Recent Understanding on Diagnosis and Management of Central Nervous System Vasculitis in Children

PubMed Central

Iannetti, Ludovico; Zito, Roberta; Bruschi, Simone; Papetti, Laura; Ulgiati, Fiorenza; Nicita, Francesco; Del Balzo, Francesca; Spalice, Alberto

2012-01-01

Central nervous system vasculitides in children may develop as a primary condition or secondary to an underlying systemic disease. Many vasculitides affect both adults and children, while some others occur almost exclusively in childhood. Patients usually present with systemic symptoms with single or multiorgan dysfunction. The involvement of central nervous system in childhood is not frequent and it occurs more often as a feature of subtypes like childhood polyarteritis nodosa, Kawasaki disease, Henoch Schönlein purpura, and Bechet disease. Primary angiitis of the central nervous system of childhood is a reversible cause of severe neurological impairment, including acute ischemic stroke, intractable seizures, and cognitive decline. The first line therapy of CNS vasculitides is mainly based on corticosteroids and immunosuppressor drugs. Other strategies include plasmapheresis, immunoglobulins, and biologic drugs. This paper discusses on current understanding of most frequent primary and secondary central nervous system vasculitides in children including a tailored-diagnostic approach and new evidence regarding treatment. PMID:23008735

Coordinating Mental Health Care across Primary Care and Schools: ADHD as a Case Example

ERIC Educational Resources Information Center

Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

2013-01-01

Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…

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…

40 CFR 421.90 - Applicability: Description of the metallurgical acid plants subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., primary zinc facilities, primary lead facilities, and primary molybdenum facilities, including any associated air pollution control or gas-conditioning systems for sulfur dioxide off-gases from...

Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care.

PubMed

Goroll, Allan H; Berenson, Robert A; Schoenbaum, Stephen C; Gardner, Laurence B

2007-03-01

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed.

Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

PubMed Central

Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

2007-01-01

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

Lens system for a photo ion spectrometer

DOEpatents

Gruen, D.M.; Young, C.E.; Pellin, M.J.

1990-11-27

A lens system in a photo ion spectrometer for manipulating a primary ion beam and ionized atomic component is disclosed. The atomic components are removed from a sample by a primary ion beam using the lens system, and the ions are extracted for analysis. The lens system further includes ionization resistant coatings for protecting the lens system. 8 figs.

Patients with primary diffuse large B-cell lymphoma of female genital tract have high risk of central nervous system relapse.

PubMed

Cao, Xin-xin; Li, Jian; Zhang, Wei; Duan, Ming-hui; Shen, Ti; Zhou, Dao-bin

2014-06-01

The objective of this study was to evaluate retrospectively the clinical characteristics, treatments, and outcomes of patients with primary diffuse large B-cell lymphoma (DLBCL) of the female genital tract. The basic characteristics, treatments, and outcomes of six patients diagnosed with primary DLBCL of the female genital tract, including the ovary, uterine cervix, and vagina, treated in our hospital between 2000 and 2012, were analyzed retrospectively. Seven of 323 (2.2 %) newly diagnosed DLBCLs were diagnosed as primary female genital tract DLBCL. Six patients with complete medical data were included in the analysis. The median age at diagnosis was 52.5 years (range 20-65). The presenting symptoms included abnormal vaginal bleeding, increased vaginal discharge, abdominal fullness, and abdominal pain. Two patients had stage IE disease and four patients had stage IIE disease. Treatment included chemotherapy only in five patients, and combined chemotherapy and localized radiation in one patient. After a median follow-up of 58 months, four patients showed relapse in the central nervous system and two had died from progressive disease. The median progression-free survival was 27 months and the median overall survival for this group has not been reached. Patients with primary female genital tract DLBCL may have poor outcomes and a high risk of central nervous system relapse. Central nervous system prophylaxis might be considered in addition to systemic chemotherapy for DLBCL of the female genital tract.

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. © 2012 Mount Sinai School of Medicine.

Primary CNS Lymphoma Treatment (PDQ®)—Health Professional Version

Cancer.gov

Primary central nervous system (CNS) lymphoma treatment options include radiation, chemotherapy, and corticosteroids. Get detailed information about the treatment of newly diagnosed and recurrent primary CNS lymphoma cancer in this clinician summary.

Utilities on the primary road system.

DOT National Transportation Integrated Search

1992-05-01

This chapter covers initial placement, adjustment, improvement, relocation, replacement and maintenance of utility facilities in, on, above, or below the right-of-way of primary highways, including attachments to primary highway structures. It embodi...

Wireless power transfer system

DOEpatents

Wu, Hunter; Sealy, Kylee; Gilchrist, Aaron

2016-02-23

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

Digital ultrasonic signal processing: Primary ultrasonics task and transducer characterization use and detailed description

NASA Technical Reports Server (NTRS)

Hammond, P. L.

1979-01-01

This manual describes the use of the primary ultrasonics task (PUT) and the transducer characterization system (XC) for the collection, processing, and recording of data received from a pulse-echo ultrasonic system. Both PUT and XC include five primary functions common to many real-time data acquisition systems. Some of these functions are implemented using the same code in both systems. The solicitation and acceptance of operator control input is emphasized. Those operations not under user control are explained.

Primary acquired cold urticaria.

PubMed

Lee, Chyh-Woei; Sheffer, Albert L

2003-01-01

Primary acquired cold urticaria (ACU) is the most common type of cold urticaria characterized by rapid onset of pruritic hives, swelling, and possible severe systemic reactions including hypotension and shock after cold exposure. Primary ACU is diagnosed by history of such symptoms, a positive immediate cold-contact stimulation test, and negative laboratory evaluation for underlying systemic disorders. Clinicians should be aware that patients with ACU may be susceptible to life-threatening systemic reactions especially during aquatic activities and that proper patient education is extremely important. This article reviews the clinical presentation, pathogenesis, diagnosis, and management of primary ACU.

Tracking Social Motivation Systems Deficits: The Affective Neuroscience View of Autism

ERIC Educational Resources Information Center

Carré, Arnaud; Chevallier, Coralie; Robel, Laurence; Barry, Caroline; Maria, Anne-Solène; Pouga, Lydia; Philippe, Anne; Pinabel, François; Berthoz, Sylvie

2015-01-01

Abnormal functioning of primary brain systems that express and modulate basic emotional drives are increasingly considered to underlie mental disorders including autism spectrum disorders. We hypothesized that ASD are characterized by disruptions in the primary systems involved in the motivation for social bonding. Twenty adults with ASD were…

Method for removing cesium from a nuclear reactor coolant

DOEpatents

Colburn, Richard P.

1986-01-01

A method of and system for removing cesium from a liquid metal reactor coolant including a carbon packing trap in the primary coolant system for absorbing a major portion of the radioactive cesium from the coolant flowing therethrough at a reduced temperature. A regeneration subloop system having a secondary carbon packing trap is selectively connected to the primary system for isolating the main trap therefrom and connecting it to the regeneration system. Increasing the temperature of the sodium flowing through the primary trap diffuses a portion of the cesium

Profiles of Brain Metastases: Prioritization of Therapeutic Targets.

PubMed

Ferguson, Sherise D; Zheng, Siyuan; Xiu, Joanne; Zhou, Shouhao; Khasraw, Mustafa; Brastianos, Priscilla K; Kesari, Santosh; Hu, Jethro; Rudnick, Jeremy; Salacz, Michael E; Piccioni, David; Huang, Suyun; Davies, Michael A; Glitza, Isabella C; Heymach, John V; Zhang, Jianjun; Ibrahim, Nuhad K; DeGroot, John F; McCarty, Joseph; O'Brien, Barbara J; Sawaya, Raymond; Verhaak, Roeland G W; Reddy, Sandeep K; Priebe, Waldemar; Gatalica, Zoran; Spetzler, David; Heimberger, Amy B

2018-06-19

We sought to compare the tumor profiles of brain metastases from common cancers with those of primary tumors and extracranial metastases in order to identify potential targets and prioritize rational treatment strategies. Tumor samples were collected from both the primary and metastatic sites of non-small cell lung cancer, breast cancer, and melanoma from patients in locations worldwide, and these were submitted to Caris Life Sciences for tumor multiplatform analysis, including gene sequencing (Sanger and next-generation sequencing with a targeted 47-gene panel), protein expression (assayed by immunohistochemistry), and gene amplification (assayed by in situ hybridization). The data analysis considered differential protein expression, gene amplification, and mutations among brain metastases, extracranial metastases, and primary tumors. The analyzed population included: 16,999 unmatched primary tumor and/or metastasis samples: 8178 non-small cell lung cancers (5098 primaries; 2787 systemic metastases; 293 brain metastases), 7064 breast cancers (3496 primaries; 3469 systemic metastases; 99 brain metastases), and 1757 melanomas (660 primaries; 996 systemic metastases; 101 brain metastases). TOP2A expression was increased in brain metastases from all 3 cancers, and brain metastases overexpressed multiple proteins clustering around functions critical to DNA synthesis and repair and implicated in chemotherapy resistance, including RRM1, TS, ERCC1, and TOPO1. cMET was overexpressed in melanoma brain metastases relative to primary skin specimens. Brain metastasis patients may particularly benefit from therapeutic targeting of enzymes associated with DNA synthesis, replication, and/or repair. This article is protected by copyright. All rights reserved. © 2018 UICC.

75 FR 8001 - Airworthiness Directives; Hawker Beechcraft Corporation (Type Certificate No. A00010WI Previously...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-23

... the essential bus. The disabled equipment could include the autopilot, anti-skid system, hydraulic indicator, spoiler system, pilot primary flight display, audio panel, or the 1 air data computer. This... system, pilot primary flight display, audio panel, or the 1 air data computer. This failure could lead to...

Fluid channeling system

NASA Technical Reports Server (NTRS)

Davis, Donald Y. (Inventor); Hitch, Bradley D. (Inventor)

1994-01-01

A fluid channeling system includes a fluid ejector, a heat exchanger, and a fluid pump disposed in series flow communication The ejector includes a primary inlet for receiving a primary fluid, and a secondary inlet for receiving a secondary fluid which is mixed with the primary fluid and discharged therefrom as ejector discharge. Heat is removed from the ejector discharge in the heat exchanger, and the heat exchanger discharge is compressed in the fluid pump and channeled to the ejector secondary inlet as the secondary fluid In an exemplary embodiment, the temperature of the primary fluid is greater than the maximum operating temperature of a fluid motor powering the fluid pump using a portion of the ejector discharge, with the secondary fluid being mixed with the primary fluid so that the ejector discharge temperature is equal to about the maximum operating temperature of the fluid motor.

Base excitation testing system using spring elements to pivotally mount wind turbine blades

DOEpatents

Cotrell, Jason; Hughes, Scott; Butterfield, Sandy; Lambert, Scott

2013-12-10

A system (1100) for fatigue testing wind turbine blades (1102) through forced or resonant excitation of the base (1104) of a blade (1102). The system (1100) includes a test stand (1112) and a restoring spring assembly (1120) mounted on the test stand (1112). The restoring spring assembly (1120) includes a primary spring element (1124) that extends outward from the test stand (1112) to a blade mounting plate (1130) configured to receive a base (1104) of blade (1102). During fatigue testing, a supported base (1104) of a blad (1102) may be pivotally mounted to the test stand (1112) via the restoring spring assembly (1120). The system (1100) may include an excitation input assembly (1140) that is interconnected with the blade mouting plate (1130) to selectively apply flapwise, edgewise, and/or pitch excitation forces. The restoring spring assemply (1120) may include at least one tuning spring member (1127) positioned adjacent to the primary spring element (1124) used to tune the spring constant or stiffness of the primary spring element (1124) in one of the excitation directions.

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

PubMed Central

Ranstad, Karin; Midlöv, Patrik; Halling, Anders

2017-01-01

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

75 FR 27422 - Airworthiness Directives; Hawker Beechcraft Corporation (Type Certificate No. A00010WI Previously...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

... system, pilot primary flight display, audio panel, or the 1 air data computer. This failure could lead to... include the autopilot, anti-skid system, hydraulic indicator, spoiler system, pilot primary flight display, audio panel, or the 1 air data computer. This failure could lead to a significant increase in pilot...

Policy for accommodating and adjustment of utilities on the primary road system.

DOT National Transportation Integrated Search

2012-01-01

This chapter covers initial placement, adjustment and maintenance : of utility facilities in, on, above or below the right-of-way of primary highways, including : attachments to primary highway structures. It embodies the basic specifications and : s...

Policy for accommodating and adjustment of utilities on the primary road system.

DOT National Transportation Integrated Search

2005-12-01

This chapter covers initial placement, adjustment and maintenance : of utility facilities in, on, above or below the right-of-way of primary highways, including : attachments to primary highway structures. It embodies the basic specifications and : s...

Wide acceptance angle, high concentration ratio, optical collector

NASA Technical Reports Server (NTRS)

Kruer, Mark Arthur (Inventor)

1990-01-01

The invention is directed to an optical collector requiring a wide acceptance angle, and a high concentration ratio. The invention is particularly adapted for use in solar collectors of cassegrain design. The optical collector system includes a parabolic circular concave primary mirror and a hyperbolic circular convex secondary mirror. The primary mirror includes a circular hole located at its center wherein a solar collector is located. The mirrored surface of the secondary mirror has three distinct zones: a center circle, an on-axis annulus, and an off-axis section. The parabolic shape of the primary mirror is chosen so that the primary mirror reflects light entering the system on-axis onto the on-axis annulus. A substantial amount of light entering the system off-axis is reflected by the primary mirror onto either the off-axis section or onto the center circle. Subsequently, the off-axis sections reflect the off-axis light toward the solar collector. Thus, off-axis light is captured which would otherwise be lost to the system. The novelty of the system appears to lie in the configuration of the primary mirror which focuses off-axis light onto an annular portion of the secondary mirror to enable capture thereof. This feature results in wide acceptance angle and a high concentration ratio, and also compensates for the effects of non-specular reflection, and enables a cassegrain configuration to be used where such characteristics are required.

Carcinoma of Unknown Primary Treatment (PDQ®)—Health Professional Version

Cancer.gov

Carcinoma of unknown primary (CUP) treatment depends on the best determination of the primary site, if possible. Treatment options may include surgery, radiation therapy, and systemic treatment. Get detailed information about diagnosis and treatment of CUP in this summary for clinicians.

The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

PubMed Central

Stellefson, Michael; Stopka, Christine

2013-01-01

Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

System and method for optically locating microchannel positions

DOEpatents

Brewer, Laurence R.; Kimbrough, Joseph; Balch, Joseph; Davidson, J. Courtney

2001-01-01

A system and method is disclosed for optically locating a microchannel position. A laser source generates a primary laser beam which is directed at a microchannel plate. The microchannel plates include microchannels at various locations. A back-reflectance beam detector receives a back-reflected beam from the plate. The back-reflected beam is generated when the primary beam reflects off of the plate. A photodiode circuit generates a trigger signal when the back-reflected beam exceeds a predetermined threshold, indicating a presence of the microchannel. The method of the present invention includes the steps of generating a primary beam, directing the primary beam to a plate containing a microchannel, receiving from the plate a back-reflected beam generated in response to the primary beam, and generating a trigger signal when the back-reflected beam exceeds a predetermined threshold which corresponds to a presence of the microchannel.

Database Access Systems.

ERIC Educational Resources Information Center

Dalrymple, Prudence W.; Roderer, Nancy K.

1994-01-01

Highlights the changes that have occurred from 1987-93 in database access systems. Topics addressed include types of databases, including CD-ROMs; enduser interface; database selection; database access management, including library instruction and use of primary literature; economic issues; database users; the search process; and improving…

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.

Automatic quadrature control and measuring system. [using optical coupling circuitry

NASA Technical Reports Server (NTRS)

Hamlet, J. F. (Inventor)

1974-01-01

A quadrature component cancellation and measuring system comprising a detection system for detecting the quadrature component from a primary signal, including reference circuitry to define the phase of the quadrature component for detection is described. A Raysistor optical coupling control device connects an output from the detection system to a circuit driven by a signal based upon the primary signal. Combining circuitry connects the primary signal and the circuit controlled by the Raysistor device to subtract quadrature components. A known current through the optically sensitive element produces a signal defining the magnitude of the quadrature component.

Spark discharge trace element detection system

DOEpatents

Adler-Golden, Steven; Bernstein, Lawrence S.; Bien, Fritz

1988-01-01

A spark discharge trace element detection system is provided which includes a spark chamber including a pair of electrodes for receiving a sample of gas to be analyzed at no greater than atmospheric pressure. A voltage is provided across the electrodes for generating a spark in the sample. The intensity of the emitted radiation in at least one primary selected narrow band of the radiation is detected. Each primary band corresponds to an element to be detected in the gas. The intensity of the emission in each detected primary band is integrated during the afterglow time interval of the spark emission and a signal representative of the integrated intensity of the emission in each selected primary bond is utilized to determine the concentration of the corresponding element in the gas.

Spark discharge trace element detection system

DOEpatents

Adler-Golden, S.; Bernstein, L.S.; Bien, F.

1988-08-23

A spark discharge trace element detection system is provided which includes a spark chamber including a pair of electrodes for receiving a sample of gas to be analyzed at no greater than atmospheric pressure. A voltage is provided across the electrodes for generating a spark in the sample. The intensity of the emitted radiation in at least one primary selected narrow band of the radiation is detected. Each primary band corresponds to an element to be detected in the gas. The intensity of the emission in each detected primary band is integrated during the afterglow time interval of the spark emission and a signal representative of the integrated intensity of the emission in each selected primary bond is utilized to determine the concentration of the corresponding element in the gas. 12 figs.

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

NASA Technical Reports Server (NTRS)

1991-01-01

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

Bearing system

DOEpatents

Kapich, Davorin D.

1987-01-01

A bearing system includes backup bearings for supporting a rotating shaft upon failure of primary bearings. In the preferred embodiment, the backup bearings are rolling element bearings having their rolling elements disposed out of contact with their associated respective inner races during normal functioning of the primary bearings. Displacement detection sensors are provided for detecting displacement of the shaft upon failure of the primary bearings. Upon detection of the failure of the primary bearings, the rolling elements and inner races of the backup bearings are brought into mutual contact by axial displacement of the shaft.

Goldstone Solar System Radar (GSSR)

NASA Technical Reports Server (NTRS)

Renzetti, N. A.

1991-01-01

The primary objective of the Goldstone Solar System Radar is the investigation of solar system bodies by means of Earth-based radar. Targets of primary interest include the Galilean moons, Saturn's rings and moons, and Earth-approaching asteroids and comets. Planets are also of interest, particularly Mercury and the planets to which NASA has not yet planned spacecraft visits. Based on a history of solid achievement, including the definition of the Astronomical Unit, imaging and topography of Mars, Venus, and Mercury, and contributions to the general theory of relativity, the program will continue to support flight project requirements and its primary objectives. The individual target objectives are presented, and information on the following topics are presented in tabular form: Deep Space Network support, compatibility tests, telemetry, command, and tracking support responsibility.

Method for removing cesium from a nuclear reactor coolant

DOEpatents

Colburn, R.P.

1983-08-10

A method of and system for removing cesium from a liquid metal reactor coolant including a carbon packing trap in the primary coolant system for absorbing a major portion of the radioactive cesium from the coolant flowing therethrough at a reduced temperature. A regeneration subloop system having a secondary carbon packing trap is selectively connected to the primary system for isolating the main trap therefrom and connecting it to the regeneration system. Increasing the temperature of the sodium flowing through the primary trap diffuses a portion of the cesium inventory thereof further into the carbon matrix while simultaneously redispersing a portion into the regeneration system for absorption at a reduced temperature by the secondary trap.

Measuring the Attainment of Primary Care.

ERIC Educational Resources Information Center

Starfield, Barbara

1979-01-01

The definition of primary care is developed and a way is suggested to measure whether it is being achieved. Evaluative questions are identified that can determine whether a system of care is oriented toward primary care. They include assessing first-contact care, coordination of care, comprehensiveness, and longitudinality. (LBH)

Modular inverter system

DOEpatents

Ma, Mingyao; Hu, Haibing; Kutkut, Nasser; Batarseh, Issa; Shen, John; , Bkayrat, Raed

2017-08-01

A system connected to an AC power grid having an AC phase signal includes an inverter module including a first inverter coupled to a DC voltage, actuated based on the AC phase signal. The first inverter provides a first voltage signal having predetermined harmonic components. A second inverter includes second switch elements coupled to the DC voltage and actuated by a second set of control signals phase delayed with respect to the first control signals. A transformer module has first and second primary windings coupled to the first and second inverters. The transformer module further includes a secondary winding coupled to first primary winding, the second primary winding, and the AC power grid. The secondary winding is configured to provide a secondary output voltage to the AC power grid by combining the first voltage signal and the second voltage signal such that the predetermined harmonic components are substantially cancelled.

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)

Slag processing system for direct coal-fired gas turbines

DOEpatents

Pillsbury, Paul W.

1990-01-01

Direct coal-fired gas turbine systems and methods for their operation are provided by this invention. The gas turbine system includes a primary zone for burning coal in the presence of compressed air to produce hot combustion gases and debris, such as molten slag. The turbine system further includes a secondary combustion zone for the lean combustion of the hot combustion gases. The operation of the system is improved by the addition of a cyclone separator for removing debris from the hot combustion gases. The cyclone separator is disposed between the primary and secondary combustion zones and is in pressurized communication with these zones. In a novel aspect of the invention, the cyclone separator includes an integrally disposed impact separator for at least separating a portion of the molten slag from the hot combustion gases.

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…

Organosilicon-Based Electrolytes for Long-Life Lithium Primary Batteries

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

Fenton, Kyle R.; Nagasubramanian, Ganesan; Staiger, Chad L.

2015-09-01

This report describes advances in electrolytes for lithium primary battery systems. Electrolytes were synthesized that utilize organosilane materials that include anion binding agent functionality. Numerous materials were synthesized and tested in lithium carbon monofluoride battery systems for conductivity, impedance, and capacity. Resulting electrolytes were shown to be completely non-flammable and showed promise as co-solvents for electrolyte systems, due to low dielectric strength.

Primary health care in Canada: systems in motion.

PubMed

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

2011-06-01

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. 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. 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. 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. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

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

PubMed

Ranstad, Karin; Midlöv, Patrik; Halling, Anders

2017-06-09

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

Dual Tank Fuel System

DOEpatents

Wagner, Richard William; Burkhard, James Frank; Dauer, Kenneth John

1999-11-16

A dual tank fuel system has primary and secondary fuel tanks, with the primary tank including a filler pipe to receive fuel and a discharge line to deliver fuel to an engine, and with a balance pipe interconnecting the primary tank and the secondary tank. The balance pipe opens close to the bottom of each tank to direct fuel from the primary tank to the secondary tank as the primary tank is filled, and to direct fuel from the secondary tank to the primary tank as fuel is discharged from the primary tank through the discharge line. A vent line has branches connected to each tank to direct fuel vapor from the tanks as the tanks are filled, and to admit air to the tanks as fuel is delivered to the engine.

32 CFR Appendix F to Part 505 - Example of a System of Records Notice

Code of Federal Regulations, 2012 CFR

2012-07-01

...) System Location: Specify the address of the primary system and any decentralized elements, including... title and duty address of the system manager. For decentralized systems, show the locations, the...

32 CFR Appendix F to Part 505 - Example of a System of Records Notice

Code of Federal Regulations, 2014 CFR

2014-07-01

...) System Location: Specify the address of the primary system and any decentralized elements, including... title and duty address of the system manager. For decentralized systems, show the locations, the...

40 CFR 63.1444 - What emissions limitations and work practice standards must I meet for my copper concentrate...

Code of Federal Regulations, 2013 CFR

2013-07-01

... converter department uses Pierce-Smith converters, the capture system design must include use of a primary... discharged to the atmosphere from any Pierce-Smith converter primary hood capture system or Hoboken converter... construction commenced on or after April 20, 1998, the use of batch copper converters is prohibited. (f...

40 CFR 63.1444 - What emissions limitations and work practice standards must I meet for my copper concentrate...

Code of Federal Regulations, 2012 CFR

2012-07-01

... converter department uses Pierce-Smith converters, the capture system design must include use of a primary... discharged to the atmosphere from any Pierce-Smith converter primary hood capture system or Hoboken converter... construction commenced on or after April 20, 1998, the use of batch copper converters is prohibited. (f...

40 CFR 63.1444 - What emissions limitations and work practice standards must I meet for my copper concentrate...

Code of Federal Regulations, 2014 CFR

2014-07-01

... converter department uses Pierce-Smith converters, the capture system design must include use of a primary... discharged to the atmosphere from any Pierce-Smith converter primary hood capture system or Hoboken converter... construction commenced on or after April 20, 1998, the use of batch copper converters is prohibited. (f...

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

PubMed

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

Teleradiology as a foundation for an enterprise-wide health care delivery system.

PubMed

Dionisio, J D; Taira, R K; Sinha, U; Johnson, D B; Dai, B Y; Tashima, G H; Blythe, S; Johnson, R; Kangarloo, H

2000-01-01

An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.

Performance of the Primary Mirror Center-of-Curvature Optical Metrology System during Cryogenic Testing of the JWST Pathfinder Telescope

NASA Technical Reports Server (NTRS)

Hadaway, James B.; Wells, Conrad; Olczak, Gene; Waldman, Mark; Whitman, Tony; Cosentino, Joseph; Connolly, Mark; Chaney, David; Telfer, Randal

2016-01-01

The JWST primary mirror consists of 18 1.5 m hexagonal segments, each with 6-DoF and RoC adjustment. The telescope will be tested at its cryogenic operating temperature at Johnson Space Center. The testing will include center-of-curvature measurements of the PM, using the Center-of-Curvature Optical Assembly (COCOA) and the Absolute Distance Meter Assembly (ADMA). The performance of these metrology systems, including hardware, software, procedures, was assessed during two cryogenic tests at JSC, using the JWST Pathfinder telescope. This paper describes the test setup, the testing performed, and the resulting metrology system performance.

Social Validity of the Social Skills Improvement System--Classwide Intervention Program (SSIS-CIP) in the Primary Grades

ERIC Educational Resources Information Center

Wollersheim Shervey, Sarah; Sandilos, Lia E.; DiPerna, James C.; Lei, Pui-Wa

2017-01-01

The purpose of this study was to examine the social validity of the Social Skills Improvement System--Classwide Intervention Program (SSIS-CIP) for teachers in the primary grades. Participants included 45 first and second grade teachers who completed a 16-item social validity questionnaire during each year of the SSIS-CIP efficacy trial. Findings…

Social Validity of the Social Skills Improvement System--Classwide Intervention Program (SSIS-CIP) in the Primary Grades

ERIC Educational Resources Information Center

Wollersheim Shervey, Sarah; Sandilos, Lia E.; DiPerna, James C.; Lei, Pui-Wa

2017-01-01

The purpose of this study was to examine the social validity of the Social Skills Improvement System-Classwide Intervention Program (SSIS-CIP) for teachers in the primary grades. Participants included 45 first and second grade teachers who completed a 16-item social validity questionnaire during each year of the SSIS-CIP efficacy trial. Findings…

Towards Optimal Education Including Self-Regulated Learning in Technology-Enhanced Preschools and Primary Schools

ERIC Educational Resources Information Center

Mooij, Ton; Dijkstra, Elma M.; Walraven, Amber; Kirschner, Paul A.

2014-01-01

At the start of preschool, four-year-old pupils differ in their development, including in their capacity to self-regulate their playing and learning. In preschool and primary school, educational processes are generally adapted to the mean age of the pupils in the class. The same may apply to pupil-monitoring systems based on information and…

Planning for New Primary Airports in the United States: A Survey of Metropolitan Planning Organizations

NASA Technical Reports Server (NTRS)

NewMyer, David A.

1999-01-01

Airport congestion at primary airports in major metropolitan areas was analyzed in a report prepared by the Transportation Research Board (TRB) in 1990. Taking the top twenty-three most congested airports from this study, a questionnaire was prepared and sent to the metropolitan planning organizations (MPOs) for twenty of the twenty-three metropolitan areas represented in the TRB study, The questionnaire focused on the role of the MPOs in planning for new primary airports in the United States, including questions about the status of the most recent MPO airport system plan, whether or not the latest plan recommends a new primary airport, and whether or not any other entities in the MPO areas are recommending new primary airports. The results indicated that 44.4 percent of the eighteen respondent MPOs have airport system plans that are five years old or older. Also, only two of the respondent MPOs have recommended a new primary airport in their latest regional airport system plan and only one of these two is a common recommendation in the Federal Aviation Administration's National Plan of Integrated Airport System.

Planning for New Primary Airports in the United States: A Survey of Metropolitan Planning Organizations

NASA Technical Reports Server (NTRS)

NewMeyer, David A.

1999-01-01

Airport congestion at primary airports in major metropolitan areas was analyzed in a report prepared by the Transportation Research Board (TRB) in 1990. Taking the top twenty-three most congested airports from this study, a questionnaire was prepared and sent to the metropolitan planning organizations (MPOS) for twenty of the twenty-three metropolitan areas represented in the TRB study. The questionnaire focused on the role of the MPOs in planning for new primary airports in the United States, including questions about the status of the most recent MPO airport system plan, whether or not the latest plan recommends a new primary airport, and whether or not any other entities in the MPO areas are recommending new primary airports. The results indicated that 44.4 percent of the eighteen respondent MPOs have airport system plans that are five years old or older. Also, only two of the respondent MPOs have recommended a new primary airport in their latest regional airport system plan and only one of these two is a common recommendation in the Federal Aviation Administration's National Plan of Integrated Airport System.

Systemic treatment and primary tumor location in patients with metastatic colorectal cancer.

PubMed

Antoniou, Efstathios; Andreatos, Nikolaos; Margonis, Georgios A; Papalois, Apostolos; Wang, Jaeyun; Damaskos, Christos; Garmpis, Nikolaos; Buettner, Stefan; Deshwar, Amar; Pappas, Vasilios; Weiss, Matthew J; Pawlik, Timothy M; Pikoulis, Emmanouel

2017-01-01

Tumor location (right-sided vs. left-sided) is known to exert a significant influence on the prognosis of primary colorectal cancer (CRC). Given the genetic continuity between primary and metastatic lesions, we aimed to summarize the existing literature on the prognostic implications of primary tumor site as well as to examine the response to chemotherapy by primary tumor location in patients with metastatic CRC (mCRC). A structured review of the literature was performed between 6/1/2016-7/1/2016 using the Pubmed database. Original research articles published between 1/1/2000- 07/01/2016 were considered eligible. The primary endpoints were overall survival (OS)/ progression free survival (PFS) and response to systemic treatment in patients with mCRC. Eleven studies were included. Tumor site was a strong independent predictor of worse OS/PFS in 9 studies, with right-sided tumors having worse prognosis in all cases. Furthermore, 6 studies demonstrated an inferior response to systemic treatment or worse prognosis following the administration of specific regimens among patients with right-sided cancers. As such, there is significant evidence that right-sided lesions are associated with poor outcomes and resistance to systemic treatment. Consequently, primary tumor location should be a consideration, when the administration of systemic therapy is contemplated in mCRC.

Apollo Onboard Navigation Techniques

NASA Technical Reports Server (NTRS)

Interbartolo, Michael

2009-01-01

This viewgraph presentation reviews basic navigation concepts, describes coordinate systems and identifies attitude determination techniques including Primary Guidance, Navigation and Control System (PGNCS) IMU management and Command and Service Module Stabilization and Control System/Lunar Module (LM) Abort Guidance System (AGS) attitude management. The presentation also identifies state vector determination techniques, including PGNCS coasting flight navigation, PGNCS powered flight navigation and LM AGS navigation.

Assessing primary care in Austria: room for improvement.

PubMed

Stigler, Florian L; Starfield, Barbara; Sprenger, Martin; Salzer, Helmut J F; Campbell, Stephen M

2013-04-01

There is emerging evidence that strong primary care achieves better health at lower costs. Although primary care can be measured, in many countries, including Austria, there is little understanding of primary care development. Assessing the primary care development in Austria. A primary care assessment tool developed by Barbara Starfield in 1998 was implemented in Austria. This tool defines 15 primary care characteristics and distinguishes between system and practice characteristics. Each characteristic was evaluated by six Austrian primary care experts and rated as 2 (high), 1 (intermediate) or 0 (low) points, respectively, to their primary care strength (maximum score: n = 30). Austria received 7 out of 30 points; no characteristic was rated as '2' but 8 were rated as '0'. Compared with the 13 previously assessed countries, Austria ranks 10th of 14 countries and is classified as a 'low primary care' country. This study provides the first evidence concerning primary care in Austria, benchmarking it as weak and in need of development. The practicable application of an existing assessment tool can be encouraging for other countries to generate evidence about their primary care system as well.

Multispectral glancing incidence X-ray telescope

NASA Technical Reports Server (NTRS)

Hoover, Richard B. (Inventor)

1990-01-01

A multispectral glancing incidence X-ray telescope is illustrated capable of broadband, high-resolution imaging of solar and stellar X-ray and extreme ultraviolet radiation sources which includes a primary optical system preferably of the Wolter I type having a primary mirror system (20, 22). The primary optical system further includes an optical axis (24) having a primary focus (F1) at which the incoming radiation is focused by the primary mirrors. A plurality of ellipsoidal mirrors (30a, 30b, 30cand 30d) are carried at an inclination to the optical axis behind the primary focus (F1). A rotating carrier (32) is provided on which the ellipsoidal mirrors are carried so that a desired one of the ellipsoidal mirrors may be selectively positioned in front of the incoming radiation beam (26). In the preferred embodiment, each of the ellipsoidal mirrors has an identical concave surface carrying a layered synthetic microstructure coating tailored to reflect a desired wavelength of 1.5 .ANG. or longer. Each of the identical ellipsoidal mirrors has a second focus (F2) at which a detector (16) is carried. Thus the different wavelength image is focused upon the detector irregardless of which mirror is positioned in front of the radiation beam. In this manner, a plurality of low wavelengths in a wavelength band generally less than 30 angstroms can be imaged with a high resolution.

Monovision techniques for telerobots

NASA Technical Reports Server (NTRS)

Goode, P. W.; Carnils, K.

1987-01-01

The primary task of the vision sensor in a telerobotic system is to provide information about the position of the system's effector relative to objects of interest in its environment. The subtasks required to perform the primary task include image segmentation, object recognition, and object location and orientation in some coordinate system. The accomplishment of the vision task requires the appropriate processing tools and the system methodology to effectively apply the tools to the subtasks. The functional structure of the telerobotic vision system used in the Langley Research Center's Intelligent Systems Research Laboratory is discussed as well as two monovision techniques for accomplishing the vision subtasks.

Design Study of 8 Meter Monolithic Mirror UV/Optical Space Telescope

NASA Technical Reports Server (NTRS)

Stahl, H. Philip

2008-01-01

The planned Ares V launch vehicle with its 10 meter fairing shroud and 55,000 kg capacity to the Sun Earth L2 point enables entirely new classes of space telescopes. NASA MSFC has conducted a preliminary study that demonstrates the feasibility of launching a 6 to 8 meter class monolithic primary mirror telescope to Sun-Earth L2 using an Ares V. Specific technical areas studied included optical design; structural design/analysis including primary mirror support structure, sun shade and secondary mirror support structure; thermal analysis; launch vehicle performance and trajectory; spacecraft including structure, propulsion, GN&C, avionics, power systems and reaction wheels; operations and servicing; mass and power budgets; and system cost.

Principals' and Teachers' Perceptions of Quality Management in Hong Kong Primary Schools

ERIC Educational Resources Information Center

Cheng, Alison Lai Fong; Yau, Hon Keung

2011-01-01

Purpose: The purpose of this paper is to examine the perceptions of a sample of Hong Kong principals and teachers of the extent to which quality management (QM) has been effectively implemented in primary schools. The features of QM improvement implemented in Hong Kong primary schools include: values and duties, systems and teams(ST) resources and…

"A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit.

PubMed

Doohan, Noemi; Coutinho, Anastasia J; Lochner, Jennifer; Wohler, Diana; DeVoe, Jennifer

The inaugural Starfield Summit was hosted in April 2016 by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care with additional partners and sponsors, including the Pisacano Leadership Foundation (PLF). The Summit addressed critical topics in primary care and health care delivery, including payment, measurement, and team-based care. Invited participants included an interdisciplinary group of pediatricians, family physicians, internists, behaviorists, trainees, researchers, and advocates. Among the family physicians invited were both current and past PLF (Pisacano) scholars. After the Summit, a small group of current and past Pisacano scholars formed a writing group to reflect on and summarize key lessons and conclusions from the Summit. A Summit participant's statement, "a paradox persists when the paradigm is wrong," became a repeated theme regarding the paradox of primary care within the context of the health care system in the United States. The Summit energized participants to renew their commitment to Dr. Starfield's 4 C's of Primary Care (first contact access, continuity, comprehensiveness, and care coordination) and to the Quadruple Aim (quality, value, and patient and physician satisfaction) and to continue to explore how primary care can best shape the future of the nation's health care system. © Copyright 2016 by the American Board of Family Medicine.

What is found positive in healthcare information and communication technology implementation?-the results of a nationwide survey in Finland.

PubMed

Winblad, Ilkka; Hämäläinen, Päivi; Reponen, Jarmo

2011-03-01

Considerable expectations have been placed on information and communication technology (ICT) in improving the processes and quality of healthcare. Our purpose was to find out which element is found positive in healthcare ICT implementation. An online questionnaire on e-Health implementation submitted to all Finnish public health service providers and a sample from the private sector included an open question about which the electronic working methods, systems, or applications have most positively influenced the fluency or quality of service processes. The electronic health record was mentioned as an item that has positive influence by 52% of the respondents from the hospital districts, 27% of those from the primary healthcare centers, and 38% of those from the private providers. Digital radiology systems (including teleradiology) were mentioned by 52% of the hospital districts and 27% of the primary healthcare centers. The figures for digital laboratory systems (including telelaboratory) were 5% and 11%, respectively. The figures for teleradiology itself were 5% for the hospital districts and 15% for the primary healthcare centers; the figures for telelaboratory systems were 5% and 9%, respectively. The specialized healthcare seem to experience intraorganizational electronic services integrated to the electronic health record, such as digital radiology and laboratory services as exerting a positive influence, whereas the primary healthcare find such influence from different functions such as interorganizational data exchange and telemedicine services. These might indicate where the efforts should be focused when implementing ICT in healthcare.

Design Study of an 8 Meter Monolithic Mirror UV/Optical Space Telescope

NASA Technical Reports Server (NTRS)

Stahl, H. Philip

2008-01-01

This paper will review a recent NASA MSFC preliminary study that demonstrated the feasibility of launching a 6 to 8 meter class monolithic primary mirror telescope to Sun-Earth L2 using an Ares V. The study started with the unique capabilities of the Ares V vehicle and examined the feasibility of launching a large aperture low cost low risk telescope based on a conventional ground based glass primary mirror. Specific technical areas studied included optical design; structural design/analysis including primary mirror support structure, sun shade and secondary mirror support structure; thermal analysis; launch vehicle performance and trajectory; spacecraft including structure, propulsion, GN & C, avionics, power systems and reaction wheels; operations & servicing, mass budget and system cost. The study telescope was an on-axis three-mirror anastigmatic design with a fine steering mirror. The observatory has a 100 arc-minute (8.4 X 12 arc-minutes) of diffraction limited field of view at a wavelength les than 500 nm. The study assumed that the primary mirror would be fabricated from an existing Schott Zerodur residual VLT blank edged to 6.2 meters, 175 mm thick at the edge with a mass of 11,000 kg. The entire mass budget for the observatory including primary mirror, structure, light baffle tube, instruments, space craft, avionics, etc. is less than 40,000 kg - a 33% mass margin on the Ares V's 60,000 kg Sun-Earth L2 capability. An 8 meter class observatory would have a total mass of less than 60,000 kg of which the primary mirror is the largest contributor.

