (6) and bowel function (3) or lumbosacral polyradicular paresis (1), resolving only incompletely over a follow-up period of 9-30 months. In six of these seven patients, lumbosacral magnetic resonance imaging (MRI) was negative for leptomeningeal infiltration or arachnoiditis. Cerebrospinal fluid (CSF) analysis performed in six of these seven patients showed normal cell count in all and increased total protein in four of them. One patient among these seven suffered a seizure without other identifiable causes. Conus/cauda syndrome has to be considered as a serious potential neurotoxic side-effect in patients receiving liposomal Ara-C as part of a multimodal regimen including high-dose systemic MTX and Ara-C.

  4. Assessment of Primary Production of Horticultural Safety Management Systems of Mushroom Farms in South Africa.

    PubMed

    Dzingirayi, Garikayi; Korsten, Lise

    2016-07-01

    Growing global consumer concern over food safety in the fresh produce industry requires producers to implement necessary quality assurance systems. Varying effectiveness has been noted in how countries and food companies interpret and implement food safety standards. A diagnostic instrument (DI) for global fresh produce industries was developed to measure the compliancy of companies with implemented food safety standards. The DI is made up of indicators and descriptive grids for context factors and control and assurance activities to measure food safety output. The instrument can be used in primary production to assess food safety performance. This study applied the DI to measure food safety standard compliancy of mushroom farming in South Africa. Ten farms representing almost half of the industry farms and more than 80% of production were independently assessed for their horticultural safety management system (HSMS) compliance via in-depth interviews with each farm's quality assurance personnel. The data were processed using Microsoft Office Excel 2010 and are represented in frequency tables. The diagnosis revealed that the mushroom farming industry had an average food safety output. The farms were implementing an average-toadvanced HSMS and operating in a medium-risk context. Insufficient performance areas in HSMSs included inadequate hazard analysis and analysis of control points, low specificity of pesticide assessment, and inadequate control of suppliers and incoming materials. Recommendations to the industry and current shortcomings are suggested for realization of an improved industry-wide food safety assurance system.

  5. Modeling and Analysis of Alternative Concept of ITER Vacuum Vessel Primary Heat Transfer System

    SciTech Connect

    Carbajo, Juan J; Yoder Jr, Graydon L; Dell'Orco, Giovanni; Curd, Warren; Kim, Seokho H

    2010-01-01

    A RELAP5-3D model of the ITER (Latin for the way ) vacuum vessel (VV) primary heat transfer system has been developed to evaluate a proposed design change that relocates the heat exchangers (HXs) from the exterior of the tokamak building to the interior. This alternative design protects the HXs from external hazards such as wind, tornado, and aircraft crash. The proposed design integrates the VV HXs into a VV pressure suppression system (VVPSS) tank that contains water to condense vapour in case of a leak into the plasma chamber. The proposal is to also use this water as the ultimate sink when removing decay heat from the VV system. The RELAP5-3D model has been run under normal operating and abnormal (decay heat) conditions. Results indicate that this alternative design is feasible, with no effects on the VVPSS tank under normal operation and with tank temperature and pressure increasing under decay heat conditions resulting in a requirement to remove steam generated if the VVPSS tank low pressure must be maintained.

  6. [A case of primary intracerebral malignant lymphoma in systemic lupus erythematosus].

    PubMed

    Tomabechi, M; Daita, G; Ohgami, S; Yonemasu, Y; Maekawa, I

    1992-04-01

    The patient, a 44-year-old female, was admitted to our department because of right hemiparesis and left oculomotor nerve palsy on February 7, 1986. Neither lymphadenopathy nor hepatosplenomegaly was present. She had been treated with prednisolone for systemic lupus erythematosus (SLE) for one and a half year before admission. The CT scan revealed a homogeneously enhanced mass lesion from the midbrain through the thalamus on the right side. The whole body gallium scintigram showed no abnormal uptake except in the brain. Stereotaxic biopsy was performed. Histopathological diagnosis was malignant lymphoma, diffuse, large cell type (International Working Formulation). The enhanced mass lesion disappeared after radiation therapy. Subsequently, she received chemotherapy. She remained well until May 1988 when she died because of the systemic lymphadenopathy. The association of malignant lymphoma and SLE has appeared occasionally in the literature. Primary intracerebral malignant lymphoma associated with SLE is much rarer but it should be considered in the differential diagnosis of symptoms of the central nervous system in a patient with SLE. Therefore, biopsy of a cerebral mass lesion is mandatory if appropriate therapy such as radiation and chemotherapy is to be administered.

  7. Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review.

    PubMed

    Fasano, S; Margiotta, D P; Navarini, L; Pierro, L; Pantano, I; Riccardi, A; Afeltra, A; Valentini, G

    2017-01-01

    Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000-2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

  8. Net ecosystem calcification and net primary production in two Hawaii back-reef systems

    NASA Astrophysics Data System (ADS)

    Kiili, S.; Colbert, S.; Hart, K.

    2016-02-01

    Back-reef systems have complex carbon cycling, driven by dominant benthic communities that change with environmental conditions and display characteristic patterns of net primary production (NP) and net ecosystem calcification (G). The G/NP ratio provides a fundamental community-level assessment to compare systems spatially and to evaluate temporal changes in carbon cycling. Carbon dynamics were examined at leeward Hōnaunau and windward Waíōpae, Hawaíi Island. Both locations discharge brackish groundwater, including geothermal water at Waíōpae. The change in total CO2 (TCO2) and total alkalinity (TA) between morning and afternoon was measured to calculate the G/NP ratio along a salinity gradient. At both sites, aragonite saturation (ΩAr) was lower than open ocean conditions, and increased with salinity. Between the morning and afternoon, ΩAr increased by at least 1 as photosynthesis consumed CO2. At Waíōpae, water was corrosive to aragonite due to the input of acidic groundwater, but not at Honaunau, demonstrating the importance of local watershed characteristics on ΩAr. Across the salinity gradient, TA and TCO2 decreased between morning and afternoon. At Hōnaunau, G/NP increased from 0.11 to 0.31 with salinity, consistent with an offshore increase in coral cover. But at Waíōpae, G/NP decreased from 0.49 to 0.0 with salinity, despite an increase in coral cover with salinity. Low G may be caused by benthic processes, including coral bleaching or high rates of carbonate dissolution in interstitial waters between tide pools. Broader environmental conditions than just salinity, including pH of fresh groundwater inputs, shape the carbon cycling in the back-reef system. Examining the G/NP ratio of a back-reef system allows for a simple method to establish community level activity, and possibly indicate changes in a dynamic system.

  9. Performance of Core Exit Thermocouple for PWR Accident Management Action in Vessel Top Break LOCA Simulation Experiment at OECD/NEA ROSA Project

    NASA Astrophysics Data System (ADS)

    Suzuki, Mitsuhiro; Takeda, Takeshi; Nakamura, Hideo

    Presented are experiment results of the Large Scale Test Facility (LSTF) conducted at the Japan Atomic Energy Agency (JAEA) with a focus on core exit thermocouple (CET) performance to detect core overheat during a vessel top break loss-of-coolant accident (LOCA) simulation experiment. The CET temperatures are used to start accident management (AM) action to quickly depressurize steam generator (SG) secondary side in case of core temperature excursion. Test 6-1 is the first test of the OECD/NEA ROSA Project started in 2005, simulating withdraw of a control rod drive mechanism penetration nozzle at the vessel top head. The break size is equivalent to 1.9% cold leg break. The AM action was initiated when CET temperature rose up to 623K. There was no reflux water fallback onto the CETs during the core heat-up period. The core overheat, however, was detected with a time delay of about 230s. In addition, a large temperature discrepancy was observed between the CETs and the hottest core region. This paper clarifies the reasons of time delay and temperature discrepancy between the CETs and heated core during boil-off including three-dimensional steam flows in the core and core exit. The paper discusses applicability of the LSTF CET performance to pressurized water reactor (PWR) conditions and a possibility of alternative indicators for earlier AM action than in Test 6-1 is studied by using symptom-based plant parameters such as a reactor vessel water level detection.

  10. Development and Assessment of CFD Models Including a Supplemental Program Code for Analyzing Buoyancy-Driven Flows Through BWR Fuel Assemblies in SFP Complete LOCA Scenarios

    NASA Astrophysics Data System (ADS)

    Artnak, Edward Joseph, III

    This work seeks to illustrate the potential benefits afforded by implementing aspects of fluid dynamics, especially the latest computational fluid dynamics (CFD) modeling approach, through numerical experimentation and the traditional discipline of physical experimentation to improve the calibration of the severe reactor accident analysis code, MELCOR, in one of several spent fuel pool (SFP) complete loss-ofcoolant accident (LOCA) scenarios. While the scope of experimental work performed by Sandia National Laboratories (SNL) extends well beyond that which is reasonably addressed by our allotted resources and computational time in accordance with initial project allocations to complete the report, these simulated case trials produced a significant array of supplementary high-fidelity solutions and hydraulic flow-field data in support of SNL research objectives. Results contained herein show FLUENT CFD model representations of a 9x9 BWR fuel assembly in conditions corresponding to a complete loss-of-coolant accident scenario. In addition to the CFD model developments, a MATLAB based controlvolume model was constructed to independently assess the 9x9 BWR fuel assembly under similar accident scenarios. The data produced from this work show that FLUENT CFD models are capable of resolving complex flow fields within a BWR fuel assembly in the realm of buoyancy-induced mass flow rates and that characteristic hydraulic parameters from such CFD simulations (or physical experiments) are reasonably employed in corresponding constitutive correlations for developing simplified numerical models of comparable solution accuracy.

  11. A new control method depending on primary phase angle of transcutaneous energy transmission system for artificial heart.

    PubMed

    Miura, H; Saito, I; Sato, F; Shiraishi, Y; Yambe, T; Matsuki, H

    2013-01-01

    A new control method for stabilizing output voltage of the transcutaneous energy transmission system for artificial heart is proposed. This method is primary side, is outside of the body, which is not depending on a signal transmission system from the implanted device. The impedance observed from primary side changes from inductive to capacitive and the output voltage decreases drastically when the output current is large and the coupling factor is higher than that of the optimal condition. In this case, the driving frequency should be changed to higher so that the phase angle of the primary impedance is zero degree. The preliminary examination showed that this control method can enhance the output voltage limit to twice and the feasibility of the primary side control.

  12. Review of accidental safety studies for the European HCPB test blanket system

    NASA Astrophysics Data System (ADS)

    Boccaccini, L. V.; Ciattaglia, S.; Meyder, R.; Jin, X.

    2007-07-01

    This paper presents a review of safety studies for accidental sequences in the European solid breeder test blanket module (TBM) system. These studies are the starting point for the Preliminary Safety Analysis Report of ITER, under preparation to get the construction permit first and then later the operation licence. In general the reduced inventory of activation products and tritium associated with the TBM system makes the impact of this test system almost negligible on the overall safety risk of ITER. Nevertheless, the possibility of jeopardizing the ITER safety concept has been analysed in connection to the consequences of specific accident sequences, e.g. the pressurization of the vacuum vessel due to the He coolant blow-down, the hydrogen production from the Be-steam reaction, the possible interconnection between the port cell and the vacuum vessel causing air ingress and the necessity to assure heat removal in the short and long periods. In the frame of this assessment, three LOCA sequences have been selected as representative of accidents judged to cover all scenarios envisaged in Cat II to IV events involving the TBM, namely, in-vessel LOCA, ex-vessel LOCA and in-box LOCA.

  13. Analysis of cell identity, morphology, apoptosis and mitotic activity in a primary neural cell culture system in Drosophila

    PubMed Central

    2012-01-01

    In Drosophila, most neurogenetic research is carried out in vivo. Mammalian research demonstrates that primary cell culture techniques provide a powerful model to address cell autonomous and non-autonomous processes outside their endogenous environment. We developed a cell culture system in Drosophila using wildtype and genetically manipulated primary neural tissue for long-term observations. We assessed the molecular identity of distinct neural cell types by immunolabeling and genetically expressed fluorescent cell markers. We monitored mitotic activity of cell cultures derived from wildtype and tumorous larval brains. Our system provides a powerful approach to unveil developmental processes in the nervous system and to complement studies in vivo. PMID:22554060

  14. Metabolic Profiling of Systemic Lupus Erythematosus and Comparison with Primary Sjögren’s Syndrome and Systemic Sclerosis

    PubMed Central

    Bengtsson, Anders A.; Trygg, Johan; Wuttge, Dirk M.; Sturfelt, Gunnar; Theander, Elke; Donten, Magdalena; Moritz, Thomas; Sennbro, Carl-Johan; Torell, Frida; Lood, Christian; Surowiec, Izabella; Rännar, Stefan; Lundstedt, Torbjörn

    2016-01-01

    Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease which can affect most organ systems including skin, joints and the kidney. Clinically, SLE is a heterogeneous disease and shares features of several other rheumatic diseases, in particular primary Sjögrens syndrome (pSS) and systemic sclerosis (SSc), why it is difficult to diagnose The pathogenesis of SLE is not completely understood, partly due to the heterogeneity of the disease. This study demonstrates that metabolomics can be used as a tool for improved diagnosis of SLE compared to other similar autoimmune diseases. We observed differences in metabolic profiles with a classification specificity above 67% in the comparison of SLE with pSS, SSc and a matched group of healthy individuals. Selected metabolites were also significantly different between studied diseases. Biochemical pathway analysis was conducted to gain understanding of underlying pathways involved in the SLE pathogenesis. We found an increased oxidative activity in SLE, supported by increased xanthine oxidase activity and an increased turnover in the urea cycle. The most discriminatory metabolite observed was tryptophan, with decreased levels in SLE patients compared to control groups. Changes of tryptophan levels were related to changes in the activity of the aromatic amino acid decarboxylase (AADC) and/or to activation of the kynurenine pathway. PMID:27441838

  15. Metabolic Profiling of Systemic Lupus Erythematosus and Comparison with Primary Sjögren's Syndrome and Systemic Sclerosis.

    PubMed

    Bengtsson, Anders A; Trygg, Johan; Wuttge, Dirk M; Sturfelt, Gunnar; Theander, Elke; Donten, Magdalena; Moritz, Thomas; Sennbro, Carl-Johan; Torell, Frida; Lood, Christian; Surowiec, Izabella; Rännar, Stefan; Lundstedt, Torbjörn

    2016-01-01

    Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease which can affect most organ systems including skin, joints and the kidney. Clinically, SLE is a heterogeneous disease and shares features of several other rheumatic diseases, in particular primary Sjögrens syndrome (pSS) and systemic sclerosis (SSc), why it is difficult to diagnose The pathogenesis of SLE is not completely understood, partly due to the heterogeneity of the disease. This study demonstrates that metabolomics can be used as a tool for improved diagnosis of SLE compared to other similar autoimmune diseases. We observed differences in metabolic profiles with a classification specificity above 67% in the comparison of SLE with pSS, SSc and a matched group of healthy individuals. Selected metabolites were also significantly different between studied diseases. Biochemical pathway analysis was conducted to gain understanding of underlying pathways involved in the SLE pathogenesis. We found an increased oxidative activity in SLE, supported by increased xanthine oxidase activity and an increased turnover in the urea cycle. The most discriminatory metabolite observed was tryptophan, with decreased levels in SLE patients compared to control groups. Changes of tryptophan levels were related to changes in the activity of the aromatic amino acid decarboxylase (AADC) and/or to activation of the kynurenine pathway.

  16. Red Light-Green Light: A Classwide Management System for Students with Behavior Disorders in Primary Grades.

    ERIC Educational Resources Information Center

    Barbetta, Patricia M.

    1990-01-01

    Red Light-Green Light is a levels system providing immediate behavior modification feedback and varying privilege levels throughout the school day for primary students with behavior disorders. This article presents guidelines for implementation, covering development of classroom rules, classroom expectations, and system maintenance. Tips for…

  17. Enhanced Control of PWR Primary Coolant Water Chemistry Using Selective Separation Systems for Recovery and Recycle of Enriched Boric Acid

    SciTech Connect

    Ken Czerwinski; Charels Yeamans; Don Olander; Kenneth Raymond; Norman Schroeder; Thomas Robison; Bryan Carlson; Barbara Smit; Pat Robinson

    2006-02-28

    The objective of this project is to develop systems that will allow for increased nuclear energy production through the use of enriched fuels. The developed systems will allow for the efficient and selective recover of selected isotopes that are additives to power water reactors' primary coolant chemistry for suppression of corrosion attack on reactor materials.

  18. Creating an optical spectroscopy system for use in a primary care clinical setting (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Eshein, Adam; Nguyen, The-Quyen; Radosevich, Andrew J.; Gould, Bradley; Wu, Wenli; Konda, Vani; Yang, Leslie W.; Koons, Ann; Feder, Seth; Valuckaite, Vesta; Roy, Hemant K.; Backman, Vadim

    2016-03-01

    While there are a plethora of in-vivo spectroscopic techniques that have demonstrated the ability to detect a number of diseases in research trials, very few techniques have successfully become a fully realized clinical technology. This is primarily due to the stringent demands on a clinical device for widespread implementation. Some of these demands include: simple operation requiring minimal or no training, safe for in-vivo patient use, no disruption to normal clinic workflow, tracking of system performance, warning for measurement abnormality, and meeting all FDA guidelines for medical use. Previously, our group developed a fiber optic probe-based optical sensing technique known as low-coherence enhanced backscattering spectroscopy (LEBS) to quantify tissue ultrastructure in-vivo. Now we have developed this technique for the application of prescreening patients for colonoscopy in a primary care (PC) clinical setting. To meet the stringent requirements for a viable medical device used in a PC clinical setting, we developed several novel components including an automated calibration tool, optical contact sensor for signal acquisition, and a contamination sensor to identify measurements which have been affected by debris. The end result is a state-of-the-art medical device that can be realistically used by a PC physician to assess a person's risk for harboring colorectal precancerous lesions. The pilot study of this system shows great promise with excellent stability and accuracy in identifying high-risk patients. While this system has been designed and optimized for our specific application, the system and design concepts are universal to most in-vivo fiber optic based spectroscopic techniques.

  19. RELAP5 Model of the First Wall/Blanket Primary Heat Transfer System

    SciTech Connect

    Popov, Emilian L; Yoder Jr, Graydon L; Kim, Seokho H

    2010-06-01

    ITER inductive power operation is modeled and simulated using a system level computer code to evaluate the behavior of the Primary Heat Transfer System (PHTS) and predict parameter operational ranges. The control algorithm strategy and derivation are summarized in this report as well. A major feature of ITER is pulsed operation. The plasma does not burn continuously, but the power is pulsed with large periods of zero power between pulses. This feature requires active temperature control to maintain a constant blanket inlet temperature and requires accommodation of coolant thermal expansion during the pulse. In view of the transient nature of the power (plasma) operation state a transient system thermal-hydraulics code was selected: RELAP5. The code has a well-documented history for nuclear reactor transient analyses, it has been benchmarked against numerous experiments, and a large user database of commonly accepted modeling practices exists. The process of heat deposition and transfer in the blanket modules is multi-dimensional and cannot be accurately captured by a one-dimensional code such as RELAP5. To resolve this, a separate CFD calculation of blanket thermal power evolution was performed using the 3-D SC/Tetra thermofluid code. A 1D-3D co-simulation more realistically models FW/blanket internal time-dependent thermal inertia while eliminating uncertainties in the time constant assumed in a 1-D system code. Blanket water outlet temperature and heat release histories for any given ITER pulse operation scenario are calculated. These results provide the basis for developing time dependent power forcing functions which are used as input in the RELAP5 calculations.