Systems and Methods for Determining Inertial Navigation System Faults

NASA Technical Reports Server (NTRS)

Bharadwaj, Raj Mohan (Inventor); Bageshwar, Vibhor L. (Inventor); Kim, Kyusung (Inventor)

2017-01-01

An inertial navigation system (INS) includes a primary inertial navigation system (INS) unit configured to receive accelerometer measurements from an accelerometer and angular velocity measurements from a gyroscope. The primary INS unit is further configured to receive global navigation satellite system (GNSS) signals from a GNSS sensor and to determine a first set of kinematic state vectors based on the accelerometer measurements, the angular velocity measurements, and the GNSS signals. The INS further includes a secondary INS unit configured to receive the accelerometer measurements and the angular velocity measurements and to determine a second set of kinematic state vectors of the vehicle based on the accelerometer measurements and the angular velocity measurements. A health management system is configured to compare the first set of kinematic state vectors and the second set of kinematic state vectors to determine faults associated with the accelerometer or the gyroscope based on the comparison.

Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System.

PubMed

Vimalananda, Varsha G; Dvorin, Kelly; Fincke, B Graeme; Tardiff, Nicole; Bokhour, Barbara G

Successful coordination of specialty care requires understanding the perspectives of patients, primary care providers, and specialists-that is, the specialty care "triad." This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these efforts.

Validating "Value Added" in the Primary Grades: One District's Attempts to Increase Fairness and Inclusivity in Its Teacher Evaluation System

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey; Polasky, Sarah; Holloway-Libell, Jessica

2016-01-01

One urban district in the state of Arizona sought to use an alternative achievement test (i.e., the Northwest Evaluation Association's (NWEA) Measures of Academic Progress for Primary Grades (MAP)) to include more value-added ineligible teachers in the districts' growth and merit pay system. The goal was to allow for its K-2 teachers to be more…

Primary care in the United States and its precarious future.

PubMed

Starfield, Barbara; Oliver, Thomas

1999-09-01

Primary care has not secured a firm place within the US health services system. Since primary care lacks a strong research base, is not institutionalized in medical education or in policy-making and is marginalized in both proposed and actual reforms, it has not developed into a central component of the health care infrastructure. We discuss recent efforts that promised modest improvements, including the Clinton health care reform proposals and subsequent federal and state actions, in the role of primary care within the health services system. We also assess the likely fate of primary care given the accelerated growth of managed care and market competition, the dissatisfaction of large segments of the population with managed care and misperceptions of managed care as synonymous with primary care. We highlight how managed care fails to achieve the cardinal functions of primary care and summarize initiatives that, at a minimum, would be required to secure a stronger position for primary care in the future.

The Curricular Reform of Art Education in Primary School in Slovenia in Terms of Certain Components of the European Competence of Cultural Awareness and Expression

ERIC Educational Resources Information Center

Bracun Sova, Rajka; Kemperl, Metoda

2012-01-01

One of the important positions of the last curricular reform in Slovenia, which included systemic issues of education (White Paper on Education, 2011) and curricula for compulsory subjects in primary school, is the fact that Slovenia has been integrated into Europe, and thus education should also include the development of core European…

Narcolepsy and syndromes of primary excessive daytime somnolence.

PubMed

Black, Jed E; Brooks, Stephen N; Nishino, Seiji

2004-09-01

Excessive daytime sleepiness (EDS) or somnolence is common in our patients and in society in general. The most common cause of EDS is "voluntary" sleep restriction. Other common causes include sleep-fragmenting disorders such as the obstructive sleep apnea syndrome. Somewhat less familiar to the clinician are EDS conditions arising from central nervous system dysfunction. Of these so-called primary disorders of somnolence, narcolepsy is the most well known and extensively studied, yet often misunderstood and misdiagnosed. Idiopathic hypersomnia, the recurrent hypersomnias, and EDS associated with nervous system disorders also must be well-understood to provide appropriate evaluation and management of the patient with EDS. This review summarizes the distinguishing features of these clinical syndromes of primary EDS. A brief overview of the pharmacological management of primary EDS is included. Finally, in view of the tremendous advances that have occurred in the past few years in our understanding of the pathophysiology of canine and human narcolepsy, we also highlight these discoveries.

Are Binary Separations related to their System Mass?

NASA Astrophysics Data System (ADS)

Sterzik, M. F.; Durisen, R. H.

2004-08-01

We compile most recent multiplicity fractions and binary separation distributions for different primary masses, including very low-mass and brown dwarf primaries, and compare them with dynamical decay models of small-N clusters. The model predictions are based on detailed numerical calculations of the internal cluster dynamics, as well as on Monte-Carlo methods. Both observations and models reflect the same trends: (1) The multiplicity fraction is an increasing function of the primary mass. (2) The mean binary separations are increasing with the system mass in the sense that very low-mass binaries have average separations around ≈ 4AU, while the binary separation distribution for solar-type primaries peaks at ≈ 40AU. M-type binary systems apparently preferentially populate intermediate separations. Similar specific energy at the time of cluster formation for all cluster masses can possibly explain this trend.

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

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

D.L. McGregor

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

POWER REACTOR

DOEpatents

Zinn, W.H.

1958-07-01

A fast nuclear reactor system ls described for producing power and radioactive isotopes. The reactor core is of the heterogeneous, fluid sealed type comprised of vertically arranged elongated tubular fuel elements having vertical coolant passages. The active portion is surrounded by a neutron reflector and a shield. The system includes pumps and heat exchangers for the primary and secondary coolant circuits. The core, primary coolant pump and primary heat exchanger are disposed within an irapenforate tank which is filled with the primary coolant, in this case a liquid metal such as Na or NaK, to completely submerge these elements. The tank is completely surrounded by a thick walled concrete shield. This reactor system utilizes enriched uranium or plutonium as the fissionable material, uranium or thorium as a diluent and thorium or uranium containing less than 0 7% of the U/sup 235/ isotope as a fertile material.

A Detailed Picture of the (93) Minerva Triple System

NASA Astrophysics Data System (ADS)

Marchis, F.; Descamps, P.; Dalba, P.; Enriquez, J. E.; Durech, J.; Emery, J. P.; Berthier, J.; Vachier, F.; Merlbourne, J.; Stockton, A. N.; Fassnacht, C. D.; Dupuy, T. J.

2011-10-01

We developed an orbital model of the satellites of (93) Minerva based on Keck II AO observations recorded in 2009 and a mutual event between one moon and the primary detected in March 2010. Using new lightcurves we found an approximated ellipsoid shape model for the primary. With a reanalysis of the IRAS data, we derived a preliminary bulk density of 1.5±0.2 g/cc. We will present a detailed analysis of the system, including a 3D shape model of the 93 Minerva primary derived by combining our AO observations, lightcurve, and stellar occultations.

System and plastic scintillator for discrimination of thermal neutron, fast neutron, and gamma radiation

DOEpatents

Zaitseva, Natalia P.; Carman, M. Leslie; Faust, Michelle A.; Glenn, Andrew M.; Martinez, H. Paul; Pawelczak, Iwona A.; Payne, Stephen A.

2017-05-16

A scintillator material according to one embodiment includes a polymer matrix; a primary dye in the polymer matrix, the primary dye being a fluorescent dye, the primary dye being present in an amount of 3 wt % or more; and at least one component in the polymer matrix, the component being selected from a group consisting of B, Li, Gd, a B-containing compound, a Li-containing compound and a Gd-containing compound, wherein the scintillator material exhibits an optical response signature for thermal neutrons that is different than an optical response signature for fast neutrons and gamma rays. A system according to one embodiment includes a scintillator material as disclosed herein and a photodetector for detecting the response of the material to fast neutron, thermal neutron and gamma ray irradiation.

Weighting Primary Care Patient Panel Size: A Novel Electronic Health Record-Derived Measure Using Machine Learning.

PubMed

Rajkomar, Alvin; Yim, Joanne Wing Lan; Grumbach, Kevin; Parekh, Ami

2016-10-14

Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists. Using a combination of decision rules and k-means clustering, we identified clusters of patients with similar health care system activity. Phenotypes with basic demographic information were used to predict future health care utilization using log-linear models. Phenotypes were also used to calculate weighted panel sizes. We identified 7 primary care utilization phenotypes, which were characterized by various combinations of primary care and specialty usage and were deemed clinically distinct by primary care physicians. These phenotypes, combined with age-sex and primary payer variables, predicted future primary care utilization with R 2 of .394 and were used to create weighted panel sizes. Individual patients' health care utilization may be useful for classifying patients by primary care work effort and for predicting future primary care usage.

Tracking social motivation systems deficits: the affective neuroscience view of autism.

PubMed

Carré, Arnaud; Chevallier, Coralie; Robel, Laurence; Barry, Caroline; Maria, Anne-Solène; Pouga, Lydia; Philippe, Anne; Pinabel, François; Berthoz, Sylvie

2015-10-01

Abnormal functioning of primary brain systems that express and modulate basic emotional drives are increasingly considered to underlie mental disorders including autism spectrum disorders. We hypothesized that ASD are characterized by disruptions in the primary systems involved in the motivation for social bonding. Twenty adults with ASD were compared to 20 neurotypical participants on the basis of self-reports and clinical assessments, including the Social Anhedonia Scale (SAS) and the Affective Neuroscience Personality Scales (ANPS). ASD diagnosis was related to SAS, as well as to positive (PLAYFULNESS) and negative (FEAR) ANPS-traits. In the overall sample, levels of autistic traits (AQ) were related to SAS and PLAYFULNESS. We argue that PLAYFULNESS could be at the root of social bonding impairments in ASD.

The CASE Programme Implemented Across the Primary and Secondary School Transition in Ireland

NASA Astrophysics Data System (ADS)

McCormack, Lorraine; Finlayson, Odilla E.; McCloughlin, Thomas J. J.

2014-11-01

In the Irish education system, there is little continuity between the primary and secondary education systems. The transfer between these systems is particularly problematic in the area of science. In order to alleviate some of these problems, as well as to enhance the cognitive development of students, the Cognitive Acceleration through Science Education programme was adapted for use and implemented across the primary-secondary school transition in Ireland. The programme was delivered in a variety of ways across the two levels, including the teacher and researcher teaching the programmes individually and team-teaching arrangements. The results on cognitive development measures showed that the students who were taught the programme in primary and secondary school made significant gains, when compared to the non-intervention group. There were also gains evident for students who only received one part of the programme (i.e. in either primary or secondary school). The greater gains, in terms of effect size, were evident at secondary school. The rationale, methodology and results are detailed in this paper.

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 health issues. Generic health system weaknesses in Kenya impact on efforts for horizontal integration of mental health into routine primary care practice, and greatly frustrate health worker efforts.Improvement of medicine supplies, information systems, explicit inclusion of mental health in district level targets, management and supervision to primary care are likely to greatly improve primary care health worker effectiveness, and enable training programmes to be followed by better use in the field of newly acquired skills. A major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels, so that supportive supervision from the district level to primary care would become routine practice rather than very scarce activity. Trial registration ISRCTN 53515024.

Fuel cell system with interconnect

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

Goettler, Richard; Liu, Zhien

The present invention includes a fuel cell system having a plurality of adjacent electrochemical cells formed of an anode layer, a cathode layer spaced apart from the anode layer, and an electrolyte layer disposed between the anode layer and the cathode layer. The fuel cell system also includes at least one interconnect, the interconnect being structured to conduct free electrons between adjacent electrochemical cells. Each interconnect includes a primary conductor embedded within the electrolyte layer and structured to conduct the free electrons.

Fuel cell system with interconnect

DOEpatents

Goettler, Richard; Liu, Zhien

2015-08-11

The present invention includes a fuel cell system having a plurality of adjacent electrochemical cells formed of an anode layer, a cathode layer spaced apart from the anode layer, and an electrolyte layer disposed between the anode layer and the cathode layer. The fuel cell system also includes at least one interconnect, the interconnect being structured to conduct free electrons between adjacent electrochemical cells. Each interconnect includes a primary conductor embedded within the electrolyte layer and structured to conduct the free electrons.

Fuel cell system with interconnect

DOEpatents

Goettler, Richard; Liu, Zhien

2015-03-10

The present invention includes a fuel cell system having a plurality of adjacent electrochemical cells formed of an anode layer, a cathode layer spaced apart from the anode layer, and an electrolyte layer disposed between the anode layer and the cathode layer. The fuel cell system also includes at least one interconnect, the interconnect being structured to conduct free electrons between adjacent electrochemical cells. Each interconnect includes a primary conductor embedded within the electrolyte layer and structured to conduct the free electrons.

Fuel cell system with interconnect

DOEpatents

Liu, Zhien; Goettler, Richard

2015-09-29

The present invention includes a fuel cell system having a plurality of adjacent electrochemical cells formed of an anode layer, a cathode layer spaced apart from the anode layer, and an electrolyte layer disposed between the anode layer and the cathode layer. The fuel cell system also includes at least one interconnect, the interconnect being structured to conduct free electrons between adjacent electrochemical cells. Each interconnect includes a primary conductor embedded within the electrolyte layer and structured to conduct the free electrons.

The development of an augmentor wing jet STOL research aircraft (modified C-8A). Volume 2: Analysis of contractor's flight test

NASA Technical Reports Server (NTRS)

Skavdahl, H.; Patterson, D. H.

1972-01-01

The initial flight test phase of the modified C-8A airplane was conducted. The primary objective of the testing was to establish the basic airworthiness of the research vehicle. This included verification of the structural design and evaluation of the aircraft's systems. Only a minimum amount of performance testing was scheduled; this has been used to provide a preliminary indication of the airplane's performance and flight characteristics for future flight planning. The testing included flutter and loads investigations up to the maximum design speed. The operational characteristics of all systems were assessed including hydraulics, environmental control system, air ducts, the vectoring conical nozzles, and the stability augmentation system (SAS). Approaches to stall were made at three primary flap settings: up, 30 deg and 65 deg, but full stalls were not scheduled. Minimum control speeds and maneuver margins were checked. All takeoffs and landings were conventional, and STOL performance was not scheduled during this phase of the evaluation.

Hydrocarbon fluid, ejector refrigeration system

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

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

1993-08-31

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

A systemic identification approach for primary transcription start site of Arabidopsis miRNAs from multidimensional omics data.

PubMed

You, Qi; Yan, Hengyu; Liu, Yue; Yi, Xin; Zhang, Kang; Xu, Wenying; Su, Zhen

2017-05-01

The 22-nucleotide non-coding microRNAs (miRNAs) are mostly transcribed by RNA polymerase II and are similar to protein-coding genes. Unlike the clear process from stem-loop precursors to mature miRNAs, the primary transcriptional regulation of miRNA, especially in plants, still needs to be further clarified, including the original transcription start site, functional cis-elements and primary transcript structures. Due to several well-characterized transcription signals in the promoter region, we proposed a systemic approach integrating multidimensional "omics" (including genomics, transcriptomics, and epigenomics) data to improve the genome-wide identification of primary miRNA transcripts. Here, we used the model plant Arabidopsis thaliana to improve the ability to identify candidate promoter locations in intergenic miRNAs and to determine rules for identifying primary transcription start sites of miRNAs by integrating high-throughput omics data, such as the DNase I hypersensitive sites, chromatin immunoprecipitation-sequencing of polymerase II and H3K4me3, as well as high throughput transcriptomic data. As a result, 93% of refined primary transcripts could be confirmed by the primer pairs from a previous study. Cis-element and secondary structure analyses also supported the feasibility of our results. This work will contribute to the primary transcriptional regulatory analysis of miRNAs, and the conserved regulatory pattern may be a suitable miRNA characteristic in other plant species.

Primary care providers' experiences caring for complex patients in primary care: a qualitative study.

PubMed

Loeb, Danielle F; Bayliss, Elizabeth A; Candrian, Carey; deGruy, Frank V; Binswanger, Ingrid A

2016-03-22

Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of optimal care, implementation of effective systemic approaches should be considered.

Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma.

PubMed

Porter, Alyx B; Giannini, Caterina; Kaufmann, Timothy; Lucchinetti, Claudia F; Wu, Wenting; Decker, Paul A; Atkinson, John L D; O'Neill, Brian Patrick

2008-05-01

The objective is to determine whether corticosteroid administration before biopsy prevents histopathological diagnosis of primary central nervous system lymphoma (PCNSL). A retrospective review was performed of immunocompetent PCNSL patients from 1985 to 2005. A total of 109 patients was identified. Sixty-eight (63.6%) patients received corticosteroids before diagnosis. Thirteen patients (of 109; 12%) had undergone repeat brain biopsy to confirm PCNSL. These included 8 (of 68) patients who had received corticosteroids (12%), and 5 (of 39) who had not (13%) (p = 1.0). The majority of PCNSL patients who received corticosteroids before diagnosis did not experience significant radiographic change or require second biopsy for diagnosis.

The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

PubMed

Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

2016-04-01

When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

Ground-Based Telescope Parametric Cost Model

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Rowell, Ginger Holmes

2004-01-01

A parametric cost model for ground-based telescopes is developed using multi-variable statistical analysis, The model includes both engineering and performance parameters. While diameter continues to be the dominant cost driver, other significant factors include primary mirror radius of curvature and diffraction limited wavelength. The model includes an explicit factor for primary mirror segmentation and/or duplication (i.e.. multi-telescope phased-array systems). Additionally, single variable models based on aperture diameter are derived. This analysis indicates that recent mirror technology advances have indeed reduced the historical telescope cost curve.

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

PubMed

Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

2012-01-01

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

14 CFR 121.313 - Miscellaneous equipment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... from its primary operating system to an alternate system, the means must include a positive positioning...) AIR CARRIERS AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING... equivalent for each pilot station. (c) A power supply and distribution system that meets the requirements of...

14 CFR 121.313 - Miscellaneous equipment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... from its primary operating system to an alternate system, the means must include a positive positioning...) AIR CARRIERS AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING... equivalent for each pilot station. (c) A power supply and distribution system that meets the requirements of...

Operational and maintenance instruction manual for the Ingham County Geriatric Medical Care Facility solar water-heating system

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

Not Available

The Ingham County solar system consists of approximately 10,000 square feet of solar collectors connected in a closed configuration loop. The primary loop solution is a 1:12 mixture of water and propylene glycol which flows through the tube side of a heat exchanger connected to the primary storage tank. The heat energy which is supplied to the primary storage tank is subsequently used to preheat the temperature of the laundry water, kitchen water, and domestic potable water. Included in this report are: detailed drawings and flow chart; operational methodology; preventive maintenance instructions; general instructions and safety precautions; and a correctivemore » maintenance and tabulation of failure modes. Appendices include: manufacturers technical manual and component specifications; IBM data sensors and responsibilities; digital county monitor operations manual; and on site monitor operations manual. Reference CAPE-2834. (LS)« less

Energy Models

EPA Science Inventory

Energy models characterize the energy system, its evolution, and its interactions with the broader economy. The energy system consists of primary resources, including both fossil fuels and renewables; power plants, refineries, and other technologies to process and convert these r...

Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis.

PubMed

de Boysson, H; Boulouis, G; Parienti, J-J; Touzé, E; Zuber, M; Arquizan, C; Dequatre, N; Detante, O; Bienvenu, B; Aouba, A; Guillevin, L; Pagnoux, C; Naggara, O

2017-10-01

3D-TOF-MRA and DSA are 2 available tools to demonstrate neurovascular involvement in primary central nervous system vasculitis. We aimed to compare the diagnostic concordance of vessel imaging using 3D-TOF-MRA and DSA in patients with primary central nervous system vasculitis. We retrospectively identified all patients included in the French primary central nervous system vasculitis cohort of 85 patients who underwent, at baseline, both intracranial 3D-TOF-MRA and DSA in an interval of no more than 2 weeks and before treatment initiation. Two neuroradiologists independently reviewed all 3D-TOF-MRA and DSA imaging. Brain vasculature was divided into 25 arterial segments. Concordance between 3D-TOF-MRA and DSA for the identification of arterial stenosis was assessed by the Cohen κ Index. Thirty-one patients met the inclusion criteria, including 20 imaged with a 1.5T MR unit and 11 with a 3T MR unit. Among the 25 patients (81%) with abnormal DSA findings, 24 demonstrated abnormal 3D-TOF-MRA findings, whereas all 6 remaining patients with normal DSA findings had normal 3D-TOF-MRA findings. In the per-segment analysis, concordance between 1.5T 3D-TOF-MRA and DSA was 0.82 (95% CI, 0.75-0.93), and between 3T 3D-TOF-MRA and DSA, it was 0.87 (95% CI, 0.78-0.91). 3D-TOF-MRA shows a high concordance with DSA in diagnostic performance when analyzing brain vasculature in patients with primary central nervous system vasculitis. In patients with negative 3T 3D-TOF-MRA findings, the added diagnostic value of DSA is limited. © 2017 by American Journal of Neuroradiology.

The status of power supplies for primary electric propulsion in the U.S.A.

NASA Technical Reports Server (NTRS)

Jones, R. M.; Scott-Monck, J. A.

1984-01-01

This paper reviews the status of and requirements on solar electric and nuclear electric power supplies for primary electric propulsion missions. The power supply requirements of power level, specific mass (kg/kWe) and lifetime are defined as a function of the mission and electric propulsion system characteristics for planetary missions. The technology status of planar and concentrator arrays is discussed. Nuclear reactors and thermoelectric, thermionic, Brayton and Rankine conversion technologies are reviewed, as well as recent nuclear power system design concepts and program activity. Technology projections for power supplies applicable to primary electric propulsion missions are included.

Promising More Information

NASA Technical Reports Server (NTRS)

2003-01-01

When NASA needed a real-time, online database system capable of tracking documentation changes in its propulsion test facilities, engineers at Stennis Space Center joined with ECT International, of Brookfield, Wisconsin, to create a solution. Through NASA's Dual-Use Program, ECT developed Exdata, a software program that works within the company's existing Promise software. Exdata not only satisfied NASA s requirements, but also expanded ECT s commercial product line. Promise, ECT s primary product, is an intelligent software program with specialized functions for designing and documenting electrical control systems. An addon to AutoCAD software, Promis e generates control system schematics, panel layouts, bills of material, wire lists, and terminal plans. The drawing functions include symbol libraries, macros, and automatic line breaking. Primary Promise customers include manufacturing companies, utilities, and other organizations with complex processes to control.

Physician specialty and the quality of medical care experiences in the context of the Taiwan national health insurance system.

PubMed

Tsai, Jenna; Shi, Leiyu; Yu, Wei-Lung; Hung, Li-Mei; Lebrun, Lydie A

2010-01-01

Based on a recent patient survey from Taiwan, where there is universal health insurance coverage and unrestricted physician choice, this study examined the relationship between physician specialty and the quality of primary medical care experiences. We assessed ambulatory patients' experiences with medical care using the Primary Care Assessment Tool, representing 7 primary care domains: first contact (ie, accessibility and utilization); longitudinality (ie, ongoing care); coordination (ie, referrals and information systems); comprehensiveness (ie, services available and provided); family centeredness; community orientation; and cultural competence. Having a primary care physician was significantly associated with patients reporting higher quality of primary care experiences. Specifically, relative to specialty care physicians, primary care physicians enhanced accessibility, achieved better community orientation and cultural competence, and provided more comprehensive services. In an area with universal health insurance and unrestricted physician choice, ambulatory patients of primary care physicians rated their medical care experiences as superior to those of patients of specialists. In addition to providing health insurance coverage, promoting primary care should be included as a health policy to improve patients' quality of ambulatory medical care experiences.

The Excellent Education System for One and a Half Million Children.

ERIC Educational Resources Information Center

Shiba, Shoji

1986-01-01

This description of popular private educational system in Japan, the Kumon Method, focuses on instruction in arithmetic for primary school students. Highlights include the educational philosophy of the system, instructor training, acceptance by parents, and use of the system as a model for educational systems of the future. (LRW)

Genetic Heterogeneity in Therapy-Naïve Synchronous Primary Breast Cancers and Their Metastases.

PubMed

Ng, Charlotte K Y; Bidard, Francois-Clement; Piscuoglio, Salvatore; Geyer, Felipe C; Lim, Raymond S; de Bruijn, Ino; Shen, Ronglai; Pareja, Fresia; Berman, Samuel H; Wang, Lu; Pierga, Jean-Yves; Vincent-Salomon, Anne; Viale, Agnes; Norton, Larry; Sigal, Brigitte; Weigelt, Britta; Cottu, Paul; Reis-Filho, Jorge S

2017-08-01

Purpose: Paired primary breast cancers and metachronous metastases after adjuvant treatment are reported to differ in their clonal composition and genetic alterations, but it is unclear whether these differences stem from the selective pressures of the metastatic process, the systemic therapies, or both. We sought to define the repertoire of genetic alterations in breast cancer patients with de novo metastatic disease who had not received local or systemic therapy. Experimental Design: Up to two anatomically distinct core biopsies of primary breast cancers and synchronous distant metastases from nine patients who presented with metastatic disease were subjected to high-depth whole-exome sequencing. Mutations, copy number alterations and their cancer cell fractions, and mutation signatures were defined using state-of-the-art bioinformatics methods. All mutations identified were validated with orthogonal methods. Results: Genomic differences were observed between primary and metastatic deposits, with a median of 60% (range 6%-95%) of shared somatic mutations. Although mutations in known driver genes including TP53, PIK3CA , and GATA3 were preferentially clonal in both sites, primary breast cancers and their synchronous metastases displayed spatial intratumor heterogeneity. Likely pathogenic mutations affecting epithelial-to-mesenchymal transition-related genes, including SMAD4, TCF7L2 , and TCF4 ( ITF2 ), were found to be restricted to or enriched in the metastatic lesions. Mutational signatures of trunk mutations differed from those of mutations enriched in the primary tumor or the metastasis in six cases. Conclusions: Synchronous primary breast cancers and metastases differ in their repertoire of somatic genetic alterations even in the absence of systemic therapy. Mutational signature shifts might contribute to spatial intratumor genetic heterogeneity. Clin Cancer Res; 23(15); 4402-15. ©2017 AACR . ©2017 American Association for Cancer Research.

Embracing a diversified future for US primary care.

PubMed

Hoff, Timothy

2013-01-01

Although less focused upon given the current emphasis on the patient-centered medical home innovation, the future for US primary care is arguably one that will be characterized by diversity in service delivery structures and personnel. The drivers of this diversity include increased patient demand requiring a larger number of primary care access points; the need for lower-cost delivery structures that can flourish in a low-margin business model; greater interest in primary care delivery by retailers and hospitals that see their involvement as a means to enhance their core business goals; the increased desire by non-physician providers to gain work independence; and a growing cadre of younger PCPs whose career and job preferences leave them open to working in a variety of different settings and structures. A key issue to ask of a more diversified primary care system is whether or not it will be characterized by competition or cooperation. While a competitive system would not be unexpected given historical and current trends, such a system would likely stunt the prospects for a full revitalization of US primary care. However, there is reason to believe that a cooperative system is possible and would be advantageous, given the mutual dependencies that already exist among primary care stakeholders, and additional steps that could be taken to enhance such dependencies even more into the future.

Reduction of vibration by using mechatronical subsystem

NASA Astrophysics Data System (ADS)

Białas, K.; Buchacz, A.

2015-11-01

The primary aim introduced in this paper is synthesis of mechatronical system understand as planning of this type of systems. Mechatronical system is consisted of fundamental mechanical system and subsystem reducing vibration including electric elements. Fundamental system is received applying reverse task of dynamic (synthesis) and it's including inertial and elastic elements. The subsystem includes electric elements by means moving-coil transducer. The synthesis can also be used to change the already existing systems. Due to the method, introduced in this work, may be performed as early as whilst the designing of future functions. Using this way of designing is support for designers of mechanical systems with active reducing of vibrations.

DISC BRAKE SYSTEM (CENTER), INCLUDING BELT DRIVE TO SECONDARY GENERAL ...

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

DISC BRAKE SYSTEM (CENTER), INCLUDING BELT DRIVE TO SECONDARY GENERAL MOTORS ENGINE (LEFT)AND FERREL REDUCTION GEAR CONNECTION TO ALLIS-CHALMERS DIESEL ENGINE (RIGHT), LOOKING NORTH. NOTE TORQUE CONVERTER (TOP) AND THROTTLE (BELOW) LINES CONNECTING TO PRIMARY ENGINE. - Mad River Glen, Single Chair Ski Lift, 62 Mad River Glen Resort Road, Fayston, Washington County, VT

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.

40 CFR 141.804 - Aircraft water system operations and maintenance plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule... must include the following requirements for procedures for disinfection and flushing of aircraft water system. (i) The air carrier must conduct disinfection and flushing of the aircraft water system in...

Supervising Family Therapy Trainees in Primary Care Medical Settings: Context Matters

ERIC Educational Resources Information Center

Edwards, Todd M.; Patterson, Jo Ellen

2006-01-01

The purpose of this article is to identify and describe four essential skills for effective supervision of family therapy trainees in primary care medical settings. The supervision skills described include: (1) Understand medical culture; (2) Locate the trainee in the treatment system; (3) Investigate the biological/health issues; and (4) Be…

Women Students In Rural Communities: A Preliminary Report.

ERIC Educational Resources Information Center

Moore-West, Maggi; Lucero, Susan

Personality and a social support system are two factors that may influence women medical students' choice of a rural primary care specialty. The 2-year study of 11 University of New Mexico School of Medicine women students engaged in 4-month rural primary care preceptorships included interviews and a personality inventory. Three women had…

Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level.

PubMed

Pratt, Rebekah; Gyllstrom, Beth; Gearin, Kim; Lange, Carol; Hahn, David; Baldwin, Laura-Mae; VanRaemdonck, Lisa; Nease, Don; Zahner, Susan

Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.

Microwave scanning beam landing system compatibility and performance: Engineering analyses 75-1 and 75-2. [space shuttle orbiter landing

NASA Technical Reports Server (NTRS)

1977-01-01

The microwave scanning beam landing system (MSBLS) is the primary position sensor of the Orbiter's navigation subsystem during the autoland phase of the flight. Portions of the system are discussed with special emphasis placed on potential problem areas as referenced to the Orbiter's mission. Topics discussed include system compatability, system accuracy, and expected RF signal levels. A block and flow diagram of MSBLS system operation is included with a list of special tests required to determine system performance.

A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults.

PubMed

Dolovich, Lisa; Oliver, Doug; Lamarche, Larkin; Agarwal, Gina; Carr, Tracey; Chan, David; Cleghorn, Laura; Griffith, Lauren; Javadi, Dena; Kastner, Monika; Longaphy, Jennifer; Mangin, Dee; Papaioannou, Alexandra; Ploeg, Jenny; Raina, Parminder; Richardson, Julie; Risdon, Cathy; Santaguida, P Lina; Straus, Sharon; Thabane, Lehana; Valaitis, Ruta; Price, David

2016-04-05

Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging. This is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person's life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months. Evidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system's transformation of person-focused, primary care for older adults. ClinicalTrials.gov NCT02283723.

Structure and Mechanics

NASA Technical Reports Server (NTRS)

Sanger, George

1991-01-01

Artemis is a Common Lunar Lander (CLL) design for the Space Exploration Initiative (SEI). Structure factors for the CLL's primary and secondary structures are listed in tabular form. Additionally, engineering drawings of various systems, including the propulsion and landing systems, are presented.

A system for classifying wood-using industries and recording statistics for automatic data processing.

Treesearch

E.W. Fobes; R.W. Rowe

1968-01-01

A system for classifying wood-using industries and recording pertinent statistics for automatic data processing is described. Forms and coding instructions for recording data of primary processing plants are included.

Collaborative efforts to improve system response to families who are experiencing child maltreatment and domestic violence.

PubMed

Banks, Duren; Dutch, Nicole; Wang, Kathleen

2008-07-01

The Greenbook demonstration initiative provided federal funding and other support to six communities to establish collaborations to plan and implement policy and practice changes in systems that serve families who are experiencing domestic violence and child maltreatment or child exposure to domestic violence. The demonstration sites established and organized collaborative groups in accordance with the Greenbook foundational principles and recommendations, including representation from multiple levels within the primary partner systems and other organizations, as well as the community. The sites struggled with how to engage consumers of the primary systems, however, and devoted a great deal of time to understanding and addressing organizational differences among the partners. Other salient collaborative influences included leadership, resources, trust, and commitment. The stakeholders noted that the collaborative relationships required a great deal of work but were ultimately one of the main successes of the initiative.

Prospects for rebuilding primary care using the patient-centered medical home.

PubMed

Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C

2010-05-01

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

PubMed

Johnston, Sharon; Hogel, Matthew

2016-05-01

In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

Written language impairments in primary progressive aphasia: a reflection of damage to central semantic and phonological processes.

PubMed

Henry, Maya L; Beeson, Pélagie M; Alexander, Gene E; Rapcsak, Steven Z

2012-02-01

Connectionist theories of language propose that written language deficits arise as a result of damage to semantic and phonological systems that also support spoken language production and comprehension, a view referred to as the "primary systems" hypothesis. The objective of the current study was to evaluate the primary systems account in a mixed group of individuals with primary progressive aphasia (PPA) by investigating the relation between measures of nonorthographic semantic and phonological processing and written language performance and by examining whether common patterns of cortical atrophy underlie impairments in spoken versus written language domains. Individuals with PPA and healthy controls were administered a language battery, including assessments of semantics, phonology, reading, and spelling. Voxel-based morphometry was used to examine the relation between gray matter volumes and language measures within brain regions previously implicated in semantic and phonological processing. In accordance with the primary systems account, our findings indicate that spoken language performance is strongly predictive of reading/spelling profile in individuals with PPA and suggest that common networks of critical left hemisphere regions support central semantic and phonological processes recruited for spoken and written language.

Phase-shifting point diffraction interferometer focus-aid enhanced mask

DOEpatents

Naulleau, Patrick

2000-01-01

A phase-shifting point diffraction interferometer system (PS/PDI) employing a PS/PDI mask that includes a PDI focus aid is provided. The PDI focus aid mask includes a large or secondary reference pinhole that is slightly displaced from the true or primary reference pinhole. The secondary pinhole provides a larger capture tolerance for interferometrically performing fine focus. With the focus-aid enhanced mask, conventional methods such as the knife-edge test can be used to perform an initial (or rough) focus and the secondary (large) pinhole is used to perform interferometric fine focus. Once the system is well focused, high accuracy interferometry can be performed using the primary (small) pinhole.

Health information technology needs help from primary care researchers.

PubMed

Krist, Alex H; Green, Lee A; Phillips, Robert L; Beasley, John W; DeVoe, Jennifer E; Klinkman, Michael S; Hughes, John; Puro, Jon; Fox, Chester H; Burdick, Tim

2015-01-01

While health information technology (HIT) efforts are beginning to yield measurable clinical benefits, more is needed to meet the needs of patients and clinicians. Primary care researchers are uniquely positioned to inform the evidence-based design and use of technology. Research strategies to ensure success include engaging patient and clinician stakeholders, working with existing practice-based research networks, and using established methods from other fields such as human factors engineering and implementation science. Policies are needed to help support primary care researchers in evaluating and implementing HIT into everyday practice, including expanded research funding, strengthened partnerships with vendors, open access to information systems, and support for the Primary Care Extension Program. Through these efforts, the goal of improved outcomes through HIT can be achieved. © Copyright 2015 by the American Board of Family Medicine.

Triply redundant integrated navigation and asset visibility system

DOEpatents

Smith, Stephen F [Loudon, TN; Moore, James A [Powell, TN

2011-11-29

Methods and apparatus are described for a navigation system. A method includes providing a global positioning system fix having a plurality of tracking parameters; providing a theater positioning system fix; monitoring the plurality of tracking parameters for predetermined conditions; and, when the predetermined conditions are met, sending a notifying signal and switching to the theater positioning system fix as a primary fix. An apparatus includes a system controller; a global positioning system receiver coupled to the system controller; a radio frequency locating receiver coupled to the system controller; and an operator interface coupled to the system controller.

Triply redundant integrated navigation and asset visibility system

DOEpatents

Smith, Stephen F.; Moore, James A.

2013-01-22

Methods and apparatus are described for a navigation system. A method includes providing a global positioning system fix having a plurality of tracking parameters; providing a theater positioning system fix; monitoring the plurality of tracking parameters for predetermined conditions; and, when the predetermined conditions are met, sending a notifying signal and switching to the theater positioning system fix as a primary fix. An apparatus includes a system controller; a global positioning system receiver coupled to the system controller; a radio frequency locating receiver coupled to the system controller; and an operator interface coupled to the system controller.

A policy of introducing a new contract and funding system of general practice in Estonia.

PubMed

Lember, Margus

2002-01-01

The socialist bloc of post-war Europe was obliged to follow the Soviet example with a hierarchical, centrally controlled health care system based on polyclinics and other facilities providing extensive specialist services at the first level of contact. All the countries of Central and Eastern Europe have now expressed their wish to totally change their health care systems. Changes in these countries include: the introduction of market economy mechanisms in health care, an increased focus on population health needs in guiding health care systems, and the possibility of introducing a more general type of care at primary level. Patient expectations of access, choice and convenience are factors in shaping new models of health care delivery. Appropriate timing is the key determinant of the success of reforms. In Estonia the beginning of the 1990s was the time when several interest groups in society supported changes in the health care system. The first step after regaining independence was the reintroduction of a Bismarck-type insurance system. In the late 1990s the primary care reforms have changed the initial plans and elements of a National Health Service were introduced, especially general practitioners' lists, capitation payment and gate-keeping principles. The family medicine reform in Estonia has two main objectives: introduction of general practice as a specialty into Estonian health care and changing the remuneration system of primary care doctors. The specific tasks are: to provide practising primary care doctors with opportunities for retraining to gain the specialty status of a general practitioner, to create a list system for the population to register with a primary care doctor, to introduce a partial gate-keeping system and to give the status of the independent contractor to primary care doctors.

Advancing primary care to promote equitable health: implications for China

PubMed Central

2012-01-01

China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform. PMID:22264309

Rituximab treatment in primary angiitis of the central nervous system.

PubMed

Patel, Shreeya; Ross, Laura; Oon, Shereen; Nikpour, Mandana

2018-06-01

Primary angiitis of the central nervous system (PACNS) is a rare autoimmune vasculitis affecting the brain and spinal cord. Treatment with biological agents has revolutionised the treatment of many rheumatic conditions but there is scant literature regarding the use of biological agents in PACNS. We present three cases of PACNS treated with rituximab, including two cases of relapsed disease, and a literature review suggesting a role for rituximab in this condition. © 2018 Royal Australasian College of Physicians.