  20. Influence of aging treatments on microtensile bond strength of adhesive systems to primary dentin.

    PubMed

    Rocha, Rachel; Soares, Fabio Z M; Rodrigues, Celia R M D; Rodrigues Filho, Leonardo Eloy

    2007-01-01

    The purpose of this study was to evaluate the in vitro influence of aging treatments on the microtensile bond strength of 2-step total-etch and self-etch adhesive systems to primary dentin. Class I cavities (4 mm x 4 mm x 2 mm) were prepared in 80 extracted human primary molars divided into 8 groups (N=5) per adhesive system: (1) Single Bond (SI); and (2) Clearfil SE Bond (SE). Restored teeth were exposed to individual and combined aging treatments: (1) thermal (2,000 x at 5-55 degrees C; T); (2) mechanical load (100,000 x 80 N; M); (3) pH (mineralizing/demineralizing solutions; pH); and (4) control (24-hour water storage; C). Beam-shaped microtensile specimens were prepared (0.8 mm2 cross-sectional area) and loaded at a crosshead speed of 1.0 mm/minute in a universal testing machine. Fracture modes were examined by scanning electron microscope. Means (MPa) and standard deviations (+/-) were: (1) SI-T=24.17 (+/-1.99); (2) SI-M=25.64 (+/-9.75); (3) Si-pH=23.43 (+/-4.19); (4) SI-C=33.81 (+/-2.45); (5) SI-TM=18.60 (+/-3.57); (6) SI-TpH=23.90 (+/-4.28); (7) SI-MpH=20.96 (+/-4.06); (8) SI-TMpH=20.94 (+/-3.15); (9) SE-T=24.08 (+/-4.52); (10) SE-M=18.30 (+/-14.12); (11) SE-pH=19.22 (+/-8.93); (12) SE-C=37.80 (+/-7.28); (13) SE-TM=22.89 (+/-11.74); (14) SE-TpH=27.87 (+/-12.77); (15) SE-MpH=18.87 (+/-10.95); and (16) SE-TMpH=22.55 (+/-3.05). Both adhesive systems presented similar dentin bond strength (P>.05) which were significantly reduced when combined aging treatments were applied or when pH cycling (pH) was done. Combined aging treatments and also pH cycling alone influenced negatively adhesive bond strengths.

  1. Characteristics of primary care office systems as predictors of mammography utilization.

    PubMed

    Gann, P; Melville, S K; Luckmann, R

    1993-06-01

    To evaluate the association between primary care office systems and mammography utilization by women older than 50 years. Cross-sectional. An independent-practice association health maintenance organization (HMO) in Massachusetts. One hundred thirty-two primary care practices, representing 321 physicians and 4378 women with at least 12 months of recent, continuous assignment to a practice participating in the HMO. Practice characteristics and procedures for mammography referral and follow-up were ascertained by interviews of office managers. For each practice, the proportion of women older than 50 years who received a mammogram during their most recent 12-month period of assignment to the practice was calculated. Forty-five percent of eligible women received a mammogram during their most recent year of assignment to an HMO practice. In a regression model, use of one particular urban mammography center, group practice, and low percentage of Medicaid patients in the practice were each associated with 9% to 12% higher mammography utilization; use of flowsheets and the scheduling of mammograms by the patients themselves were associated with 7% to 9% higher utilization. Smaller, nonsignificant increases were associated with the use of reminders to patients (5%) and the presence of only internists on staff (5%). The model accounted for 51% of the variation in mammography utilization among practices. Mammography utilization among women older than 50 years, in a population in which cost was not a barrier, was related to specific office characteristics. Features of the mammography center, the process for scheduling mammograms, the use of flowsheets to prompt physicians, and the use of reminders to patients are important.

  2. A situational analysis of ocular health promotion in the South African primary health-care system.

    PubMed

    Sithole, Hlupheka Lawrence

    2017-03-01

    South Africa has a serious burden of avoidable blindness and visual impairment, which may be due to poor ocular health promotional policies and programs or implementation. Therefore, this paper sought to critically analyse the South African primary health-care policies and programs, to identify the components of ocular health promotional policies and programs as well as how they are currently being implemented and to suggest areas that can be improved in order to minimise the burden of blindness and visual impairment. Triangulated quantitative and qualitative research methods were used in the study. Questionnaire and interviews were used to solicit data from national and provincial managers of different health directorates. Eye-care managers from each province also completed the questionnaire. Furthermore, relevant health policy and program documents from national and provincial departments of health were studied to identify areas relating to ocular health promotion. The study found varying degrees of implementation of various ocular health promotional activities in the provinces with the majority of respondents (62 per cent) indicating that ocular health promotion was not part of their responsibility and another 81 per cent revealing that vision screening does not form part of their health promotional programs. It further revealed a lack of a dedicated directorate for ocular health-care issues and the absence of an integrated ocular health promotional policy. Ocular health promotional activities were absent in other provinces. This may be a major contributing factor to poor ocular health promotion in South Africa and hence, the high prevalence of blindness and visual impairment. Therefore, it is recommended that an integrated ocular health promotional model (directorate and policies) be developed and be part of the South African primary health-care system. © 2016 Optometry Australia.

  3. [Ocular hypotensive effect of systemic beta-blockers in patients with primary glaucoma and arterial hypertension].

    PubMed

    Onishchenko, A L; Kolbasko, A V; Zakharova, A V; Onishchenko, E G; Zhilina, N M

    2017-01-01

    to evaluate the ocular hypotensive efficacy of systemic beta-blockers in primary glaucoma patients suffering from arterial hypertension (AH). The study included 29 patients with POAG (58 eyes) aged from 47 to 83 years. Patients with stage I-III POAG received instillations of prostaglandin analogs and carbonic anhydrase inhibitors. All POAG patients also suffered from arterial hypertension and were prescribed selective beta-blockers (metoprolol, bisoprolol, or nebivalol) as monotherapy or as part of combination therapy (if the target arterial pressure had not been achieved under the initial treatment). After the start of oral beta-blockers therapy, the patients were re-examined at 2 and 4 weeks, 3 months, 6 months, and 1 year. A clinically significant reduction of IOP in the most seriously affected eye - by 3.3 mmHg (p<0.05), or 14% - occurred four weeks after the start of selective beta-blockers. Over three months of combination therapy, IOP in the 'worst' eye decreased by 4.4 mmHg (18.5%). At 1 year, IOP in the 'worst' eye was 6.2 mmHg (26%) lower than at baseline (p<0.05). Aged and senile patients with primary glaucoma usually suffer from polypathy (on average, they have 6.3±0.6 concurrent somatic diseases). To reduce the risk of polypharmacy and the frequency of side effects in the treatment of POAG and AH patients, it is advised that the treatment includes oral selective beta-blockers able to provide target levels of arterial pressure and IOP. In this study, oral beta-blockers in POAG and AH patients enabled IOP reduction as great as 18.5%-26% of baseline values over a 1-year follow-up period.

  4. Proteinase-3 antineutrophil cytoplasm antibody positivity in patients without primary systemic vasculitis.

    PubMed

    McAdoo, Stephen Paul; Hall, Angela; Levy, Jeremy; Salama, Alan D; Pusey, Charles D

    2012-10-01

    Antineutrophil cytoplasm antibodies (ANCAs) are useful diagnostic markers in vasculitis. Historical data have suggested the combination of cytoplasmic (C-ANCA) staining with antibodies specific for proteinase 3 (PR3-ANCA) is 99% to 100% specific for granulomatosis with polyangiitis. We aimed to establish the frequency and associations of PR3-ANCA in patients without primary systemic vasculitis using current methods in our laboratory. This was a retrospective review of all patients identified as C-and PR3-ANCA positive as determined by indirect immunofluorescence and Luminex testing, respectively, in our laboratory over a 6-month period. One hundred ninety-four patients were positive for both C- and PR3-ANCA. One hundred seventy-five patients had primary ANCA-associated vasculitis (AAV). Nineteen patients (9.7%) were C- and PR3-ANCA positive but without AAV. Clinical associations included infections, other autoimmune disorders, and malignancy. PR3-ANCA titer ranged from 31 to 278 U/mL (reference range, 0-25 U/mL). Three patients became PR3-ANCA negative after treatment of associated conditions. One patient went on to develop AAV 6 months after the study period. We detected a higher than expected frequency (9.7%) of "incidental" C- and PR3-ANCA. Several factors may be contributing, including the occurrence of ANCAs in other inflammatory states, the increased use of ANCA testing in unselected populations with low clinical suspicion of AAV, recent changes to detection methods for ANCA, and the probability that circulating ANCAs predate onset of clinical disease. Our data underscore the need to secure tissue diagnosis in AAV and to exclude other underlying conditions such as infection. In addition, patients with unexplained ANCAs should be followed up because they are at risk of developing disease over time.

  5. Assessment of Field Experience Related to Pressurized Water Reactor Primary System Leaks

    SciTech Connect

    A. G. Ware; C. Hsu; C. L. Atwood; M. B. Sattison; R. S. Hartley; V. N. Shah

    1999-02-01

    This paper presents our assessment of field experience related to pressurized water reactor (PWR) primary system leaks in terms of their number and rates, how aging affects frequency of leak events, the safety significance of such leaks, industry efforts to reduce leaks, and effectiveness of current leak detection systems. We have reviewed the licensee event reports to identify the events that took place during 1985 to the third quarter of 1996, and reviewed related technical literature and visited PWR plants to analyze these events. Our assessment shows that USNRC licensees have taken effective actions to reduce the number of leak events. One main reason for this decreasing trend was the elimination or reportable leakages from valve stem packing after 1991. Our review of leak events related to vibratory fatigue reveals a statistically significant decreasing trend with age (years of operation), but not in calendar time. Our assessment of worldwide data on leakage caused by thermal fatigue cracking is that the fatigue of aging piping is a safety significant issue. Our review of leak events has identified several susceptible sites in piping having high safety significance; but the inspection of some of these sites is not required by the ASME Code. These sites may be included in the risk-informed inspection programs.

  6. Assessment of Field Experience Related to Pressurized Water Reactor Primary System Leaks

    SciTech Connect

    Shah, Vikram Naginbhai; Ware, Arthur Gates; Atwood, Corwin Lee; Sattison, Martin Blaine; Hartley, Robert Scott; Hsu, C.