Principle Findings from Development of a Recirculated Exhaust Gas Intake Sensor (REGIS) Enabling Cost-Effective Fuel Efficiency Improvement

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

Schnabel, Claus

Kick-off of the Bosch scope of work for the REGIS project started in October 2012. The primary work-packages included in the Bosch scope of work were the following: overall project management, development of the EGR sensor (design of sensor element, design of protection tube, and design of mounting orientation), development of EGR system control strategy, build-up of prototype sensors, evaluation of system performance with the new sensor and the new control strategy, long-term durability testing, and development of a 2nd generation sensor concept for continued technology development after the REGIS project. The University of Clemson was a partner with Boschmore » in the REGIS project. The Clemson scope of work for the REGIS project started in June 2013. The primary work-packages included in the Clemson scope of work were the following: development of EGR system control strategy, and evaluation of system performance with the new sensor and new control strategy. This project was split into phase I, phase II and phase III. Phase I work was completed by the end of June 2014 and included the following primary work packages: development of sensor technical requirements, assembly of engine testbench at Clemson, design concept for sensor housing, connector, and mounting orientation, build-up of EGR flow test benches at Bosch, and build-up of first sensor prototypes. Phase II work was completed by the end of June 2015 and included the following primary work pack ages: development of an optimizing function and demonstration of robustness of sensor, system control strategy implementation and initial validation, completion of engine in the loop testing of developed control algorithm, completion of sensor testing including characteristic line, synthetic gas test stand, and pressure dependency characterization, demonstration of benefits of control w/o sensing via simulation, development of 2nd generation sensor concept. Notable technical achievements from phase II were the following: publication of two new technical papers by Clemson detailing the control strategies used for the EGR system control. The two papers was published in the 2016 SAE World Congress in April 2016. The titles of each paper are, “Physics-Based Exhaust Pressure and Temperature Estimation for Low Pressure EGR Control in Turbocharged Gasoline Engines,” by K. Siokos, and “A Control Algorithm for Low Pressure – EGR Systems using a Smith Predictor with Intake Oxygen Sensor Feedback”, by R. Koli. All phase III work packages have been completed. The primary work packages in phase III were the following: completion of long-term sensor durability testing, final demonstration of benefits of EGR control w/o sensing, final decision of the second generation sensor development path.« less

Measurements Methods for the analysis of Nuclear Reactors Thermal Hydraulic in Water Scaled Facilities

NASA Astrophysics Data System (ADS)

Spaccapaniccia, C.; Planquart, P.; Buchlin, J. M. AB(; ), AC(; )

2018-01-01

The Belgian nuclear research institute (SCK•CEN) is developing MYRRHA. MYRRHA is a flexible fast spectrum research reactor, conceived as an accelerator driven system (ADS). The configuration of the primary loop is pool-type: the primary coolant and all the primary system components (core and heat exchangers) are contained within the reactor vessel, while the secondary fluid is circulating in the heat exchangers. The primary coolant is Lead Bismuth Eutectic (LBE). The recent nuclear accident of Fukushima in 2011 changed the requirements for the design of new reactors, which should include the possibility to remove the residual decay heat through passive primary and secondary systems, i.e. natural convection (NC). After the reactor shut down, in the unlucky event of propeller failures, the primary and secondary loops should be able to remove the decay heat in passive way (Natural Convection). The present study analyses the flow and the temperature distribution in the upper plenum by applying laser imaging techniques in a laboratory scaled water model. A parametric study is proposed to study stratification mitigation strategies by varying the geometry of the buffer tank simulating the upper plenum.

A Web-based Examination System Based on PHP+MySQL.

PubMed

Wen, Ji; Zhang, Yang; Yan, Yong; Xia, Shunren

2005-01-01

The design and implementation of web-based examination system constructed by PHP and MySQL is presented in this paper. Three primary parts, including students',teachers' and administrators', are introduced and analyzed in detail. Initial application has demonstrated the system's feasibility and reasonability.^*

Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction: A Patient Population Study Comparing a Pharmacoinvasive Strategy With a Primary Percutaneous Coronary Intervention Strategy Within a Regional System.

PubMed

Rashid, Mohammed K; Guron, Nita; Bernick, Jordan; Wells, George A; Blondeau, Melissa; Chong, Aun-Yeong; Dick, Alexander; Froeschl, Michael P V; Glover, Chris A; Hibbert, Benjamin; Labinaz, Marino; Marquis, Jean-François; Osborne, Christina; So, Derek Y; Le May, Michel R

2016-10-10

This study investigated the safety and efficacy of a pharmacoinvasive strategy compared with a primary percutaneous coronary intervention (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in the context of a real-world system. Primary PCI continues to be the optimal reperfusion therapy; however, in areas where PCI centers are not readily available, a pharmacoinvasive strategy has been proposed. The University of Ottawa Heart Institute regional STEMI system provides a primary PCI strategy for patients presenting within a 90-km radius from the PCI center, and a pharmacoinvasive strategy for patients outside this limit. We included all confirmed STEMI patients between April 2009 and May 2011. The primary efficacy outcome was a composite of mortality, reinfarction, or stroke and the primary safety outcome was major bleeding. We identified 236 and 980 consecutive patients enrolled in pharmacoinvasive and primary PCI strategies, respectively. The median door-to-needle time was 31 min in the pharmacoinvasive group and the median door-to-balloon time was 95 min in the primary PCI group. In a multivariable model, there was no significant difference in the primary efficacy outcome (odds ratio: 1.54; p = 0.21); however, the propensity for more bleeding with a pharmacoinvasive strategy approached statistical significance (odds ratio: 2.02; p = 0.08). Within the context of a STEMI system, a pharmacoinvasive strategy was associated with similar rates of the composite of mortality, reinfarction, or stroke as compared with a primary PCI strategy; however, there was a propensity for more bleeding with a pharmacoinvasive strategy. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Virtual care policy recommendations for patient-centred primary care: findings of a consensus policy dialogue using a nominal group technique.

PubMed

Shaw, James; Jamieson, Trevor; Agarwal, Payal; Griffin, Bailey; Wong, Ivy; Bhatia, R Sacha

2017-01-01

Background The development of new virtual care technologies (including telehealth and telemedicine) is growing rapidly, leading to a number of challenges related to health policy and planning for health systems around the world. Methods We brought together a diverse group of health system stakeholders, including patient representatives, to engage in policy dialogue to set health system priorities for the application of virtual care in the primary care sector in the Province of Ontario, Canada. We applied a nominal group technique (NGT) process to determine key priorities, and synthesized these priorities with group discussion to develop recommendations for virtual care policy. Methods included a structured priority ranking process, open-ended note-taking, and thematic analysis to identify priorities. Results Recommendations were summarized under the following themes: (a) identify clear health system leadership to embed virtual care strategies into all aspects of primary and community care; (b) make patients the focal point of health system decision-making; (c) leverage incentives to achieve meaningful health system improvements; and (d) building virtual care into streamlined workflows. Two key implications of our policy dialogue are especially relevant for an international audience. First, shifting the dialogue away from technology toward more meaningful patient engagement will enable policy planning for applications of technology that better meet patients' needs. Second, a strong conceptual framework on guiding the meaningful use of technology in health care settings is essential for intelligent planning of virtual care policy. Conclusions Policy planning for virtual care needs to shift toward a stronger focus on patient engagement to understand patients' needs.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

PubMed

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

PubMed Central

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

12 CFR 611.1153 - General restrictions and prohibitions on the use of UBEs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... than the functions and services that one or more System institutions owning the UBE are authorized to... collateral at issue involves a multi-lender transaction that includes System and non-System lenders. (g... designated as the primary beneficiary of a third-party UBE, either alone or with other System institutions...

Characterization of interdigitated electrode piezoelectric fiber composites under high electrical and mechanical loading

NASA Astrophysics Data System (ADS)

Rodgers, John P.; Bent, Aaron A.; Hagood, Nesbitt W.

1996-05-01

The primary objective of this work is to develop a standard methodology for characterizing structural actuation systems intended for operation in high electrical and mechanical loading environments. The designed set of tests evaluates the performance of the active materials system under realistic operating conditions. The tests are also used to characterize piezoelectric fiber composites which have been developed as an alternative to monolithic piezoceramic wafers for structural actuation applications. The performance of this actuator system has been improved using an interdigitated electrode pattern, which orients the primary component of the electric field into the plane of the structure, enabling the use of the primary piezoelectric effect along the active fibers. One possible application of this technology is in the integral twist actuation of helicopter rotor blades for higher harmonic control. This application requires actuators which can withstand the harsh rotor blade operating environment. This includes large numbers of electrical and mechanical cycles with considerable centripetal and bending loads. The characterization tests include standard active material tests as well as application-driven tests which evaluate the performance of the actuators during simulated operation. Test results for several actuator configurations are provided, including S2 glass- reinforced and E-glass laminated actuators. The study concludes that the interdigitated electrode piezoelectric fiber composite actuator has great potential for high loading applications.

Development of the digital design environment ProjectWise(TM) - phase 1.

DOT National Transportation Integrated Search

2017-04-28

The goal of this research was to develop a project document management system capable of managing : Connecticut Department of Transportation (CTDOT) Capital Road and Bridge Program. Primary targets of : research and development included the system, c...

Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology.

PubMed

Martínez-Sánchez, Carlos; Arias-Mendoza, Alexandra; González-Pacheco, Héctor; Araiza-Garaygordobil, Diego; Marroquín-Donday, Luis Alfonso; Padilla-Ibarra, Jorge; Sierra-Fernández, Carlos; Altamirano-Castillo, Alfredo; Álvarez-Sangabriel, Amada; Azar-Manzur, Francisco Javier; Briseño-de la Cruz, José Luis; Mendoza-García, Salvador; Piña-Reyna, Yigal; Martínez-Ríos, Marco Antonio

Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy?

PubMed Central

Kim, Soo Hee; Chang, Hee Jin; Kim, Dae Yong; Park, Ji Won; Baek, Ji Yeon; Kim, Sun Young; Park, Sung Chan; Oh, Jae Hwan; Yu, Ami; Nam, Byung-Ho

2016-01-01

Purpose Tumor regression grade (TRG) is predictive of therapeutic response in rectal cancer patients after chemoradiotherapy (CRT) followed by curative resection. However, various TRG systems have been suggested, with subjective categorization, resulting in interobserver variability. This study compared the prognostic validity of four different TRG systems in order to identify the most ideal TRG system. Materials and Methods This study included 933 patients who underwent preoperative CRT and curative resection. Primary tumors alone were graded according to the American Joint Committee on Cancer (AJCC), Dworak, and Ryan TRG systems, and both primary tumors and regional lymph nodes were graded according to a modified Dworak TRG system. The ability of each TRG system to predict recurrence-free survival (RFS) and overall survival (OS) was analyzed using chi-square and C statistics. Results All four TRG systems were significantly predictive of both RFS and OS (p < 0.001 each), however none was a better predictor of prognosis than ypStage. Among the four TRGs, the mDworak TRG system was a better predictor of RFS and OS than the AJCC, Dworak, and Ryan TRG systems, and both the chi-square and C statistics were higher for the former, although the differences were not statistically significant. The combination of ypStage and the modified Dworak TRG better predicted RFS and OS than ypStage alone. Conclusion The modified Dworak TRG system for evaluation of entire tumors including regional lymph nodes is a better predictor of survival than current TRG systems for evaluation of the primary tumor alone. PMID:26511803

Development and implementation of a psychotherapy tracking database in primary care.

PubMed

Craner, Julia R; Sawchuk, Craig N; Mack, John D; LeRoy, Michelle A

2017-06-01

Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Chapter 22: Compressed Air Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Benton, Nathanael; Burns, Patrick

Compressed-air systems are used widely throughout industry for many operations, including pneumatic tools, packaging and automation equipment, conveyors, and other industrial process operations. Compressed-air systems are defined as a group of subsystems composed of air compressors, air treatment equipment, controls, piping, pneumatic tools, pneumatically powered machinery, and process applications using compressed air. A compressed-air system has three primary functional subsystems: supply, distribution, and demand. Air compressors are the primary energy consumers in a compressed-air system and are the primary focus of this protocol. The two compressed-air energy efficiency measures specifically addressed in this protocol are: High-efficiency/variable speed drive (VSD) compressormore » replacing modulating, load/unload, or constant-speed compressor; and Compressed-air leak survey and repairs. This protocol provides direction on how to reliably verify savings from these two measures using a consistent approach for each.« less

Solar water-heating system for the Ingham County geriatric medical care facility, Okemos, Michigan. Operational and maintenance instruction manual

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

Not Available

The objectives of the Ingham County Solar Project include: the demonstration of a major operational supplement to fossil fuels, thereby reducing the demand for non-renewable energy sources, demonstration of the economic and technical feasibility of solar systems as an important energy supplement over the expected life of the building, and to encourage Michigan industry to produce and incorporate solar systems in their own facility. The Ingham County solar system consists of approximately 10,000 square feet of solar collectors connected in a closed configuration loop. The primary loop solution is a mixture of water and propylene glycol which flows through themore » tube side of a heat exchanger connected to the primary storage tank. The heat energy which is supplied to the primary storage tank is subsequently utilized to increase the temperature of the laundry water, kitchen water, and domestic potable water.« less

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 several different previously described concepts and extends the understanding of how PHC systems can be strengthened through systematic and partnership-based approaches. We describe a model developed from these concepts and its application in the Australian Indigenous primary healthcare context, and raise questions about sustainability and wider relevance of the model. PMID:24344640

Technology requirements for future Earth-to-geosynchronous orbit transportation systems. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Caluori, V. A.; Conrad, R. T.; Jenkins, J. C.

1980-01-01

Technologies including accelerated technology that are critical to performance and/or provide cost advantages for future space transportation systems are identified. Mission models are scoped and include priority missions, and cargo missions. Summary data, providing primary design concepts and features, are given for the SSTO, HLLV, POTV, and LCOTV vehicles. Significant system costs and total system costs in terms of life cycle costs in both discounted and undiscounted dollars are summarized for each of the vehicles.

Integrated primary care in Germany: the road ahead.

PubMed

Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

2009-04-20

Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and 'community medicine nurses'. Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

Integrated primary care in Germany: the road ahead

PubMed Central

Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

2009-01-01

Problem statement Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers. PMID:19513180

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

PubMed

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

Nonimaging light concentrator with uniform irradiance

DOEpatents

Winston, Roland; Gee, Randy C.

2003-04-01

A nonimaging light concentrator system including a primary collector of light, an optical mixer disposed near the focal zone for collecting light from the primary collector, the optical mixer having a transparent entrance aperture, an internally reflective housing for substantially total internal reflection of light, a transparent exit aperture and an array of photovoltaic cells disposed near the transparent exit aperture.

Annual Forest Inventories for the North Central Region of the United States

Treesearch

Ronald E. McRoberts; Mark H. Hansen

1999-01-01

The primary objective in developing procedures for annual forest inventories for the north central region of the United States is to establish the capability of producing standard forest inventory and analysis estimates on an annual basis. The inventory system developed to accomplish this objective features several primary functions, including (1) an annual sample of...

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population

USDA-ARS?s Scientific Manuscript database

There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demo...

Societal Changes Affecting Primary School Education after the Second World War in Finland

ERIC Educational Resources Information Center

Paksuniemi, Merja; Niemisalo, Sari

2016-01-01

To demonstrate how changes in both foreign and domestic environments after the Second World War affected primary education and teacher training in Finland, the article presents a historical picture of the post-war reality of the school system, based on a review of sources that include laws, decrees, curricula, textbooks and previous research. The…

Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Symptoms, Tests, Prognosis, Stages (PDQ®)—Patient Version

Cancer.gov

Ovarian epithelial, fallopian tube, and primary peritoneal cancers form in the same type of tissue and use the same staging system. Risk factors include family history and inherited gene mutations. Learn more about why ovarian cancers are often found at advanced stages and the tests to diagnose and stage the cancer.

Primary Education in Pakistan. Part IV. Annexes to the Analysis.

ERIC Educational Resources Information Center

Development Associates, Inc., Arlington, VA.

The fourth part of a four-part analysis and assessment of Pakistan's system of primary education presents annexes to the analysis that was reported in the second part of the overall report. Five annexes are included: (A) Acronyms; (B) Scope of Work; (C) Persons Interviewed; (D) Chapter Annexes; and (E) Bibliography. A number of charts and diagrams…

The Odd Man Out: How Fathers Navigate the Special Education System

ERIC Educational Resources Information Center

Mueller, Tracy Gershwin; Buckley, Pamela C.

2014-01-01

Research about parent experiences with the special education system is largely dominated by the perspectives of mothers. Using purposeful sampling techniques, we interviewed 20 active fathers about their experiences navigating the special education system. All the fathers described three primary roles they experienced, including acting as a…

Social validity of the Social Skills Improvement System-Classwide Intervention Program (SSIS-CIP) in the primary grades.

PubMed

Wollersheim Shervey, Sarah; Sandilos, Lia E; DiPerna, James C; Lei, Pui-Wa

2017-09-01

The purpose of this study was to examine the social validity of the Social Skills Improvement System-Classwide Intervention Program (SSIS-CIP) for teachers in the primary grades. Participants included 45 first and second grade teachers who completed a 16-item social validity questionnaire during each year of the SSIS-CIP efficacy trial. Findings indicated that teachers generally perceived the SSIS-CIP as a socially valid and feasible intervention for primary grades; however, teachers' ratings regarding ease of implementation and relevance and sequence demonstrated differences across grade levels in the second year of implementation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines.

PubMed

Laue, Johanna; Reierth, Eirik; Melbye, Hasse

2015-02-19

Not all patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) benefit from treatment with systemic corticosteroids and antibiotics. The aim of the study was to identify criteria recommended in current COPD guidelines for treating acute exacerbations with systemic corticosteroids and antibiotics and to assess the underlying evidence. Current COPD guidelines were identified by a systematic literature search. The most recent guidelines as per country/organisation containing recommendations about treating acute exacerbations of COPD were included. Guideline development and criteria for treating acute exacerbations with systemic corticosteroids and antibiotics were appraised. Randomised controlled trials directly referred to in context with the recommendations were evaluated in terms of study design, setting, and study population. A total of 19 COPD guidelines were included. Systemic corticosteroids were often universally recommended to all patients with acute exacerbations. Criteria for treatment with antibiotics were mainly an increase in respiratory symptoms. Objective diagnostic tests or clinical examination were only rarely recommended. Only few criteria were directly linked to underlying evidence, and the trial patients represented a highly specific group of COPD patients. Current COPD guidelines are of little help in primary care to identify patients with acute exacerbations probably benefitting from treatment with systemic corticosteroids and antibiotics in primary care, and might contribute to overuse or inappropriate use of either treatment.

The Effect of VPA on Increasing Radiosensitivity in Osteosarcoma Cells and Primary-Culture Cells from Chemical Carcinogen-Induced Breast Cancer in Rats.

PubMed

Liu, Guochao; Wang, Hui; Zhang, Fengmei; Tian, Youjia; Tian, Zhujun; Cai, Zuchao; Lim, David; Feng, Zhihui

2017-05-10

This study explored whether valproic acid (VPA, a histone deacetylase inhibitor) could radiosensitize osteosarcoma and primary-culture tumor cells, and determined the mechanism of VPA-induced radiosensitization. The working system included osteosarcoma cells (U2OS) and primary-culture cells from chemical carcinogen (DMBA)-induced breast cancer in rats; and clonogenic survival, immunofluorescence, fluorescent in situ hybridization (FISH) for chromosome aberrations, and comet assays were used in this study. It was found that VPA at the safe or critical safe concentration of 0.5 or 1.0 mM VPA could result in the accumulation of more ionizing radiation (IR)-induced DNA double strand breaks, and increase the cell radiosensitivity. VPA-induced radiosensitivity was associated with the inhibition of DNA repair activity in the working systems. In addition, the chromosome aberrations including chromosome breaks, chromatid breaks, and radial structures significantly increased after the combination treatment of VPA and IR. Importantly, the results obtained by primary-culture cells from the tissue of chemical carcinogen-induced breast cancer in rats further confirmed our findings. The data in this study demonstrated that VPA at a safe dose was a radiosensitizer for osteosarcoma and primary-culture tumor cells through suppressing DNA-double strand breaks repair function.

The Effect of VPA on Increasing Radiosensitivity in Osteosarcoma Cells and Primary-Culture Cells from Chemical Carcinogen-Induced Breast Cancer in Rats

PubMed Central

Liu, Guochao; Wang, Hui; Zhang, Fengmei; Tian, Youjia; Tian, Zhujun; Cai, Zuchao; Lim, David; Feng, Zhihui

2017-01-01

This study explored whether valproic acid (VPA, a histone deacetylase inhibitor) could radiosensitize osteosarcoma and primary-culture tumor cells, and determined the mechanism of VPA-induced radiosensitization. The working system included osteosarcoma cells (U2OS) and primary-culture cells from chemical carcinogen (DMBA)-induced breast cancer in rats; and clonogenic survival, immunofluorescence, fluorescent in situ hybridization (FISH) for chromosome aberrations, and comet assays were used in this study. It was found that VPA at the safe or critical safe concentration of 0.5 or 1.0 mM VPA could result in the accumulation of more ionizing radiation (IR)-induced DNA double strand breaks, and increase the cell radiosensitivity. VPA-induced radiosensitivity was associated with the inhibition of DNA repair activity in the working systems. In addition, the chromosome aberrations including chromosome breaks, chromatid breaks, and radial structures significantly increased after the combination treatment of VPA and IR. Importantly, the results obtained by primary-culture cells from the tissue of chemical carcinogen-induced breast cancer in rats further confirmed our findings. The data in this study demonstrated that VPA at a safe dose was a radiosensitizer for osteosarcoma and primary-culture tumor cells through suppressing DNA-double strand breaks repair function. PMID:28489060

40 CFR 141.711 - Filtered system additional Cryptosporidium treatment requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced...(including softening) Direct filtration Slow sand or diatomaceous earth filtration Alternative filtration... survey or an equivalent source water assessment that after a system completed the monitoring conducted...

40 CFR 141.711 - Filtered system additional Cryptosporidium treatment requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced...(including softening) Direct filtration Slow sand or diatomaceous earth filtration Alternative filtration... survey or an equivalent source water assessment that after a system completed the monitoring conducted...

40 CFR 141.711 - Filtered system additional Cryptosporidium treatment requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced...(including softening) Direct filtration Slow sand or diatomaceous earth filtration Alternative filtration... survey or an equivalent source water assessment that after a system completed the monitoring conducted...

[Diagnostic values of bronchoscopy and multi-slice spiral CT for congenital dysplasia of the respiratory system in infants: a comparative study].

PubMed

Wang, Xing-Lu; Huang, Ying; Li, Qu-Bei; Dai, Ji-Hong

2013-09-01

To investigate and compare the diagnostic values of bronchoscopy and multi-slice spiral computed tomography (CT) for congenital dysplasia of the respiratory system in infants. Analysis was performed on the clinical data, bronchoscopic findings and multi-slice spiral CT findings of 319 infants (≤1 years old) who underwent bronchoscopy and/or multi-slice spiral CT and were diagnosed with congenital dysplasia of the respiratory system. A total of 476 cases of congenital dysplasia of the respiratory system were found in the 319 infants, including primary dysplasia of the respiratory system (392 cases) and compressive dysplasia of the respiratory system (84 cases). Of the 392 cases of primary dysplasia of the respiratory system, 225 (57.4%) were diagnosed by bronchoscopy versus 167 (42.6%) by multi-slice spiral CT. There were significant differences in etiological diagnosis between bronchoscopy and multi-slice spiral CT in infants with congenital dysplasia of the respiratory system (P<0.05). All 76 cases of primary dysplasia of the respiratory system caused by tracheobronchomalacia were diagnosed by bronchoscopy and all 17 cases of primary dysplasia of the respiratory system caused by lung tissue dysplasia were diagnosed by multi-slice spiral CT. Of the 84 cases of compressive dysplasia of the respiratory system, 74 cases were diagnosed by multi-slice spiral CT and only 10 cases were diagnosed by bronchoscopy. Compared with multi-slice spiral CT, bronchoscopy can detect primary dysplasia of the respiratory system more directly. Bronchoscopy is valuable in the confirmed diagnosis of tracheobronchomalacia. Multi-slice spiral CT has a higher diagnostic value for lung tissue dysplasia than bronchoscopy.

Accelerator system and method of accelerating particles

NASA Technical Reports Server (NTRS)

Wirz, Richard E. (Inventor)

2010-01-01

An accelerator system and method that utilize dust as the primary mass flux for generating thrust are provided. The accelerator system can include an accelerator capable of operating in a self-neutralizing mode and having a discharge chamber and at least one ionizer capable of charging dust particles. The system can also include a dust particle feeder that is capable of introducing the dust particles into the accelerator. By applying a pulsed positive and negative charge voltage to the accelerator, the charged dust particles can be accelerated thereby generating thrust and neutralizing the accelerator system.

Conceptual designs study for a Personnel Launch System (PLS)

NASA Technical Reports Server (NTRS)

Wetzel, E. D.

1990-01-01

A series of conceptual designs for a manned, Earth to Low Earth Orbit transportation system was developed. Non-winged, low L/D vehicle shapes are discussed. System and subsystem trades emphasized safety, operability, and affordability using near-term technology. The resultant conceptual design includes lessons learned from commercial aviation that result in a safe, routine, operationally efficient system. The primary mission for this Personnel Launch System (PLS) would be crew rotation to the SSF; other missions, including satellite servicing, orbital sortie, and space rescue were also explored.

Development of a filter regeneration system for advanced spacecraft fluid systems

NASA Technical Reports Server (NTRS)

Behrend, A. F., Jr.; Descamp, V. A.

1974-01-01

The development of a filter regeneration system for efficiently cleaning fluid particulate filters is presented. Based on a backflush/jet impingement technique, the regeneration system demonstrated a cleaning efficiency of 98.7 to 100%. The operating principles and design features are discussed with emphasis on the primary system components that include a regenerable filter, vortex particle separator, and zero-g particle trap. Techniques and equipment used for ground and zero-g performance tests are described. Test results and conclusions, as well as possible areas for commercial application, are included.

Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

PubMed

Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

2014-01-01

Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

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

PubMed

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

2014-11-01

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

Health System Features That Enhance Access to Comprehensive Primary Care for Women Living with HIV in High-Income Settings: A Systematic Mixed Studies Review.

PubMed

O'Brien, Nadia; Hong, Quan Nha; Law, Susan; Massoud, Sarah; Carter, Allison; Kaida, Angela; Loutfy, Mona; Cox, Joseph; Andersson, Neil; de Pokomandy, Alexandra

2018-04-01

Women living with HIV in high-income settings continue to experience modifiable barriers to care. We sought to determine the features of care that facilitate access to comprehensive primary care, inclusive of HIV, comorbidity, and sexual and reproductive healthcare. Using a systematic mixed studies review design, we reviewed qualitative, mixed methods, and quantitative studies identified in Ovid MEDLINE, EMBASE, and CINAHL databases (January 2000 to August 2017). Eligibility criteria included women living with HIV; high-income countries; primary care; and healthcare accessibility. We performed a thematic synthesis using NVivo. After screening 3466 records, we retained 44 articles and identified 13 themes. Drawing on a social-ecological framework on engagement in HIV care, we situated the themes across three levels of the healthcare system: care providers, clinical care environments, and social and institutional factors. At the care provider level, features enhancing access to comprehensive primary care included positive patient-provider relationships and availability of peer support, case managers, and/or nurse navigators. Within clinical care environments, facilitators to care were appointment reminder systems, nonidentifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, comorbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education, and dispelling HIV-related stigma. This review highlights several features of care that are particularly relevant to the care-seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.

Incidence of revision after primary implantation of the Agility™ total ankle replacement system: a systematic review.

PubMed

Roukis, Thomas S

2012-01-01

Revision of failed total ankle replacement remains a challenge with limited information available to guide treatment options. I undertook a systematic review of electronic databases and other relevant sources to identify material relating to the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved patients undergoing primary Agility™ Total Ankle Replacement; had evaluated patients at a mean follow-up of 12 months or longer; included details of the revision performed; and included revision etiologies of aseptic loosening, ballooning osteolysis, cystic changes, malalignment, or instability. A total of 14 studies involving 2312 ankles, with a weighted mean follow-up of 22.8 months, were included. Of the 2312 ankles, 224 (9.7%) underwent revision, of which 182 (81.3%) underwent implant component replacement, 34 (15.2%) underwent arthrodesis, and 8 (3.6%) underwent below-knee amputation. No significant effect from the surgeon's learning curve on the incidence of revision or the type of revision surgery performed was identified. However, excluding the inventor increased the incidence of revision twofold, from 6.6% to 12.2%, and skewed the type of revision away from arthrodesis and toward implant component replacement or below-knee amputation. Regardless, the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System was less than historically reported and amenable to implant component revision more than 80% of the time. However, methodologically sound cohort studies are needed that include the outcomes after revision surgery, specifically focusing on what implant component replacement techniques are effective in enhancing survivorship of these revised implants and the role of custom-stemmed talar and tibial components have in revision of the Agility™ Total Ankle Replacement System. A direct comparison of the incidence of revision between the various contemporary total ankle replacement systems in common use is also warranted. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Development of a category 2 approach system model

NASA Technical Reports Server (NTRS)

Johnson, W. A.; Mcruer, D. T.

1972-01-01

An analytical model is presented which provides, as its primary output, the probability of a successful Category II approach. Typical applications are included using several example systems (manual and automatic) which are subjected to random gusts and deterministic wind shear. The primary purpose of the approach system model is to establish a structure containing the system elements, command inputs, disturbances, and their interactions in an analytical framework so that the relative effects of changes in the various system elements on precision of control and available margins of safety can be estimated. The model is intended to provide insight for the design and integration of suitable autopilot, display, and navigation elements; and to assess the interaction of such elements with the pilot/copilot.

Paraneoplastic syndromes related to lung cancer.

PubMed

McClelland, Mary T

2010-06-01

Paraneoplastic syndromes (PNSs) are defined as signs or symptoms that occur as a result of organ or tissue damage at locations that are remote from the primary tumor site or metastases. Many cancers are associated with PNSs; however, small cell lung cancer (SCLC) is the most prevalent. In SCLC, the systems primarily affected by PNSs include the endocrine system, the neurologic system, and the integumental system. This article provides an overview of primary disorders and classical syndromes, as well as symptom management associated with each system. PNSs are rare, and the best approach is to treat the underlying tumor. Therefore, oncology nurses and other healthcare practitioners should be familiar with PNSs so that they can take prompt and proper courses of action, potentially leading to positive outcomes for patients.

Describing the primary care system capacity for the prevention and management of non-communicable diseases in rural Vietnam.

PubMed

Van Minh, Hoang; Do, Young Kyung; Bautista, Mary Ann Cruz; Tuan Anh, Tran

2014-01-01

The primary care system in Vietnam has been shown to play a crucial role in disease prevention and health promotion. This study described the primary care system in a selected rural area in Vietnam in terms of its capacity for prevention and control of non-communicable diseases (NCDs). The study was conducted in 2011 in Dong Hy district, Thai Nguyen province-a rural community located in northern Vietnam. Mixed methods were used, including quantitative and qualitative and literature review approaches, to collect data on the current status of the six building blocks of the primary care system in Dong Hy district. Selected health workers and stakeholders in the selected healthcare facilities were surveyed. A description of Dong Hy district's primary care capacity for NCD prevention and control is reported. (i) Service delivery: The current practice in NCD prevention and treatment is mainly based on a single risk factor rather than a combination of cardiovascular disease risks. (ii) Governance: At the primary care level, multi-sectoral collaborations are limited, and there is insufficient integration of NCD preventive activities. (iii) Financing: A national budget for NCD prevention and control is lacking. The cost of treatment and medicines is high, whereas the health insurance scheme limits the list of available medicines and the reimbursement ceiling level. Health workers have low remuneration despite their important roles in NCD prevention. (iv) Human resources: The quantity and quality of health staff working at the primary care level, especially those in preventive medicine, are insufficient. (v) Information and research: The health information system in the district is weak, and there is no specific information system for collecting population-based NCD data. (vi) Medical products and technology: Not all essential equipment and medicines recommended by the WHO are always available at the commune health centre. The capacity of the primary care system in Vietnam is still inadequate to serve the NCD-related health needs of the population. There is an urgent need to improve the primary care capacity for NCD prevention and management in Vietnam. Copyright © 2013 John Wiley & Sons, Ltd.

23 CFR 657.13 - Certification requirement.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Geographic Information Systems (GIS) as an Evaluation Tool.

ERIC Educational Resources Information Center

Renger, Ralph; Cimetta, Adriana; Pettygrove, Sydney; Rogan, Seumas

2002-01-01

Describes how Geographic Information Systems (GIS) can be used to help evaluators convey complex information simply through a spatial representation. Demonstrates how GIS can be used to plot change over time, including impact and outcome data gathered by primary data collection. (SLD)

Consensus statement on essential patient characteristics in systemic treatment trials for metastatic colorectal cancer: Supported by the ARCAD Group.

PubMed

Goey, Kaitlyn K H; Sørbye, Halfdan; Glimelius, Bengt; Adams, Richard A; André, Thierry; Arnold, Dirk; Berlin, Jordan D; Bodoky, György; de Gramont, Aimery; Díaz-Rubio, Eduardo; Eng, Cathy; Falcone, Alfredo; Grothey, Axel; Heinemann, Volker; Hochster, Howard S; Kaplan, Richard S; Kopetz, Scott; Labianca, Roberto; Lieu, Christopher H; Meropol, Neal J; Price, Timothy J; Schilsky, Richard L; Schmoll, Hans-Joachim; Shacham-Shmueli, Einat; Shi, Qian; Sobrero, Alberto F; Souglakos, John; Van Cutsem, Eric; Zalcberg, John; van Oijen, Martijn G H; Punt, Cornelis J A; Koopman, Miriam

2018-06-21

Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous metastases, (K)RAS and BRAF mutation status, microsatellite instability/mismatch repair status and number of prior treatment lines. A total of five patient characteristics were considered the most relevant stratification factors: RAS/BRAF mutation status, performance status, primary tumour sidedness and liver-only disease. This survey provides a minimum set of essential baseline patient characteristics and stratification factors to include in phase 3 trials of systemic treatment of mCRC. Inclusion of these patient characteristics and strata in study protocols and final study reports will improve interpretation of trial results and facilitate cross-study comparisons. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Carnegie Mellon/Sirsi Corporation Alliance.

ERIC Educational Resources Information Center

Troll, Denise A.; Depellegrin, Tracey A.; Myers, Melanie D.

1999-01-01

Describes the relationship between Carnegie Mellon University libraries and Sirsi Corporation, their integrated library-management system vendor. Topics include Carnegie Mellon's expertise in library automation research and development; and three primary elements of the alliance: research, including user protocols, surveys, and focus groups;…

Wind Evaluation Breadboard electronics and software

NASA Astrophysics Data System (ADS)

Núñez, Miguel; Reyes, Marcos; Viera, Teodora; Zuluaga, Pablo

2008-07-01

WEB, the Wind Evaluation Breadboard, is an Extremely Large Telescope Primary Mirror simulator, developed with the aim of quantifying the ability of a segmented primary mirror to cope with wind disturbances. This instrument supported by the European Community (Framework Programme 6, ELT Design Study), is developed by ESO, IAC, MEDIA-ALTRAN, JUPASA and FOGALE. The WEB is a bench of about 20 tons and 7 meter diameter emulating a segmented primary mirror and its cell, with 7 hexagonal segments simulators, including electromechanical support systems. In this paper we present the WEB central control electronics and the software development which has to interface with: position actuators, auxiliary slave actuators, edge sensors, azimuth ring, elevation actuator, meteorological station and air balloons enclosure. The set of subsystems to control is a reduced version of a real telescope segmented primary mirror control system with high real time performance but emphasizing on development time efficiency and flexibility, because WEB is a test bench. The paper includes a detailed description of hardware and software, paying special attention to real time performance. The Hardware is composed of three computers and the Software architecture has been divided in three intercommunicated applications and they have been implemented using Labview over Windows XP and Pharlap ETS real time operating system. The edge sensors and position actuators close loop has a sampling and commanding frequency of 1KHz.

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

ERIC Educational Resources Information Center

Oxford, Rebecca L.

2015-01-01

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

Education for All Meets Political Democratization: Free Primary Education and the Neoliberalization of the Malawian School and State

ERIC Educational Resources Information Center

Kendall, Nancy

2007-01-01

In recent years sub-Saharan African states, including Malawi, have adopted the Education for All (EFA) goal of universal, fee-free primary education (UPE). The EFA process is often linked to the expansion and sustainability of universal rights, democratic processes, and political systems. The EFA policies have also been tied, discursively and in…

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.

Global Control of GacA in Secondary Metabolism, Primary Metabolism, Secretion Systems, and Motility in the Rhizobacterium Pseudomonas aeruginosa M18

PubMed Central

Wei, Xue; Tang, Lulu; Wu, Daqiang

2013-01-01

The rhizobacterium Pseudomonas aeruginosa M18 can produce a broad spectrum of secondary metabolites, including the antibiotics pyoluteorin (Plt) and phenazine-1-carboxylic acid (PCA), hydrogen cyanide, and the siderophores pyoverdine and pyochelin. The antibiotic biosynthesis of M18 is coordinately controlled by multiple distinct regulatory pathways, of which the GacS/GacA system activates Plt biosynthesis but strongly downregulates PCA biosynthesis. Here, we investigated the global influence of a gacA mutation on the M18 transcriptome and related metabolic and physiological processes. Transcriptome profiling revealed that the transcript levels of 839 genes, which account for approximately 15% of the annotated genes in the M18 genome, were significantly influenced by the gacA mutation during the early stationary growth phase of M18. Most secondary metabolic gene clusters, such as pvd, pch, plt, amb, and hcn, were activated by GacA. The GacA regulon also included genes encoding extracellular enzymes and cytochrome oxidases. Interestingly, the primary metabolism involved in the assimilation and metabolism of phosphorus, sulfur, and nitrogen sources was also notably regulated by GacA. Another important category of the GacA regulon was secretion systems, including H1, H2, and H3 (type VI secretion systems [T6SSs]), Hxc (T2SS), and Has and Apr (T1SSs), and CupE and Tad pili. More remarkably, GacA inhibited swimming, swarming, and twitching motilities. Taken together, the Gac-initiated global regulation, which was mostly mediated through multiple regulatory systems or factors, was mainly involved in secondary and primary metabolism, secretion systems, motility, etc., contributing to ecological or nutritional competence, ion homeostasis, and biocontrol in M18. PMID:23708134

Visible Parts, Invisible Whole: Swedish Technology Student Teachers' Conceptions about Technological Systems

ERIC Educational Resources Information Center

Hallström, Jonas; Klasander, Claes

2017-01-01

Technological systems are included as a component of national technology curricula and standards for primary and secondary education as well as corresponding teacher education around the world. Little is known, however, of how pupils, students, and teachers conceive of technological systems. In this article we report on a study investigating…

An Integrated Design and Development System for Graphics Simulation.

ERIC Educational Resources Information Center

Richardson, J. Jeffrey

In the training of maintenance and operations technicians, three enhancements to a basic, straightforward, fixed-sequence simulation system can be useful. The primary advantage of the resultant system is that the principal object of simulation is the task to be performed, which includes both the planning knowledge and the equipment actions…

A Case of the Cauda Equina Syndrome Associated With the Intrathecal Chemotherapy in a Patient With Primary Central Nervous System Lymphoma

PubMed Central

Park, Seunglee; Kang, Jung-Il; Bang, Hyun; Kim, Bo-Ram

2013-01-01

The intrathecal chemotherapy with methotrexate and cytarabine arabinoside is used for the treatment and prophylaxis of the primary central nervous system lymphoma. The therapy may induce neurotoxicity including the cauda equina syndrome. We report a case of a 58-year-old man with the diffuse large B-cell lymphoma, who developed the cauda equina syndrome after the administration of intrathecal methotrexate and cytarabine arabinoside, as diagnosed by the electrodiagnostic, urodynamic, and radiologic approaches. PMID:23869341

The analysis of the statistical and historical information gathered during the development of the Shuttle Orbiter Primary Flight Software

NASA Technical Reports Server (NTRS)

Simmons, D. B.; Marchbanks, M. P., Jr.; Quick, M. J.

1982-01-01

The results of an effort to thoroughly and objectively analyze the statistical and historical information gathered during the development of the Shuttle Orbiter Primary Flight Software are given. The particular areas of interest include cost of the software, reliability of the software, requirements for the software and how the requirements changed during development of the system. Data related to the current version of the software system produced some interesting results. Suggestions are made for the saving of additional data which will allow additional investigation.

Reforming the reform: the Greek National Health System in transition.

PubMed

Tountas, Yannis; Karnaki, Panagiota; Pavi, Elpida

2002-10-01

The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.

Auger electron spectroscopy at high spatial resolution and nA primary beam currents

NASA Technical Reports Server (NTRS)

Todd, G.; Poppa, H.; Moorhead, D.; Bales, M.

1975-01-01

An experimental Auger microprobe system is described which incorporates a field-emission electron gun and total beam currents in the nanoampere range. The distinguishing characteristics of this system include a large multistation UHV specimen chamber, pulse counting and fully digital Auger signal-processing techniques, and digital referencing methods to eliminate the effects of beam instabilities. Some preliminary results obtained with this system are described, and it is concluded that field-emission electron sources can be used for high-resolution Auger electron spectroscopy with primary-beam spots of less than 100 nm and beam currents of the order of 1 nA.

Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study

PubMed Central

Litchfield, Ian; Fitzmaurice, David; Apenteng, Patricia; Harrison, Sian; Heneghan, Carl; Ward, Alison; Greenfield, Sheila

2016-01-01

Background Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. Aim To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. Design and setting Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. Method Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. Results A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. Conclusion The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. PMID:27266864

Up-front systemic chemotherapy is a feasible option compared to primary tumor resection followed by chemotherapy for colorectal cancer with unresectable synchronous metastases.

PubMed

Niitsu, Hiroaki; Hinoi, Takao; Shimomura, Manabu; Egi, Hiroyuki; Hattori, Minoru; Ishizaki, Yasuyo; Adachi, Tomohiro; Saito, Yasufumi; Miguchi, Masashi; Sawada, Hiroyuki; Kochi, Masatoshi; Mukai, Shoichiro; Ohdan, Hideki

2015-04-24

In stage IV colorectal cancer (CRC) with unresectable metastases, whether or not resection of the primary tumor should be indicated remains controversial. We aim to determine the impact of primary tumor resection on the survival of stage IV CRC patients with unresectable metastases. We retrospectively investigated 103 CRC patients with stage IV colorectal cancer with metastases, treated at Hiroshima University Hospital between 2007 and 2013. Of these, those who had resectable primary tumor but unresectable metastases and received any chemotherapy were included in the study. We analyzed the overall survival (OS) and short-term outcomes between the patients who received up-front systemic chemotherapy (USC group) and those who received primary tumor resection followed by chemotherapy (PTR group). Of the 57 included patients, 15 underwent USC and 42 PTR. The median survival times were 13.4 and 23.9 months in the USC and PTR groups, respectively (P = 0.093), but multivariate analysis for the overall survival showed no significant difference between the two groups (hazard ratio, 1.30; 95% confidence interval (CI), 0.60 to 2.73, P = 0.495). In the USC group, the disease control rate of primary tumor was observed in 12 patients (80.0%), but emergency laparotomy was required for 1 patient. Morbidity in the PTR group was observed in 18 cases (42.9%). The overall survival did not differ significantly between the USC and PTR groups. USC may help avoid unnecessary resection and consequently the high morbidity rate associated with primary tumor resection for stage IV CRC with unresectable metastases.

Sorbent-Based Atmosphere Revitalization System

NASA Technical Reports Server (NTRS)

Knox, James C (Inventor); Miller, Lee A. (Inventor)

2017-01-01

The present invention is a sorbent-based atmosphere revitalization (SBAR) system using treatment beds each having a bed housing, primary and secondary moisture adsorbent layers, and a primary carbon dioxide adsorbent layer. Each bed includes a redirecting plenum between moisture adsorbent layers, inlet and outlet ports connected to inlet and outlet valves, respectively, and bypass ports connected to the redirecting plenums. The SBAR system also includes at least one bypass valve connected to the bypass ports. An inlet channel connects inlet valves to an atmosphere source. An outlet channel connects the bypass valve and outlet valves to the atmosphere source. A vacuum channel connects inlet valves, the bypass valve and outlet valves to a vacuum source. In use, one bed treats air from the atmosphere source while another bed undergoes regeneration. During regeneration, the inlet, bypass, and outlet valves sequentially open to the vacuum source, removing accumulated moisture and carbon dioxide.

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

PubMed

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

2018-02-28

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

The experience of dentists who gained enhanced skills in endodontics within a novel pilot training programme.

PubMed

Eliyas, S; Briggs, P; Gallagher, J E

2017-02-24

Objective To explore the experiences of primary care dentists following training to enhance endodontic skills and their views on the implications for the NHS.Design Qualitative study using anonymised free text questionnaires.Setting Primary care general dental services within the National Health Service (NHS) in London, United Kingdom.Subjects and methods Eight primary care dentists who completed this training were asked about factors affecting participant experience of the course, perceived impact on themselves, their organisation, their patients and barriers/facilitators to providing endodontic treatment in NHS primary care. Data were transferred verbatim to a spreadsheet and thematically analysed.Intervention 24-month part-time educational and service initiative to provide endodontics within the NHS, using a combination of training in simulation lab and treatment of patients in primary care.Results Positive impacts were identified at individual (gains in knowledge, skills, confidence, personal development), patient (more teeth saved, quality of care improved) and system levels (access, value for money). Suggested developments for future courses included more case discussions, teaching of practical skills earlier in the course and refinement of the triaging processes. Barriers to using the acquired skills in providing endodontic treatment in primary care within the NHS were perceived to be resources (remuneration, time, skills) and accountability. Facilitators included appropriately remunerated contracts, necessary equipment and time.Conclusion This novel pilot training programme in endodontics combining general practice experience with education/training, hands-on experience and a portfolio was perceived by participants as beneficial for extending skills and service innovation in primary dental care. The findings provide insight into primary dental care practitioners' experience with education/training and have implications for future educational initiatives in support of systems innovation within the NHS.

Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics.

PubMed

Gómez Roselló, E; Quiles Granado, A M; Laguillo Sala, G; Pedraza Gutiérrez, S

2018-02-23

Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Orbiter escape pole

NASA Technical Reports Server (NTRS)

Goodrich, Winston D. (Inventor); Wesselski, Clarence J. (Inventor); Pelischek, Timothy E. (Inventor); Becker, Bruce H. (Inventor); Kahn, Jon B. (Inventor); Grimaldi, Margaret E. (Inventor); McManamen, John P. (Inventor); Castro, Edgar O. (Inventor)

1989-01-01

A Shuttle type of aircraft (10) with an escape hatch (12) has an arcuately shaped pole housing (16) attachable to an interior wall and ceiling with its open end adjacent to the escape hatch. The pole housing 16 contains a telescopically arranged and arcuately shaped primary pole member (22) and extension pole member (23) which are guided by roller assemblies (30,35). The extension pole member (23) is slidable and extendable relative to the primary pole member (22). For actuation, a spring actuated system includes a spring (52) in the pole housing. A locking member (90) engages both pole members (22,23) through notch portions (85,86) in the pole members. The locking member selectively releases the extension pole member (23) and the primary pole member (22). An internal one-way clutch or anti-return mechanism prevents retraction of the extension pole member from an extended position. Shock absorbers (54)(150,152) are for absoring the energy of the springs. A manual backup deployment system is provided which includes a canted ring (104) biased by a spring member (108). A lever member (100) with a slot and pin connection (102) permits the mechanical manipulation of the canted ring to move the primary pole member. The ring (104) also prevents retraction of the main pole. The crew escape mechanism includes a magazine (60) and a number of lanyards (62), each lanyard being mounted by a roller loop (68) over the primary pole member (22). The strap on the roller loop has stitching for controlled release, a protection sheath (74) to prevent tangling and a hook member (69) for attachment to a crew harness.

Auxiliary power unit for moving a vehicle

DOEpatents

Akasam, Sivaprasad [Peoria, IL; Johnson, Kris W [Peoria, IL; Johnson, Matthew D [Peoria, IL; Slone, Larry M [Washington, IL; Welter, James Milton [Chillicothe, IL

2009-02-03

A power system is provided having at least one traction device and a primary power source configured to power the at least one traction device. In addition, the power system includes an auxiliary power source also configured to power the at least one traction device.

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

Estimates of power requirements for a Manned Mars Rover powered by a nuclear reactor

NASA Technical Reports Server (NTRS)

Morley, Nicholas J.; El-Genk, Mohamed S.; Cataldo, Robert; Bloomfield, Harvey

1991-01-01

This paper assesses the power requirement for a Manned Mars Rover vehicle. Auxiliary power needs are fulfilled using a hybrid solar photovoltaic/regenerative fuel cell system, while the primary power needs are meet using an SP-100 type reactor. The primary electric power needs, which include 30-kW(e) net user power, depend on the reactor thermal power and the efficiency of the power conversion system. Results show that an SP-100 type reactor coupled to a Free Piston Stirling Engine yields the lowest total vehicle mass and lowest specific mass for the power system. The second lowest mass was for a SP-100 reactor coupled to a Closed Brayton Cycle using He/Xe as the working fluid. The specific mass of the nuclear reactor power system, including a man-rated radiation shield, ranged from 150-kg/kW(e) to 190-kg/KW(e) and the total mass of the Rover vehicle varied depend upon the cruising speed.

Management of colorectal trauma: a review.

PubMed

Cheong, Ju Yong; Keshava, Anil

2017-07-01

Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed. Primary repair is now the preferred surgical option. Patients who have been identified as having destructive injuries have been found to have higher anastomotic leak rates after a primary repair. Damage control principles need to be adhered to in surgical decision-making. In this review, we discuss the mechanisms of injury, classifications, clinical presentation and current recommendations for the management of colorectal trauma. © 2017 Royal Australasian College of Surgeons.

Diagnosis abnormalities of limb movement in disorders of the nervous system

NASA Astrophysics Data System (ADS)

Tymchik, Gregory S.; Skytsiouk, Volodymyr I.; Klotchko, Tatiana R.; Bezsmertna, Halyna; Wójcik, Waldemar; Luganskaya, Saule; Orazbekov, Zhassulan; Iskakova, Aigul

2017-08-01

The paper deals with important issues of diagnosis early signs of diseases of the nervous system, including Parkinson's disease and other specific diseases. Small quantities of violation trajectory of spatial movement of the extremities of human disease at the primary level as the most appropriate features are studied. In modern medical practice is very actual the control the emergence of diseases of the nervous system, including Parkinson's disease. In work a model limbs with six rotational kinematic pairs for diagnosis of early signs of diseases of the nervous system is considered. subject.

Spread-spectrum multiple access using wideband noncoherent MFSK

NASA Technical Reports Server (NTRS)

Ha, Tri T.; Pratt, Timothy; Maggenti, Mark A.

1987-01-01

Two spread-spectrum multiple access systems which use wideband M-ary frequency shift keying (FSK) (MFSK) as the primary modulation are presented. A bit error rate performance analysis is presented and system throughput is calculated for sample C band and Ku band satellite systems. Sample link analyses are included to illustrate power and adjacent satellite interference considerations in practical multiple access systems.

Experiences From Creating the Guide to the Systems Engineering Body of Knowledge (SEBoK) v. 1.0

DTIC Science & Technology

2013-03-01

00-00-2013 to 00-00-2013 4. TITLE AND SUBTITLE Experiences From Creating the Guide to the Systems Engineering Body of Knowledge (SEBoK) v. 1.0 5a...external sources, was not easy to achieve. SE Literature: The most comprehensive source of SE knowledge today is the Systems Engineering Handbook [3...recommended for further reading - SEBoK v. 1.0 includes 224 primary references; and (3) Additional references include other related literature that are good

The Development and Performance of After-Hours Primary Care in the Netherlands: A Narrative Review.

PubMed

Smits, Marleen; Rutten, Martijn; Keizer, Ellen; Wensing, Michel; Westert, Gert; Giesen, Paul

2017-05-16

In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care physician (PCP) cooperatives. This article provides an overview of the organization, performance, and development of PCP cooperatives in the Netherlands. The Dutch after-hours primary care system might offer opportunities for other countries facing problems with after-hours care and inappropriate emergency department visits. During the past several years, the number of contacts with Dutch PCP cooperatives has increased to 245 contacts per 1000 citizens per year. Many contacts (45%) are nonurgent, and about half occur as part of a series of primary care contacts. Low accessibility and availability of daytime primary care are related to greater use of after-hours primary care. To prevent unnecessary attendance at the cooperatives, physicians advocate copayment, a stricter triage system, and a larger role for telephone doctors. More than half of the PCP cooperatives in the Netherlands have integrated with hospital emergency departments, forming "emergency care access points." This collaboration has decreased emergency department use by 13% to 22%, and treatment of self-referrals by PCP cooperatives in emergency care access points is safe and cost-effective. Direct access to diagnostic facilities may optimize efficiency even more. Other recent developments include access to electronic health records of daytime primary care practices, task substitution from physicians to nurses, and the launch of a 2-year training program for PCPs to become experts in emergency care.

A shared computer-based problem-oriented patient record for the primary care team.

PubMed

Linnarsson, R; Nordgren, K

1995-01-01

1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a primary care area with 30,000 inhabitants. It is being used by all the primary care team members: 15 general practitioners, 25 district nurses, and 10 physiotherapists. Several years of practical experience of the CPR system shows that it has a positive impact on quality of care on four levels: 1) improved clinical follow-up of individual patients; 2) facilitated follow-up of aggregated data such as practice activity analysis, annual reports, and clinical indicators; 3) automated medical audit; and 4) concurrent audit. Within that primary care area, quality of care has improved substantially in several aspects due to the use of the CPR system [1].

Pre-Visit Prioritization for complex patients with diabetes: Randomized trial design and implementation within an integrated health care system.

PubMed

Grant, Richard W; Uratsu, Connie S; Estacio, Karen R; Altschuler, Andrea; Kim, Eileen; Fireman, Bruce; Adams, Alyce S; Schmittdiel, Julie A; Heisler, Michele

2016-03-01

Despite robust evidence to guide clinical care, most patients with diabetes do not meet all goals of risk factor control. Improved patient-provider communication during time-limited primary care visits may represent one strategy for improving diabetes care. We designed a controlled, cluster-randomized, multi-site intervention (Pre-Visit Prioritization for Complex Patients with Diabetes) that enables patients with poorly controlled type 2 diabetes to identify their top priorities prior to a scheduled visit and sends these priorities to the primary care physician progress note in the electronic medical record. In this paper, we describe strategies to address challenges to implementing our health IT-based intervention study within a large health care system. This study is being conducted in 30 primary care practices within a large integrated care delivery system in Northern California. Over a 12-week period (3/1/2015-6/6/2015), 146 primary care physicians consented to enroll in the study (90.1%) and approved contact with 2496 of their patients (97.6%). Implementation challenges included: (1) navigating research vs. quality improvement requirements; (2) addressing informed consent considerations; and (3) introducing a new clinical tool into a highly time-constrained workflow. Strategies for successfully initiating this study included engagement with institutional leaders, Institutional Review Board members, and clinical stakeholders at multiple stages both before and after notice of Federal funding; flexibility by the research team in study design; and strong support from institutional leadership for "self-learning health system" research. By paying careful attention to identifying and collaborating with a wide range of key clinical stakeholders, we have shown that researchers embedded within a learning care system can successfully apply rigorous clinical trial methods to test new care innovations. Copyright © 2016 Elsevier Inc. All rights reserved.

Primary care models for treating opioid use disorders: What actually works? A systematic review

PubMed Central

Klasa, Katarzyna; Bush, Christopher; Heisler, Michele; Chopra, Vineet; Bohnert, Amy

2017-01-01

Background Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. Objective The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. Data sources PubMed, EMBASE, CINAHL, and PsychInfo. Methods We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. Results We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient “agreements,” and using home inductions to make treatment more convenient for patients and providers. Conclusions The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed. PMID:29040331

Sidechain biology and the immunogenicity of PDC-E2, the major autoantigen of primary biliary cirrhosis.

PubMed

Mao, Tin K; Davis, Paul A; Odin, Joseph A; Coppel, Ross L; Gershwin, M Eric

2004-12-01

The E2 component of mitochondrial pyruvate dehydrogenase complex (PDC-E2) is the immunodominant autoantigen of primary biliary cirrhosis. Whereas lipoylation of PDC-E2 is essential for enzymatic activity and predominates under normal conditions, other biochemical systems exist that also target the lysine residue, including acylation of fatty acids or xenobiotics and ubiquitinylation. More importantly, the immunogenicity can be affected by derivatization of the lysine residue, as the recognition of lipoylated PDC-E2 by patient autoantibodies is enhanced compared with octanoylated PDC-E2. Furthermore, our laboratory has shown that various xenobiotic modifications of a peptide representing the immunodominant region of PDC-E2 are immunoreactive against patient sera. The only purported regulatory system that prevents the accumulation of potentially autoreactive PDC-E2 is glutathionylation, in which the lysine-lipoic acid moiety is further modified with glutathione during apoptosis. Interestingly, this system is found in several cell lines, including HeLa, Jurkat, and Caco-2 cells, but not in cholangiocytes and salivary gland epithelial cells, both of which are targets for destruction in primary biliary cirrhosis. Hence, the failure of this or other regulatory system(s) may overwhelm the immune system with immunogenic PDC-E2 that can initiate the breakdown of tolerance in a genetically susceptible individual. In this review the authors survey the data available on the biochemical life of PDC-E2, with particular emphasis on the lysine residue and its known interactions with machinery involved in various posttranslational modifications.

Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.

PubMed

Kohrt, Brandon A; Jordans, Mark J D; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, Vikram

2018-01-01

Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, RE ducing S tigma among H ealthc A re P roviders to Improv E mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k  = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities ( n  = 150); indirect beneficiaries are their patients ( n  = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. ClinicalTrials.gov identifier, NCT02793271.

Primary Angiitis of the Central Nervous System: Magnetic Resonance Imaging Spectrum of Parenchymal, Meningeal, and Vascular Lesions at Baseline.

PubMed

Boulouis, Grégoire; de Boysson, Hubert; Zuber, Mathieu; Guillevin, Loïc; Meary, Eric; Costalat, Vincent; Pagnoux, Christian; Naggara, Olivier

2017-05-01

Primary angiitis of the central nervous system remains challenging. To report an overview and pictorial review of brain magnetic resonance imaging findings in adult primary angiitis of the central nervous system and to determine the distribution of parenchymal, meningeal, and vascular lesions in a large multicentric cohort. Adult patients from the French COVAC cohort (Cohort of Patients With Primary Vasculitis of the Central Nervous System), with biopsy or angiographically proven primary angiitis of the central nervous system and brain magnetic resonance imaging available at the time of diagnosis were included. A systematic imaging review was performed blinded to clinical data. Sixty patients met inclusion criteria. Mean age was 45 years (±12.9). Patients initially presented focal deficit(s) (83%), headaches (53%), cognitive disorder (40%), and seizures (38.3%). The most common magnetic resonance imaging finding observed in 42% of patients was multiterritorial, bilateral, distal acute stroke lesions after small to medium artery distribution, with a predominant carotid circulation distribution. Hemorrhagic infarctions and parenchymal hemorrhages were also frequently found in the cohort (55%). Acute convexity subarachnoid hemorrhage was found in 26% of patients and 42% demonstrated pre-eminent leptomeningeal enhancement, which is found to be significantly more prevalent in biopsy-proven patients (60% versus 28%; P =0.04). Seven patients had tumor-like presentations. Seventy-seven percent of magnetic resonance angiographic studies were abnormal, revealing proximal/distal stenoses in 57% and 61% of patients, respectively. Adult primary angiitis of the central nervous system is a heterogenous disease, with multiterritorial, distal, and bilateral acute stroke being the most common pattern of parenchymal lesions found on magnetic resonance imaging. Our findings suggest a higher than previously thought prevalence of hemorrhagic transformation and other hemorrhagic manifestations. © 2017 American Heart Association, Inc.

Organization of primary health care for diabetes and hypertension in high, low and middle income countries.

PubMed

Lall, Dorothy; Prabhakaran, Dorairaj

2014-08-01

Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.

Health information technology in primary health care in developing countries: a literature review.

PubMed Central

Tomasi, Elaine; Facchini, Luiz Augusto; Maia, Maria de Fatima Santos

2004-01-01

This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed. PMID:15640923

Twin-tailed fail-over for fileservers maintaining full performance in the presence of a failure

DOEpatents

Coteus, Paul W.; Gara, Alan G.; Giampapa, Mark E.; Heidelberger, Philip; Steinmacher-Burow, Burkhard D.

2008-02-12

A method for maintaining full performance of a file system in the presence of a failure is provided. The file system having N storage devices, where N is an integer greater than zero and N primary file servers where each file server is operatively connected to a corresponding storage device for accessing files therein. The file system further having a secondary file server operatively connected to at least one of the N storage devices. The method including: switching the connection of one of the N storage devices to the secondary file server upon a failure of one of the N primary file servers; and switching the connections of one or more of the remaining storage devices to a primary file server other than the failed file server as necessary so as to prevent a loss in performance and to provide each storage device with an operating file server.

Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study.

PubMed

Jennings, Jacky M; Stover, Jeffrey A; Bair-Merritt, Megan H; Fichtenberg, Caroline; Munoz, Mary Grace; Maziad, Rafiq; Ketemepi, Sherry Johnson; Zenilman, Jonathan

2009-01-01

Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems. The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected. Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture. The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.

Initial Results from the Bloomsburg University Goniometer Laboratory

NASA Technical Reports Server (NTRS)

Shepard, M. K.

2002-01-01

The Bloomsburg University Goniometer Laboratory (B.U.G. Lab) consists of three systems for studying the photometric properties of samples. The primary system is an automated goniometer capable of measuring the entire bi-directional reflectance distribution function (BRDF) of samples. Secondary systems include a reflectance spectrometer and digital video camera with macro zoom lens for characterizing and documenting other physical properties of measured samples. Works completed or in progress include the characterization of the BRDF of calibration surfaces for the 2003 Mars Exploration Rovers (MER03), Martian analog soils including JSC-Mars-1, and tests of photometric models.

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

Barr, Jonathan L.; Taira, Randal Y.; Orr, Heather M.

The purpose of this document is to describe the operating concepts, capabilities, and benefits of RAMS including descriptions of how the system implementations can improve emergency response, damage assessment, task prioritization, and situation awareness. This CONOPS provides general information on operational processes and procedures required to utilize RAMS, and expected performance benefits of the system. The primary audiences for this document are the end users of RAMS (including flight operators and incident commanders) and the RAMS management team. Other audiences include interested offices within the Department of Homeland Security (DHS), and officials from other state and local jurisdictions who wantmore » to implement similar systems.« less

Off-resonance frequency operation for power transfer in a loosely coupled air core transformer

DOEpatents

Scudiere, Matthew B

2012-11-13

A power transmission system includes a loosely coupled air core transformer having a resonance frequency determined by a product of inductance and capacitance of a primary circuit including a primary coil. A secondary circuit is configured to have a substantially same product of inductance and capacitance. A back EMF generating device (e.g., a battery), which generates a back EMF with power transfer, is attached to the secondary circuit. Once the load power of the back EMF generating device exceeds a certain threshold level, which depends on the system parameters, the power transfer can be achieved at higher transfer efficiency if performed at an operating frequency less than the resonance frequency, which can be from 50% to 95% of the resonance frequency.

Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care.

PubMed

Gilson, Lucy; Elloker, Soraya; Olckers, Patti; Lehmann, Uta

2014-06-16

New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC). Using theory about complex adaptive systems and policy implementation, this paper considers how actors' sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC. The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa. Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis. It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC. The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it - act as a barrier to centrally-led initiatives to strengthen PHC. Staff often fail to take ownership of such initiatives and experience them as disempowering. Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges. Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning. PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and incorporate them into their everyday routines and practices. This requires a leadership of sensemaking that enables front line staff to exercise their collective discretionary power in strengthening PHC. We hope this theoretically-framed analysis of one set of experiences stimulates wider thinking about the leadership needed to sustain primary health care in other settings.

Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care

PubMed Central

2014-01-01

Background New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC). Using theory about complex adaptive systems and policy implementation, this paper considers how actors’ sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC. Methods The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa. Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis. It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC. Results The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it – act as a barrier to centrally-led initiatives to strengthen PHC. Staff often fail to take ownership of such initiatives and experience them as disempowering. Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges. Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning. Conclusions PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and incorporate them into their everyday routines and practices. This requires a leadership of sensemaking that enables front line staff to exercise their collective discretionary power in strengthening PHC. We hope this theoretically-framed analysis of one set of experiences stimulates wider thinking about the leadership needed to sustain primary health care in other settings. PMID:24935658

Wrinkling instabilities in soft bilayered systems

PubMed Central

Budday, Silvia; Andres, Sebastian; Walter, Bastian

2017-01-01

Wrinkling phenomena control the surface morphology of many technical and biological systems. While primary wrinkling has been extensively studied, experimentally, analytically and computationally, higher-order instabilities remain insufficiently understood, especially in systems with stiffness contrasts well below 100. Here, we use the model system of an elastomeric bilayer to experimentally characterize primary and secondary wrinkling at moderate stiffness contrasts. We systematically vary the film thickness and substrate prestretch to explore which parameters modulate the emergence of secondary instabilities, including period-doubling, period-tripling and wrinkle-to-fold transitions. Our experiments suggest that period-doubling is the favourable secondary instability mode and that period-tripling can emerge under disturbed boundary conditions. High substrate prestretch can suppress period-doubling and primary wrinkles immediately transform into folds. We combine analytical models with computational simulations to predict the onset of primary wrinkling, the post-buckling behaviour, secondary bifurcations and the wrinkle-to-fold transition. Understanding the mechanisms of pattern selection and identifying the critical control parameters of wrinkling will allow us to fabricate smart surfaces with tunable properties and to control undesired surface patterns like in the asthmatic airway. This article is part of the themed issue ‘Patterning through instabilities in complex media: theory and applications.’ PMID:28373385

Necessary organizational changes according to Burke-Litwin model in the head nurses system of management in healthcare and social welfare institutions - the Slovenia experience.

PubMed

Filej, Bojana; Skela-Savic, Brigita; Vicic, Visnja H; Hudorovic, Narcis

2009-05-01

To discover which changes should be implemented in the system of head nursing management in Slovenian healthcare institutions and social welfare institutions. The questionnaire was distributed to 155 head nurses of Slovenian hospitals, primary healthcare centres and social welfare institutions. The Burke-Litwin organizational change model has been used to look at which changes have to be implemented in the management system of head nurses. In hospitals head nurses have greater independent competence for planning professional training of nursing employees (p<.022) and are also more independent when it comes to selecting employees when it comes to new job openings (M=4.20, S.D.=.83, p<.004). According to the Burke-Litwin organizational change model, the elements to which changes should be introduced include "external environment" for primary healthcare centres and social welfare institutions, and "system (policies and procedures)" for primary healthcare centres. According to results of our study, changes are needed in leadership and management of nursing in primary healthcare centres. In social welfare institutions changes are only required in leadership. Organizational changes are not necessary for any element of the Burke-Litwin model for hospitals.

Waiting Room Education in a Community Health System: Provider Perceptions and Suggestions.

PubMed

Beckwith, Noor; Jean-Baptiste, Marie-Louise; Katz, Arlene

2016-12-01

The increasing burden of chronic diseases in the United States presents a major challenge to the nation's primary care systems, so improving the efficacy and efficiency of patient education is an important goal. Understanding the current perspectives, practices, and needs of primary care providers should guide innovation towards this end. As a part of the authors' ongoing quality improvement work, a short internet survey was an effective method of enhancing this understanding in one health care system. With a response rate of 24.6 %, the survey revealed that primary care waiting rooms in the health system studied are not conceived of or used by providers as spaces to engage patients in health education. To change this, providers suggested using both printed and technological methods for delivering health information, primarily related to medications, diabetes, and healthy lifestyle practices. Common barriers to improvement cited by providers included diverse language and literacy backgrounds in the patient population, as well as difficulty sustaining change due to infrastructural and administrative barriers. These results suggest steps for development, implementation, and investigation of new educational interventions for patients in the local primary care context.

RECOMMENDED SUB-SLAB DEPRESSURIZATION SYSTEMS DESIGN STANDARD OF THE FLORIDA RADON RESEARCH PROGRAM

EPA Science Inventory

The report recommends sub-slab depressurization systems design criteria to the State of Florida's Department of Community Affairs for their building code for radon resistant houses. Numerous details are set forth in the full report. Primary criteria include: (1) the operating soi...

Jet fuel based high pressure solid oxide fuel cell system

NASA Technical Reports Server (NTRS)

Gummalla, Mallika (Inventor); Yamanis, Jean (Inventor); Olsommer, Benoit (Inventor); Dardas, Zissis (Inventor); Bayt, Robert (Inventor); Srinivasan, Hari (Inventor); Dasgupta, Arindam (Inventor); Hardin, Larry (Inventor)

2013-01-01

A power system for an aircraft includes a solid oxide fuel cell system which generates electric power for the aircraft and an exhaust stream; and a heat exchanger for transferring heat from the exhaust stream of the solid oxide fuel cell to a heat requiring system or component of the aircraft. The heat can be transferred to fuel for the primary engine of the aircraft. Further, the same fuel can be used to power both the primary engine and the SOFC. A heat exchanger is positioned to cool reformate before feeding to the fuel cell. SOFC exhaust is treated and used as inerting gas. Finally, oxidant to the SOFC can be obtained from the aircraft cabin, or exterior, or both.

Jet Fuel Based High Pressure Solid Oxide Fuel Cell System

NASA Technical Reports Server (NTRS)

Srinivasan, Hari (Inventor); Hardin, Larry (Inventor); Gummalla, Mallika (Inventor); Yamanis, Jean (Inventor); Olsommer, Benoit (Inventor); Dardas, Zissis (Inventor); Dasgupta, Arindam (Inventor); Bayt, Robert (Inventor)

2015-01-01

A power system for an aircraft includes a solid oxide fuel cell system which generates electric power for the aircraft and an exhaust stream; and a heat exchanger for transferring heat from the exhaust stream of the solid oxide fuel cell to a heat requiring system or component of the aircraft. The heat can be transferred to fuel for the primary engine of the aircraft. Further, the same fuel can be used to power both the primary engine and the SOFC. A heat exchanger is positioned to cool reformate before feeding to the fuel cell. SOFC exhaust is treated and used as inerting gas. Finally, oxidant to the SOFC can be obtained from the aircraft cabin, or exterior, or both.

An unusual presentation of primary malignant B-cell-type dural lymphoma

PubMed Central

Low, Yin Yee Sharon; Lai, Siang Hui; Ng, Wai Hoe

2014-01-01

Primary malignant B-cell-type dural lymphoma is a rare subtype of primary central nervous system lymphoma (PCNSL). We herein report an unusual case of diffuse B-cell lymphoma that presents as a chronic subdural haematoma without extracranial involvement. The notable aspects of this case include the patient’s immunocompetence, a short clinical history of symptom onset, rapid neurological deterioration and a final diagnosis of high-grade PCNSL. This case highlights the challenges neurosurgeons face, especially in the emergency setting, when the disease manifests in varied presentations. PMID:25631982

Role of seasonality on predator-prey-subsidy population dynamics.

PubMed

Levy, Dorian; Harrington, Heather A; Van Gorder, Robert A

2016-05-07

The role of seasonality on predator-prey interactions in the presence of a resource subsidy is examined using a system of non-autonomous ordinary differential equations (ODEs). The problem is motivated by the Arctic, inhabited by the ecological system of arctic foxes (predator), lemmings (prey), and seal carrion (subsidy). We construct two nonlinear, nonautonomous systems of ODEs named the Primary Model, and the n-Patch Model. The Primary Model considers spatial factors implicitly, and the n-Patch Model considers space explicitly as a "Stepping Stone" system. We establish the boundedness of the dynamics, as well as the necessity of sufficiently nutritional food for the survival of the predator. We investigate the importance of including the resource subsidy explicitly in the model, and the importance of accounting for predator mortality during migration. We find a variety of non-equilibrium dynamics for both systems, obtaining both limit cycles and chaotic oscillations. We were then able to discuss relevant implications for biologically interesting predator-prey systems including subsidy under seasonal effects. Notably, we can observe the extinction or persistence of a species when the corresponding autonomous system might predict the opposite. Copyright © 2016 Elsevier Ltd. All rights reserved.

SFA 2.0- Watershed Structure and Controls

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

Williams, Ken

2015-01-23

Berkeley Lab Earth Scientist Ken Williams explains the watershed research within the Sustainable Systems SFA 2.0 project—including identification and monitoring of primary factors that control watershed biogeochemical functioning.

Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center and a Community Health System

PubMed Central

Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills. Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment. Success factors include continued support and investment from both organizations’ leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

PubMed

Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Laboratory testing in primary care: A systematic review of health IT impacts.

PubMed

Maillet, Éric; Paré, Guy; Currie, Leanne M; Raymond, Louis; Ortiz de Guinea, Ana; Trudel, Marie-Claude; Marsan, Josianne

2018-08-01

Laboratory testing in primary care is a fundamental process that supports patient management and care. Any breakdown in the process may alter clinical information gathering and decision-making activities and can lead to medical errors and potential adverse outcomes for patients. Various information technologies are being used in primary care with the goal to support the process, maximize patient benefits and reduce medical errors. However, the overall impact of health information technologies on laboratory testing processes has not been evaluated. To synthesize the positive and negative impacts resulting from the use of health information technology in each phase of the laboratory 'total testing process' in primary care. We conducted a systematic review. Databases including Medline, PubMed, CINAHL, Web of Science and Google Scholar were searched. Studies eligible for inclusion reported empirical data on: 1) the use of a specific IT system, 2) the impacts of the systems to support the laboratory testing process, and were conducted in 3) primary care settings (including ambulatory care and primary care offices). Our final sample consisted of 22 empirical studies which were mapped to a framework that outlines the phases of the laboratory total testing process, focusing on phases where medical errors may occur. Health information technology systems support several phases of the laboratory testing process, from ordering the test to following-up with patients. This is a growing field of research with most studies focusing on the use of information technology during the final phases of the laboratory total testing process. The findings were largely positive. Positive impacts included easier access to test results by primary care providers, reduced turnaround times, and increased prescribed tests based on best practice guidelines. Negative impacts were reported in several studies: paper-based processes employed in parallel to the electronic process increased the potential for medical errors due to clinicians' cognitive overload; systems deemed not reliable or user-friendly hampered clinicians' performance; and organizational issues arose when results tracking relied on the prescribers' memory. The potential of health information technology lies not only in the exchange of health information, but also in knowledge sharing among clinicians. This review has underscored the important role played by cognitive factors, which are critical in the clinician's decision-making, the selection of the most appropriate tests, correct interpretation of the results and efficient interventions. By providing the right information, at the right time to the right clinician, many IT solutions adequately support the laboratory testing process and help primary care clinicians make better decisions. However, several technological and organizational barriers require more attention to fully support the highly fragmented and error-prone process of laboratory testing. Copyright © 2018 Elsevier B.V. All rights reserved.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial.

PubMed

Miller, Jordan; Barber, David; Donnelly, Catherine; French, Simon; Green, Michael; Hill, Jonathan; MacDermid, Joy; Marsh, Jacquelyn; Norman, Kathleen; Richardson, Julie; Taljaard, Monica; Wideman, Timothy; Cooper, Lynn; McPhee, Colleen

2017-11-09

Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.

Concepts for the Next Generation Space Telescope

NASA Astrophysics Data System (ADS)

Margulis, M.; Tenerelli, D.

1996-12-01

In collaboration with NASA GSFC, we have examined a wide range of potential concepts for a large, passively cooled space telescope. Our design goals were to achieve a theoretical imaging sensitivity in the near-IR of 1 nJy and an angular resolution at 1 micron of 0.06 arcsec. Concepts examined included a telescope/spacecraft system with a 6-m diameter monolithic primary mirror, a variety of telescope/spacecraft systems with deployable primary mirror segments to achieve an 8-m diameter aperture, and a 12-element sparse aperture phased array telescope. Trade studies indicate that all three concept categories can achieve the required sensitivity and resolution, but that considerable technology development is required to bring any of the concepts to fruition. One attractive option is the system with the 6-m diameter monolithic primary. This option achieves high sensitivity without telescope deployments and includes a stiff structure for robust attitude and figure control. This system capitalizes on coming advances in launch vehicle and shroud technology, which should enable launch of large, monolithic payloads into orbit positions where background noise due to zodiacal dust is low. Our large space telescope study was performed by a consortium of organizations and individuals including: Domenick Tenerelli et al. (Lockheed Martin Corp.), Roger Angel et al. (U. Ariz.), Tom Casey et al. (Eastman Kodak Co.), Jim Gunn (Princeton), Shel Kulick (Composite Optics, Inc.), Jim Westphal (CIT), Johnny Batache et al. (Harris Corp.), Costas Cassapakis et al. (L'Garde, Inc.), Dave Sandler et al. (ThermoTrex Corp.), David Miller et al. (MIT), Ephrahim Garcia et al. (Garman Systems Inc.), Mark Enright (New Focus Inc.), Chris Burrows (STScI), Roc Cutri (IPAC), and Art Bradley (Allied Signal Aerospace).

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

PubMed

Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement.

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

PubMed

Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

2016-01-01

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board. Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement. Level III, therapeutic study.

Divisions of general practice in Australia: how do they measure up in the international context?