    1999-08-01

    This paper presents our assessment of field experience related to pressurized water reactor (PWR) primary system leaks in terms of their number of rates, how aging affects frequency of leak events, the safety significance of such leaks, industry efforts to reduce leaks, and effectiveness of current leak detection systems. We have reviewed the licensee event reports to identify the events that took place during 1985 to the third quarter of 1996, and reviewed related technical literature and visited PWR plants to analyze these events. Our assessment shows that USNRC licensees have taken effective actions to reduce the number of leak events. One main reason for this decreasing trend was the elimination or reportable leakages from valve stem packing after 1991. Our review of leak events related to vibratory fatigue reveals a statistically significant decreasing trend with age (years of operation), but not in calendar time. Our assessment of worldwide data on leakage caused by thermal fatigue cracking is that the fatigue of aging piping is a safety significant issue. Our review of leak events has identified several susceptible sites in piping having high safety significance; but the inspection of some of these sites is not required by the ASME Code. These sites may be included in the risk-informed inspection programs.

  7. A Conceptual Framework for Evaluation of Public Health and Primary Care System Performance in Iran

    PubMed Central

    Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Sari, Ali Akbari; Mesdaghinia, Alireza

    2015-01-01

    Introduction: The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. Methods: We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. Results: We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. Conclusion: The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report. PMID:25946937

  8. A defined, controlled culture system for primary bovine chromaffin progenitors reveals novel biomarkers and modulators.

    PubMed

    Masjkur, Jimmy; Levenfus, Ian; Lange, Sven; Arps-Forker, Carina; Poser, Steve; Qin, Nan; Vukicevic, Vladimir; Chavakis, Triantafyllos; Eisenhofer, Graeme; Bornstein, Stefan R; Ehrhart-Bornstein, Monika; Androutsellis-Theotokis, Andreas

    2014-07-01

    We present a method to efficiently culture primary chromaffin progenitors from the adult bovine adrenal medulla in a defined, serum-free monolayer system. Tissue is dissociated and plated for expansion under support by the mitogen basic fibroblast growth factor (bFGF). The cultures, although not homogenous, contain a subpopulation of cells expressing the neural stem cell marker Hes3 that also propagate. In addition, Hes3 is also expressed in the adult adrenal medulla from where the tissue is taken. Differentiation is induced by bFGF withdrawal and switching to Neurobasal medium containing B27. Following differentiation, Hes3 expression is lost, and cells acquire morphologies and biomarker expression patterns of chromaffin cells and dopaminergic neurons. We tested the effect of different treatments that we previously showed regulate Hes3 expression and cell number in cultures of fetal and adult rodent neural stem cells. Treatment of the cultures with a combination of Delta4, Angiopoietin2, and a Janus kinase inhibitor increases cell number during the expansion phase without significantly affecting catecholamine content levels. Treatment with cholera toxin does not significantly affect cell number but reduces the ratio of epinephrine to norepinephrine content and increases the dopamine content relative to total catecholamines. These data suggest that this defined culture system can be used for target identification in drug discovery programs and that the transcription factor Hes3 may serve as a new biomarker of putative adrenomedullary chromaffin progenitor cells.

  9. Primary central nervous system anaplastic large-cell lymphoma mimicking lymphomatosis cerebri.

    PubMed

    Sugino, Toshiya; Mikami, Takeshi; Akiyama, Yukinori; Wanibuchi, Masahiko; Hasegawa, Tadashi; Mikuni, Nobuhiro

    2013-01-01

    Primary central nervous system lymphoma (PCNSL) is usually diffuse large B-cell lymphoma. Anaplastic large-cell lymphoma (ALCL) rarely occurs in the central nervous system. PCNSL always presents as single or multiple nodular contrast-enhancing mass lesions within T2-hyperintense areas on magnetic resonance imaging (MRI). Infrequently, diffuse infiltrating change with little contrast enhancement called lymphomatosis cerebri can be seen in PCNSL. In this report, we describe a 75-year-old immunocompetent man who had progressive dementia. On MRI, diffuse white matter lesions with little contrast enhancement were observed to gradually progress, which was clinically consistent with his worsening condition. A biopsy specimen revealed non-destructive, diffusely infiltrating, anaplastic large CD30-positive lymphoma, indicating a diagnosis of ALCL. After the biopsy, he was treated by whole brain irradiation (total 46 Gy) and focal boost irradiation (total 14 Gy). However, his performance status worsened and there was no symptom improvement. The patient died 8 months after symptom onset. The clinical course, diagnostic workup, pathologic correlates, and treatment outcomes are described herein.

  10. Partial decoupling of primary productivity from upwelling in the California Current system

    NASA Astrophysics Data System (ADS)

    Renault, Lionel; Deutsch, Curtis; McWilliams, James C.; Frenzel, Hartmut; Liang, Jun-Hong; Colas, François

    2016-07-01

    Coastal winds and upwelling of deep nutrient-rich water along subtropical eastern boundaries yield some of the ocean's most productive ecosystems. Simple indices of coastal wind strength have been extensively used to estimate the timing and magnitude of biological productivity on seasonal and interannual timescales and underlie the prediction that anthropogenic climate warming will increase the productivity by making coastal winds stronger. The effect of wind patterns on regional net primary productivity is not captured by such indices and is poorly understood. Here we present evidence, using a realistic model of the California Current system and satellite measurements, that the observed slackening of the winds near the coast has little effect on near-shore phytoplankton productivity despite a large reduction in upwelling velocity. On the regional scale the wind drop-off leads to substantially higher production even when the total upwelling rate remains the same. This partial decoupling of productivity from upwelling results from the impact of wind patterns on alongshore currents and the eddies they generate. Our results imply that productivity in eastern boundary upwelling systems will be better predicted from indices of the coastal wind that account for its offshore structure.

  11. Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection

    PubMed Central

    Yun, Jonathan; Iwamoto, Fabio M.; Sonabend, Adam M.

    2016-01-01

    Background Primary central nervous system lymphomas (PCNSL) are rare CNS tumors that carry a poor prognosis, with most patients suffering recurrence. Progress has been made in the treatment of this pathology, notably with the widespread use of systemic high dose methotrexate. However, unlike most other malignant CNS neoplasms, surgery for cytoreduction is not routinely performed for this disease, mainly as a result of negative experiences decades ago. Since these studies were published, the availability of intraoperative monitoring, MR imaging and neuro-navigation as well as surgical adjuncts such as fluorescence- guided resection have greatly improved the safety of intracranial procedures. More recent data is suggestive of a potential survival benefit for resection of single PCNSL lesions when patients are subsequently treated with modern regimen high-dose methotrexate, yet this evidence is limited, and should be interpreted conservatively. Methods and findings A systematic review of the literature was performed to identify trials evaluating surgical options for the treatment of PCNSL. Conclusion In this review, we provide a critical overview of the evidence favoring and discouraging resection for PCNSL. This literature suffers from several biases and limitations that must be considered in the context of the extrapolation of this literature into clinical decision-making. PMID:28239600

  12. Performance Enhancement of Multi-Cyclic Detector for Cognitive Radios with an OFDM Primary System

    NASA Astrophysics Data System (ADS)

    Kim, Minseok; Po, Kimtho; Takada, Jun-Ichi

    Spectrum sensing, a key technical challenge in cognitive radios (CR) technology, is a technique that enables the spectrum of licensed systems to be accessed without causing undue interference. It is well known that cyclostationarity detectors have great advantages over energy detectors in terms of the robustness to noise uncertainty that significantly degrades the performance as well as the capability to distinguish the signal of interest from the other interferences and noise. The generalized likelihood ratio test (GLRT) is a recognized sensing technique that utilizes the inherent cyclostationarity of the signal and has been intensively studied. However, no comprehensive evaluation on its performance enhancement has been published to date. Moreover high computational complexity is still a significant problem for its realization. This paper proposes a maximum ratio combining multi-cyclic detector which uses multiple cyclic frequencies for performance enhancement with reduced computational complexity. An orthogonal frequency-division multiplexing (OFDM) signal based on the ISDB-T (integrated services digital broadcasting terrestrial), a Japanese digital television broadcasting standard, was used in the evaluation assuming this as a primary system in WRAN (wireless regional area network) applications like IEEE 802.22.

  13. Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation--an International Primary Central Nervous System Lymphoma Study Group project.

    PubMed

    Bromberg, Jacoline E; Doorduijn, Jeanette K; Illerhaus, Gerald; Jahnke, Kristoph; Korfel, Agniezka; Fischer, Lars; Fritsch, Kristina; Kuittinen, Outti; Issa, Samar; van Montfort, Cees; van den Bent, Martin J

    2013-05-01

    Autologous stem cell transplantation has greatly improved the prognosis of systemic recurrent non-Hodgkin's lymphoma. However, no prospective data are available concerning the feasibility and efficacy of this strategy for systemic lymphoma relapsing in the central nervous system. We, therefore, we performed an international multicenter retrospective study of patients with a central nervous system recurrence of systemic lymphoma to assess the outcome of these patients in the era of stem cell transplantation. We collected clinical and treatment data on patients with a first central nervous system recurrence of systemic lymphoma treated between 2000 and 2010 in one of five centers in four countries. Patient- and treatment-related factors were analyzed and compared descriptively. Primary outcome measures were overall survival and percentage of patients transplanted. We identified 92 patients, with a median age of 59 years and a median Eastern Cooperative Oncology Group/World Health Organization performance status of 2, of whom 76% had diffuse large B-cell histology. The majority (79%) of these patients were treated with systemic chemotherapy with or without intravenous rituximab. Twenty-seven patients (29%) were transplanted; age and insufficient response to induction chemotherapy were the main reasons for not being transplanted in the remaining 65 patients. The median overall survival was 7 months (95% confidence interval 2.6-11.4), being 8 months (95% confidence interval 3.8-5.2) for patients ≤ 65 years old. The 1-year survival rate was 34.8%; of the 27 transplanted patients 62% survived more than 1 year. The Memorial Sloan Kettering Prognostic Index for primary central nervous system lymphoma was prognostic for both undergoing transplantation and survival. In conclusion, despite the availability of autologous stem cell transplantation for patients with central nervous system progression or relapse of systemic lymphoma, prognosis is still poor. Long-term survival

  14. Feasibility of using a knowledge-based system concept for in-flight primary flight display research

    NASA Technical Reports Server (NTRS)

    Ricks, Wendell R.