PubMed Central

Smith, Judith; Sibthorpe, Beverly

2007-01-01

Background Since the late 1980s, there has been evidence of an international trend towards more organised primary care. This has taken a number of forms including the emergence of primary care organisations. Underpinning such developments is an inherent belief in evidence that suggests that well-developed primary care is associated with improved health outcomes and greater cost-effectiveness within health systems. In Australia, primary care organisations have emerged as divisions of general practice. These are professionally-led, regionally-based, and largely government-funded voluntary associations of general practitioners that seek to co-ordinate local primary care services, and improve the quality of care and health outcomes for local communities. Discussion In this paper, we examine and debate the development of divisions in the international context, using six roles of primary care organisations outlined in published research. The six roles that are used as the basis for the critique are the ability of primary care organisations to: improve health outcomes; manage demand and control costs; engage primary care physicians; enable greater integration of health services; develop more accessible services in community and primary care settings; and enable greater scrutiny and assurance of quality of primary care services. Summary We conclude that there has been an evolutionary approach to divisions' development and they now appear embedded as geographically-based planning and development organisations within the Australian primary health care system. The Australian Government has to date been cautious in its approach to intervention in divisions' direction and performance. However, options for the next phase include: making greater use of contracts between government and divisions; introducing and extending proposed national quality targets for divisions, linked with financial or other incentives for performance; government sub-contracting with state-based organisations to act as purchasers of care; pursuing a fund-holding approach within divisions; and developing divisions as a form of health maintenance organisation. The challenge for the Australian Government, should it wish to see divisions' role expand, is to find mechanisms to enable this without compromising the relatively strong GP engagement that increasingly distinguishes divisions of general practice within the international experience of primary care organisations. PMID:17626642

Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review

PubMed Central

Braithwaite, Jeffrey; Testa, Luke; Lamprell, Gina; Herkes, Jessica; Ludlow, Kristiana; McPherson, Elise; Campbell, Margie; Holt, Joanna

2017-01-01

Introduction The sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system. Methods and analysis The protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies. Ethics and dissemination As no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems. PMID:29133332

Implementing Advanced Technologies in the Republic of China Air Force Officer Training System

DTIC Science & Technology

1994-03-01

Strategy Political Radar Systems Emergency Education Medicine Maneuvers Entertainment & Systems Design Primary Care Welfare Telegraph Systems I1 The...Planning area includes the career fields of Organization, Aircraft, Weapons, Air Strategy , and Maneuvers. In the Political area of occupational...materials to be considered. The current strategy is to maintain massive inventories of written testing materials for use in officer evaluations

40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Alternative sources of water supply; (iii) Restructuring or consolidation changes, including ownership change... public water system, State and the Administrator in ensuring that sufficient information is available and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING...

40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Alternative sources of water supply; (iii) Restructuring or consolidation changes, including ownership change... public water system, State and the Administrator in ensuring that sufficient information is available and... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING...

Diversification of Tertiary Education in Norway, Case Study.

ERIC Educational Resources Information Center

Ottosen, Kristian

The educational system of Norway, which is organized into primary, secondary and higher education, is reviewed. Types of schools and/or courses in secondary education are listed including present enrollment figures by main types of secondary education and transfer rates of secondary to tertiary education. The system of tertiary education is…

Argument for a Joint Safety Reporting System

DTIC Science & Technology

2015-02-13

Process Manager for the HQ AF Safety Center (AFSEC) at Kirtland AFB, New Mexico . His primary duties included leadership and oversight of the day-to...Military Mishaps Functional Lead and Navy-Marine Corps Subject Matter Expert ( SME ) for the SIMWG, the DOD Force Risk Reduction system rolls up the service

Cooperative Intersection Collision Avoidance System - Stop Sign Assist : experiments to validate use of an in-vehicle interface design.

DOT National Transportation Integrated Search

2012-04-01

The three studies included in the current report examine the transition from an infrastructure-based rural : intersection crossing assist system to one located inside a vehicle. The primary goals of the first study, conducted in : a simulator, were t...

Active Cooperation Between Primary Users and Cognitive Radio Users in Heterogeneous Ad-Hoc Networks

DTIC Science & Technology

2012-04-01

processing to wireless communications and networking, including space-time coding and modulation for MIMO wireless communications, MIMO - OFDM systems, and...multiinput-multioutput ( MIMO ) system that can significantly increase the link capacity and realize a new form of spatial diversity which has been termed

Interlibrary loan in primary access libraries: challenging the traditional view.

PubMed

Dudden, R F; Coldren, S; Condon, J E; Katsh, S; Reiter, C M; Roth, P L

2000-10-01

Primary access libraries serve as the foundation of the National Network of Libraries of Medicine (NN/LM) interlibrary loan (ILL) hierarchy, yet few published reports directly address the important role these libraries play in the ILL system. This may reflect the traditional view that small, primary access libraries are largely users of ILL, rather than important contributors to the effectiveness and efficiency of the national ILL system. This study was undertaken to test several commonly held beliefs regarding ILL system use by primary access libraries. Three hypotheses were developed. HI: Colorado and Wyoming primary access libraries comply with the recommended ILL guideline of adhering to a hierarchical structure, emphasizing local borrowing. H2: The closures of two Colorado Council of Medical Librarians (CCML) primary access libraries in 1996 resulted in twenty-three Colorado primary access libraries' borrowing more from their state resource library in 1997. H3: The number of subscriptions held by Colorado and Wyoming primary access libraries is positively correlated with the number of items they loan and negatively correlated with the number of items they borrow. The hypotheses were tested using the 1992 and 1997 DOCLINE and OCLC data of fifty-four health sciences libraries, including fifty primary access libraries, two state resource libraries, and two general academic libraries in Colorado and Wyoming. The ILL data were obtained electronically and analyzed using Microsoft Word 98, Microsoft Excel 98, and JMP 3.2.2. CCML primary access libraries comply with the recommended guideline to emphasize local borrowing by supplying each other with the majority of their ILLs, instead of overburdening libraries located at higher levels in the ILL hierarchy (H1). The closures of two CCML primary access libraries appear to have affected the entire ILL system, resulting in a greater volume of ILL activity for the state resource library and other DOCLINE libraries higher up in the ILL hierarchy and highlighting the contribution made by CCML primary access libraries (H2). CCML primary access libraries borrow and lend in amounts that are proportional to their collection size, rather than overtaxing libraries at higher levels in the ILL hierarchy with large numbers of requests (H3). The main limitations of this study were the small sample size and the use of data collected for another purpose, the CCML ILL survey. The findings suggest that there is little evidence to support several commonly held beliefs regarding ILL system use by primary access libraries. In addition to validating the important contributions made by primary access libraries to the national ILL system, baseline data that can be used to benchmark current practice performance are provided.

Interlibrary loan in primary access libraries: challenging the traditional view

PubMed Central

Dudden, Rosalind Farnam; Coldren, Sue; Condon, Joyce Elizabeth; Katsh, Sara; Reiter, Catherine Morton; Roth, Pamela Lynn

2000-01-01

Introduction: Primary access libraries serve as the foundation of the National Network of Libraries of Medicine (NN/LM) interlibrary loan (ILL) hierarchy, yet few published reports directly address the important role these libraries play in the ILL system. This may reflect the traditional view that small, primary access libraries are largely users of ILL, rather than important contributors to the effectiveness and efficiency of the national ILL system. Objective: This study was undertaken to test several commonly held beliefs regarding ILL system use by primary access libraries. Hypotheses: Three hypotheses were developed. H1: Colorado and Wyoming primary access libraries comply with the recommended ILL guideline of adhering to a hierarchical structure, emphasizing local borrowing. H2: The closures of two Colorado Council of Medical Librarians (CCML) primary access libraries in 1996 resulted in twenty-three Colorado primary access libraries' borrowing more from their state resource library in 1997. H3: The number of subscriptions held by Colorado and Wyoming primary access libraries is positively correlated with the number of items they loan and negatively correlated with the number of items they borrow. Methods: The hypotheses were tested using the 1992 and 1997 DOCLINE and OCLC data of fifty-four health sciences libraries, including fifty primary access libraries, two state resource libraries, and two general academic libraries in Colorado and Wyoming. The ILL data were obtained electronically and analyzed using Microsoft Word 98, Microsoft Excel 98, and JMP 3.2.2. Results: CCML primary access libraries comply with the recommended guideline to emphasize local borrowing by supplying each other with the majority of their ILLs, instead of overburdening libraries located at higher levels in the ILL hierarchy (H1). The closures of two CCML primary access libraries appear to have affected the entire ILL system, resulting in a greater volume of ILL activity for the state resource library and other DOCLINE libraries higher up in the ILL hierarchy and highlighting the contribution made by CCML primary access libraries (H2). CCML primary access libraries borrow and lend in amounts that are proportional to their collection size, rather than overtaxing libraries at higher levels in the ILL hierarchy with large numbers of requests (H3). Limitations: The main limitations of this study were the small sample size and the use of data collected for another purpose, the CCML ILL survey. Conclusions: The findings suggest that there is little evidence to support several commonly held beliefs regarding ILL system use by primary access libraries. In addition to validating the important contributions made by primary access libraries to the national ILL system, baseline data that can be used to benchmark current practice performance are provided. PMID:11055297

WE-DE-207B-09: Scatter Radiation Measurement From a Digital Breast Tomosynthesis System and Its Impact On Shielding Consideration

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

Yang, K; Li, X; Liu, B

2016-06-15

Purpose: To accurately measure the scatter radiation from a Hologic digital breast tomosynthesis (DBT) system and to provide updated scatter distribution to guide radiation shielding calculation for DBT rooms. Methods: A high sensitivity GOS-based linear detector was used to measure the angular distribution of scatter radiation from a Hologic Selenia Dimensions DBT system. The linear detector was calibrated for its energy response of typical DBT spectra. Following the NCRP147 approach, the measured scatter intensity was normalized by the primary beam area and primary air kerma at 1m from the scatter phantom center and presented as the scatter fraction. Direct comparisonmore » was made against Simpkin’s initial measurement. Key parameters including the phantom size, primary beam area, and kV/anode/target combination were also studied. Results: The measured scatter-to-primary-ratio and scatter fraction data closely matched with previous data from Simpkin. The measured data demonstrated the unique nonisotropic distribution of the scattered radiation around a Hologic DBT system, with two strong peaks around 25° and 160°. The majority scatter radiation (>70%) originated from the imaging detector assembly, instead of the phantom. With a workload from a previous local survey, the scatter air kerma at 1m from the phantom center for wall/door is 0.018mGy/patient, for floor is 0.164mGy/patient, and for ceiling is 0.037mGy/patient. Conclusion: Comparing to Simpkin’s previous data, the scatter air kerma from Holgoic DBT is at least two times higher. The main reasons include the harder primary beam with higher workload, added tomosynthesis acquisition, and strong small angle forward scattering. Due to the highly conservative initial assumptions, the shielding recommendation from NCRP147 is still sufficient for the Hologic DBT system given the workload from a previous local survey. With the data provided from this study, accurate shielding calculation can be performed for Hologic DBT systems with specific workload and barrier distance.« less

Measuring value for money: a scoping review on economic evaluation of health information systems.

PubMed

Bassi, Jesdeep; Lau, Francis

2013-01-01

To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations. We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed. Forty-two papers were selected and 33 were deemed high quality (scores ≥ 8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative. We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified.

Evaluation of coated columbium alloy heat shields for space shuttle thermal protection system application. Volume 3, phase 3: Full size TPS evaluation

NASA Technical Reports Server (NTRS)

Baer, J. W.; Black, W. E.

1974-01-01

The thermal protection system (TPS), designed for incorporation with space shuttle orbiter systems, consists of one primary heat shield thermally and structurally isolated from the test fixture by eight peripheral guard panels, all encompassing an area of approximately 12 sq ft. TPS components include tee-stiffened Cb 752/R-512E heat shields, bi-metallic support posts, panel retainers, and high temperature insulation blankets. The vehicle primary structure was simulated by a titanium skin, frames, and stiffeners. Test procedures, manufacturing processes, and methods of analysis are fully documented. For Vol. 1, see N72-30948; for Vol. 2, see N74-15660.

JEN-1 Reactor Control System; SISTEMA DE CONTROL DEL REACTOR JEN-1

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

Cantillo, M.F.; Nuno, C.M.; Andreu, J.L.M.

1963-01-01

ABS>The JEN-1 3Mw power swimming pool reactor electrical control circuits are described. Start-up, power generation in the core, and shutdown are controlled by the reactor control system. This control system guarantees in each moment the safety conditions during reactor operation. Each circuit was represented by a scheme, complemented with a description of its function, components, and operation theory. Components described include: scram circuit; fission counter control circuit; servo control circuit; control circuit of safety sheets; control circuits of primary, secondary, and clean-up pump motors and tower fan motor; primary valve motor circuit; center cubicle alarm circuit; and process alarm circuit.more » (auth)« less

Lymphoma—Health Professional Version

Cancer.gov

Lymphoma refers to cancers that form in the lymphatic system, including Hodgkin lymphoma, non-Hodgkin lymphoma, AIDS-related lymphoma, and primary CNS lymphoma. Find evidence-based information on lymphoma treatment, research, genomics, and statistics.

Fuel cell system combustor

DOEpatents

Pettit, William Henry

2001-01-01

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

Magnetic Field Satellite (Magsat) data processing system specifications

NASA Technical Reports Server (NTRS)

Berman, D.; Gomez, R.; Miller, A.

1980-01-01

The software specifications for the MAGSAT data processing system (MDPS) are presented. The MDPS is divided functionally into preprocessing of primary input data, data management, chronicle processing, and postprocessing. Data organization and validity, and checks of spacecraft and instrumentation are dicussed. Output products of the MDPS, including various plots and data tapes, are described. Formats for important tapes are presented. Dicussions and mathematical formulations for coordinate transformations and field model coefficients are included.

Pediatricians’ and health visitors’ views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study

PubMed Central

2014-01-01

Background The present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Methods Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. Results Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. Conclusions Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices. PMID:24725738

Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

PubMed

Kanchense, Jane Handina Murigwa

2006-08-01

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.

Embedding online patient record access in UK primary care: a survey of stakeholder experiences.

PubMed

Pagliari, Claudia; Shand, Tim; Fisher, Brian

2012-05-01

To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

A review of near patient testing in primary care.

PubMed

Hobbs, F D; Delaney, B C; Fitzmaurice, D A; Wilson, S; Hyde, C J; Thorpe, G H; Earl-Slater, A S; Jowett, S; Tobias, R S

1997-01-01

The aim was to identify publications relating to near patient testing (NPT), the use of alternative delivery systems between laboratory and general practice, including electronic data interchange (EDI), and computerised diagnostic decision support (CDDS), in the primary care setting to answer the following questions. What is the availability of NPT for primary care? What evidence is available to support the clinical effectiveness of NPT? What evidence is available on the accuracy and reliability of NPT within primary care? What evidence is available on the cost-effectiveness of different NPTs? How may CDDS improve the effectiveness of NPT? What evidence is available that compares NPT and existing laboratory services? What evidence is available on the cost-effectiveness of EDI or alternative delivery systems? Eight databases were searched, and the bibliographies from relevant publications checked for completeness. Unpublished work and publications not included in the databases were obtained by personal contact with collaborators, and from a postal survey sent to heads of academic departments of general practice and clinical chemistry and to researchers active or interested in the field worldwide. Questionnaires were also sent to 150 commercial organisations. Publications that met agreed definitions and reported original data were included in the systematic review. Of the 1057 publications identified, 102 (92 related to NPT, eight to CDDS, and two to EDI) were passed to the reviewers for appraisal of validity. The limited amount of published research relating to any particular NPT prohibited meta-analysis. Scoring systems to assess the validity of evaluations were also difficult to apply. A wide variety of NPT systems have been developed. In general, the quality of the methods reported in the literature was poor. The issue of patient convenience and acceptability has not been adequately addressed. No evaluations of alternative delivery systems met the review criteria. No studies have evaluated the telephone or fax machine as a means of reporting results. For EDI, the majority of papers were descriptive. EDI and alternative delivery systems are not a replacement for NPT when the provision of an immediate result might have an impact on the quality of care. EDI may have clinical and cost advantages over traditional means of communication, but this has not been evaluated. The advisory role of the laboratory can be supported by CDDS. The use of CDDS and NPT has not, however, been fully evaluated. Few economic analyses have been conducted, and most were simple cost analyses. There are insufficient data for conclusions to be drawn on the cost-effectiveness of NPT in primary care. FURTHER SYSTEMATIC REVIEWS: Subject-specific systematic reviews are required that include laboratory and secondary care studies, and consider the potential for altering current management and patient acceptability. Priority topics include: biochemistry profiles on desktop analysers; cholesterol testing; urinalysis for the diagnosis of urinary tract infection; anticoagulation control; NPTs for the identification of acute infection. (ABSTRACT TRUNCATED)

Primary Airway Epithelial Cell Gene Editing Using CRISPR-Cas9.

PubMed

Everman, Jamie L; Rios, Cydney; Seibold, Max A

2018-01-01

The adaptation of the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR associated endonuclease 9 (CRISPR-Cas9) machinery from prokaryotic organisms has resulted in a gene editing system that is highly versatile, easily constructed, and can be leveraged to generate human cells knocked out (KO) for a specific gene. While standard transfection techniques can be used for the introduction of CRISPR-Cas9 expression cassettes to many cell types, delivery by this method is not efficient in many primary cell types, including primary human airway epithelial cells (AECs). More efficient delivery in AECs can be achieved through lentiviral-mediated transduction, allowing the CRISPR-Cas9 system to be integrated into the genome of the cell, resulting in stable expression of the nuclease machinery and increasing editing rates. In parallel, advancements have been made in the culture, expansion, selection, and differentiation of AECs, which allow the robust generation of a bulk edited AEC population from transduced cells. Applying these methods, we detail here our latest protocol to generate mucociliary epithelial cultures knocked out for a specific gene from donor-isolated primary human basal airway epithelial cells. This protocol includes methods to: (1) design and generate lentivirus which targets a specific gene for KO with CRISPR-Cas9 machinery, (2) efficiently transduce AECs, (3) culture and select for a bulk edited AEC population, (4) molecularly screen AECs for Cas9 cutting and specific sequence edits, and (5) further expand and differentiate edited cells to a mucociliary airway epithelial culture. The AEC knockouts generated using this protocol provide an excellent primary cell model system with which to characterize the function of genes involved in airway dysfunction and disease.

Confirmation of saturation equilibrium conditions in crater populations

NASA Technical Reports Server (NTRS)

Hartmann, William K.; Gaskell, Robert W.

1993-01-01

We have continued work on realistic numerical models of cratered surfaces, as first reported at last year's LPSC. We confirm the saturation equilibrium level with a new, independent test. One of us has developed a realistic computer simulation of a cratered surface. The model starts with a smooth surface or fractal topography, and adds primary craters according to the cumulative power law with exponent -1.83, as observed on lunar maria and Martian plains. Each crater has an ejecta blanket with the volume of the crater, feathering out to a distance of 4 crater radii. We use the model to test the levels of saturation equilibrium reached in naturally occurring systems, by increasing crater density and observing its dependence on various parameters. In particular, we have tested to see if these artificial systems reach the level found by Hartmann on heavily cratered planetary surfaces, hypothesized to be the natural saturation equilibrium level. This year's work gives the first results of a crater population that includes secondaries. Our model 'Gaskell-4' (September, 1992) includes primaries as described above, but also includes a secondary population, defined by exponent -4. We allowed the largest secondary from each primary to be 0.10 times the size of the primary. These parameters will be changed to test their effects in future models. The model gives realistic images of a cratered surface although it appears richer in secondaries than real surfaces are. The effect of running the model toward saturation gives interesting results for the diameter distribution. Our most heavily cratered surface had the input number of primary craters reach about 0.65 times the hypothesized saturation equilibrium, but the input number rises to more than 100 times that level for secondaries below 1.4 km in size.

Enhanced peripheral visual processing in congenitally deaf humans is supported by multiple brain regions, including primary auditory cortex.

PubMed

Scott, Gregory D; Karns, Christina M; Dow, Mark W; Stevens, Courtney; Neville, Helen J

2014-01-01

Brain reorganization associated with altered sensory experience clarifies the critical role of neuroplasticity in development. An example is enhanced peripheral visual processing associated with congenital deafness, but the neural systems supporting this have not been fully characterized. A gap in our understanding of deafness-enhanced peripheral vision is the contribution of primary auditory cortex. Previous studies of auditory cortex that use anatomical normalization across participants were limited by inter-subject variability of Heschl's gyrus. In addition to reorganized auditory cortex (cross-modal plasticity), a second gap in our understanding is the contribution of altered modality-specific cortices (visual intramodal plasticity in this case), as well as supramodal and multisensory cortices, especially when target detection is required across contrasts. Here we address these gaps by comparing fMRI signal change for peripheral vs. perifoveal visual stimulation (11-15° vs. 2-7°) in congenitally deaf and hearing participants in a blocked experimental design with two analytical approaches: a Heschl's gyrus region of interest analysis and a whole brain analysis. Our results using individually-defined primary auditory cortex (Heschl's gyrus) indicate that fMRI signal change for more peripheral stimuli was greater than perifoveal in deaf but not in hearing participants. Whole-brain analyses revealed differences between deaf and hearing participants for peripheral vs. perifoveal visual processing in extrastriate visual cortex including primary auditory cortex, MT+/V5, superior-temporal auditory, and multisensory and/or supramodal regions, such as posterior parietal cortex (PPC), frontal eye fields, anterior cingulate, and supplementary eye fields. Overall, these data demonstrate the contribution of neuroplasticity in multiple systems including primary auditory cortex, supramodal, and multisensory regions, to altered visual processing in congenitally deaf adults.

Secondary mineral formation associated with respiration of nontronite, NAu-1 by iron reducing bacteria

PubMed Central

O'Reilly, S Erin; Watkins, Janet; Furukawa, Yoko

2005-01-01

Experimental batch and miscible-flow cultures were studied in order to determine the mechanistic pathways of microbial Fe(III) respiration in ferruginous smectite clay, NAu-1. The primary purpose was to resolve if alteration of smectite and release of Fe precedes microbial respiration. Alteration of NAu-1, represented by the morphological and mineralogical changes, occurred regardless of the extent of microbial Fe(III) reduction in all of our experimental systems, including those that contained heat-killed bacteria and those in which O2, rather than Fe(III), was the primary terminal electron acceptor. The solid alteration products observed under transmission electron microscopy included poorly crystalline smectite with diffuse electron diffraction signals, discrete grains of Fe-free amorphous aluminosilicate with increased Al/Si ratio, Fe-rich grains, and amorphous Si globules in the immediate vicinity of bacterial cells and extracellular polymeric substances. In reducing systems, Fe was also found as siderite. The small amount of Fe partitioned to the aqueous phase was primarily in the form of dissolved Fe(III) species even in the systems in which Fe(III) was the primary terminal electron acceptor for microbial respiration. From these observations, we conclude that microbial respiration of Fe(III) in our laboratory systems proceeded through the following: (1) alteration of NAu-1 and concurrent release of Fe(III) from the octahedral sheets of NAu-1; and (2) subsequent microbial respiration of Fe(III).

Improving Communication About Serious Illness in Primary Care: A Review.

PubMed

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will require improved training, validation, and dissemination of patient selection tools, systems for conducting and revisiting conversations, accessible documentation, and incentives for measurement, feedback, and continuous improvement.

The design of a tactical situation display

NASA Astrophysics Data System (ADS)

Kuperman, Gilbert G.; Wilson, Denise L.

The design and demonstration of a dynamic tactical situation display applicable to an advanced conceptual bomber crew system is discussed. The display is the primary source of mission pacing and situational awareness information in the Strategic Avionics Battle-Management Evaluation and Research (SABER) simulator. Aspects of the display design are described, including primary data items, horizontal situation display, point of interest indication, terrain data, graphics overlay, text window, and presentation modes.

What Did the New Social Studies Program Change in Upper Primary Level Social Studies Education in Turkish Schools? An Assessment from Teachers' Perspectives

ERIC Educational Resources Information Center

Incekara, Suleyman

2010-01-01

The Turkish education system has undergone radical changes since 2004 in all educational curricula, including social studies at the primary and secondary levels. Today, almost six years after its inception, an assessment is needed as to whether the reforms of 2004 affected beneficial changes in the social studies program. If not, it is important…

Isolation and molecular typing of Naegleria fowleri from the brain of a cow that died of primary amebic meningoencephalitis.

PubMed

Visvesvara, Govinda S; De Jonckheere, Johan F; Sriram, Rama; Daft, Barbara

2005-08-01

Naegleria fowleri causes an acute and rapidly fatal central nervous system infection called primary amebic meningoencephalitis (PAM) in healthy children and young adults. We describe here the identification of N. fowleri isolated from the brain of one of several cows that died of PAM based on sequencing of the internal transcribed spacers, including the 5.8S rRNA genes.

CW (Continuous Wave) Measurement System. Operating Manual

DTIC Science & Technology

1982-08-02

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

Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.

PubMed

Bergevin, Yves; Habib, Bettina; Elicksen-Jensen, Keesa; Samis, Stephen; Rochon, Jean; Denis, Jean-Louis; Roy, Denis

2016-01-01

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.

A model for the space shuttle main engine high pressure oxidizer turbopump shaft seal system

NASA Technical Reports Server (NTRS)

Paxson, Daniel E.

1990-01-01

A simple static model is presented which solves for the flow properties of pressure, temperature, and mass flow in the Space Shuttle Main Engine pressure Oxidizer Turbopump Shaft Seal Systems. This system includes the primary and secondary turbine seals, the primary and secondary turbine drains, the helium purge seals and feed line, the primary oxygen drain, and the slinger/labyrinth oxygen seal pair. The model predicts the changes in flow variables that occur during and after failures of the various seals. Such information would be particularly useful in a post flight situation where processing of sensor information using this model could identify a particular seal that had experienced excessive wear. Most of the seals in the system are modeled using simple one dimensional equations which can be applied to almost any seal provided that the fluid is gaseous. A failure is modeled as an increase in the clearance between the shaft and the seal. Thus, the model does not attempt to predict how the failure process actually occurs (e.g., wear, seal crack initiation). The results presented were obtained using a FORTRAN implementation of the model running on a VAX computer. Solution for the seal system properties is obtained iteratively; however, a further simplified implementation (which does not include the slinger/labyrinth combination) was also developed which provides fast and reasonable results for most engine operating conditions. Results from the model compare favorably with the limited redline data available.

Loved, Valued, and Included: Some Implications of Neurobiological, Systems, and Psychotherapeutic Research for Social Welfare

ERIC Educational Resources Information Center

Stafford, Brian

2009-01-01

The authors of the primary articles in this special edition provide early and promising evidence that developmentally sensitive psychotherapeutic interventions and integrated care systems improve the lives of children who have been exposed to abuse or neglect. Why, then, do so many children in the social welfare system receive care that is not…

Measuring access to primary care appointments: a review of methods

PubMed Central

Jones, Wendy; Elwyn, Glyn; Edwards, Peter; Edwards, Adrian; Emmerson, Melody; Hibbs, Richard

2003-01-01

Background Patient access to primary care appointments is not routinely measured despite the increasing interest in this aspect of practice activity. The generation of standardised data (or benchmarks) for access could inform developments within primary care organisations and act as a quality marker for clinical governance. Logically the setting of targets should be based on a sound system of measurement. The practicalities of developing appropriate measures need debate. Therefore we aimed to search for and compare methods that have been published or are being developed to measure patient access to primary care appointments, with particular focus on finding methods using appointment system data. Method A search and review was made of the primary care literature from 1990 to 2001, which included an assessment of online resources (websites) and communication with recognised experts. The identified methods were assessed. Results The published literature in this specific area was not extensive but revealed emerging interest in the late 1990s. Two broad approaches to the measurement of waiting times to GP appointments were identified. Firstly, appointment systems in primary care organisations were analysed in differing ways to provide numerical data and, secondly, patient perceptions (reports) of access were evaluated using survey techniques. Six different methods were found which were based on appointment systems data. Conclusion The two approaches of either using patient questionnaires or appointment system data are methods that represent entirely different aims. The latter method when used to represent patient waiting times for 'routine' elective appointments seems to hold promise as a useful tool and this avoids the definitional problems that surround 'urgent' appointments. The purpose for which the data is being collected needs to be borne in mind and will determine the chosen methods of data retrieval and representation. PMID:12846934

General practice education and training in southern China: recent development and ongoing challenges under the health care reform.

PubMed

Wang, H H X; Wang, J J; Zhou, Z H; Wang, X W; Xu, L

2013-01-01

China has launched a general practice (GP)-orientated primary care reform in 2009 to develop a more productive, coordinated, and cost-effective system to maintain and improve the health and well-being of one-fifth of the world population. The restructure of the health care system with a focus on primary care requires practitioners working on GP as gatekeepers for service delivery that is responsive to the needs of people. It is particularly prioritised to establish a sound education and training system to ensure that the competencies of practitioners are aligned with local health care needs. This article aims to provide a brief review of the development of GP, including exemplary model of education and training currently implemented in southern China, as well as the challenges to be addressed in the next step. There is a shortage of well-trained and qualified general practitioners in China where more than half of the licensed clinicians in primary care are educated below the undergraduate level. Although there is a stepwise increase in recognition that the capacity of GP is pivotal to the success of primary care development in China, challenges coming from resource restriction, rural and urban disparity, social attitude, and community involvement are highlighted as major bottlenecks that currently hinder the rapid development of GP in China. Supportive policy and guidelines are necessary to build up strong GP recognition and ensure adequate resources to underpin a robust primary care system to deliver affordable and effective health care services for the world's largest population. It might share some similar experiences with other countries that are struggling to develop a GP-based primary care system.

The Experimental Breeder Reactor II seismic probabilistic risk assessment

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

Roglans, J; Hill, D J

1994-02-01

The Experimental Breeder Reactor II (EBR-II) is a US Department of Energy (DOE) Category A research reactor located at Argonne National Laboratory (ANL)-West in Idaho. EBR-II is a 62.5 MW-thermal Liquid Metal Reactor (LMR) that started operation in 1964 and it is currently being used as a testbed in the Integral Fast Reactor (IFR) Program. ANL has completed a Level 1 Probabilistic Risk Assessment (PRA) for EBR-II. The Level 1 PRA for internal events and most external events was completed in June 1991. The seismic PRA for EBR-H has recently been completed. The EBR-II reactor building contains the reactor, themore » primary system, and the decay heat removal systems. The reactor vessel, which contains the core, and the primary system, consisting of two primary pumps and an intermediate heat exchanger, are immersed in the sodium-filled primary tank, which is suspended by six hangers from a beam support structure. Three systems or functions in EBR-II were identified as the most significant from the standpoint of risk of seismic-induced fuel damage: (1) the reactor shutdown system, (2) the structural integrity of the passive decay heat removal systems, and (3) the integrity of major structures, like the primary tank containing the reactor that could threaten both the reactivity control and decay heat removal functions. As part of the seismic PRA, efforts were concentrated in studying these three functions or systems. The passive safety response of EBR-II reactor -- both passive reactivity shutdown and passive decay heat removal, demonstrated in a series of tests in 1986 -- was explicitly accounted for in the seismic PRA as it had been included in the internal events assessment.« less

Factors associated with professional satisfaction in primary care: Results from EUprimecare project.

PubMed

Sanchez-Piedra, Carlos Alberto; Jaruseviciene, Lina; Prado-Galbarro, Francisco Javier; Liseckiene, Ida; Sánchez-Alonso, Fernando; García-Pérez, Sonia; Sarria Santamera, Antonio

2017-12-01

Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine. This study explored factors associated with professional satisfaction in seven European countries. A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians. A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8). Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.

The North American Energy System: Overview of the 3rd Chapter of SOCCR-2

NASA Astrophysics Data System (ADS)

Marcotullio, P. J.

2016-12-01

North America, including Canada, Mexico and the United States, has a large and complex energy system, which includes the extraction and conversion of primary energy sources and their storage, transmission, distribution and ultimate end use in the building, transportation and industrial sectors. The chapter overviews this system focusing on our understanding of the energy trends and system feedback dynamics, key drivers of change, and subsequent carbon emissions and the basis for carbon management. We also put the carbon emissions from the North American system in global context. Highlights include the changes to the system (sources, fuel mix, drivers, infrastructure, etc.,) over the past decade, and a review of scenarios that provide glimpses into future emissions levels and meeting the requirements for decarbonization in the medium and longer term.

Blueprint for an Undergraduate Primary Care Curriculum.

PubMed

Fazio, Sara B; Demasi, Monica; Farren, Erin; Frankl, Susan; Gottlieb, Barbara; Hoy, Jessica; Johnson, Amanda; Kasper, Jill; Lee, Patrick; McCarthy, Claire; Miller, Kathe; Morris, Juliana; O'Hare, Kitty; Rosales, Rachael; Simmons, Leigh; Smith, Benjamin; Treadway, Katherine; Goodell, Kristen; Ogur, Barbara

2016-12-01

In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.

[Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model].

PubMed

Ulrich, Lisa-R; Pham, Thuy-Nga Tia; Gerlach, Ferdinand M; Erler, Antje

2017-07-11

The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system. © Georg Thieme Verlag KG Stuttgart · New York.

The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

PubMed

Dillon, Mark T; Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

2015-06-01

Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.

SFA 2.0- Watershed Structure and Controls

ScienceCinema

Williams, Ken

2018-05-23

Berkeley Lab Earth Scientist Ken Williams explains the watershed research within the Sustainable Systems SFA 2.0 project—including identification and monitoring of primary factors that control watershed biogeochemical functioning.

Mass Media Functions, Knowledge and Social Control

ERIC Educational Resources Information Center

Donohue, G. A.; And Others

1973-01-01

Develops a macro-view of mass media as interdependent parts of a total social system including a series of interrelated subsystems with primary function involving the generation, dissemination, and assimilation of information. (RB)

Central nervous system.

PubMed

Adamson, D Cory; Rasheed, B Ahmed K; McLendon, Roger E; Bigner, Darell D

2010-01-01

Several different types of tumors, benign and malignant, have been identified in the central nervous system (CNS). The prognoses for these tumors are related to several factors, such as the age of the patient and the location and histology of the tumor. In adults, about half of all CNS tumors are malignant, whereas in pediatric patients, more than 75% are malignant. For most benign CNS tumors that require treatment, neurosurgeons can offer curative resections or at least provide significant relief from mass effect. Unfortunately, we still lack effective treatments for most primary and secondary malignant CNS tumors. However, the past decade has witnessed an explosion in the understanding of the early molecular events in malignant primary CNS tumors, and for the first time in history, oncologists are seeing that a plethora of new therapies targeting these molecular events are being tested in clinical trials. There is hope on the horizon for the fight against these deadly tumors. The distribution of CNS tumors by location has remained constant for numerous years. The majority of primary CNS tumors arise in the major cortical lobes. Twenty nine percent of primary CNS tumors arise from the dural meninges that encase the CNS structures. The vast majority of these are meningiomas, of which over 90% are benign. About 10% of primary CNS tumors are found in the sella turcica region, where the pituitary gland resides. Other much less common sites of primary CNS tumors include the pineal region, ventricular system, cerebellum, brain stem, cranial nerves, and spinal cord. The distribution of CNS tumors by histology has seen a slight increase in more malignant tumors over the past decade, possibly due to increased neuroimaging practices or environmental exposures. Arising from glial cells, gliomas represent over 36% of all primary CNS tumors and consist of astrocytomas, oligodendrogliomas, ependymomas, mixed gliomas, and neuroepithelial tumors. The benign meningiomas make up 32% of primary CNS tumors, followed by nerve sheath tumors and pituitary tumors. Primary CNS lymphomas, embryonal tumors, and craniopharyngiomas are uncommon. The most common gliomas are astrocytomas, and these tumors are typically classified by the World Health Organization (WHO) as Grades I through IV. Grade IV, the most malignant grade of astrocytoma, includes glioblastoma multiforme (GBM), the most common malignant primary CNS glioma in adults, which represents 51% of all CNS gliomas. GBM is unfortunately the most challenging to effectively treat and has the worst patient survival. This chapter is therefore primarily devoted to the current understanding of this topic. Here we describe the molecular and cellular events associated with malignant glioma initiation and progression. We also review the importance of glioma stem cell biology and tumor immunology in early gliomagenesis. In addition, we present a brief description of the most common malignant primary CNS glioma in pediatric patients - medulloblastoma, as well as familial cancer syndromes that include gliomas as part of the syndrome.

Design optimization of ultra-high concentrator photovoltaic system using two-stage non-imaging solar concentrator

NASA Astrophysics Data System (ADS)

Wong, C.-W.; Yew, T.-K.; Chong, K.-K.; Tan, W.-C.; Tan, M.-H.; Lim, B.-H.

2017-11-01

This paper presents a systematic approach for optimizing the design of ultra-high concentrator photovoltaic (UHCPV) system comprised of non-imaging dish concentrator (primary optical element) and crossed compound parabolic concentrator (secondary optical element). The optimization process includes the design of primary and secondary optics by considering the focal distance, spillage losses and rim angle of the dish concentrator. The imperfection factors, i.e. mirror reflectivity of 93%, lens’ optical efficiency of 85%, circumsolar ratio of 0.2 and mirror surface slope error of 2 mrad, were considered in the simulation to avoid the overestimation of output power. The proposed UHCPV system is capable of attaining effective ultra-high solar concentration ratio of 1475 suns and DC system efficiency of 31.8%.

Embracing value co-creation in primary care services research: a framework for success.

PubMed

Janamian, Tina; Crossland, Lisa; Jackson, Claire L

2016-04-18

Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process.

ACTS TDMA network control. [Advanced Communication Technology Satellite

NASA Technical Reports Server (NTRS)

Inukai, T.; Campanella, S. J.

1984-01-01

This paper presents basic network control concepts for the Advanced Communications Technology Satellite (ACTS) System. Two experimental systems, called the low-burst-rate and high-burst-rate systems, along with ACTS ground system features, are described. The network control issues addressed include frame structures, acquisition and synchronization procedures, coordinated station burst-time plan and satellite-time plan changes, on-board clock control based on ground drift measurements, rain fade control by means of adaptive forward-error-correction (FEC) coding and transmit power augmentation, and reassignment of channel capacities on demand. The NASA ground system, which includes a primary station, diversity station, and master control station, is also described.

Sensitivity Analysis for Steady State Groundwater Flow Using Adjoint Operators

NASA Astrophysics Data System (ADS)

Sykes, J. F.; Wilson, J. L.; Andrews, R. W.

1985-03-01

Adjoint sensitivity theory is currently being considered as a potential method for calculating the sensitivity of nuclear waste repository performance measures to the parameters of the system. For groundwater flow systems, performance measures of interest include piezometric heads in the vicinity of a waste site, velocities or travel time in aquifers, and mass discharge to biosphere points. The parameters include recharge-discharge rates, prescribed boundary heads or fluxes, formation thicknesses, and hydraulic conductivities. The derivative of a performance measure with respect to the system parameters is usually taken as a measure of sensitivity. To calculate sensitivities, adjoint sensitivity equations are formulated from the equations describing the primary problem. The solution of the primary problem and the adjoint sensitivity problem enables the determination of all of the required derivatives and hence related sensitivity coefficients. In this study, adjoint sensitivity theory is developed for equations of two-dimensional steady state flow in a confined aquifer. Both the primary flow equation and the adjoint sensitivity equation are solved using the Galerkin finite element method. The developed computer code is used to investigate the regional flow parameters of the Leadville Formation of the Paradox Basin in Utah. The results illustrate the sensitivity of calculated local heads to the boundary conditions. Alternatively, local velocity related performance measures are more sensitive to hydraulic conductivities.

Langley Atmospheric Information Retrieval System (LAIRS): System description and user's guide

NASA Technical Reports Server (NTRS)

Boland, D. E., Jr.; Lee, T.

1982-01-01

This document presents the user's guide, system description, and mathematical specifications for the Langley Atmospheric Information Retrieval System (LAIRS). It also includes a description of an optimal procedure for operational use of LAIRS. The primary objective of the LAIRS Program is to make it possible to obtain accurate estimates of atmospheric pressure, density, temperature, and winds along Shuttle reentry trajectories for use in postflight data reduction.