    1991-01-01

    A study was conducted to determine the feasibility of using knowledge-based systems architectures for inflight research of primary flight display information management issues. The feasibility relied on the ability to integrate knowledge-based systems with existing onboard aircraft systems. And, given the hardware and software platforms available, the feasibility also depended on the ability to use interpreted LISP software with the real time operation of the primary flight display. In addition to evaluating these feasibility issues, the study determined whether the software engineering advantages of knowledge-based systems found for this application in the earlier workstation study extended to the inflight research environment. To study these issues, two integrated knowledge-based systems were designed to control the primary flight display according to pre-existing specifications of an ongoing primary flight display information management research effort. These two systems were implemented to assess the feasibility and software engineering issues listed. Flight test results were successful in showing the feasibility of using knowledge-based systems inflight with actual aircraft data.

  15. A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification.

    PubMed

    Jeys, Lee M; Thorne, Chris J; Parry, Michael; Gaston, Czar Louie L; Sumathi, Vaiyapuri P; Grimer, J Robert

    2017-03-01

    Chemotherapy response and surgical margins have been shown to be associated with the risk of local recurrence in patients with osteosarcoma. However, existing surgical staging systems fail to reflect the response to chemotherapy or define an appropriate safe metric distance from the tumor that will allow complete excision and closely predict the chance of disease recurrence. We therefore sought to review a group of patients with primary high-grade osteosarcoma treated with neoadjuvant chemotherapy and surgical resection and analyzed margins and chemotherapy response in terms of local recurrence. (1) What predictor or combination of predictors available to the clinician can be assessed that more reliably predict the likelihood of local recurrence? (2) Can we determine a better predictor of local recurrence-free survival than the currently applied system of surgical margins? (3) Can we determine a better predictor of overall survival than the currently applied system of surgical margins? This retrospective study included all patients with high-grade conventional osteosarcomas without metastasis at diagnosis treated at one center between 1997 and 2012 with preoperative chemotherapy followed by resection or amputation of the primary tumor who were younger than age 50 years with minimum 24-month followup for those still alive. A total of 389 participants matched the inclusion criteria. Univariate log-rank test and multivariate Cox analyses were undertaken to identify predictors of local recurrence-free survival (LRFS). The Birmingham classification was devised on the basis of two stems: the response to chemotherapy (good response = ≥ 90% necrosis; poor response = < 90% necrosis) and margins (< 2 mm or ≥ 2 mm). The 5-year overall survival rate was 67% (95% confidence interval [CI], 61%-71%) and 47 patients developed local recurrence (12%). Intralesional margins (hazard ratio [HR], 9.9; 95% CI, 1.2-82; p = 0.03 versus radical margin HR, 1) and a poor response to

  16. Optimization design for the supporting system of 2m telescope primary mirror

    NASA Astrophysics Data System (ADS)

    Zhao, Fu; Wang, Ping; Gong, Yanjue; Zhang, Li; Lin, Jianlong

    2008-12-01

    This paper describes the optimization solution improving the total quality of the primary mirror supporting type. With the methods of Finite element analysis(FEA), Orthogonal experiment and BP Neural Network, the relationship between the structure parameters in primary mirror supporting type and the deformation of the primary mirror is built. With this relationship and Genetic Algorithm(GA) optimization design, a group of reasonable technology parameters is found that can improve the static stiffness of the primary mirror supporting type so as to reduce the gravity deformation of the primary mirror. The modal analysis and random vibration analysis are also discussed in detail, and the results indicate that the dynamic stiffness of the primary mirror supporting type is also improved.

  17. HD 35502: a hierarchical triple system with a magnetic B5IVpe primary

    NASA Astrophysics Data System (ADS)

    Sikora, J.; Wade, G. A.; Bohlender, D. A.; Shultz, M.; Adelman, S. J.; Alecian, E.; Hanes, D.; Monin, D.; Neiner, C.; MiMeS Collaboration; BinaMIcS Collaboration

    2016-08-01

    We present our analysis of HD 35502 based on high- and medium-resolution spectropolarimetric observations. Our results indicate that the magnetic B5IVsnp star is the primary component of a spectroscopic triple system and that it has an effective temperature of 18.4 ± 0.6 kK, a mass of 5.7 ± 0.6 M⊙, and a polar radius of 3.0^{+1.1}_{-0.5} R_{odot }. The two secondary components are found to be essentially identical A-type stars for which we derive effective temperatures (8.9 ± 0.3 kK), masses (2.1 ± 0.2 M⊙), and radii (2.1 ± 0.4 R⊙). We infer a hierarchical orbital configuration for the system in which the secondary components form a tight binary with an orbital period of 5.668 66(6) d that orbits the primary component with a period of over 40 yr. Least-Squares Deconvolution profiles reveal Zeeman signatures in Stokes V indicative of a longitudinal magnetic field produced by the B star ranging from approximately -4 to 0 kG with a median uncertainty of 0.4 kG. These measurements, along with the line variability produced by strong emission in Hα, are used to derive a rotational period of 0.853 807(3) d. We find that the measured v sin i = 75 ± 5 km s-1 of the B star then implies an inclination angle of the star's rotation axis to the line of sight of 24^{+6}_{-10}{}^circ. Assuming the Oblique Rotator Model, we derive the magnetic field strength of the B star's dipolar component (14^{+9}_{-3} kG) and its obliquity (63± 13deg). Furthermore, we demonstrate that the calculated Alfvén radius (41^{+17}_{-6}R_ast) and Kepler radius (2.1^{+0.4}_{-0.7}R_ast) place HD 35502's central B star well within the regime of centrifugal magnetosphere-hosting stars.

  18. RNA Disruption and Drug Response in Breast Cancer Primary Systemic Therapy.

    PubMed

    Pritzker, Kenneth; Pritzker, Laura; Generali, Daniele; Bottini, Alberto; Cappelletti, Maria Rosa; Guo, Baoqing; Parissenti, Amadeo; Trudeau, Maureen

    2015-05-01

    As there is now evidence that switching clinical nonresponders early in primary systemic therapy to alternate treatment regimens can enhance survival in some breast cancer patients, the need for a robust intermediate endpoint that can guide treatment response across all tumor subtypes is urgent. Recently, chemotherapy drugs have been shown to induce a decrease in RNA quality in tumor cells from breast cancer biopsies in some patients at midtherapy, and that this has been associated with subsequent achievement of pathological complete response (pCR). The decrease in RNA quality has been shown to be associated with RNA disruption; aberrant RNA bands visualized by RNA electrophoresis have been associated with subsequent tumor cell death. The objectives of these studies are to show that a new assay based on induction of RNA disruption in tumor cells by chemotherapy can stratify at midtherapy, pCR responders from non-pCR responders irrespective of clinical response and to present early evidence that clinically useful RNA disruption can be detected as early as 14 days after initiation of treatment. RNA disruption in tumor cells was quantified by analysis of the RNA electrophoresis banding pattern and expressed as an RNA disruption index (RDI). To develop the RNA disruption assay (RDA), RDI was correlated with clinical outcome (pCR) from the NCIC-CTG MA.22 breast cancer clinical trial (ClinicalTrials.gov NCT00066443). RDA Zones were established by stratifying patients using RDI values into Zone 1, Zone 2, and Zone 3. Zone 3 included seven out of eight pCR responders, whereas Zone 1 contained no pCR responders. An intermediate zone (Zone 2) was established which contained one pCR. Subsequently, to determine early drug response, RNA disruption was examined by RDI after 14 days exposure to trastuzumab, zoledronic acid, or letrozole + cyclophosphamide ± sorafenib therapy. In MA.22, RDA stratified 23 of 85 patients in Zone 1 as pCR nonresponders, 24 patients in Zone 2, an

  19. Establishing a Viable Workforce Pipeline of Primary Care Nurse Practitioners: Benefits of a Health System and Academic Partnership.

    PubMed

    Madler, Billie; Helland, Mary

    Maldistribution and shortages of primary care providers, changing reimbursement structures, movement from inpatient to community-based models of care, an aging population, and health care reform lead to increased numbers of patients seeking care. All of these phenomena have a part in creating a health care landscape that requires industry leaders enlist innovative strategies to meet the health care needs of their communities. Delivery of high-quality, efficient care by qualified providers is essential for the success of any health care system. Partnerships between health systems and academic centers of learning to develop a pipeline of providers is one inventive approach that can address primary care workforce needs. The purpose of this article was to share an example of an academic/health care system partnership to address primary care workforce needs in a rural Midwestern region.

  20. Model Systems for Examining Effects of Leukemia-Associated Oncogenes in Primary Human CD34+ Cells via Retroviral Transduction

    PubMed Central

    Wunderlich, Mark; Mulloy, James C.

    2010-01-01

    Summary The use of primary human cells to model cancer initiation and progression is now within the grasp of investigators. It has been nearly a decade since the first defined genetic elements were introduced into primary human epithelial and fibroblast cells to model oncogenesis. This approach has now been extended to the hematopoietic system, with the first described experimental transformation of primary human hematopoietic cells. Human cell model systems will lead to a better understanding of the species and cell type specific signals necessary for oncogenic initiation and progression, and will allow investigators to interrogate the cancer stem cell hypothesis using a well-defined hierarchical system that has been studied for decades. The molecular and biochemical link between self-renewal and differentiation can now be experimentally approached using primary human cells. In addition, the models that result from these experiments are likely to generate highly relevant systems for use in identification and validation of potential therapeutic targets as well as testing of small molecule therapeutics. We describe here the methodologies and reagents that are used to examine the effects of leukemia fusion protein expression on primary human hematopoietic cells, both in vitro and in vivo. PMID:19277588

  1. Sleep misperception, EEG characteristics and autonomic nervous system activity in primary insomnia: a retrospective study on polysomnographic data.