Pre-Visit Prioritization for Complex Patients with Diabetes: Randomized Trial Design and Implementation within an Integrated Health Care System

PubMed Central

Grant, Richard W; Uratsu, Connie S; Hansen, Karen R; Altschuler, Andrea; Kim, Eileen; Fireman, Bruce; Adams, Alyce S; Schmittdiel, Julie A; Heisler, Michele

2016-01-01

Background/Aims Despite robust evidence to guide clinical care, most patients with diabetes do not meet all goals of risk factor control. Improved patient-provider communication during time-limited primary care visits may represent one strategy for improving diabetes care. Methods We designed a controlled, cluster-randomized, multi-site intervention (Pre-Visit Prioritization for Complex Patients with Diabetes) that enables patients with poorly controlled type 2 diabetes to identify their top priorities prior to a scheduled visit and sends these priorities to the primary care physician progress note in the electronic medical record. In this paper, we describe strategies to address challenges to implementing our health IT-based intervention study within a large health care system. Results This study is being conducted in 30 primary care practices within a large integrated care delivery system in Northern California. Over a 12-week period (3/1/2015 – 6/6/2015), 146 primary care physicians consented to enroll in the study (90.1%) and approved contact with 2496 of their patients (97.6%). Implementation challenges included: (1) Navigating research vs. quality improvement requirements; (2) Addressing informed consent considerations; and (3) Introducing a new clinical tool into a highly time-constrained workflow. Strategies for successfully initiating this study included engagement with institutional leaders, Institutional Review Board members, and clinical stakeholders at multiple stages both before and after notice of Federal funding; flexibility by the research team in study design; and strong support from institutional leadership for “self-learning health system” research. Conclusions By paying careful attention to identifying and collaborating with a wide range of key clinical stakeholders, we have shown that researchers embedded within a learning care system can successfully apply rigorous clinical trial methods to test new care innovations. PMID:26820612

The implementation and use of Ada on distributed systems with high reliability requirements

NASA Technical Reports Server (NTRS)

Knight, J. C.

1988-01-01

The use and implementation of Ada were investigated in distributed environments in which reliability is the primary concern. In particular, the focus was on the possibility that a distributed system may be programmed entirely in Ada so that the individual tasks of the system are unconcerned with which processors are being executed, and that failures may occur in the software and underlying hardware. A secondary interest is in the performance of Ada systems and how that performance can be gauged reliably. Primary activities included: analysis of the original approach to recovery in distributed Ada programs using the Advanced Transport Operating System (ATOPS) example; review and assessment of the original approach which was found to be capable of improvement; development of a refined approach to recovery that was applied to the ATOPS example; and design and development of a performance assessment scheme for Ada programs based on a flexible user-driven benchmarking system.

The first aluminum coating of the 3700mm primary mirror of the Devasthal Optical Telescope

NASA Astrophysics Data System (ADS)

Bheemireddy, Krishna Reddy; Gopinathan, Maheswar; Pant, Jayshreekar; Omar, Amitesh; Kumar, Brijesh; Uddin, Wahab; Kumar, Nirmal

2016-07-01

Initially the primary mirror of the 3.6m Devasthal Optical Telescope is uncoated polished zerodur glass supplied by Lytkarino Optical Glass Factory, Russia/Advanced Mechanical and Optical Systems, Belgium. In order to do the aluminium coating on the primary mirror the coating plant including washing unit is installed near the telescope (extension building of telescope) by Hind High Vacuum (HHV) Bangalore, India. Magnetron sputtering technique is used for the coating. Several coating trials are done before the primary mirror coating; samples are tested for reflectivity, uniformity, adhesivity and finally commissioned. The primary mirror is cleaned, coated by ARIES. We present here a brief description of the coating plant installation, Mirror cleaning and coating procedures and the testing results of the samples.

[Development of an index system for the comprehensive evaluation on public health emergency events surveillance system in China].

PubMed

Hong, Zhiheng; Ni, Daxin; Cao, Yang; Meng, Ling; Tu, Wenxiao; Li, Leilei; Li, Qun; Jin, Lianmei

2015-06-01

To establish a comprehensive evaluation index system for the China Public Health Emergency Events Surveillance System (CPHEESS). A draft index system was built through literature review and under the consideration of the characteristics on CPHEESS. Delphi method was adapted to determine the final index system. The index system was divided into primary, secondary and tertiary levels. There were 4 primary indicators: System structure, Network platform, Surveillance implementation reports with Data analysis and utilization. There were 16 secondary and 70 tertiary indicators being set, with System structure including 14 tertiary indicators (accounted for 20.00%), 21 Network platforms (accounted for 30.00%). Twenty-four Surveillance implementation reports (accounted for 34.29%), 11 Data analysis and utilization (accounted for 15.71%). The average score of importance of each indicators was 4.29 (3.77-4.94), with an average coefficient variation as 0.14 (0.12-0.16). The mean Chronbach's α index was 0.84 (0.81-0.89). The adaptability of each related facilities indicator was specified. The primary indicators were set in accordance with the characteristics and goals of the surveillance systems. Secondary indicators provided key elements in the management and control of the system while the tertiary indicators were available and operative. The agreement rate of experts was high with good validity and reliability. This index system could be used for CPHEESS in future.

Tracking and data system support for the Mariner Mars 1971 mission. Volume 3: Orbit insertion through end of primary mission

NASA Technical Reports Server (NTRS)

Barnum, P. W.; Renzetti, N. A.; Textor, G. P.; Kelly, L. B.

1973-01-01

The Tracking and Data System (TDS) Support for the Mariner Mars 1971 Mission final report contains the deep space tracking and data acquisition activities in support of orbital operations. During this period a major NASA objective was accomplished: completion of the 180th revolution and 90th day of data gathering with the spacecraft about the planet Mars. Included are presentations of the TDS flight support pass chronology data for each of the Deep Space Stations used, and performance evaluation for the Deep Space Network Telemetry, Tracking, Command, and Monitor Systems. With the loss of Mariner 8 at launch, Mariner 9 assumed the mission plan of Mariner 8, which included the TV mapping cycles and a 12-hr orbital period. The mission plan was modified as a result of a severe dust storm on the surface of Mars, which delayed the start of the TV mapping cycles. Thus, the end of primary mission date was extended to complete the TV mapping cycles.

Detailed requirements document for the Interactive Financial Management System (IFMS), volume 1

NASA Technical Reports Server (NTRS)

Dodson, D. B.

1975-01-01

The detailed requirements for phase 1 (online fund control, subauthorization accounting, and accounts receivable functional capabilities) of the Interactive Financial Management System (IFMS) are described. This includes information on the following: systems requirements, performance requirements, test requirements, and production implementation. Most of the work is centered on systems requirements, and includes discussions on the following processes: resources authority, allotment, primary work authorization, reimbursable order acceptance, purchase request, obligation, cost accrual, cost distribution, disbursement, subauthorization performance, travel, accounts receivable, payroll, property, edit table maintenance, end-of-year, backup input. Other subjects covered include: external systems interfaces, general inquiries, general report requirements, communication requirements, and miscellaneous. Subjects covered under performance requirements include: response time, processing volumes, system reliability, and accuracy. Under test requirements come test data sources, general test approach, and acceptance criteria. Under production implementation come data base establishment, operational stages, and operational requirements.

Including safety-net providers in integrated delivery systems: issues and options for policymakers.

PubMed

Witgert, Katherine; Hess, Catherine

2012-08-01

Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup­porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.

Efficacy of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP) Primary Version

ERIC Educational Resources Information Center

DiPerna, James Clyde; Lei, Puiwa; Bellinger, Jillian; Cheng, Weiyi

2015-01-01

A multisite cluster randomized trial was conducted to examine the effects of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP; Elliott & Gresham, 2007) on students' classroom social behavior. The final sample included 432 students across 38 second grade classrooms. Social skills and problem behaviors were measured…

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Supervisory Neglect and Risk of Harm. Evidence from the Canadian Child Welfare System

ERIC Educational Resources Information Center

Ruiz-Casares, Monica; Trocme, Nico; Fallon, Barbara

2012-01-01

Objective: This study explores prevalence and characteristics associated with supervisory neglect and physical harm in children in the child welfare system in Canada. Methods: The sample included all substantiated primary maltreatment investigations in the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect excluding cases where…

Models for 60 double-lined binaries containing giants

NASA Astrophysics Data System (ADS)

Eggleton, Peter P.; Yakut, Kadri

2017-07-01

The observed masses, radii and temperatures of 60 medium- to long-period binaries, most of which contain a cool, evolved star and a hotter less evolved one, are compared with theoretical models which include (a) core convective overshooting, (b) mass-loss, possibly driven by dynamo action as in RS CVn binaries, and (c) tidal friction, including its effect on orbital period through magnetic braking. A reasonable fit is found in about 42 cases, but in 11 other cases the primaries appear to have lost either more mass or less mass than the models predict, and in 4 others the orbit is predicted to be either more or less circular than observed. Of the remaining three systems, two (γ Per and HR 8242) have a markedly 'overevolved' secondary, our explanation being that the primary component is the merged remnant of a former short-period sub-binary in a former triple system. The last system (V695 Cyg) defies any agreement at present. Mention is also made of three other systems (V643 Ori, OW Gem and V453 Cep), which are relevant to our discussion.

Conceptual studies for a mercury target circuit

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

Sigg, B.

1996-06-01

For the now favored target design of the European Spallation Source project, i.e. the version using mercury as target material, a basic concept of the primary system has been worked out. It does not include a detailed design of the various components of the target circuit, but tries to outline a feasible solution for the system. Besides the removal of the thermal power of about 3MW produced in the target by the proton beam, the primary system has to satisfy a number of other requirements related to processing, safety, and operation. The basic proposal uses an electromagnetic pump and amore » mercury-water intermediate heat excanger, but other alternatives are also being discussed. Basic safety requirements, i.e. protection against radiation and toxic mercury vapours, are satisfied by a design using an air-tight primary system containment, double-walled tubes in the intermediate heat exchanger, a fail-safe system for decay heat removal, and a remote handling facility for the active part of the system. Much engineering work has still to be done, because many details of the design of the mercury and gas processing systems remain to be clarified, the thermal-hydraulic components need further optimisation, the system for control and instrumentation is only known in outline and a through safety analysis will be required.« less

Primary care providers' lived experiences of genetics in practice.

PubMed

Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

2018-04-26

To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

78 FR 69520 - Designation of the Primary Freight Network

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

... NFN may fit into a multimodal National Freight System; and (5) suggestions for an urban-area route... Nation, to include goods movement in urban areas. Urban areas of 200,000 and above include a freight... Consideration for Critical Urban Freight Routes in the National Freight Network The DOT recognizes that many...

A snapshot of the organization and provision of primary care in Turkey

PubMed Central

2011-01-01

Background This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskişehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. Results Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. Conclusions The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous). PMID:21542904

Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

PubMed

Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

2018-05-09

In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Code System to Calculate Tornado-Induced Flow Material Transport.

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

ANDRAE, R. W.

1999-11-18

Version: 00 TORAC models tornado-induced flows, pressures, and material transport within structures. Its use is directed toward nuclear fuel cycle facilities and their primary release pathway, the ventilation system. However, it is applicable to other structures and can model other airflow pathways within a facility. In a nuclear facility, this network system could include process cells, canyons, laboratory offices, corridors, and offgas systems. TORAC predicts flow through a network system that also includes ventilation system components such as filters, dampers, ducts, and blowers. These ventilation system components are connected to the rooms and corridors of the facility to form amore » complete network for moving air through the structure and, perhaps, maintaining pressure levels in certain areas. The material transport capability in TORAC is very basic and includes convection, depletion, entrainment, and filtration of material.« less

Results of a coordination and shared clinical information programme between primary care and nephrology.

PubMed

García García, Manuel; Valenzuela Mújica, Mari Pau; Martínez Ocaña, Juan Carlos; Otero López, María del Sol; Ponz Clemente, Esther; López Alba, Thaïs; Gálvez Hernández, Enrique

2011-01-01

The high prevalence of chronic kidney disease (CKD) in the general population has created a need to coordinate specialised nephrology care and primary care. Although several systems have been developed to coordinate this process, published results are scarce and contradictory. To present the results of the application of a coordinated programme between nephrology care and primary care through consultations and a system of shared clinical information to facilitate communication and improve the criteria for referring patients. Elaboration of a coordinated care programme by the primary care management team and the nephrology department, based on the SEN-SEMFYC consensus document and a protocol for the study and management of arterial hypertension (AHT). Explanation and implementation in primary health care units. A directory of specialists’ consultations was created, both in-person and via e-mail. A continuous training programme in kidney disease and arterial hypertension was implemented in the in-person consultation sessions. The programme was progressively implemented over a three-year period (2007-2010) in an area of 426,000 inhabitants with 230 general practitioners. Use of a clinical information system named Salut en Xarxa that allows access to clinical reports, diagnoses, prescriptions, test results and clinical progression. Improved referral criteria between primary care and specialised nephrology service. Improved prioritisation of visits. Progressive increase in referrals denied by specialists (28.5% in 2009), accompanied by an explanatory report including suggestions for patient management. Decrease in first nephrology outpatient visits that have been referred from primary care (15% in 2009). Family doctors were generally satisfied with the improvement in communication and the continuous training programme. The main causes for denying referral requests were: patients >70 years with stage 3 CKD (44.15%); patients <70 years with stage 3a CKD (19.15%); albumin/creatinine ratio <500 mg/g (12.23%); non-secondary, non-refractory, essential AHT (11.17%). The general practitioners included in the programme showed great interest and no complaints were registered. The consultations improve adequacy and prioritisation of nephrology visits, allow for better communication between different levels of the health system, and offer systematic training for general practitioners to improve the management of nephrology patients. This process allows for referring nephrology patients with the most complex profiles to nephrology outpatient clinics.

Primary care at Swiss universities--current state and perspective.

PubMed

Tandjung, Ryan; Ritter, Catherine; Haller, Dagmar M; Tschudi, Peter; Schaufelberger, Mireille; Bischoff, Thomas; Herzig, Lilli; Rosemann, Thomas; Sommer, Johanna

2014-05-22

There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 - 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.

RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

PubMed

Engel, Charles C; Oxman, Thomas; Yamamoto, Christopher; Gould, Darin; Barry, Sheila; Stewart, Patrice; Kroenke, Kurt; Williams, John W; Dietrich, Allen J

2008-10-01

U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.

Reconstituting development of pancreatic intraepithelial neoplasia from primary human pancreas duct cells

PubMed Central

Lee, Jonghyeob; Snyder, Emily R.; Liu, Yinghua; Gu, Xueying; Wang, Jing; Flowers, Brittany M.; Kim, Yoo Jung; Park, Sangbin; Szot, Gregory L.; Hruban, Ralph H.; Longacre, Teri A.; Kim, Seung K.

2017-01-01

Development of systems that reconstitute hallmark features of human pancreatic intraepithelial neoplasia (PanINs), the precursor to pancreatic ductal adenocarcinoma, could generate new strategies for early diagnosis and intervention. However, human cell-based PanIN models with defined mutations are unavailable. Here, we report that genetic modification of primary human pancreatic cells leads to development of lesions resembling native human PanINs. Primary human pancreas duct cells harbouring oncogenic KRAS and induced mutations in CDKN2A, SMAD4 and TP53 expand in vitro as epithelial spheres. After pancreatic transplantation, mutant clones form lesions histologically similar to native PanINs, including prominent stromal responses. Gene expression profiling reveals molecular similarities of mutant clones with native PanINs, and identifies potential PanIN biomarker candidates including Neuromedin U, a circulating peptide hormone. Prospective reconstitution of human PanIN development from primary cells provides experimental opportunities to investigate pancreas cancer development, progression and early-stage detection. PMID:28272465

What keeps you strong? A systematic review identifying how primary health-care and aged-care services can support the well-being of older Indigenous peoples.

PubMed

Davy, Carol; Kite, Elaine; Aitken, Graham; Dodd, Garth; Rigney, Janice; Hayes, Jenny; Van Emden, Jan

2016-06-01

The objective of this systematic review was to identify primary health-care or aged-care strategies that have or could support the well-being of older Indigenous peoples. A search was undertaken of primary databases including Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature. Papers which reported on the perspectives of older Indigenous peoples, community members and provider participants were included. Findings were pooled using a meta-aggregative approach. Three high-level synthesised findings - maintaining Indigenous identity, promoting independence and delivering culturally safe care - were believed to be important for supporting the well-being of older Indigenous peoples. As physical independence often diminishes with age, having the support of culturally safe primary health-care and aged-care services that understand the importance of maintaining an Indigenous identity and promoting independence will be crucial for the well-being of older Indigenous peoples. © 2016 AJA Inc.

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’s perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system. PMID:24090138

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 improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system.

Severe Health-Related Quality of Life Impairment in Active Primary Sjögren's Syndrome and Patient-Reported Outcomes: Data From a Large Therapeutic Trial.

PubMed

Cornec, Divi; Devauchelle-Pensec, Valérie; Mariette, Xavier; Jousse-Joulin, Sandrine; Berthelot, Jean-Marie; Perdriger, Aleth; Puéchal, Xavier; Le Guern, Véronique; Sibilia, Jean; Gottenberg, Jacques-Eric; Chiche, Laurent; Hachulla, Eric; Yves Hatron, Pierre; Goeb, Vincent; Hayem, Gilles; Morel, Jacques; Zarnitsky, Charles; Dubost, Jean Jacques; Saliou, Philippe; Pers, Jacques Olivier; Seror, Raphaèle; Saraux, Alain

2017-04-01

To identify the principal determinants of health-related quality of life (HRQOL) impairment in patients with active primary Sjögren's syndrome (SS) participating in a large therapeutic trial, Tolerance and Efficacy of Rituximab in Primary Sjögren's Syndrome (TEARS). At the inclusion visit for the TEARS trial, 120 patients with active primary SS completed the Short Form 36 health survey (SF-36), a validated HRQOL assessment tool. Univariate then multivariate linear regression analyses were used to assess associations linking SF-36 physical and mental components to demographic data, patient-reported outcomes (symptom intensity assessments for dryness, pain, and fatigue, including the European League Against Rheumatism [EULAR] Sjögren's Syndrome Patient Reported Index [ESSPRI]), objective measures of dryness and autoimmunity, and physician evaluation of systemic activity (using the EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI]). SF-36 scores indicated marked HRQOL impairments in our population with active primary SS. Approximately one-third of the patients had low, moderate, and high systemic activity according to the ESSDAI. ESSPRI and ESSDAI scores were moderately but significantly correlated. The factors most strongly associated with HRQOL impairment were patient-reported symptoms, best assessed using the ESSPRI, with pain and ocular dryness intensity showing independent associations with HRQOL. Conversely, systemic activity level was not associated with HRQOL impairment in multivariate analyses, even in the patient subset with ESSDAI values indicating moderate-to-high systemic activity. The cardinal symptoms of primary SS (dryness, pain, and fatigue, best assessed using the ESSPRI) are stronger predictors of HRQOL impairment than systemic involvement (assessed by the ESSDAI) and should be used as end points in future therapeutic trials focusing on patients' well-being. New consensual and data-driven response criteria are needed for primary SS studies. © 2016, American College of Rheumatology.

Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City.

PubMed

Albu, Jeanine; Sohler, Nancy; Matti-Orozco, Brenda; Sill, Jordan; Baxter, Daniel; Burke, Gary; Young, Edwin

2013-01-01

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community-clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre-post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.

Isolation and Molecular Typing of Naegleria fowleri from the Brain of a Cow That Died of Primary Amebic Meningoencephalitis

PubMed Central

Visvesvara, Govinda S.; De Jonckheere, Johan F.; Sriram, Rama; Daft, Barbara

2005-01-01

Naegleria fowleri causes an acute and rapidly fatal central nervous system infection called primary amebic meningoencephalitis (PAM) in healthy children and young adults. We describe here the identification of N. fowleri isolated from the brain of one of several cows that died of PAM based on sequencing of the internal transcribed spacers, including the 5.8S rRNA genes. PMID:16081978

Ground difference compensating system

DOEpatents

Johnson, Kris W.; Akasam, Sivaprasad

2005-10-25

A method of ground level compensation includes measuring a voltage of at least one signal with respect to a primary ground potential and measuring, with respect to the primary ground potential, a voltage level associated with a secondary ground potential. A difference between the voltage level associated with the secondary ground potential and an expected value is calculated. The measured voltage of the at least one signal is adjusted by an amount corresponding to the calculated difference.

System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

PubMed

Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

2016-01-01

There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy. The findings identify areas of focus for development of barrier-driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health center performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.

Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

PubMed

Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

2017-12-01

Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for referral exist and could serve as the basis for a more robust system. Well-integrated acute care referral systems in low-income countries, like Liberia, may help to mitigate future public health crises by augmenting a country's capacity for emergency preparedness. Kim J , Barreix M , Babcock C , Bills CB . Acute care referral systems in Liberia: transfer and referral capabilities in a low-income country. Prehosp Disaster Med. 2017;32(6):642-650.

Envisioning an Ecologically Sustainable Campus At New England College

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

Paula Amato; Gregory Palmer

Appropriation funding for our project Ecologically Sustainable Campus - New England College (NH). 67.09. supported five environmental initiatives: (1) a wood pellet boiler for our Science Building, (2) solar hot water panels and systems for five campus buildings, (3) campus-wide energy lighting efficiency project, (4) new efficiency boiler system in Colby Residence Hall, and (5) energy efficient lighting system for the new artificial athletic turf field. (1) New England College purchased and installed a new wood pellet boiler in the Science Building. This new boiler serves as the primary heating source for this building. Our boiler was purchased through Newmore » England Wood Pellet, LLC, located in Jaffrey, New Hampshire. The boiler selected was a Swebo, P500. 300KW wood pellet boiler. The primary goals, objectives, and outcomes of this initiative include the installation of a wood pellet boiler system that is environmentally friendly, highly efficient, and represents a sustainable and renewable resource for New England College. This project was completed on December 15, 2010. (2) New England College purchased and installed solar hot water panels and systems for the Science Building, the Simon Center (student center), the H. Raymond Danforth Library, Gilmore Dining Hall, and Bridges Gymnasium. The College worked with Granite State Plumbing & Heating, LLC, located in Weare, New Hampshire on this project. The solar panels are manufactured by Heat Transfer; the product is Heat Transfer 30-tube collector panels (Evacuated Tube Type) with stainless steel hardware. The interior equipment includes Super Stor Ultra stainless steel super insulated storage tank, Taco 009 Bronze circulator pump, Solar Relay Control Pack, and a Taco Thermal Expansion Tank. The primary goals, objectives, and outcomes of this initiative will allow the College to utilize the sun as an energy resource. These solar hot water panels and systems will alleviate our dependency on fossil fuel as our primary fuel resource and provide a reliable energy source that supplies the hot water needs for sanitation, dishwashing at our dining facilities, and shower facilities for our athletes. This project initiative was completed on June 30, 2010. (3) New England College has completed energy efficiency lighting projects throughout campus, which included upgrades and new systems throughout our buildings. This project also installed efficiency controls for the Lee Clement Arena and refrigeration equipment in the Gilmore Dining Hall. The College worked with Atlantic Energy Solutions, located in Foxboro, Massachusetts on our 50/50 energy efficiency lighting project and campus-wide audit. The actual implementation of the project was completed by D. Poole Electrical Services, located in Center Barnstead, New Hampshire. The primary goals, objectives, and outcomes of this initiative were to install energy efficient lighting systems throughout our campus buildings, which ultimately will provide New England College with a more efficient way to manage and control its energy use. This project initiative was completed on February 15, 2010. (4) New England College purchased and installed a high efficiency and clean burning system for the Colby Residence Hall, which is the primary housing for our freshman. We purchased and installed two Buderus Boilers, model number G515/10 with two Riello Burners, model number RL 38/2. The College worked with Granite State Plumbing & Heating, LLS, located in Weare, New Hampshire on the installation of this high efficiency and clean burning system for the Colby Residence Hall. The primary goals, objectives, and outcomes for this initiative included the installation of a designed system of two boilers to provide redundancy for backup measures. This new system will provide New England College the flexibility to utilize just one smaller boiler to provide heat and hot water during non-peak periods thus continued reduction in energy use and our carbon footprint. This project initiative was completed on September 18, 2009. (5) New England College purchased and installed energy efficient lighting for our new artificial athletic turf field. The College selected Light-Structure Green lighting systems and worked with Musco Lighting, located in Oskaloosa. Iowa. The primary goals, objectives, and outcomes of this initiative were to install innovative lighting systems that significantly reduce energy costs and provide a high level of efficiency, resulting in overall utility savings to the College. This lighting technology combines the energy efficient equipment along with a focused lighting objective (field playing surface) to reduce the number of lighting heads needed to illuminate the playing surface to NCAA standards while reducing energy consumption by 50%. This project was completed on October 15, 2009.« less

77 FR 21099 - Public Water System Supervision Program Approval for the State of Ohio

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... the National Primary Drinking Water Regulations, including the Administrative Penalty Authority (APA... the APA since October 1, 1999, with amendments effective on October 17, 2003. Ohio EPA's revised...

Analysis of traffic growth rates

DOT National Transportation Integrated Search

2001-08-01

The primary objectives of this study were to determine patterns of traffic flow and develop traffic growth rates by traffic composition and highway type for Kentucky's system of highways. Additional subtasks included the following: 1) a literature se...

78 FR 58861 - Presidential Determination With Respect to Foreign Governments' Efforts Regarding Trafficking in...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... the United States Government; (4) has as its primary objective the improvement of Zimbabwe's legal system, including in areas that impact Zimbabwe's ability to investigate and prosecute trafficking cases...

Alternatives to steel grid decks - phase II.

DOT National Transportation Integrated Search

2012-09-01

The primary objective of this research project was to investigate alternatives to open grid steel decks for movable bridges. Three alternative deck systems, including aluminum deck, ultra-high performance concrete (UHPC)-high-strength steel (HSS) dec...

Infrastructure monitoring data management.

DOT National Transportation Integrated Search

2015-07-01

The primary objective of this project is to advance the development of a structural health monitoring : system (SHMS) for the Cut River Bridge. The scope includes performing an analysis from the fiber : optic strain gauge readings and making recommen...

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

PubMed Central

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

2015-01-01

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

Primary tuberculosis clinically presenting as gingival enlargement: a case report.

PubMed

Sharma, C G Dileep; Pradeep, A R; Karthikeyan, B V

2006-11-01

Tuberculosis is a chronic systemic granulomatous disease which rarely affects the oral cavity. Oral lesions can be either primary or secondary to systemic tuberculosis, the former being rare. This is a never-before reported case of primary tuberculosis presenting as a localized diffuse gingival enlargement in an 11-year-old Indian female patient. The diagnosis was reached through identification of positive histopathological features, Tuberculin test results, presence of anti-tubercular antibodies confirmed by a polymerase chain reaction. In view of the recent increase in the incidence of tuberculosis and the prevalence of the same, it is reasonable to include tuberculosis in the differential diagnosis of gingival enlargements. This is essential to avoid any serious complications for both the clinician and patient due to a delay in the diagnosis of such a rare but plausible oral condition.

Cooling system for a nuclear reactor

DOEpatents

Amtmann, Hans H.

1982-01-01

A cooling system for a gas-cooled nuclear reactor is disclosed which includes at least one primary cooling loop adapted to pass coolant gas from the reactor core and an associated steam generator through a duct system having a main circulator therein, and at least one auxiliary cooling loop having communication with the reactor core and adapted to selectively pass coolant gas through an auxiliary heat exchanger and circulator. The main and auxiliary circulators are installed in a common vertical cavity in the reactor vessel, and a common return duct communicates with the reactor core and intersects the common cavity at a junction at which is located a flow diverter valve operative to effect coolant flow through either the primary or auxiliary cooling loops.

Aircraft Engine Systems

NASA Technical Reports Server (NTRS)

Veres, Joseph

2001-01-01

This report outlines the detailed simulation of Aircraft Turbofan Engine. The objectives were to develop a detailed flow model of a full turbofan engine that runs on parallel workstation clusters overnight and to develop an integrated system of codes for combustor design and analysis to enable significant reduction in design time and cost. The model will initially simulate the 3-D flow in the primary flow path including the flow and chemistry in the combustor, and ultimately result in a multidisciplinary model of the engine. The overnight 3-D simulation capability of the primary flow path in a complete engine will enable significant reduction in the design and development time of gas turbine engines. In addition, the NPSS (Numerical Propulsion System Simulation) multidisciplinary integration and analysis are discussed.

The epidemiology of malpractice claims in primary care: a systematic review

PubMed Central

Wallace, E; Lowry, J; Smith, S M; Fahey, T

2013-01-01

Objectives The aim of this systematic review was to examine the epidemiology of malpractice claims in primary care. Design A computerised systematic literature search was conducted. Studies were included if they reported original data (≥10 cases) pertinent to malpractice claims, were based in primary care and were published in the English language. Data were synthesised using a narrative approach. Setting Primary care. Participants Malpractice claimants. Primary outcome Malpractice claim (defined as a written demand for compensation for medical injury). We recorded: medical misadventure cited in claims, missed/delayed diagnoses cited in claims, outcome of claims, prevalence of claims and compensation awarded to claimants. Results Of the 7152 articles retrieved by electronic search, a total of 34 studies met the inclusion criteria and were included in the narrative analysis. Twenty-eight studies presented data from medical indemnity malpractice claims databases and six studies presented survey data. Fifteen studies were based in the USA, nine in the UK, seven in Australia, one in Canada and two in France. The commonest medical misadventure resulting in claims was failure to or delay in diagnosis, which represented 26–63% of all claims across included studies. Common missed or delayed diagnoses included cancer and myocardial infarction in adults and meningitis in children. Medication error represented the second commonest domain representing 5.6–20% of all claims across included studies. The prevalence of malpractice claims in primary care varied across countries. In the USA and Australia when compared with other clinical disciplines, general practice ranked in the top five specialties accounting for the most claims, representing 7.6–20% of all claims. However, the majority of claims were successfully defended. Conclusions This review of malpractice claims in primary care highlights diagnosis and medication error as areas to be prioritised in developing educational strategies and risk management systems. PMID:23869100

Flight test experience and controlled impact of a remotely piloted jet transport aircraft

NASA Technical Reports Server (NTRS)

Horton, Timothy W.; Kempel, Robert W.

1988-01-01

The Dryden Flight Research Center Facility of NASA Ames Research Center (Ames-Dryden) and the FAA conducted the controlled impact demonstration (CID) program using a large, four-engine, remotely piloted jet transport airplane. Closed-loop primary flight was controlled through the existing onboard PB-20D autopilot which had been modified for the CID program. Uplink commands were sent from a ground-based cockpit and digital computer in conjunction with an up-down telemetry link. These uplink commands were received aboard the airplane and transferred through uplink interface systems to the modified PB-20D autopilot. Both proportional and discrete commands were produced by the ground system. Prior to flight tests, extensive simulation was conducted during the development of ground-based digital control laws. The control laws included primary control, secondary control, and racetrack and final approach guidance. Extensive ground checks were performed on all remotely piloted systems; however, piloted flight tests were the primary method and validation of control law concepts developed from simulation. The design, development, and flight testing of control laws and systems required to accomplish the remotely piloted mission are discussed.

Engineering the Future: Cell 6

NASA Technical Reports Server (NTRS)

Stahl, P. H.

2010-01-01

This slide presentation reviews the development of the James Webb Space Telescope (JWST), explaining the development using a systems engineering methodology. Included are slides showing the organizational chart, the JWST Science Goals, the size of the primary mirror, and full scale mockups of the JSWT. Also included is a review of the JWST Optical Telescope Requirements, a review of the preliminary design and analysis, the technology development required to create the JWST, with particular interest in the specific mirror technology that was required, and views of the mirror manufacturing process. Several slides review the process of verification and validation by testing and analysis, including a diagram of the Cryogenic Test Facility at Marshall, and views of the primary mirror while being tested in the cryogenic facility.

Aerospace Medicine and Biology: A continuing bibliography with indexes (supplement 259)

NASA Technical Reports Server (NTRS)

1984-01-01

A bibliography containing 476 documents introduced into the NASA scientific and technical information system in May 1984 is presented. The primary subject categories included are: life sciences, aerospace medicine, behavioral sciences, man/system technology, life support, and planetary biology. Topics extensively represented were space flight stress, man machine systems, weightlessness, human performance, mental performance, and spacecraft environments. Abstracts for each citation are given.

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

NASA Image and Video Library

1966-03-01

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

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol.

PubMed

Loignon, Christine; Hudon, Catherine; Boudreault-Fournier, Alexandrine; Dupéré, Sophie; Macaulay, Ann C; Pluye, Pierre; Gaboury, Isabelle; Haggerty, Jeannie L; Fortin, Martin; Goulet, Émilie; Lambert, Mireille; Pelissier-Simard, Luce; Boyer, Sophie; de Laat, Marianne; Lemire, Francine; Champagne, Louise; Lemieux, Martin

2013-03-11

Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations. This study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews. The proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty. By involving knowledge users, including service recipients, our study is more likely to produce a transformation of professional practices and encourage healthcare organizations to take into account the needs of persons living in poverty.

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol

PubMed Central

2013-01-01

Background Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations. Methods/design This study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews. Discussion The proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty. By involving knowledge users, including service recipients, our study is more likely to produce a transformation of professional practices and encourage healthcare organizations to take into account the needs of persons living in poverty. PMID:23497400

Orbital schwannomatosis in the absence of neurofibromatosis.

PubMed

Koktekir, Bengu Ekinci; Kim, H Jane; Geske, Mike; Bloomer, Michelle; Vagefi, Reza; Kersten, Robert C

2014-11-01

The aim of this study was to describe 3 cases of primary orbital schwannomatosis without associated systemic neurofibromatosis. This is a retrospective interventional study of 3 patients who presented with multiple, distinct masses in the orbit (n = 3) as well as in the hemiface (n = 1). The clinical presentation, imaging features, surgical procedures, and outcomes were defined. Two women and a man presented with of exophthalmos and diplopia. Pain was the most prominent complaint in 2 patients. None of the patients had associated systemic neurofibromatosis by history or examination. Radiologic evaluation with computed tomography or magnetic resonance imaging of orbit revealed multiple well-demarcated intraconal and extraconal masses. Masses were excised, and histopathology confirmed all masses to be schwannomas. Postoperative follow-up was uneventful with alleviation of primary complaints in all patients. Multiple orbital schwannomas (primary orbital schwannomatosis) may be observed in patients without systemic association of neurofibromatosis. Management includes surgical excision of the tumors to achieve relief from their mass effects.

Propulsion technology needs for advanced space transportation systems. [orbit maneuvering engine (space shuttle), space shuttle boosters

NASA Technical Reports Server (NTRS)

Gregory, J. W.

1975-01-01

Plans are formulated for chemical propulsion technology programs to meet the needs of advanced space transportation systems from 1980 to the year 2000. The many possible vehicle applications are reviewed and cataloged to isolate the common threads of primary propulsion technology that satisfies near term requirements in the first decade and at the same time establish the technology groundwork for various potential far term applications in the second decade. Thrust classes of primary propulsion engines that are apparent include: (1) 5,000 to 30,000 pounds thrust for upper stages and space maneuvering; and (2) large booster engines of over 250,000 pounds thrust. Major classes of propulsion systems and the important subdivisions of each class are identified. The relative importance of each class is discussed in terms of the number of potential applications, the likelihood of that application materializing, and the criticality of the technology needed. Specific technology programs are described and scheduled to fulfill the anticipated primary propulsion technology requirements.

Flight test experience and controlled impact of a large, four-engine, remotely piloted airplane

NASA Technical Reports Server (NTRS)

Kempel, R. W.; Horton, T. W.

1985-01-01

A controlled impact demonstration (CID) program using a large, four engine, remotely piloted transport airplane was conducted. Closed loop primary flight control was performed from a ground based cockpit and digital computer in conjunction with an up/down telemetry link. Uplink commands were received aboard the airplane and transferred through uplink interface systems to a highly modified Bendix PB-20D autopilot. Both proportional and discrete commands were generated by the ground pilot. Prior to flight tests, extensive simulation was conducted during the development of ground based digital control laws. The control laws included primary control, secondary control, and racetrack and final approach guidance. Extensive ground checks were performed on all remotely piloted systems. However, manned flight tests were the primary method of verification and validation of control law concepts developed from simulation. The design, development, and flight testing of control laws and the systems required to accomplish the remotely piloted mission are discussed.

ASHRAE's new Chiller Heat Recovery Application Guide

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

Dorgan, C.B.; Dorgan, C.E.

2000-07-01

The new Chiller Heat Recovery Application Guide, published by the American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE), provides a comprehensive reference manual on the options available for chiller heat recovery. The information in the guide will assist engineers, owners, and system operators in evaluating the potential of integrating chiller heat recovery into their cooling and heating systems. The primary focus is on new construction and applications where a chiller is being replaced due to inefficiency, high operating and maintenance (O and M) costs, or elimination of refrigerants containing ozone-depleting chemicals known as CFC/HCFCs. While chiller systems for commercialmore » buildings are the primary focus of the guide, the information and procedures also apply to industrial heat pumps. The function of this paper is to highlight key information contained in the guide, including the major benefits of chiller heat recovery, primary candidates, and application procedures. A description of the guide's general format and contents is also provided.« less

[Pilot plan for a mobile health communication and monitoring system for people with diabetes].

PubMed

Alcayaga, Claudia; Pérez, Janet Carola; Bustamante, Claudia; Campos, Solange; Lange, Ilta; Zuñiga, Francisca

2014-01-01

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review.

PubMed

Braithwaite, Jeffrey; Testa, Luke; Lamprell, Gina; Herkes, Jessica; Ludlow, Kristiana; McPherson, Elise; Campbell, Margie; Holt, Joanna

2017-11-12

The sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system. The protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies. As no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Hugo, Jacques

The software application is called "HFE-Trace". This is an integrated method and tool for the management of Human Factors Engineering analyses and related data. Its primary purpose is to support the coherent and consistent application of the nuclear industry's best practices for human factors engineering work. The software is a custom Microsoft® Access® application. The application is used (in conjunction with other tools such as spreadsheets, checklists and normal documents where necessary) to collect data on the design of a new nuclear power plant from subject matter experts and other sources. This information is then used to identify potential systemmore » and functional breakdowns of the intended power plant design. This information is expanded by developing extensive descriptions of all functions, as well as system performance parameters, operating limits and constraints, and operational conditions. Once these have been verified, the human factors elements are added to each function, including intended operator role, function allocation considerations, prohibited actions, primary task categories, and primary work station. In addition, the application includes a computational method to assess a number of factors such as system and process complexity, workload, environmental conditions, procedures, regulations, etc.) that may shape operator performance. This is a unique methodology based upon principles described in NUREG/CR-3331 ("A methodology for allocating nuclear power plant control functions to human or automatic control") and it results in a semi-quantified allocation of functions to three or more levels of automation for a conceptual automation system. The aggregate of all this information is then linked to the Task Analysis section of the application where the existing information on all operator functions is transformed into task information and ultimately into design requirements for Human-System Interfaces and Control Rooms. This final step includes assessment of methods to prevent potential operator errors.« less

Measuring value for money: a scoping review on economic evaluation of health information systems

PubMed Central

Bassi, Jesdeep; Lau, Francis

2013-01-01

Objective To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations. Materials and methods We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed. Results Forty-two papers were selected and 33 were deemed high quality (scores ≥8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative. Conclusions We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified. PMID:23416247

Calibrating the metallicity of M dwarfs in wide physical binaries with F-, G-, and K- primaries - I: High-resolution spectroscopy with HERMES: stellar parameters, abundances, and kinematics

NASA Astrophysics Data System (ADS)

Montes, D.; González-Peinado, R.; Tabernero, H. M.; Caballero, J. A.; Marfil, E.; Alonso-Floriano, F. J.; Cortés-Contreras, M.; González Hernández, J. I.; Klutsch, A.; Moreno-Jódar, C.