    PubMed

    Maes, J; Verbraecken, J; Willemen, M; De Volder, I; van Gastel, A; Michiels, N; Verbeek, I; Vandekerckhove, M; Wuyts, J; Haex, B; Willemen, T; Exadaktylos, V; Bulckaert, A; Cluydts, R

    2014-03-01

    Misperception of Sleep Onset Latency, often found in Primary Insomnia, has been cited to be influenced by hyperarousal, reflected in EEG- and ECG-related indices. The aim of this retrospective study was to examine the association between Central Nervous System (i.e. EEG) and Autonomic Nervous System activity in the Sleep Onset Period and the first NREM sleep cycle in Primary Insomnia (n=17) and healthy controls (n=11). Furthermore, the study examined the influence of elevated EEG and Autonomic Nervous System activity on Stage2 sleep-protective mechanisms (K-complexes and sleep spindles). Confirming previous findings, the Primary Insomnia-group overestimated Sleep Onset Latency and this overestimation was correlated with elevated EEG activity. A higher amount of beta EEG activity during the Sleep Onset Period was correlated with the appearance of K-complexes immediately followed by a sleep spindle in the Primary Insomnia-group. This can be interpreted as an extra attempt to protect sleep continuity or as a failure of the sleep-protective role of the K-complex by fast EEG frequencies following within one second. The strong association found between K-alpha (K-complex within one second followed by 8-12 Hz EEG activity) in Stage2 sleep and a lower parasympathetic Autonomic Nervous System dominance (less high frequency HR) in Slow-wave sleep, further assumes a state of hyperarousal continuing through sleep in Primary Insomnia.

  2. Meckel-Gruber syndrome and the role of primary cilia in kidney, skeleton, and central nervous system development.

    PubMed

    Barker, Amy R; Thomas, Rhys; Dawe, Helen R

    2014-01-01

    The ciliopathies are a group of related inherited diseases characterized by malformations in organ development. The diseases affect multiple organ systems, with kidney, skeleton, and brain malformations frequently observed. Research over the last decade has revealed that these diseases are due to defects in primary cilia, essential sensory organelles found on most cells in the human body. Here we discuss the genetic and cell biological basis of one of the most severe ciliopathies, Meckel-Gruber syndrome, and explain how primary cilia contribute to the development of the affected organ systems.

  3. Meckel-Gruber syndrome and the role of primary cilia in kidney, skeleton, and central nervous system development

    PubMed Central

    Barker, Amy R; Thomas, Rhys; Dawe, Helen R

    2014-01-01

    The ciliopathies are a group of related inherited diseases characterized by malformations in organ development. The diseases affect multiple organ systems, with kidney, skeleton, and brain malformations frequently observed. Research over the last decade has revealed that these diseases are due to defects in primary cilia, essential sensory organelles found on most cells in the human body. Here we discuss the genetic and cell biological basis of one of the most severe ciliopathies, Meckel-Gruber syndrome, and explain how primary cilia contribute to the development of the affected organ systems. PMID:24322779

  4. [Retrospective study of 48 cases of primary central nervous system lymphoma].

    PubMed

    Alessandro, Lucas; Pastor Rueda, José M; Villalonga, Juan F; Bruno, Verónica A; Carpani, Federico; Blaquier, Juan B; Tognarelli, Sofía; Varela, Francisco J; Muggeri, Alejandro

    2017-01-01

    Primary central nervous system lymphoma (PCNSL) is an infrequent form of non-Hodgkin lymphoma restricted to the CNS. More than 90% are type B and mainly affect patients aged 50-70 years. Immunodeficiency is the most important risk factor. The aim of our study was to evaluate the immune status, clinical presentation and findings in complementary studies of PCNSL patients. A retrospective analysis of 48 cases treated in our center between January 1992 and May 2015 was performed. Median age at diagnosis was 61 years (range 25-84); with male predominance (2.1:1). Forty one cases (85%) were immunocompetent patients. Brain MRI findings showed parenchymal involvement in 45 cases (94%), 43% with frontal lobe and 35% basal ganglia, 4% had meningeal involvement and 2% had ophthalmic involvement at diagnosis. Fifty-five percent had restricted signal on diffusion weighted imaging and contrast enhancement was found in 89%. Pyramidal syndrome was the main initial clinical manifestation (56%). There were abnormal findings in 62% of CSF samples, but in only 11.1% positive cytology results were detected. The most frequent type was diffuse large B-cell lymphoma (83%), being B-cell type the most common form between them (96%). In our series PCNSL was more frequent in immunocompetent elderly male subjects. At initial evaluation, clinical manifestations and MRI findings were variable. The initial suspicion of this entity would allow an early diagnosis, avoiding empirical treatments that may confuse or delay diagnosis.

  5. Review of Failure Probability Calculations for HFIR Primary Coolant System Piping

    SciTech Connect

    Simonen, Fredric A.

    2001-10-31

    During July 2001, Pacific Northwest National Laboratory was requested by the U.S. Department of Energy, Office of Nuclear Facilities Management, Office of Nuclear Energy, Science and Technology, Germantown, Maryland, to review calculations of piping failure probabilities for the High Flux Test Reactor (HFIR) located at and operated by the Oak Ridge National Laboratory (ORNL). The objective of the failure probability calculations was to estimate the probabilities of large leaks (>1500 gpm) that are of sufficient size to disable the primary coolant system of HFIR to the extent that there is a potential for core damage. PNNL reviewed the computational methods and the inputs to the calculations along with an evaluation of potential failure mechanisms not explicitly addressed by the ORNL calculations. The review concluded that the calculated failure probabilities even with consideration of uncertainties in the calculations and of other potential failure mechanisms provide a high level of confidence that failure frequencies are less than the stated goal of 10-6 piping failures per year.

  6. Task-relevant modulation of primary somatosensory cortex suggests a prefrontal-cortical sensory gating system.

    PubMed

    Schaefer, Michael; Heinze, Hans-Jochen; Rotte, Michael

    2005-08-01

    Increasing evidence suggests that somatosensory information is modulated cortically for task-specific sensory inflow: Several studies report short-term adaptation of representational maps in primary somatosensory cortex (SI) due to attention or induced by task-related motor activity such as handwriting. Recently, it has been hypothesized that the frontal or prefrontal cortex may modulate SI. In order to test this hypothesis, we studied the functional organization of SI while subjects performed the Tower of Hanoi task. This task is known to be related to activation of frontal or prefrontal areas. The functional organization of SI while performing the Tower of Hanoi task was compared to the organization of SI during performing the same movements but without the Tower of Hanoi task and with rest. Topography of SI was assessed using neuromagnetic source imaging based on tactile stimulation of the first (D1) and fifth digits (D5). Performing the Tower of Hanoi task was accompanied by plastic changes in SI as indicated by significant shifts in the cortical representations of D1 and D5: They moved further apart during the Tower of Hanoi task compared to the control task containing the same movements but without the cognitive characteristic. Thus, we conclude that SI maps undergo dynamic modulation depending on motor tasks with different cognitive demands. The results suggest that this short-term plasticity may be regulated by a prefrontal-cortical sensory gating system.

  7. Primary central nervous system ALK-positive anaplastic large cell lymphoma in an adult

    PubMed Central

    Dong, Xiaoqin; Li, Jun; Huo, Na; Wang, Yan; Wu, Zhao; Lin, Xiaohong; Zhao, Hong

    2016-01-01

    Abstract Rationale: Anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin lymphoma. It mostly invades lymph nodes with extranodal involvement observed in the soft tissue, bone, and skin. Patient concerns: We report a 34-year-old Chinese male patient who presented with headache, diplopia, and vomit. Cerebrospinal fluid (CSF) analysis via lumbar puncture showed elevated CSF pressure, elevated CSF protein concentrations, decreased CSF glucose and chloride concentration significantly, and pleocytosis of 68 to 350 × 106/L, in which lymphocytes and monocytes were predominant. These changes could be suggestive of tuberculous (TB) meningitis. Enhanced magnetic resonance imaging of spinal cord delineated multiple enhancing nodules in spinal cord, cauda equina, and cristae membrane, and multiple abnormal enhancing lesions in bilateral lumbar intervertebral foramen. Diagnoses: Spinal dura mater biopsy and paraffin pathology examination revealed anaplastic lymphoma kinase positive ALCL. Interventions: High-dose methotrexate, cytosine arabinoside craniospinal, and radiotherapy. Outcomes: Last follow-up on September 22, 2015 showed no evidence of tumor recurrence and the lower extremity muscle strength recovered to 4/5. Lessons: ALCL of primary central nervous system is an exceedingly rare tumor, which is usually misdiagnosed as meningitis (especially TB meningitis) according to clinical manifestation and laboratory examination. Thus closely monitoring patient's conditions and timely adjusting therapeutic regimen during treatment are necessary. PMID:27930548

  8. Imbalances of T cell subpopulations in primary immunodeficiencies and systemic lupus erythematosus.

    PubMed

    Pandolfi, F; Quinti, I; Sirianni, M C; Fiorilli, M; Zolla, S; Aiuti, F

    1981-01-01

    In the present report we describe a recently proposed technique for the enumeration of T lymphocyte subpopulations. The study was performed on peripheral blood lymphocytes (PBL) of 21 patients with primary immunodeficiencies and 10 with systemic lupus erythematosus (SLE). With this methodology, sheep rosettes are evaluated before and after preincubation with theophylline. Previous reports have shown that cells rosetting after the preincubation (T-res) contain most of the percentages of the helper activity, whereas sensitive cells (T-sens) exert suppression. T-res and T-sens cells were compared to several clinical and immunological parameters, including the detection of lymphocytes with Fc IgM and IgG receptors. We demonstrated a significant positive correlation between T-res and and EAox IgM cells and between T-sens and EAox IgG cells. In addition, patients with Ig defects demonstrated heterogeneity regarding alterations in the proportions of T-res and T-sens cells. On the contrary, in 8 patients with SLE, there was a markedly reduced proportion of T-sens cells. Variations in the balance of subpopulations were observed after treatment with thymic hormones and levamisole. We may conclude that theophylline rosettes represent an easy technique that can be profitably used in the evaluation of T cell subpopulations in immunological diseases.

  9. Primary angiitis of the central nervous system presenting as unilateral optic neuritis.

    PubMed

    Rao, Neal M; Prasad, Pradeep S; Flippen, Charles C; Wagner, Aaron S; Yim, Catherine M; Salamon, Noriko; Vinters, Harry V

    2014-12-01

    A middle-aged woman who experienced recurrent episodes of unilateral vision loss and eye pain. On presentation, magnetic resonance imaging (MRI) demonstrated left optic nerve enhancement with patchy hyperintensities in the white matter of both frontal lobes and ill-defined enhancement in a lenticulostriate distribution. Ophthalmologic examination revealed left optic disc edema with a macular scar consistent with neuroretinitis. Her subsequent clinical course was notable for 2 episodes of painful vision loss, without associated neurologic symptoms, which resolved with intravenous and oral steroids. More than 1 year after her initial presentation, the patient developed right facial weakness and slurred speech, and shortly thereafter suffered a fatal intracerebral hemorrhage. Histopathology on autopsy confirmed a diagnosis of primary angiitis of the central nervous system (PACNS). This is an unusual case of PACNS presenting with recurrent unilateral optic neuritis. The vascular enhancement pattern on MRI suggesting inflamed cerebral blood vessels is a rarely described pattern, which likely reflects intracerebral extension of the ocular pathology. The combination of neuroretinitis and perivascular MRI enhancement pattern may represent a subtype of PACNS.

  10. Neuroradiologic Characteristics of Primary Angiitis of the Central Nervous System According to the Affected Vessel Size.

    PubMed

    Thaler, Christian; Kaufmann-Bühler, Ann-Katrin; Gansukh, Tserenchunt; Gansukh, Amarjargal; Schuster, Simon; Bachmann, Henrike; Thomalla, Götz; Magnus, Tim; Matschke, Jakob; Fiehler, Jens; Siemonsen, Susanne

    2017-09-05

    Magnetic resonance imaging (MRI) has an important impact in diagnosing primary angiitis of the central nervous system (PACNS). However, neuroradiologic findings may vary immensely, making an easy and definite diagnosis challenging. In this retrospective, single center study, we analyzed neuroradiologic findings of patients with PACNS diagnosed at our hospital between 2009 and 2014. Furthermore, we classified patients according to the affected vessel size and compared imaging characteristics between the subgroups. Thirty-three patients were included (mean age 43 [±15.3] years, 17 females) in this study. Patients with positive angiographic findings were classified as either medium or large vessel PACNS and presented more ischemic lesions (p < 0.001) and vessel wall enhancement (p = 0.017) compared to patients with small vessel PACNS. No significant differences were detected for the distribution of contrast-enhancing lesions (parenchymal or leptomeningeal), hemorrhages, or lesions with mass effect. Twenty-five patients underwent brain biopsy. Patients with medium or large vessel PACNS were less likely to have positive biopsy results. It is essential to differentiate between small and medium/large vessel PACNS since results in MRI, digital subtraction angiography and brain biopsy may differ immensely. Since image quality of MR scanners improves gradually and brain biopsy may often be nonspecific or negative, our results emphasize the importance of MRI/MRA in the diagnosis process of PACNS.

  11. A virtual tissue bank for primary central nervous system lymphomas in immunocompetent individuals.

    PubMed

    Ponzoni, Maurilio; Kwee, Ivo; Mazzucchelli, Luca; Ferreri, Andrés J M; Zucca, Emanuele; Doglioni, Claudio; Cavalli, Franco; Bertoni, Francesco

    2007-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma with continuously increasing incidence in both immunosuppressed and immunocompetent individuals. PCNSL is a very aggressive tumor with a poor outcome, and its clinical outcome is much worse than for nodal lymphomas. Differently from lymphomas arising in lymph nodes or in other extranodal sites, the treatment of PCNSL remains very unsatisfactory. Current biologic knowledge of PCNSL is still limited and several fundamental questions remain to be answered. This is mainly due to the paucity of PCNSL material for adequate translational research. With the aim of providing biologic material to investigators interested in PCNSL, we have implemented a virtual tissue bank (VTB) for PCNSL in immunocompetent patients. After registration, the VTB is accessible via any web browser at www.ielsg.org. Only anonymous data are centralized at the website of the International Extranodal Lymphoma Study Group, whilst the pathologic material is maintained at the local pathology institutes. (c) 2007 S. Karger AG, Basel.

  12. Photodynamic Diagnosis Using 5-Aminolevulinic Acid in 41 Biopsies for Primary Central Nervous System Lymphoma.

    PubMed

    Yamamoto, Tetsuya; Ishikawa, Eiichi; Miki, Shunichiro; Sakamoto, Noriaki; Zaboronok, Alexander; Matsuda, Masahide; Akutsu, Hiroyoshi; Nakai, Kei; Tsuruta, Wataro; Matsumura, Akira

    2015-11-01

    We evaluated the feasibility of 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) in the biopsy for primary central nervous system lymphoma (PCNSL). 5-ALA (20 mg kg(-1) ) was administered orally 4 hours preoperatively. Forty-one biopsies obtained under PDD in 47 consecutive biopsies (46 patients) that were finally pathologically diagnosed as PCNSL were evaluated. Positive fluorescence was observed in 34 of those 41 biopsies (82.9%). An intraoperative pathological diagnosis (IOD) of suspected PCNSL was made in 21 of the biopsies with positive fluorescence (61.8%). However, the eight IODs in the remaining 13 biopsies (23.5%) were not correct (atypical cell, 4; high-grade glioma, 1; gliosis, 1; unremarkable, 2). In those 8 biopsies, PCNSL was confirmed by the final pathological diagnosis. There was no difference in the mean Mib-1 labeling index between the biopsies with positive fluorescence (86.5%) and those without positive fluorescence (90.0%). IOD was not performed in 6 biopsies; however, 5 of those biopsies (83.3%) showed positive fluorescence and were finally pathologically diagnosed as PCNSL. Use of PDD in biopsies for patients with suspected PCNSL is a reliable way of obtaining specimens of adequate quality for the final pathological diagnosis and may lead to improved diagnostic yield in the biopsy of PCNSL.

  13. Trends in primary central nervous system lymphoma incidence and survival in the U.S.

    PubMed

    Shiels, Meredith S; Pfeiffer, Ruth M; Besson, Caroline; Clarke, Christina A; Morton, Lindsay M; Nogueira, Leticia; Pawlish, Karen; Yanik, Elizabeth L; Suneja, Gita; Engels, Eric A

    2016-08-01

    It is suspected that primary central nervous system lymphoma (PCNSL) rates are increasing among immunocompetent people. We estimated PCNSL trends in incidence and survival among immunocompetent persons by excluding cases among human immunodeficiency virus (HIV)-infected persons and transplant recipients. PCNSL data were derived from 10 Surveillance, Epidemiology and End Results (SEER) cancer registries (1992-2011). HIV-infected cases had reported HIV infection or death due to HIV. Transplant recipient cases were estimated from the Transplant Cancer Match Study. We estimated PCNSL trends overall and among immunocompetent individuals, and survival by HIV status. A total of 4158 PCNSLs were diagnosed (36% HIV-infected; 0·9% transplant recipients). HIV prevalence in PCNSL cases declined from 64·1% (1992-1996) to 12·7% (2007-2011), while the prevalence of transplant recipients remained low. General population PCNSL rates were strongly influenced by immunosuppressed cases, particularly in 20-39 year-old men. Among immunocompetent people, PCNSL rates in men and women aged 65+ years increased significantly (1·7% and 1·6%/year), but remained stable in other age groups. Five-year survival was poor, particularly among HIV-infected cases (9·0%). Among HIV-uninfected cases, 5-year survival increased from 19·1% (1992-1994) to 30·1% (2004-2006). In summary, PCNSL rates have increased among immunocompetent elderly adults, but not in younger individuals. Survival remains poor for both HIV-infected and HIV-uninfected PCNSL patients.

  14. Prevalence of Systemic Sclerosis in Primary Biliary Cholangitis Using the New ACR/EULAR Classification Criteria.

    PubMed

    Zheng, Boyang; Vincent, Catherine; Fritzler, Marvin J; Senécal, Jean-Luc; Koenig, Martial; Joyal, France

    2017-01-01

    Systemic sclerosis (SSc) is a well-established disease associated with primary biliary cholangitis (PBC). However, the original 1980 American College of Rheumatology (ACR) criteria have poor sensitivity, especially for the detection of earlier SSc in previous studies. The objective was to evaluate the prevalence of SSc in patients with PBC using more sensitive 2001 LeRoy and Medsger criteria and the 2013 ACR/European League Against Rheumatism (EULAR) classification criteria. The secondary objective was to evaluate the frequency of individual clinical features. One hundred consecutive patients with PBC without previously diagnosed SSc were recruited between 2005 and 2007 from a tertiary care gastroenterology clinic. All patients underwent a complete clinical examination, determination of SSc-specific antibodies, and a nailfold capillary microscopy. Fulfillment of the 3 different criteria sets was analyzed, along with individual disease features. Of 100 patients with PBC, 1% met the ACR 1980 criteria, 22% met the 2001 LeRoy and Medsger criteria for early SSc, and 17% the 2013 ACR/EULAR criteria. Raynaud phenomenon, SSc-related antibodies, and SSc capillaroscopic patterns were the most prevalent findings, with the highest sensitivities to help guide future screening. Our data show a high prevalence of SSc in patients with PBC with probable underestimation by previous studies using the original ACR criteria. Comorbid SSc should be actively searched for based on newly described criteria to improve detection and increase benefits of earlier treatment.