2018-05-01

We investigated almost 500 stars distributed among 193 binary or multiple systems made of late-F, G-, or early-K primaries and late-K or M dwarf companion candidates. For all of them, we compiled or measured coordinates, J-band magnitudes, spectral types, distances, and proper motions. With these data, we established a sample of 192 physically bound systems. In parallel, we carried out observations with HERMES/Mercator and obtained high-resolution spectra for the 192 primaries and five secondaries. We used these spectra and the automatic STEPAR code for deriving precise stellar atmospheric parameters: Teff, log g, ξ, and chemical abundances for 13 atomic species, including [Fe/H]. After computing Galactocentric space velocities for all the primary stars, we performed a kinematic analysis and classified them in different Galactic populations and stellar kinematic groups of very different ages, which match our own metallicity determinations and isochronal age estimations. In particular, we identified three systems in the halo and 33 systems in the young Local Association, Ursa Major and Castor moving groups, and IC 2391 and Hyades Superclusters. We finally studied the exoplanet-metallicity relation in our 193 primaries and made a list 13 M-dwarf companions with very high metallicity that can be the targets of new dedicated exoplanet surveys. All in all, our dataset will be of great help for future works on the accurate determination of metallicity of M dwarfs.

Instrumentation & Data Acquisition System (D AS) Engineer

NASA Technical Reports Server (NTRS)

Jackson, Markus Deon

2015-01-01

The primary job of an Instrumentation and Data Acquisition System (DAS) Engineer is to properly measure physical phenomenon of hardware using appropriate instrumentation and DAS equipment designed to record data during a specified test of the hardware. A DAS system includes a CPU or processor, a data storage device such as a hard drive, a data communication bus such as Universal Serial Bus, software to control the DAS system processes like calibrations, recording of data and processing of data. It also includes signal conditioning amplifiers, and certain sensors for specified measurements. My internship responsibilities have included testing and adjusting Pacific Instruments Model 9355 signal conditioning amplifiers, writing and performing checkout procedures, writing and performing calibration procedures while learning the basics of instrumentation.

100-kWe lunar/Mars surface power utilizing the SP-100 reactor with dynamic conversion

NASA Technical Reports Server (NTRS)

Harty, Richard B.; Mason, Lee S.

1992-01-01

Results are presented from a study of the coupling of an SP-100 nuclear reactor with either a Stirling or Brayton power system, at the 100 kWe level, for a power generating system suitable for operation in the lunar and Martian surface environments. In the lunar environment, the reactor and primary coolant loop would be contained in a guard vessel to protect from a loss of primary loop containment. For Mars, all refractory components, including the reactor, coolant, and power conversion components will be contained in a vacuum vessel for protection against the CO2 environment.

Difference method to search for the anisotropy of primary cosmic radiation

NASA Astrophysics Data System (ADS)

Pavlyuchenko, V. P.; Martirosov, R. M.; Nikolskaya, N. M.; Erlykin, A. D.

2018-01-01

The original difference method used in the search for an anisotropy of primary cosmic radiation at the knee region of its energy spectrum is considered. Its methodical features and properties are analyzed. It is shown that this method, in which properties of particle fluxes (rather than an intensity) are investigated, is stable against random experimental errors and allows one to separate anomalies connected with the laboratory coordinate system from anomalies in the celestial coordinate system. The method uses the multiple scattering of charged particles in the magnetic fields of the Galaxy to study the whole celestial sphere, including the regions outside the line of sight of the installation.

Integrating disease management into the outpatient delivery system during and after managed care.

PubMed

Villagra, Victor G

2004-01-01

Managed care introduced disease management as a replacement strategy to utilization management. The focus changed from influencing treatment decisions to supporting self-care and compliance. Disease management rendered operational many elements of the chronic care model, but it did so outside the delivery system, thus escaping the financial limitations, cultural barriers, and inertia inherent in effecting radical change from within. Medical management "after managed care" should include the functional and structural integration of disease management with primary care clinics. Such integration would supply the infrastructure that primary care physicians need to coordinate the care of chronically ill patients more effectively.

Device and method for redirecting electromagnetic signals

DOEpatents

Garcia, Ernest J.

1999-01-01

A device fabricated to redirect electromagnetic signals, the device including a primary driver adapted to provide a predetermined force, a linkage system coupled to the primary driver, a pusher rod rotationally coupled to the linkage system, a flexible rod element attached to the pusher rod and adapted to buckle upon the application of the predetermined force, and a mirror structure attached to the flexible rod element at one end and to the substrate at another end. When the predetermined force buckles the flexible rod element, the mirror structure and the flexible rod element both move to thereby allow a remotely-located electromagnetic signal directed towards the device to be redirected.

'Systemic Failures' and 'Human Error' in Canadian TSB Aviation Reports Between 1996 and 2002

NASA Technical Reports Server (NTRS)

Holloway, C. M.; Johnson, C. W.

2004-01-01

This paper describes the results of an independent analysis of the primary and contributory causes of aviation accidents in Canada between 1996 and 2003. The purpose of the study was to assess the comparative frequency of a range of causal factors in the reporting of these adverse events. Our results suggest that the majority of these high consequence accidents were attributed to human error. A large number of reports also mentioned wider systemic issues, including the managerial and regulatory context of aviation operations. These issues are more likely to appear as contributory rather than primary causes in this set of accident reports.

Calculation of natural convection test at Phenix using the NETFLOW++ code

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

Mochizuki, H.; Kikuchi, N.; Li, S.

2012-07-01

The present paper describes modeling and analyses of a natural convection of the pool-type fast breeder reactor Phenix. The natural convection test was carried out as one of the End of Life Tests of the Phenix. Objective of the present study is to assess the applicability of the NETFLOW++ code which has been verified thus far using various water facilities and validated using the plant data of the loop-type FBR 'Monju' and the loop-type experimental fast reactor 'Joyo'. The Phenix primary heat transport system is modeled based on the benchmark documents available from IAEA. The calculational model consists of onlymore » the primary heat transport system with boundary conditions on the secondary-side of IHX. The coolant temperature at the primary pump inlet, the primary coolant temperature at the IHX inlet and outlet, the secondary coolant temperatures and other parameters are calculated by the code where the heat transfer between the hot and cold pools is explicitly taken into account. A model including the secondary and tertiary systems was prepared, and the calculated results also agree well with the measured data in general. (authors)« less

Surgical Management of Metastatic Disease.

PubMed

Keung, Emily Z; Fairweather, Mark; Raut, Chandrajit P

2016-10-01

Sarcomas are rare cancers of mesenchymal cell origin that include many histologic subtypes and molecularly distinct entities. For primary resectable sarcoma, surgery is the mainstay of treatment. Despite treatment, approximately 50% of patients with soft tissue sarcoma are diagnosed with or develop distant metastases, significantly affecting their survival. Although systemic therapy with conventional chemotherapy remains the primary treatment modality for those with metastatic sarcoma, increased survival has been achieved in select patients who receive multimodality therapy, including surgery, for their metastatic disease. This article provides an overview of the literature on surgical management of pulmonary and hepatic sarcoma metastases. Copyright © 2016 Elsevier Inc. All rights reserved.

[Systematization of primary headache: current and future prospects].

PubMed

Odinak, M M; Iskra, D A

2014-02-01

The article is devoted to the current state of the problem of systematization of primary headaches and main clinical forms. The conceptual evolution of ideas about the classification of certain options of cephalgia and identified major trends for its improvement is given. Verification of types and subtypes of individual cephalgia can present a significant challenge even for experienced neurologists, neurosurgeons, and internists. In this regard in most European countries and the US. have set up specialized centers for the treatment of headaches. Concluded that in the short term in the national health care system, including. Including the Armed Forces, it is advisable to create such centers.

Liquidus Projections of Bi-Se-Ga and Bi-Se-Te Ternary Systems

NASA Astrophysics Data System (ADS)

Lin, Po-han; Chen, Sinn-wen; Hwang, Jenn-dong; Chu, Hsu-shen

2016-12-01

This study determines the liquidus projections of both Bi-Se-Ga and Bi-Se-Te ternary systems which are constituent ternary systems of promising Bi-Se-Te-Ga thermoelectric materials. Ternary Bi-Se-Ga and Bi-Se-Te alloys are prepared. Their primary solidification phases are experimentally determined, and thermal analysis experiments are carried out. The liquidus projections are determined based on the ternary experimental results and phase diagrams of constituent binary systems. The Bi-Se-Ga system includes seven primary solidification phases, Bi, Ga, GaSe, Ga2Se3, Se, Bi2Se3, and (Bi2)n(Bi2Se3)m. In the Bi-Se-Te system, there are five primary solidification phases, Bi, (Bi2)n(Bi2Te3)m, Bi2(Se,Te)3, (Se,Te), and (Bi2)n(Bi2Se3)m. Both the (Bi2)n(Bi2Te3)m and (Bi2)n(Bi2Se3)m phases are not a single phase, but a collection of series undetermined phases. Large miscibility gaps are observed in the Bi-Se-Ga system. The temperatures of the invariant reactions, Liquid + Bi + GaSe = Ga and Liquid + Ga2Se3 = Bi + GaSe, are at 495 K (222 °C) and 533 K (260 °C), respectively.

Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning.

PubMed

Alcaide-Leon, P; Dufort, P; Geraldo, A F; Alshafai, L; Maralani, P J; Spears, J; Bharatha, A

2017-06-01

Accurate preoperative differentiation of primary central nervous system lymphoma and enhancing glioma is essential to avoid unnecessary neurosurgical resection in patients with primary central nervous system lymphoma. The purpose of the study was to evaluate the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma and enhancing glioma. Seventy-one adult patients with enhancing gliomas and 35 adult patients with primary central nervous system lymphomas were included. The tumors were manually contoured on contrast-enhanced T1WI, and the resulting volumes of interest were mined for textural features and subjected to a support vector machine-based machine-learning protocol. Three readers classified the tumors independently on contrast-enhanced T1WI. Areas under the receiver operating characteristic curves were estimated for each reader and for the support vector machine classifier. A noninferiority test for diagnostic accuracy based on paired areas under the receiver operating characteristic curve was performed with a noninferiority margin of 0.15. The mean areas under the receiver operating characteristic curve were 0.877 (95% CI, 0.798-0.955) for the support vector machine classifier; 0.878 (95% CI, 0.807-0.949) for reader 1; 0.899 (95% CI, 0.833-0.966) for reader 2; and 0.845 (95% CI, 0.757-0.933) for reader 3. The mean area under the receiver operating characteristic curve of the support vector machine classifier was significantly noninferior to the mean area under the curve of reader 1 ( P = .021), reader 2 ( P = .035), and reader 3 ( P = .007). Support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma. © 2017 by American Journal of Neuroradiology.

Apollo experience report: Guidance and control systems - Digital autopilot design development

NASA Technical Reports Server (NTRS)

Peters, W. H.; Cox, K. J.

1973-01-01

The development of the Apollo digital autopilots (the primary attitude control systems that were used for all phases of the lunar landing mission) is summarized. This report includes design requirements, design constraints, and design philosophy. The development-process functions and the essential information flow paths are identified. Specific problem areas that existed during the development are included. A discussion is also presented on the benefits inherent in mechanizing attitude-controller logic and dynamic compensation in a digital computer.

Describing the content of primary care: limitations of Canadian billing data.

PubMed

Katz, Alan; Halas, Gayle; Dillon, Michael; Sloshower, Jordan

2012-02-15

Primary health care systems are designed to provide comprehensive patient care. However, the ICD 9 coding system used for billing purposes in Canada neither characterizes nor captures the scope of clinical practice or complexity of physician-patient interactions. This study aims to describe the content of primary care clinical encounters and examine the limitations of using administrative data to capture the content of these visits. Although a number of U.S studies have described the content of primary care encounters, this is the first Canadian study to do so. Study-specific data collection forms were completed by 16 primary care physicians in community health and family practice clinics in Winnipeg, Manitoba, Canada. The data collection forms were completed immediately following the patient encounter and included patient and visit characteristics, such as primary reason for visit, topics discussed, actions taken, degree of complexity as well as diagnosis and ICD-9 codes. Data was collected for 760 patient encounters. The diagnostic codes often did not reflect the dominant topic of the visit or the topic requiring the most amount of time. Physicians often address multiple problems and provide numerous services thus increasing the complexity of care. This is one of the first Canadian studies to critically analyze the content of primary care clinical encounters. The data allowed a greater understanding of primary care clinical encounters and attests to the deficiencies of singular ICD-9 coding which fails to capture the comprehensiveness and complexity of the primary care encounter. As primary care reform initiatives in the U.S and Canada attempt to transform the way family physicians deliver care, it becomes increasingly important that other tools for structuring primary care data are considered in order to help physicians, researchers and policy makers understand the breadth and complexity of primary care.

30 CFR 250.917 - What are the CVA's primary duties during the fabrication phase?

Code of Federal Regulations, 2011 CFR

2011-07-01

... overall structure, including any turrets, turret-and-hull interfaces, any mooring line and chain and riser... must also consider: (i) Drilling, production, and pipeline risers, and riser tensioning systems (at...

Primary Macroglobulinemia

PubMed Central

Edwards, A. M.; Costopoulous, L. B.; Bell, H. E.

1964-01-01

Clinical features presented by a patient with primary macroglobulinemia over a four-year period included cachexia, weight loss, bleeding tendency, anemia, lymphadenopathy, hepatosplenomegaly and recurrent pulmonary bacterial infections. Immunoelectrophoresis demonstrated the presence of a β2 macroglobulin which, on ultracentrifugation, was found to have a sedimentation constant of 14.9 S20, w; this macroglobulin constituted over 40% of the total serum protein. Postmortem findings included the typical “naked” lymphocyte infiltration of the reticuloendothelial system, with septic embolization from a terminal Gram-negative bacteremia, associated with a mesenteric vascular occlusion. A feature of particular interest was the antemortem appearance of gas in the portal venous system, shown on two abdominal scout radiographs taken one and two hours before death. The diagnostic significance of this rare radiologic sign is discussed. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13Fig. 14Fig. 15 PMID:14226112

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

PubMed

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

2017-06-05

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

NASA'S Water Resources Element Within the Applied Sciences Program

NASA Technical Reports Server (NTRS)

Toll, David; Doorn, Bradley; Engman, Edwin

2011-01-01

The NASA Earth Systems Division has the primary responsibility for the Applied Science Program and the objective to accelerate the use of NASA science results in applications to help solve problems important to society and the economy. The primary goal of the NASA Applied Science Program is to improve future and current operational systems by infusing them with scientific knowledge of the Earth system gained through space-based observation, assimilation of new observations, and development and deployment of enabling technologies, systems, and capabilities. This paper discusses major problems facing water resources managers, including having timely and accurate data to drive their decision support tools. It then describes how NASA's science and space based satellites may be used to overcome this problem. Opportunities for the water resources community to participate in NASA's Water Resources Applications Program are described.

Ultracool dwarf benchmarks with Gaia primaries

NASA Astrophysics Data System (ADS)

Marocco, F.; Pinfield, D. J.; Cook, N. J.; Zapatero Osorio, M. R.; Montes, D.; Caballero, J. A.; Gálvez-Ortiz, M. C.; Gromadzki, M.; Jones, H. R. A.; Kurtev, R.; Smart, R. L.; Zhang, Z.; Cabrera Lavers, A. L.; García Álvarez, D.; Qi, Z. X.; Rickard, M. J.; Dover, L.

2017-10-01

We explore the potential of Gaia for the field of benchmark ultracool/brown dwarf companions, and present the results of an initial search for metal-rich/metal-poor systems. A simulated population of resolved ultracool dwarf companions to Gaia primary stars is generated and assessed. Of the order of ˜24 000 companions should be identifiable outside of the Galactic plane (|b| > 10 deg) with large-scale ground- and space-based surveys including late M, L, T and Y types. Our simulated companion parameter space covers 0.02 ≤ M/M⊙ ≤ 0.1, 0.1 ≤ age/Gyr ≤ 14 and -2.5 ≤ [Fe/H] ≤ 0.5, with systems required to have a false alarm probability <10-4, based on projected separation and expected constraints on common distance, common proper motion and/or common radial velocity. Within this bulk population, we identify smaller target subsets of rarer systems whose collective properties still span the full parameter space of the population, as well as systems containing primary stars that are good age calibrators. Our simulation analysis leads to a series of recommendations for candidate selection and observational follow-up that could identify ˜500 diverse Gaia benchmarks. As a test of the veracity of our methodology and simulations, our initial search uses UKIRT Infrared Deep Sky Survey and Sloan Digital Sky Survey to select secondaries, with the parameters of primaries taken from Tycho-2, Radial Velocity Experiment, Large sky Area Multi-Object fibre Spectroscopic Telescope and Tycho-Gaia Astrometric Solution. We identify and follow up 13 new benchmarks. These include M8-L2 companions, with metallicity constraints ranging in quality, but robust in the range -0.39 ≤ [Fe/H] ≤ +0.36, and with projected physical separation in the range 0.6 < s/kau < 76. Going forward, Gaia offers a very high yield of benchmark systems, from which diverse subsamples may be able to calibrate a range of foundational ultracool/sub-stellar theory and observation.

Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System.

PubMed

Patel, Malhar P; Schettini, Priscille; O'Leary, Colin P; Bosworth, Hayden B; Anderson, John B; Shah, Kevin P

2018-05-01

Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016. The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments. Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates. The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors.

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review

PubMed Central

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-01-01

Abstract Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. PMID:28453713

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

integrated Earth System Model

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

Jones, Andew; Di Vittorio, Alan; Collins, William

The integrated Earth system model (iESM) has been developed as a new tool for projecting the joint human/climate system. The iESM is based upon coupling an integrated assessment model (IAM) and an Earth system model (ESM) into a common modeling infrastructure. IAMs are the primary tool for describing the human-Earth system, including the sources of global greenhouse gases (GHGs) and short-lived species (SLS), land use and land cover change (LULCC), and other resource-related drivers of anthropogenic climate change. ESMs are the primary scientific tools for examining the physical, chemical, and biogeochemical impacts of human-induced changes to the climate system. Themore » iESM project integrates the economic and human-dimension modeling of an IAM and a fully coupled ESM within a single simulation system while maintaining the separability of each model if needed. Both IAM and ESM codes are developed and used by large communities and have been extensively applied in recent national and international climate assessments. By introducing heretofore-omitted feedbacks between natural and societal drivers, we can improve scientific understanding of the human-Earth system dynamics. Potential applications include studies of the interactions and feedbacks leading to the timing, scale, and geographic distribution of emissions trajectories and other human influences, corresponding climate effects, and the subsequent impacts of a changing climate on human and natural systems.« less

The Light That Doesn't Fail

NASA Technical Reports Server (NTRS)

1989-01-01

Rayovac Corporation's Luma 2 flashlight incorporates NASA's systems redundancy. The company also received assistance from NERAC. The flashlight has an extra-bright Super Krypton primary bulb and an independent backup system including a separate lithium power cell (a NASA developed technology), its own bulb and switch with corrosion proof sealed contacts. NERAC has also assisted Rayovac in developing other products.

Data and Network Science for Noisy Heterogeneous Systems

ERIC Educational Resources Information Center

Rider, Andrew Kent

2013-01-01

Data in many growing fields has an underlying network structure that can be taken advantage of. In this dissertation we apply data and network science to problems in the domains of systems biology and healthcare. Data challenges in these fields include noisy, heterogeneous data, and a lack of ground truth. The primary thesis of this work is that…

Incorporating English Learner Progress into State Accountability Systems

ERIC Educational Resources Information Center

Goldschmidt, Pete; Hakuta, Kenji

2017-01-01

The Every Student Succeeds Act (ESSA) proposes changes in how states include the nation's growing population of English Learners (ELs) into the accountability system. The purpose of this paper is to identify key issues and questions that might be considered and explored by state decision makers in this area. Our primary audience is anyone in a…

Methylphenidate Transdermal System in Adults with Past Stimulant Misuse: An Open-Label Trial

ERIC Educational Resources Information Center

McRae-Clark, Aimee L.; Brady, Kathleen T.; Hartwell, Karen J.; White, Kathleen; Carter, Rickey E.

2011-01-01

Objective: This 8-week, open-label trial assessed the efficacy of methylphenidate transdermal system (MTS) in 14 adult individuals diagnosed with ADHD and with a history of stimulant misuse, abuse, or dependence. Method: The primary efficacy endpoint was the Wender-Reimherr Adult ADHD Scale (WRAADS), and secondary efficacy endpoints included the…

Lecture Capture with Real-Time Rearrangement of Visual Elements: Impact on Student Performance

ERIC Educational Resources Information Center

Yu, P.-T.; Wang, B.-Y.; Su, M.-H.

2015-01-01

The primary goal of this study is to create and test a lecture-capture system that can rearrange visual elements while recording is still taking place, in such a way that student performance can be positively influenced. The system we have devised is capable of integrating and rearranging multimedia sources, including learning content, the…

Turkish Primary Science Teachers' Perceptions of an Ideal Teacher Education System

ERIC Educational Resources Information Center

Korkmaz, Hunkar; Altindag, Ahmet

2017-01-01

The goals of this descriptive study were to determine Turkish pre-service science teachers' perceptions of an ideal teacher education system. The sample consisted of 137 pre-service teachers, including 74 females and 63 males. The questionnaire was based on open-ended questions and was developed to investigate ideal teacher education system…

Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel.

PubMed

Ayalon, Liat; Karkabi, Khaled; Bleichman, Igor; Fleischmann, Silvia; Goldfracht, Margalit

2016-03-01

The present study examined physicians' perceived barriers to the management of mental illness in primary care settings in Israel. Seven focus groups that included a total of 52 primary care Israeli physicians were conducted. Open coding analysis was employed, consisting of constant comparisons within and across interviews. Three major themes emerged: (a) barriers to the management of mental illness at the individual-level, (b) barriers to the management of mental illness at the system-level, and (c) the emotional ramifications that these barriers have on physicians. The findings highlight the parallelism between the experiences of primary care physicians and their patients. The findings also stress the need to attend to physicians' emotional reactions when working with patients who suffer from mental illness and to better structure mental health treatment in primary care.

Demonstration of fully coupled simplified extended station black-out accident simulation with RELAP-7

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

Zhao, Haihua; Zhang, Hongbin; Zou, Ling

2014-10-01

The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The RELAP-7 code develop-ment effort started in October of 2011 and by the end of the second development year, a number of physical components with simplified two phase flow capability have been de-veloped to support the simplified boiling water reactor (BWR) extended station blackout (SBO) analyses. The demonstration case includes the major components for the primary system of a BWR, as well as the safety system components for the safety relief valve (SRV), the reactor core isolation cooling (RCIC)more » system, and the wet well. Three scenar-ios for the SBO simulations have been considered. Since RELAP-7 is not a severe acci-dent analysis code, the simulation stops when fuel clad temperature reaches damage point. Scenario I represents an extreme station blackout accident without any external cooling and cooling water injection. The system pressure is controlled by automatically releasing steam through SRVs. Scenario II includes the RCIC system but without SRV. The RCIC system is fully coupled with the reactor primary system and all the major components are dynamically simulated. The third scenario includes both the RCIC system and the SRV to provide a more realistic simulation. This paper will describe the major models and dis-cuss the results for the three scenarios. The RELAP-7 simulations for the three simplified SBO scenarios show the importance of dynamically simulating the SRVs, the RCIC sys-tem, and the wet well system to the reactor safety during extended SBO accidents.« less

What constitutes an effective community pharmacy?--development of a preliminary model of organizational effectiveness through concept mapping with multiple stakeholders.

PubMed

Scahill, S L; Harrison, J; Carswell, P

2010-08-01

To develop a multi-constituent model of organizational effectiveness for community pharmacy. Using Concept Systems software, a project with 14 stakeholders included a three stage process: (i) face to face brainstorming to generate statements describing what constitutes an effective community pharmacy, followed by (ii) statement reduction and approval by participants, followed by (iii) sorting of the statements into themes with rating of each statement for importance. Primary care in a government-funded, national health care system. A multi-constituent group representing policy-makers and health care providers including; community pharmacy, professional pharmacy organizations, primary health care funders and policy-makers, general practitioners and general practice support organizations. Statement clusters included: 'has safe and effective workflows', 'contributes to the safe use of medicines', 'manages human resources and has leadership', 'has a community focus', 'is integrated within primary care', 'is a respected innovator', 'provides health promotion and preventative care', 'communicates and advocates'. These clusters fit into a quadrant model setting stakeholder focus against role development. The poles of stakeholder focus are 'internal capacity' and 'social utility'. The poles of role development are labelled 'traditional safety roles' and 'integration and innovation'. Organizational effectiveness in community pharmacy includes the internal and external focus of the organization and role development. Our preliminary model describes an effective community pharmacy and provides a platform for investigation of the factors that may influence the organizational effectiveness of individual community pharmacies now and into the future.

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 government programs. These standards require GPs to have ready access to spirometry, but do not require every practice to have a spirometer. The initial assessment and management of acute respiratory illnesses currently seen in primary health care settings will continue, but for this to occur the sector may have to adapt traditional workforce roles because of workforce shortages. In the longer term, climate change and migration patterns may result in changes in the epidemiology of regions and populations. The health system will continue to reform incrementally in order to deliver improved chronic disease care, including care of people with asthma and COPD. The incoming Labor Government's National Primary Health Care Strategy provides the high level policy opportunity to drive reform. Australia's complex primary health care system is incrementally changing from one of exclusive acute- and episodic-care orientation in both the public and private sectors to a system that delivers effective anticipatory chronic disease care as well. From a national policy perspective, asthma has received most attention. COPD and possibly other respiratory diseases may now receive focus.

A design assessment of multiwall, metallic stand-off, and RSI reusable thermal protection systems including space shuttle application

NASA Technical Reports Server (NTRS)

Jackson, L. R.; Dixon, S. C.

1980-01-01

The design and assessment of reusable surface insulation (RSI), metallic stand off and multiwall thermal protection systems (TPS) is discussed. Multiwall TPS is described in some detail, and analyses useful for design of multiwall are included. Results indicate that multiwall has the potential to satisfy the TPS design goals better than the other systems. The total mass of the stand-off TPS and of the metallic systems require less primary structure mass than the RSI system, since the nonbuckling skin criteria required for RSI may be removed. Continued development of multiwall TPS is required to verify its potential and to provide the necessary data base for design.

A Phase 1-2 Multi-Center Study Evaluating Axicabtagene Ciloleucel in Subjects With Refractory Aggressive Non-Hodgkin Lymphoma (ZUMA-1)

ClinicalTrials.gov

2018-06-18

Refractory Diffuse Large B Cell Lymphoma; Refractory Primary Mediastinal B Cell Lymphoma; Refractory Transformed Follicular Lymphoma; Relapsed/Refractory Transplant Ineligible Diffuse Large B Cell Lymphoma; Relapsed/Refractory Transplant Ineligible Primary Mediastinal B Cell Lymphoma; Relapsed/Refractory Transplant Ineligible Transformed Follicular Lymphoma; Relapsed/Refractory Large B Cell Lymphoma Including DLBCL, PMBCL, TFL and HGBCL After Two Systemic Lines of Therapy" in Phase 2 Expanded Cohorts

Metastatic Male Ductal Breast Cancer Mimicking Obstructing Primary Colon Cancer

PubMed Central

Koleilat, Issam; Syal, Anil; Hena, Muhammad

2010-01-01

Male breast cancer comprises only about 1% of all breast cancers. Commonly, sites of metastases include the central nervous system, lungs, bones, and even liver. In females, extrahepatic gastrointestinal metastases are unusual but have been reported with various clinical presentations. We are reporting the first case of a male patient with a history of ductal breast carcinoma that developed colonic metastasis and presented with mechanical large bowel obstruction masquerading as primary colon cancer. PMID:23675178

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 2: Design options

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 2 is the development of an information base that will support the conduct of trade studies and provide sufficient data to make key design/programmatic decisions. This includes: (1) the establishment of option categories that are most likely to influence Space Station Data System (SSDS) definition; (2) the identification of preferred options in each category; and (3) the characterization of these options with respect to performance attributes, constraints, cost and risk. This volume contains the options development for the design category. This category comprises alternative structures, configurations and techniques that can be used to develop designs that are responsive to the SSDS requirements. The specific areas discussed are software, including data base management and distributed operating systems; system architecture, including fault tolerance and system growth/automation/autonomy and system interfaces; time management; and system security/privacy. Also discussed are space communications and local area networking.

Aligning provider incentives to improve primary healthcare delivery in the United States

PubMed Central

DeVoe, JE; Stenger, R

2016-01-01

Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

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

Interpreting U-Pb data from primary and secondary features in lunar zircon

NASA Astrophysics Data System (ADS)

Grange, M. L.; Pidgeon, R. T.; Nemchin, A. A.; Timms, N. E.; Meyer, C.

2013-01-01

In this paper, we describe primary and secondary microstructures and textural characteristics found in lunar zircon and discuss the relationships between these features and the zircon U-Pb isotopic systems and the significance of these features for understanding lunar processes. Lunar zircons can be classified according to: (i) textural relationships between zircon and surrounding minerals in the host breccias, (ii) the internal microstructures of the zircon grains as identified by optical microscopy, cathodoluminescence (CL) imaging and electron backscattered diffraction (EBSD) mapping and (iii) results of in situ ion microprobe analyses of the Th-U-Pb isotopic systems. Primary zircon can occur as part of a cogenetic mineral assemblage (lithic clast) or as an individual mineral clast and is unzoned, or has sector and/or oscillatory zoning. The age of primary zircon is obtained when multiple ion microprobe analyses across the polished surface of the grain give reproducible and essentially concordant data. A secondary set of microstructures, superimposed on primary zircon, include localised recrystallised domains, localised amorphous domains, crystal-plastic deformation, planar deformation features and fractures, and are associated with impact processes. The first two secondary microstructures often yield internally consistent and close to concordant U-Pb ages that we interpret as dating impact events. Others secondary microstructures such as planar deformation features, crystal-plastic deformation and micro-fractures can provide channels for Pb diffusion and result in partial resetting of the U-Pb isotopic systems.

Malaysia. A Study of the Educational System of Malaysia and a Guide to the Academic Placement of Students in Educational Institutions of the United States. World Education Series.

ERIC Educational Resources Information Center

Stedman, Joann Bye

Information on the educational system of Malaysia and guidelines on the placement of Malaysian students in U.S. high schools and colleges are presented. After a brief introduction on the country and the educational system, attention is directed to preschool, primary, and secondary education. Included are reproductions of certificates of…

Primary health care reform, dilemmatic space and risk of burnout among health workers.

PubMed

Freeman, Toby; Baum, Fran; Labonté, Ronald; Javanparast, Sara; Lawless, Angela

2018-05-01

Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work 'under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

Global resistance and resilience of primary production following extreme drought are predicted by mean annual precipitation

NASA Astrophysics Data System (ADS)

Stuart-Haëntjens, E. J.; De Boeck, H. J.; Lemoine, N. P.; Gough, C. M.; Kröel-Dulay, G.; Mänd, P.; Jentsch, A.; Schmidt, I. K.; Bahn, M.; Lloret, F.; Kreyling, J.; Wohlgemuth, T.; Stampfli, A.; Anderegg, W.; Classen, A. T.; Smith, M. D.

2017-12-01

Extreme drought is increasing globally in frequency and intensity, with uncertain consequences for the resistance and resilience of key ecosystem functions, including primary production. Primary production resistance, the capacity of an ecosystem to withstand change in primary production following extreme climate, and resilience, the degree to which primary production recovers, vary among and within ecosystem types, obscuring global patterns of resistance and resilience to extreme drought. Past syntheses on resistance have focused climatic gradients or individual ecosystem types, without assessing interactions between the two. Theory and many empirical studies suggest that forest production is more resistant but less resilient than grassland production to extreme drought, though some empirical studies reveal that these trends are not universal. Here, we conducted a global meta-analysis of sixty-four grassland and forest sites, finding that primary production resistance to extreme drought is predicted by a common continuum of mean annual precipitation (MAP). However, grasslands and forests exhibit divergent production resilience relationships with MAP. We discuss the likely mechanisms underlying the mixed production resistance and resilience patterns of forests and grasslands, including different plant species turnover times and drought adaptive strategies. These findings demonstrate the primary production responses of forests and grasslands to extreme drought are mixed, with far-reaching implications for Earth System Models, ecosystem management, and future studies of extreme drought resistance and resilience.

Patient and Clinician Openness to Including a Broader Range of Healing Options in Primary Care

PubMed Central

Hsu, Clarissa; Cherkin, Daniel C.; Hoffmeyer, Sylvia; Sherman, Karen J.; Phillips, William R.

2011-01-01

PURPOSE We studied the openness of patients and clinicians to introducing a broader range of healing options into primary care. METHODS Focus groups were conducted with primary care patients (4 groups) and clinicians (3 groups) from an integrated medical care system in 2008. Transcripts of discussions were analyzed using an immersion/crystallization approach. RESULTS Both patients (n = 44) and clinicians (n = 32) were open to including a wider variety of healing options in primary care. Patients desired some evidence of effectiveness, although there was wide variation in the type of evidence required. Many patients believed that the clinician’s personal and practice experience was an important form of evidence. Patients wanted to share in the decision to refer and the choice of options. Clinicians were most concerned with safety of specific treatments, including some of the herbs and dietary supplements. They also believed they lacked adequate information about the nature, benefits, and risks of many alternatives, and they were not aware of local practitioners and resources to whom they could confidently refer their patients. Both patients and clinicians were concerned that services recommended be covered by insurance or be affordable to patients. CONCLUSIONS Integrating additional healing options into primary care may be feasible and desirable, as well as help meet the needs of patients with conditions that have not been responsive to standard medical treatments. PMID:21911764

The Solar Neighborhood XLIV: RECONS Discoveries within 10 parsecs

NASA Astrophysics Data System (ADS)

Henry, Todd J.; Jao, Wei-Chun; Winters, Jennifer G.; Dieterich, Sergio B.; Finch, Charlie T.; Ianna, Philip A.; Riedel, Adric R.; Silverstein, Michele L.; Subasavage, John P.; Halley Vrijmoet, Eliot

2018-06-01

We describe the 44 systems discovered to be within 10 pc of the Sun by the RECONS team, primarily via the long-term astrometry program at the CTIO/SMARTS 0.9 m that began in 1999. The systems—including 41 with red dwarf primaries, 2 white dwarfs, and 1 brown dwarf—have trigonometric parallaxes greater than 100 mas, with errors of 0.4–2.4 mas in all but one case. We provide updated astrometric, photometric (VRIJHK magnitudes), spectral type, and multiplicity information here. Among these are 14 systems that are new entries to the 10 pc sample, including the first parallaxes for 9 systems and new values for 5 systems that had previous parallaxes with errors greater than 10 mas or values placing them beyond 10 pc. We also provide new data for 22 systems known to lie within 10 pc and 9 systems reported to be closer than that horizon but for which new parallaxes place them further away, bringing the total to 75 systems. The 44 systems added by RECONS comprise one of every 7 systems known within 10 pc. We illustrate the evolution of the 10 pc sample from the 191 systems known when the final Yale Parallax Catalog was published in 1995 to the 317 systems known today. Even so close to the Sun, additional discoveries of white, red, and brown dwarfs are possible, both as primaries and secondaries, although we estimate that at least 90% of the stellar systems closer than 10 pc have now been identified.

Herbal medicine (Hyeolbuchukeo-tang or Xuefu Zhuyu decoction) for treating primary dysmenorrhoea: protocol for a systematic review of randomised controlled trials.

PubMed

Jo, Junyoung; Leem, Jungtae; Lee, Jin Moo; Park, Kyoung Sun

2017-06-15

Primary dysmenorrhoea is menstrual pain without pelvic pathology and is the most common gynaecological condition in women. Xuefu Zhuyudecoction (XZD) or Hyeolbuchukeo-tang, a traditional herbal formula, has been used as a treatment for primary dysmenorrhoea. The purpose of this study is to assess the current published evidence regarding XZD as treatment for primary dysmenorrhoea. The following databases will be searched from their inception until April 2017: MEDLINE (via PubMed), Allied and Complementary Medicine Database (AMED), EMBASE, The Cochrane Library, six Korean medical databases (Korean Studies Information Service System, DBPia, Oriental Medicine Advanced Searching Integrated System, Research Information Service System, Korea Med and the Korean Traditional Knowledge Portal), three Chinese medical databases (China National Knowledge Infrastructure (CNKI), Wan Fang Database and Chinese Scientific Journals Database (VIP)) and one Japanese medical database (CiNii). Randomised clinical trials (RCTs) that will be included in this systematic review comprise those that used XZD or modified XZD. The control groups in the RCTs include no treatment, placebo, conventional medication or other treatments. Trials testing XZD as an adjunct to other treatments and studies where the control group received the same treatment as the intervention group will be also included. Data extraction and risk of bias assessments will be performed by two independent reviewers. The risk of bias will be assessed with the Cochrane risk of bias tool. All statistical analyses will be conducted using Review Manager software (RevMan V.5.3.0). This systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. The review will benefit patients and practitioners in the fields of traditional and conventional medicine. CRD42016050447. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of the serum reproductive system related autoantibodies of infertility patients in Tianjin region of China

PubMed Central

Huo, Yan; Xu, Yanying; Wang, Jianmei; Wang, Fang; Liu, Yu; Zhang, Yujuan; Zhang, Bumei

2015-01-01

Object: Reproductive system related autoantibodies have been proposed to be associated with natural infertility. However, large scale systematic analysis of these of antibodies has not been conducted. The aim of this study is to analyze the positive rate of antisperm antibody (ASAb), anti-endometrium antibody (EMAb), anti-ovary antibody (AOAb), anti-zona pellucida antibody (AZP) and anticardiolipin antibody (ACA) in infertility patients in Tianjin region of China. Methods: 1305 male and 1711 female primary infertility patients and 1100 female secondary infertility patients were included in this study, as well as 627 healthy female controls. The above autoantibodies were tested and the positive rates in each group were calculated. Results: the positive rate of ASAb were significantly higher in primary infertility female than that in male, further analysis revealed that primary infertility population all exhibit significant higher positive rate of EMAb, AOAb, AZP and ACA compared with control group. Furthermore, the positive rates of all the antibodies in primary infertility female were significantly higher than those in secondary infertility female. Conclusions: Our study thus indicates that these autoantibodies might be associated with immunological related primary infertility and may have clinical significance in its diagnosis and treatment. PMID:26550366

Air-flow regulation system for a coal gasifier

DOEpatents

Fasching, George E.