  15. Intraoperative rapid diagnosis of primary central nervous system lymphomas: advantages and pitfalls.

    PubMed

    Sugita, Yasuo; Terasaki, Mizuhiko; Nakashima, Shinji; Ohshima, Koichi; Morioka, Motohiro; Abe, Hideyuki

    2014-10-01

    To study the advantages and pitfalls of intraoperative rapid diagnosis (IRD) of primary central nervous system lymphomas (PCNSL), pathology reports and frozen sections in our institution were reviewed. We examined 27 cases of PCNSL, one case of anaplastic glioma, and one case of metastatic brain tumor that were diagnosed on neuroimaging. Fifteen cases of intraoperative cytological preparations were also reviewed in a correlative manner. Among the 27 cases initially diagnosed as PCNSL, 18 were also diagnosed as PCNSL by IRD. However, IRD identified four of the 27 cases as gliosis, two as demyelination, one as atypical epithelial cells, one as malignant glioma and anaplastic astrocytoma. In addition, the case identified as metastatic brain tumor on neuroimaging was corrected to a diagnosis of PCNSL based on IRD. The final accuracy of IRD in the present study was 89.6% (26/29). After postoperative definitive diagnosis, two cases of anaplastic astrocytoma and one case of PCNSL by IRD were corrected to PCNSL, anaplastic oligodendroglioma and demyelination, respectively. PCNSL were sometimes histologically indistinguishable from malignant gliomas or demyelinating diseases in the present study, particularly in frozen sections. Notably, all cases for which both intraoperative cytology and frozen section were performed concomitantly were correctly diagnosed in the present study. In particular, lymphoglandular bodies were highly characteristic cytological findings of PCNSL. Both intraoperative cytology and frozen sections should therefore be performed concomitantly when PCNSL are suspected.

  16. Whole transcriptome sequencing enables discovery and analysis of viruses in archived primary central nervous system lymphomas.

    PubMed

    DeBoever, Christopher; Reid, Erin G; Smith, Erin N; Wang, Xiaoyun; Dumaop, Wilmar; Harismendy, Olivier; Carson, Dennis; Richman, Douglas; Masliah, Eliezer; Frazer, Kelly A

    2013-01-01

    Primary central nervous system lymphomas (PCNSL) have a dramatically increased prevalence among persons living with AIDS and are known to be associated with human Epstein Barr virus (EBV) infection. Previous work suggests that in some cases, co-infection with other viruses may be important for PCNSL pathogenesis. Viral transcription in tumor samples can be measured using next generation transcriptome sequencing. We demonstrate the ability of transcriptome sequencing to identify viruses, characterize viral expression, and identify viral variants by sequencing four archived AIDS-related PCNSL tissue samples and analyzing raw sequencing reads. EBV was detected in all four PCNSL samples and cytomegalovirus (CMV), JC polyomavirus (JCV), and HIV were also discovered, consistent with clinical diagnoses. CMV was found to express three long non-coding RNAs recently reported as expressed during active infection. Single nucleotide variants were observed in each of the viruses observed and three indels were found in CMV. No viruses were found in several control tumor types including 32 diffuse large B-cell lymphoma samples. This study demonstrates the ability of next generation transcriptome sequencing to accurately identify viruses, including DNA viruses, in solid human cancer tissue samples.

  17. Neuro-glial and systemic mechanisms of pathological responses in rat models of primary blast overpressure compared to "composite" blast.

    PubMed

    Svetlov, Stanislav I; Prima, Victor; Glushakova, Olena; Svetlov, Artem; Kirk, Daniel R; Gutierrez, Hector; Serebruany, Victor L; Curley, Kenneth C; Wang, Kevin K W; Hayes, Ronald L

    2012-01-01

    A number of experimental models of blast brain injury have been implemented in rodents and larger animals. However, the variety of blast sources and the complexity of blast wave biophysics have made data on injury mechanisms and biomarkers difficult to analyze and compare. Recently, we showed the importance of rat position toward blast generated by an external shock tube. In this study, we further characterized blast producing moderate traumatic brain injury and defined "composite" blast and primary blast exposure set-ups. Schlieren optics visualized interaction between the head and a shock wave generated by external shock tube, revealing strong head acceleration upon positioning the rat on-axis with the shock tube (composite blast), but negligible skull movement upon peak overpressure exposure off-axis (primary blast). Brain injury signatures of a primary blast hitting the frontal head were assessed and compared to damage produced by composite blast. Low to negligible levels of neurodegeneration were found following primary blast compared to composite blast by silver staining. However, persistent gliosis in hippocampus and accumulation of GFAP/CNPase in circulation was detected after both primary and composite blast. Also, markers of vascular/endothelial inflammation integrin alpha/beta, soluble intercellular adhesion molecule-1, and L-selectin along with neurotrophic factor nerve growth factor-beta were increased in serum within 6 h post-blasts and persisted for 7 days thereafter. In contrast, systemic IL-1, IL-10, fractalkine, neuroendocrine peptide Orexin A, and VEGF receptor Neuropilin-2 (NRP-2) were raised predominantly after primary blast exposure. In conclusion, biomarkers of major pathological pathways were elevated at all blast set-ups. The most significant and persistent changes in neuro-glial markers were found after composite blast, while primary blast instigated prominent systemic cytokine/chemokine, Orexin A, and Neuropilin-2 release

  18. Peripheral Neuropathy in Primary HIV Infection Associates with Systemic and CNS Immune Activation

    PubMed Central

    Wang, Samantha XY; Ho, Emily L.; Grill, Marie; Lee, Evelyn; Peterson, Julia; Robertson, Kevin; Fuchs, Dietmar; Sinclair, Elizabeth; Price, Richard W.; Spudich, Serena

    2014-01-01

    Background Peripheral neuropathy (PN) is a frequent complication of chronic HIV infection. We prospectively studied individuals with primary HIV infection (PHI, <1 year after transmission) to assess the presence of and laboratory associations with PN in this early stage. Methods Standardized examination and analysis of blood and cerebrospinal fluid (CSF) was performed in participants with laboratory-confirmed PHI. PN was defined as ≥1 of the following unilateral or bilateral signs: decreased distal limb position, vibration, or temperature sense, or hyporeflexia; symptomatic PN (SPN) as presence of these signs with symptoms. Analysis employed nonparametric statistics. Results 20/58 (35%) antiretroviral-naïve male subjects without diabetes evaluated at a median 107 days post HIV transmission (dpt) met criteria for PN. 13/20 (65%) of PN subjects met criteria for SPN; 6/20 (30%) had bilateral findings. PN subjects and no PN subjects (NPN) did not differ in median age, dpt, blood CD4 or CD8 counts, CSF or plasma HIV RNA levels, CSF white blood cell counts, or CSF:blood albumin ratio. PN and SPN subjects had elevated CSF neopterin (p=0.003 and p=0.0005), CSF MCP-1 (p=0.006 and p=0.01) and blood neopterin (p=0.006 and p=0.009) compared to NPN. PN subjects had a higher percentage of activated phenotype CSF CD8+ T lymphocytes than NPN subjects (p=0.009). Conclusions Signs of PN were detected by detailed neurologic exam in 35% of men enrolled in a neurological study at a median 3.5 months after HIV transmission. PN during this early period may be mediated by systemic and nervous system immune responses to HIV. PMID:24732871

  19. Cell communication in a coculture system consisting of outgrowth endothelial cells and primary osteoblasts.

    PubMed

    Herzog, David Paul Eric; Dohle, Eva; Bischoff, Iris; Kirkpatrick, Charles James

    2014-01-01

    Bone tissue is a highly vascularized and dynamic system with a complex construction. In order to develop a construct for implant purposes in bone tissue engineering, a proper understanding of the complex dependencies between different cells and cell types would provide further insight into the highly regulated processes during bone repair, namely, angiogenesis and osteogenesis, and might result in sufficiently equipped constructs to be beneficial to patients and thereby accomplish their task. This study is based on an in vitro coculture model consisting of outgrowth endothelial cells and primary osteoblasts and is currently being used in different studies of bone repair processes with special regard to angiogenesis and osteogenesis. Coculture systems of OECs and pOBs positively influence the angiogenic potential of endothelial cells by inducing the formation of angiogenic structures in long-term cultures. Although many studies have focused on cell communication, there are still numerous aspects which remain poorly understood. Therefore, the aim of this study is to investigate certain growth factors and cell communication molecules that are important during bone repair processes. Selected growth factors like VEGF, angiopoietins, BMPs, and IGFs were investigated during angiogenesis and osteogenesis and their expression in the cultures was observed and compared after one and four weeks of cultivation. In addition, to gain a better understanding on the origin of different growth factors, both direct and indirect coculture strategies were employed. Another important focus of this study was to investigate the role of "gap junctions," small protein pores which connect adjacent cells. With these bridges cells are able to exchange signal molecules, growth factors, and other important mediators. It could be shown that connexins, the gap junction proteins, were located around cell nuclei, where they await their transport to the cell membrane. In addition, areas in which two

  20. MGMT promoter methylation and correlation with protein expression in primary central nervous system lymphoma.

    PubMed

    Toffolatti, L; Scquizzato, E; Cavallin, S; Canal, F; Scarpa, M; Stefani, P M; Gherlinzoni, F; Dei Tos, A P

    2014-11-01

    The O (6)-methylguanine-DNA-methyltransferase (MGMT) gene encodes for a DNA repairing enzyme of which silencing by promoter methylation is involved in brain tumorigenesis. MGMT promoter methylation represents a favorable prognostic factor and has been associated with a better response to alkylating agents in glioma and systemic lymphoma. Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal malignant lymphoma. The current standard of care, based on high-dose methotrexate chemotherapy, has improved prognosis but outcome remains poor for a majority of patients. Therapeutic progress in this field is conditioned by limited biological and molecular knowledge about the disease. Temozolomide has recently emerged as an alternative option for PCNSL treatment. We aimed to analyze the MGMT gene methylation status in a series of 24 PCNSLs, to investigate the relationship between methylation status of the gene and immunohistochemical expression of MGMT protein and to evaluate the possible prognostic significance of these biomarkers. Our results confirm that methylation of the MGMT gene and loss of MGMT protein are frequent events in these lymphomas (54 % of our cases) and suggest that they are gender and age related. MGMT methylation showed high correlation with loss of protein expression (concordance correlation coefficient = -0.49; Fisher exact test: p < 0.01), different from what has been observed in other brain tumors. In the subgroup of ten patients who received high dose chemotherapy, the presence of methylated MGMT promoter (n = 4), seems to be associated with a prolonged overall survival (>60 months in three of four patients). The prognostic significance of these molecular markers in PCNSL needs to be further studied in groups of patients treated in a homogeneous way.