1984-01-01

An improved air-flow regulator for a fixed-bed coal gasifier is provided which allows close air-flow regulation from a compressor source even though the pressure variations are too rapid for a single primary control loop to respond. The improved system includes a primary controller to control a valve in the main (large) air supply line to regulate large slow changes in flow. A secondary controller is used to control a smaller, faster acting valve in a secondary (small) air supply line parallel to the main line valve to regulate rapid cyclic deviations in air flow. A low-pass filter with a time constant of from 20 to 50 seconds couples the output of the secondary controller to the input of the primary controller so that the primary controller only responds to slow changes in the air-flow rate, the faster, cyclic deviations in flow rate sensed and corrected by the secondary controller loop do not reach the primary controller due to the high frequency rejection provided by the filter. This control arrangement provides at least a factor of 5 improvement in air-flow regulation for a coal gasifier in which air is supplied by a reciprocating compressor through a surge tank.

Targeting dorsal root ganglia and primary sensory neurons for the treatment of chronic pain

PubMed Central

Berta, Temugin; Qadri, Yawar; Tan, Ping-Heng; Ji, Ru-Rong

2018-01-01

Introduction Currently the treatment of chronic pain is inadequate and compromised by debilitating central nervous system side effects. Here we discuss new therapeutic strategies that target dorsal root ganglia (DRGs) in the peripheral nervous system for a better and safer treatment of chronic pain. Areas covered The DRGs contain the cell bodies of primary sensory neurons including nociceptive neurons. After painful injuries, primary sensory neurons demonstrate maladaptive molecular changes in DRG cell bodies and in their axons. These changes result in hypersensitivity and hyperexcitability of sensory neurons (peripheral sensitization) and are crucial for the onset and maintenance of chronic pain. We discuss the following new strategies to target DRGs and primary sensory neurons as a means of alleviating chronic pain and minimizing side effects: inhibition of sensory neuron-expressing ion channels such as TRPA1, TRPV1, and Nav1.7, selective blockade of C- and Aβ-afferent fibers, gene therapy, and implantation of bone marrow stem cells. Expert opinion These peripheral pharmacological treatments, as well as gene and cell therapies, aimed at DRG tissues and primary sensory neurons can offer better and safer treatments for inflammatory, neuropathic, cancer, and other chronic pain states. PMID:28480765

Multispectral variable magnification glancing incidence x ray telescope

NASA Technical Reports Server (NTRS)

Hoover, Richard B. (Inventor)

1992-01-01

A multispectral, variable magnification, glancing incidence, x-ray telescope capable of broadband, high resolution imaging of solar and stellar x-ray and extreme ultraviolet radiation sources is discussed. The telescope includes a primary optical system which focuses the incoming radiation to a primary focus. Two or more rotatable mirror carriers, each providing a different magnification, are positioned behind the primary focus at an inclination to the optical axis. Each carrier has a series of ellipsoidal mirrors, and each mirror has a concave surface covered with a multilayer (layered synthetic microstructure) coating to reflect a different desired wavelength. The mirrors of both carriers are segments of ellipsoids having a common first focus coincident with the primary focus. A detector such as an x-ray sensitive photographic film is positioned at the second respective focus of each mirror so that each mirror may reflect the image at the first focus to the detector at the second focus. The carriers are selectively rotated to position a selected mirror for receiving radiation from the primary optical system, and at least the first carrier may be withdrawn from the path of the radiation to permit a selected mirror on the second carrier to receive the radiation.

Comparison of primary optics in amonix CPV arrays

NASA Astrophysics Data System (ADS)

Nayak, Aditya; Kinsey, Geoffrey S.; Liu, Mingguo; Bagienski, William; Garboushian, Vahan

2012-10-01

The Amonix CPV system utilizes an acrylic Fresnel lens Primary Optical Element (POE) and a reflective Secondary Optical Element (SOE). Improvements in the optical design have contributed to more than 10% increase in rated power last year. In order to further optimize the optical power path, Amonix is looking at various trade-offs in optics, including, concentration, optical materials, reliability, and cost. A comparison of optical materials used for manufacturing the primary optical element and optical design trade off's used to maximize power output will be presented. Optimization of the power path has led to the demonstration of a module lens-area efficiency of 35% in outdoor testing at Amonix.

Reforming Victoria's primary health and community service sector: rural implications.

PubMed

Alford, K

2000-01-01

In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

Electric controlled air incinerator for radioactive wastes

DOEpatents

Warren, Jeffery H.; Hootman, Harry E.

1981-01-01

A two-stage incinerator is provided which includes a primary combustion chamber and an afterburner chamber for off-gases. The latter is formed by a plurality of vertical tubes in combination with associated manifolds which connect the tubes together to form a continuous tortuous path. Electrically-controlled heaters surround the tubes while electrically-controlled plate heaters heat the manifolds. A gravity-type ash removal system is located at the bottom of the first afterburner tube while an air mixer is disposed in that same tube just above the outlet from the primary chamber. A ram injector in combination with rotary magazine feeds waste to a horizontal tube forming the primary combustion chamber.

Health care reform and care at the behavioral health--primary care interface.

PubMed

Druss, Benjamin G; Mauer, Barbara J

2010-11-01

The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative.

PubMed

Elder, Charles R; Debar, Lynn L; Ritenbaugh, Cheryl; Rumptz, Maureen H; Patterson, Charlotte; Bonifay, Allison; Cowan, Penney; Lancaster, Lindsay; Deyo, Richard A

2017-01-01

Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care. We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting. We identify lessons on how to engage stakeholders and improve patient-centered care for those with chronic conditions within the primary care setting. A qualitative analysis of project minutes, interviews, and focus groups was conducted to evaluate stakeholder experiences. Stakeholders included patients, caregivers, clinicians, medical office support staff, health plan administrators, an information technology consultant, and a patient advocate. Our stakeholders included many patients with no prior experience with research. This approach enriched the applicability of feedback but necessitated extra time for stakeholder training and meeting preparation. Types of stakeholders varied over the course of the project, and more involvement of medical assistants and Information Technology staff was required than originally anticipated. Meaningful engagement of patient and physician stakeholders must be solicited in a well-coordinated manner with broad health care system supports in place to ensure full execution of patient-centered processes.

International Student Affairs.

ERIC Educational Resources Information Center

Wood, Melinda; Kia, Parandeh

2000-01-01

Describes international student service units in higher education, including their primary functions, staff roles and responsibilities, major functional challenges, professional challenges and support systems, professional literature, and tips for those interested in the field. Also describes the author's personal career path in international…

40 CFR 141.806 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

The Printout: Computers and Reading in the United Kingdom.

ERIC Educational Resources Information Center

Ewing, James M.

1988-01-01

Offers an overview of some reading and language arts computer projects in the United Kingdom, including language teaching and intelligent knowledge-based systems, assessment of written style by computer, and desktop publishing in the primary school. (ARH)

Conceptual development of an impact-attenuation system for intersecting roadways.

DOT National Transportation Integrated Search

2015-09-01

Longitudinal barriers are commonly used to shield hazards, including stiff bridge rail ends and slopes. In some locations, : a secondary roadway intersects the primary roadway within the guardrails length-of-need (LON). Some intersections may : ha...

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Two-stage concentrating systems for pumping of solar lasers

NASA Astrophysics Data System (ADS)

Klichev, Sh.; Bakhramov, S.; Abdurakhmanov, A.; Fazilov, A.; Payziyev, Sh.; Ismanjanov, A.; Bokoev, K.; Dudko, J.; Klichev, Z.

2008-02-01

One of the ways to increase the concentrating ability of solar concentrators used for pumping of lasers is an additional concentration of a sunlight by a secondary concentrator allocated in a focal area of the primary concentrator. Limiting concentrations of those compound systems on the basis of non-imaging optics have been received by Winston. However more detailed calculations on the basis of irradiance integral are necessary for designing and practical realization of such systems. It is especially important for the systems including generally compound of two secondary concentrators. The full design procedure for concentration by systems of type compound parabolic concentrator or Winston concentrator (focon) and a cone concentrator is developed in the work in view of real distribution of brightness on a solar disk and discrepancies of primary concentrator geometry. The generalized dependences of efficiency of compound systems for the maximal and mean concentration in a focal plane of the primary paraboloidal concentrator depending on its disclosing angle U 0 and discrepancies of geometry are received. It is shown, that focon only up to U 0 < 30° is more effective, than the cone and further their efficiencies are identical. It is shown, that secondary concentrator allows to increase the pumping efficiency not less, than 30%.

Cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in lymphoma patients.

PubMed

Lathia, Nina; Isogai, Pierre K; De Angelis, Carlo; Smith, Thomas J; Cheung, Matthew; Mittmann, Nicole; Hoch, Jeffrey S; Walker, Scott

2013-08-07

Febrile neutropenia is a serious toxicity of cancer chemotherapy that is usually treated in hospital. We assessed the cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in diffuse large B-cell lymphoma (DLBCL) patients undergoing chemotherapy. We used a Markov model that followed patients through induction chemotherapy to compare the three prophylaxis strategies: 1) no primary prophylaxis against febrile neutropenia; 2) primary prophylaxis with 10 days of filgrastim therapy; and 3) primary prophylaxis with a single dose of pegfilgrastim. The target population was a hypothetical cohort of 64-year-old men and women with DLBCL. Data sources included published literature and current clinical practice. The analysis was conducted from a publicly funded health-care system perspective. The main outcome measures included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). In the base-case analysis, costs associated with no primary prophylaxis, primary prophylaxis with 10 days of filgrastim, and primary prophylaxis with pegfilgrastim were CaD $7314, CaD $13947, and CaD $16290, respectively. The QALYs associated with the three strategies were 0.2004, 0.2015, and 0.2024, respectively. The ICER for the filgrastim vs no primary prophylaxis strategy was CaD $5796000 per QALY. The ICER for the pegfilgrastim vs filgrastim primary prophylaxis strategy was CaD $2611000 per QALY. All one-way sensitivity analyses yielded ICERs greater than CaD $400000 per QALY. Cost-effectiveness acceptability curves show that 20.0% of iterations are cost-effective at a willingness-to-pay threshold of CaD $1595000 for the filgrastim strategy and CaD $561000 for the pegfilgrastim strategy. Primary prophylaxis against febrile neutropenia with either filgrastim or pegfilgrastim is not cost-effective in DLBCL patients.

Primary care at Swiss universities - current state and perspective

PubMed Central

2014-01-01

Background There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. Results Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 – 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. Conclusion So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture. PMID:24885148

The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study.

PubMed

Hunt, Jacquelyn S; Siemienczuk, Joseph; Gillanders, William; LeBlanc, Benjamin H; Rozenfeld, Yelena; Bonin, Kerry; Pape, Ginger

2009-01-01

To determine the impact of a physician-directed, multifaceted health information technology (HIT) system on diabetes outcomes. A pre/post-interventional study. The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older. The study intervention included implementation of the CareManager HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials. The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) target <7%, and the proportion of patients meeting guideline-recommended targets for those measures. All measures were analysed using closed and open cohort approaches. A total of 6072 patients were identified at baseline, 70% of whom were continuously enrolled during the 24-month study. Significant improvements were observed in all diabetes related outcomes except mean HbA1c. LDL goal attainment improved from 32% to 56% (P=0.002), while mean LDL decreased by 13 mg/dL (0.33 mmol/l, P=0.002). BP goal attainment increased significantly from 30% to 52%, with significant decreases in both mean systolic and diastolic BP. The proportion of patients with an HbA1c below 7% was higher at the end of the study (P=0.008). Mean patient satisfaction remained high, with no significant difference between baseline and follow-up. Total Relative Value Units per patient per year significantly increased as a result of an increase in the number of visits in year one and the coding complexity throughout. Implementation of a physician-directed, multifaceted HIT system in primary care was associated with significantly improved diabetes process and outcome measures.

A near miss: the importance of context in a public health informatics project in a New Zealand case study.

PubMed

Wells, Stewart; Bullen, Chris

2008-01-01

This article describes the near failure of an information technology (IT) system designed to support a government-funded, primary care-based hepatitis B screening program in New Zealand. Qualitative methods were used to collect data and construct an explanatory model. Multiple incorrect assumptions were made about participants, primary care workflows and IT capacity, software vendor user knowledge, and the health IT infrastructure. Political factors delayed system development and it was implemented untested, almost failing. An intensive rescue strategy included system modifications, relaxation of data validity rules, close engagement with software vendors, and provision of intensive on-site user support. This case study demonstrates that consideration of the social, political, technological, and health care contexts is important for successful implementation of public health informatics projects.

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

Primary Energy Efficiency Analysis of Different Separate Sensible and Latent Cooling Techniques

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

Abdelaziz, Omar

2015-01-01

Separate Sensible and Latent cooling (SSLC) has been discussed in open literature as means to improve air conditioning system efficiency. The main benefit of SSLC is that it enables heat source optimization for the different forms of loads, sensible vs. latent, and as such maximizes the cycle efficiency. In this paper I use a thermodynamic analysis tool in order to analyse the performance of various SSLC technologies including: multi-evaporators two stage compression system, vapour compression system with heat activated desiccant dehumidification, and integrated vapour compression with desiccant dehumidification. A primary coefficient of performance is defined and used to judge themore » performance of the different SSLC technologies at the design conditions. Results showed the trade-off in performance for different sensible heat factor and regeneration temperatures.« less

Traceable Dynamic Calibration of Force Transducers by Primary Means

PubMed Central

Vlajic, Nicholas; Chijioke, Ako

2018-01-01

We describe an apparatus for traceable, dynamic calibration of force transducers using harmonic excitation, and report calibration measurements of force transducers using this apparatus. In this system, the force applied to the transducer is produced by the acceleration of an attached mass, and is determined according to Newton’s second law, F = ma. The acceleration is measured by primary means, using laser interferometry. The capabilities of this system are demonstrated by performing dynamic calibrations of two shear-web-type force transducers up to a frequency of 2 kHz, with an expanded uncertainty below 1.2 %. We give an accounting of all significant sources of uncertainty, including a detailed consideration of the effects of dynamic tilting (rocking), which is a leading source of uncertainty in such harmonic force calibration systems. PMID:29887643

Prehospital care of tsunami victims in Thailand: description and analysis.

PubMed

Schwartz, Dagan; Goldberg, Avishay; Ashkenasi, Issac; Nakash, Guy; Pelts, Rami; Leiba, Adi; Levi, Yeheskel; Bar-Dayan, Yaron

2006-01-01

On 26 December 2004 at 09:00 h, an earthquake of 9.0 magnitude (Richter scale) struck the area off of the western coast of northern Sumatra, Indonesia, triggering a Tsunami. As of 25 January 2005, 5,388 fatalities were confirmed, 3,120 people were reported missing, and 8,457 people were wounded in Thailand alone. Little information is available in the medical literature regarding the response and restructuring of the prehospital healthcare system in dealing with major natural disasters. The objective of the study was to analyze the prehospital medical response to the Tsunami in Thailand, and to identify possible ways of improving future preparedness and response. The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research delegation to study the response of the Thai medical system to the 2004 earthquake and Tsunami disaster. The delegation met with Thai healthcare and military personnel, who provided medical care for and evacuated the Tsunami victims. The research instruments included questionnaires (open and closed questions), interviews, and a review of debriefing session reports held in the days following the Tsunami. Beginning the day after the event, primary health care in the affected provinces was expanded and extended. This included: (1) strengthening existing primary care facilities with personnel and equipment; (2) enhancing communication and transportation capabilities; (3) erecting healthcare facilities in newly constructed evacuation centers; (4) deploying mobile, medical teams to make house calls to flood refugees in affected areas; and (5) deploying ambulance crews to the affected areas to search for survivors and provide primary care triage and transportation. The restructuring of the prehospital healthcare system was crucial for optimal management of the healthcare needs of Tsunami victims and for the reduction of the patient loads on secondary medical facilities. The disaster plan of a national healthcare system should include special consideration for the restructuring and reinforcement prehospital system.

Characterization of systemic disease in primary Sjögren's syndrome: EULAR-SS Task Force recommendations for articular, cutaneous, pulmonary and renal involvements.

PubMed

Ramos-Casals, Manuel; Brito-Zerón, Pilar; Seror, Raphaèle; Bootsma, Hendrika; Bowman, Simon J; Dörner, Thomas; Gottenberg, Jacques-Eric; Mariette, Xavier; Theander, Elke; Bombardieri, Stefano; De Vita, Salvatore; Mandl, Thomas; Ng, Wan-Fai; Kruize, Aike; Tzioufas, Athanasios; Vitali, Claudio

2015-12-01

To reach a European consensus on the definition and characterization of the main organ-specific extraglandular manifestations in primary SS. The EULAR-SS Task Force Group steering committee agreed to approach SS-related systemic involvement according to the EULAR SS Disease Activity Index (ESSDAI) classification and proposed the preparation of four separate manuscripts: articular, cutaneous, pulmonary and renal ESSDAI involvement; muscular, peripheral nervous system, CNS and haematological ESSDAI involvement; organs not included in the ESSDAI classification; and lymphoproliferative disease. Currently available evidence was obtained by a systematic literature review focused on SS-related systemic features. The following information was summarized for articular, cutaneous, pulmonary and renal involvement: a clear, consensual definition of the clinical feature, a brief epidemiological description including an estimate of the prevalence reported in the main clinical series and a brief list of the key clinical and diagnostic features that could help physicians clearly identify these features. Unfortunately we found that the body of evidence relied predominantly on information retrieved from individual cases, and the scientific information provided was heterogeneous. The analysis of types of involvement was biased due to the unbalanced reporting of severe cases over non-severe cases, although the main sources of bias were the heterogeneous definitions of organ involvement (or even the lack of definition in some studies) and the heterogeneous diagnostic approach used in studies to investigate involvment of each organ. The proposals included in this article are a first step to developing an optimal diagnostic approach to systemic involvement in primary SS and may pave the way for further development of evidence-based diagnostic and therapeutic guidelines. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An Organ System Approach to Explore the Antioxidative, Anti-Inflammatory, and Cytoprotective Actions of Resveratrol

PubMed Central

Bath, Sundeep

2015-01-01

Resveratrol is a phenolic phytochemical, with a stilbene backbone, derived from edible plants such as grape and peanut. It is a bioactive molecule with physiological effects on multiple organ systems. Its effects range from the neuroprotective to the nephroprotective, including cardiovascular, neuronal, and antineoplastic responses as a part of its broad spectrum of action. In this review, we examine the effects of resveratrol on the following organ systems: the central nervous system, including neurological pathology such as Parkinson's and Alzheimer's disease; the cardiovascular system, including disorders such as atherosclerosis, ischemia-reperfusion injury, and cardiomyocyte hypertrophy; the kidneys, including primary and secondary nephropathies and nephrolithiasis; multiple forms of cancer; and metabolic syndromes including diabetes. We emphasize commonalities in extracellular matrix protein alterations and intracellular signal transduction system induction following resveratrol treatment. We summarize the known anti-inflammatory, antioxidative, and cytoprotective effects of resveratrol across disparate organ systems. Additionally, we analyze the available literature regarding the pharmacokinetics of resveratrol formulations used in these studies. Finally, we critically examine select clinical trials documenting a lack of effect following resveratrol treatment. PMID:26180596

Energy implications of mechanical and mechanical–biological treatment compared to direct waste-to-energy

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

Cimpan, Ciprian, E-mail: cic@kbm.sdu.dk; Wenzel, Henrik

2013-07-15

Highlights: • Compared systems achieve primary energy savings between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste.} • Savings magnitude is foremost determined by chosen primary energy and materials production. • Energy consumption and process losses can be upset by increased technology efficiency. • Material recovery accounts for significant shares of primary energy savings. • Direct waste-to-energy is highly efficient if cogeneration (CHP) is possible. - Abstract: Primary energy savings potential is used to compare five residual municipal solid waste treatment systems, including configurations with mechanical (MT) and mechanical–biological (MBT) pre-treatment, which produce waste-derived fuels (RDF and SRF), biogasmore » and/or recover additional materials for recycling, alongside a system based on conventional mass burn waste-to-energy and ash treatment. To examine the magnitude of potential savings we consider two energy efficiency levels (state-of-the-art and best available technology), the inclusion/exclusion of heat recovery (CHP vs. PP) and three different background end-use energy production systems (coal condensing electricity and natural gas heat, Nordic electricity mix and natural gas heat, and coal CHP energy quality allocation). The systems achieved net primary energy savings in a range between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste}, in the different scenario settings. The energy footprint of transportation needs, pre-treatment and reprocessing of recyclable materials was 3–9.5%, 1–18% and 1–8% respectively, relative to total energy savings. Mass combustion WtE achieved the highest savings in scenarios with CHP production, nonetheless, MBT-based systems had similarly high performance if SRF streams were co-combusted with coal. When RDF and SRF was only used in dedicated WtE plants, MBT-based systems totalled lower savings due to inherent system losses and additional energy costs. In scenarios without heat recovery, the biodrying MBS-based system achieved the highest savings, on the condition of SRF co-combustion. As a sensitivity scenario, alternative utilisation of SRF in cement kilns was modelled. It supported similar or higher net savings for all pre-treatment systems compared to mass combustion WtE, except when WtE CHP was possible in the first two background energy scenarios. Recovery of plastics for recycling before energy recovery increased net energy savings in most scenario variations, over those of full stream combustion. Sensitivity to assumptions regarding virgin plastic substitution was tested and was found to mostly favour plastic recovery.« less

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

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.

Experience of sleep disruption in primary Sjögren’s syndrome: A focus group study

PubMed Central

Deary, Vincent; Deane, Katherine HO; Newton, Julia L; Ng, Wan-Fai; Rapley, Tim

2018-01-01

Introduction Primary Sjögren’s syndrome is the third most common systemic autoimmune rheumatic disease, following rheumatoid arthritis and systemic lupus erythematosus, and results in dryness, fatigue, discomfort and sleep disturbances. Sleep is relatively unexplored in primary Sjögren’s syndrome. We investigated the experiences of sleep disturbances from the viewpoint of primary Sjögren’s syndrome patients and their partners and explored the acceptability of cognitive behavioural therapy for insomnia. Method We used focus groups to collect qualitative data from 10 patients with primary Sjögren’s syndrome and three partners of patients. The data were recorded, transcribed verbatim and analysed using thematic analysis. Results Five themes emerged from the data: (a) Experience of sleep disturbances; (b) variation and inconsistency in sleep disturbances; (c) the domino effect of primary Sjögren’s syndrome symptoms; (d) strategies to manage sleep; (e) acceptability of evidence-based techniques. Sleep disturbances were problematic for all patients, but specific disturbances varied between participants. These included prolonged sleep onset time and frequent night awakenings and were aggravated by pain and discomfort. Patients deployed a range of strategies to try and self-manage. Cognitive behavioural therapy for insomnia was seen as an acceptable intervention, as long as a rationale for its use is given and it is tailored for primary Sjögren’s syndrome. Conclusion Primary Sjögren’s syndrome patients described a range of sleep disturbances. Applying tailored, evidence-based sleep therapy interventions may improve sleep, severity of other primary Sjögren’s syndrome symptoms and functional ability. PMID:29657352

Status and costs of primary prevention for ischemic stroke in China.

PubMed

Zhao, J J; He, G Q; Gong, S Y; He, L

2013-10-01

Despite the benefits in reducing the risk of stroke, primary prevention is not well translated into practice. We sought to evaluate patient compliance with guidelines and the cost of primary stroke prevention in southwest China. We consecutively enrolled 305 patients with headaches and/or dizziness who were at high risk of stroke from our hospital. We retrospectively obtained their information, including the extent of their knowledge of stroke risk factors, adherence to guidelines, medications taken, and costs of primary prevention for stroke within the past year. Only 45.9% of patients had any knowledge of primary prevention, and only 17.0% had completely followed guidelines. Moreover, 79.0% of the patients were using medications, but only 39.3% took their medication as recommended. In patients who took medication, 89.6% were prescribed by physicians. The annual costs of primary prevention were estimated to be US$517.8 per capita, which included direct medical costs (US$435.4), direct non-medical costs (US$18.1), and indirect costs (US$64.3). Costs in the hypertension group were less than those reported by a similar international study. Although our population sample may not be representative of the population at high risk of stroke in China, it is appropriate for the evaluation of our primary prevention system. Primary prevention for stroke in southwest China is very challenging, with few medical resource investments. There is a current urgency to improve patient knowledge of primary prevention, which would bridge the gaps between guidelines and practice and increase medical resource investments. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

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

2015-03-01

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

Stories and metaphors in the sensemaking of multiple primary health care organizational identities.

PubMed

Rodríguez, Charo; Bélanger, Emmanuelle

2014-03-04

The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

Research needs for an improved primary care response to chronic non-communicable diseases in Africa.

PubMed

Maher, D; Sekajugo, J; Harries, A D; Grosskurth, H

2010-02-01

With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa.

Primary Surface Particle Motion as a Mechanism for YORP-Driven Binary Asteroid Evolution

NASA Astrophysics Data System (ADS)

Fahnestock, Eugene G.; Scheeres, D. J.

2008-09-01

Within the largest class of binary asteroid systems -- asynchronous binaries typified by 1999 KW4 -- we hypothesize continued YORP spin-up of the rapidly rotating primary leads to recurring episodic lofting motion of primary equator regolith. We theorize this is a mechanism for transporting YORP-injected angular momentum from primary spin into the mutual orbit. This both enables binary primaries to continue to spin at near surface fission rates and produces continued orbit expansion on time scales several times faster than expansion predicted by tidal dissipation alone. This is distinct from the Binary Yorp (BYORP) phenomenon, not studied in this work but to be added to it later. We evaluate our hypotheses using a combination of techniques for an example binary system. First high-fidelity dynamic simulation of surface-originating particles in the full-detail gravity field of the binary components, themselves propagated according to the full two body problem, gives particle final disposition (return impact, transfer impact, escape). Trajectory end states found for regolith lofted at different initial primary spin rates and relative poses are collected into probability matrices, allowing probabilistic propagation of surface particles for long durations at low computational cost. We track changes to mass, inertia dyad, rotation state, and centroid position and velocity for each component in response to this mapped particle motion. This allows tracking of primary, secondary, and mutual orbit angular momenta over time, clearly demonstrating the angular momentum transfer mechanism and validating our hypotheses. We present current orbit expansion rates and estimated orbit size doubling times consistent with this mechanism, for a few binary systems. We also discuss ramifications of this type of rapid binary evolution towards separation, including the frequency with which "divorced binaries" on similar heliocentric orbits are produced, formation of triple systems such as 2001 SN263, and separation timescale dependence on heliocentric distance.

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

PubMed Central

Daker-White, Gavin; Hays, Rebecca; McSharry, Jennifer; Giles, Sally; Cheraghi-Sohi, Sudeh; Rhodes, Penny; Sanders, Caroline

2015-01-01

Objective Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model. Method Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies. Results Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system. Conclusion Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation. PMID:26244494

Nox control for high nitric oxide concentration flows through combustion-driven reduction

DOEpatents

Yeh, James T.; Ekmann, James M.; Pennline, Henry W.; Drummond, Charles J.

1989-01-01

An improved method for removing nitrogen oxides from concentrated waste gas streams, in which nitrogen oxides are ignited with a carbonaceous material in the presence of substoichiometric quantities of a primary oxidant, such as air. Additionally, reductants may be ignited along with the nitrogen oxides, carbonaceous material and primary oxidant to achieve greater reduction of nitrogen oxides. A scrubber and regeneration system may also be included to generate a concentrated stream of nitrogen oxides from flue gases for reduction using this method.

STS/Spacelab payload utilization planning study: Executive summary

NASA Technical Reports Server (NTRS)

1976-01-01

The planning process recommended to meet the orbital flight requirements for the Space Transportation System and payload development, procurement, operations, and support leading to authorization and funding of STS and payload project activities is described. The rationale and rp primary products of STS utilization planning are summarized along with the implementation of the system. Major recommendations of the study are included.

Cultural Attitudes, Parental Aspirations, and Socioeconomic Influence on Post-Primary School Selection in Northern Ireland

ERIC Educational Resources Information Center

Kelleher, Luke; Smyth, Austin; McEldowney, Malachy

2016-01-01

This research considers implications of planned reform of the education system in Northern Ireland for school choice and travel behavior. The school system is currently segregated on the basis of religion and academic ability at age 11. Discrete Choice Models based on a Stated Preference experiment included in a program of parental surveys yielded…

Project Echo: System Calculations

NASA Technical Reports Server (NTRS)

Ruthroff, Clyde L.; Jakes, William C., Jr.

1961-01-01

The primary experimental objective of Project Echo was the transmission of radio communications between points on the earth by reflection from the balloon satellite. This paper describes system calculations made in preparation for the experiment and their adaptation to the problem of interpreting the results. The calculations include path loss computations, expected audio signal-to-noise ratios, and received signal strength based on orbital parameters.

[Clinical diagnosis of primary unknown cancer-the present situation and problems].

PubMed

Mukai, Hirofumi

2009-06-01

The first step of diagnosis of primary unknown cancer(PUC)the detailed history intake and physical examination including breast, genitourinary system and rectum. Laboratory test, chest X-p and systemic computed tomography are allowed to be performed for all patients with PUC. Other tests should be performed according to the results of clinical and pathological evaluation. Utility of the tumor marker is limited, and this test is not recommended as a routine usage. There is not enough evidence on the utility of FDG-PTT or FDG-PET/CT for patients with PUC. Diagnosis of PUC should be made within one month from a patient's first visit to a hospital.

Using the ISS as a testbed to prepare for the next generation of space-based telescopes

NASA Astrophysics Data System (ADS)

Postman, Marc; Sparks, William B.; Liu, Fengchuan; Ess, Kim; Green, Joseph; Carpenter, Kenneth G.; Thronson, Harley; Goullioud, Renaud

2012-09-01

The infrastructure available on the ISS provides a unique opportunity to develop the technologies necessary to assemble large space telescopes. Assembling telescopes in space is a game-changing approach to space astronomy. Using the ISS as a testbed enables a concentration of resources on reducing the technical risks associated with integrating the technologies, such as laser metrology and wavefront sensing and control (WFS&C), with the robotic assembly of major components including very light-weight primary and secondary mirrors and the alignment of the optical elements to a diffraction-limited optical system in space. The capability to assemble the optical system and remove and replace components via the existing ISS robotic systems such as the Special Purpose Dexterous Manipulator (SPDM), or by the ISS Flight Crew, allows for future experimentation as well as repair if necessary. In 2015, first light will be obtained by the Optical Testbed and Integration on ISS eXperiment (OpTIIX), a small 1.5-meter optical telescope assembled on the ISS. The primary objectives of OpTIIX include demonstrating telescope assembly technologies and end-to-end optical system technologies that will advance future large optical telescopes.

Tracking the Key Constituents of Concern of the WTP LAW Stream

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

Mabrouki, Ridha B.; Matlack, Keith S.; Abramowitz, Howard

The testing results presented in the present report were also obtained on a DM10 melter system operated with the primary WTP LAW offgas system components with recycle, as specified in the statement of work (SOW) [6] and detailed in the Test Plan for this work [7]. The primary offgas system components include the SBS, the WESP, and a recycle system that allows recycle of liquid effluents back to the melter, as in the present baseline for the WTP LAW vitrification. The partitioning of technetium and other key constituents between the glass waste form, the offgas system liquid effluents, the offgasmore » stream that exits the WESP, and the liquid condensate from the vacuum evaporator were quantified in this work. The tests employed three different LAW streams spanning a range of waste compositions anticipated for WTP. Modifications to the offgas system and operational strategy were made to expedite the approach to steady state concentrations of key constituents in the glass and offgas effluent solutions during each test.« less

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.

Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review.

PubMed

Ford, John A; Wong, Geoff; Jones, Andy P; Steel, Nick

2016-05-17

The aim of this review is to identify and understand the contexts that effect access to high-quality primary care for socioeconomically disadvantaged older people in rural areas. A realist review. MEDLINE and EMBASE electronic databases and grey literature (from inception to December 2014). Broad inclusion criteria were used to allow articles which were not specific, but might be relevant to the population of interest to be considered. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded for concepts relating to context, mechanism or outcome. An overarching patient pathway was generated and used as the basis to explore contexts, causal mechanisms and outcomes. 162 articles were included. Most were from the USA or the UK, cross-sectional in design and presented subgroup data by age, rurality or deprivation. From these studies, a patient pathway was generated which included 7 steps (problem identified, decision to seek help, actively seek help, obtain appointment, get to appointment, primary care interaction and outcome). Important contexts were stoicism, education status, expectations of ageing, financial resources, understanding the healthcare system, access to suitable transport, capacity within practice, the booking system and experience of healthcare. Prominent causal mechanisms were health literacy, perceived convenience, patient empowerment and responsiveness of the practice. Socioeconomically disadvantaged older people in rural areas face personal, community and healthcare barriers that limit their access to primary care. Initiatives should be targeted at local contextual factors to help individuals recognise problems, feel welcome, navigate the healthcare system, book appointments easily, access appropriate transport and have sufficient time with professional staff to improve their experience of healthcare; all of which will require dedicated primary care resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

PubMed Central

2011-01-01

Background Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure. Methods/Design The international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations. Results An integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230). Discussion The PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of South Africa and Malawi. PMID:21791048

Acute flaccid paraparesis (cauda equina syndrome) in a patient with Bardet-Biedl syndrome.

PubMed

Viswanathan, Vibhu Krishnan; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad; Rajasekaran, S

2017-01-01

Bardet-Biedl syndrome (BBS) is a rare, autosomal-recessive, debilitating genetic disorder, which can present with multitudinous systemic clinical features including rod-cone dystrophy, polydactyly, Frohlich-like central obesity, mental retardation, hypogonadism, and renal anomalies. Diverse neuromuscular manifestations in patients afflicted by this heterogeneous disorder include ataxia, cervical, and thoracic canal stenoses, presenting as spastic quadriparesis and other gait disturbances. We report a young patient with BBS, who had presented with acute flaccid paraparesis due to severe primary lumbar canal stenosis. She underwent immediate lumbar decompression and discectomy following which she recovered significantly. Acute cauda equina syndrome due to primary lumbar canal stenosis has not been reported as a clinical feature of BBS previously.

Curriculum Guidelines for Pathology and Oral Pathology.

ERIC Educational Resources Information Center

Journal of Dental Education, 1985

1985-01-01

Guidelines for dental school pathology courses describe the interrelationships of general, systemic, and oral pathology; primary educational goals; prerequisites; a core curriculum outline and behavioral objectives for each type of pathology. Notes on sequencing, faculty, facilities, and occupational hazards are included. (MSE)

I-15 express lanes study, phase I : system evaluation.

DOT National Transportation Integrated Search

2014-06-01

The primary objectives of this research included an identification of literature in Utah and nationally on : how changing toll rates, occupancies, and violation rates have had an effect on Express Lane use and an examination : of the utilization of t...

THE WESTERN EMAP APPROACH TO ASSESSMENT OF COASTAL ECOLOGICAL CONDITION

EPA Science Inventory

The primary objective of the Western Coastal Environmental Monitoring and Assessment Program (WEMAP) is the assessment of ecological condition of the coastal systems of Washington, Oregon, and California. WEMAP also includes two associated pilot projects to demonstrate feasibili...

A combination HIV reporter virus system for measuring post-entry event efficiency and viral outcome in primary CD4+ T cell subsets.

PubMed

Tilton, Carisa A; Tabler, Caroline O; Lucera, Mark B; Marek, Samantha L; Haqqani, Aiman A; Tilton, John C

2014-01-01

Fusion between the viral membrane of human immunodeficiency virus (HIV) and the host cell marks the end of the HIV entry process and the beginning of a series of post-entry events including uncoating, reverse transcription, integration, and viral gene expression. The efficiency of post-entry events can be modulated by cellular factors including viral restriction factors and can lead to several distinct outcomes: productive, latent, or abortive infection. Understanding host and viral proteins impacting post-entry event efficiency and viral outcome is critical for strategies to reduce HIV infectivity and to optimize transduction of HIV-based gene therapy vectors. Here, we report a combination reporter virus system measuring both membrane fusion and viral promoter-driven gene expression. This system enables precise determination of unstimulated primary CD4+ T cell subsets targeted by HIV, the efficiency of post-entry viral events, and viral outcome and is compatible with high-throughput screening and cell-sorting methods. Copyright © 2013 Elsevier B.V. All rights reserved.

Removing the echoes from terahertz pulse reflection system and sample

NASA Astrophysics Data System (ADS)

Liu, Haishun; Zhang, Zhenwei; Zhang, Cunlin

2018-01-01

Due to the echoes both from terahertz (THz) pulse reflection system and sample, the THz primary pulse will be distorted. The system echoes include two types. One preceding the main peak probably is caused by ultrafast laser pulse and the other at the back of the primary pulse is caused by the Fabry-Perot (F-P) etalon effect of detector. We attempt to remove the corresponding echoes by using two kinds of deconvolution. A Si wafer of 400μm was selected as the tested sample. Firstly, the method of double Gaussian filter (DGF) decnvolution was used to remove the systematic echoes, and then another deconvolution technique was employed to eliminate the two obvious echoes of the sample. The ultimate results indicated: although the combination of two deconvolution techniques could not entirely remove the echoes of sample and system, the echoes were largely reduced.

Molecular single-bond covalent radii for elements 1-118.

PubMed

Pyykkö, Pekka; Atsumi, Michiko

2009-01-01

A self-consistent system of additive covalent radii, R(AB)=r(A) + r(B), is set up for the entire periodic table, Groups 1-18, Z=1-118. The primary bond lengths, R, are taken from experimental or theoretical data corresponding to chosen group valencies. All r(E) values are obtained from the same fit. Both E-E, E-H, and E-CH(3) data are incorporated for most elements, E. Many E-E' data inside the same group are included. For the late main groups, the system is close to that of Pauling. For other elements it is close to the methyl-based one of Suresh and Koga [J. Phys. Chem. A 2001, 105, 5940] and its predecessors. For the diatomic alkalis MM' and halides XX', separate fits give a very high accuracy. These primary data are then absorbed with the rest. The most notable exclusion are the transition-metal halides and chalcogenides which are regarded as partial multiple bonds. Other anomalies include H(2) and F(2). The standard deviation for the 410 included data points is 2.8 pm.

Factors Influencing Solar Electric Propulsion Vehicle Payload Delivery for Outer Planet Missions

NASA Technical Reports Server (NTRS)

Cupples, Michael; Green, Shaun; Coverstone, Victoria

2003-01-01

Systems analyses were performed for missions utilizing solar electric propulsion systems to deliver payloads to outer-planet destinations. A range of mission and systems factors and their affect on the delivery capability of the solar electric propulsion system was examined. The effect of varying the destination, the trip time, the launch vehicle, and gravity-assist boundary conditions was investigated. In addition, the affects of selecting propulsion system and power systems characteristics (including primary array power variation, number of thrusters, thruster throttling mode, and thruster Isp) on delivered payload was examined.

Hydrogen purification systems for PEM fuel cells

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

Varma, Arvind; Hwang, Hyun Tae; Al-Kukhun, Ahmad

A system for generating and purifying hydrogen. To generate hydrogen, the system includes inlets configured to receive a hydrogen carrier and an inert insulator, a mixing chamber configured to combine the hydrogen carrier and the inert insulator, a heat exchanger configured to apply heat to the mixture of hydrogen carrier and the inert insulator, wherein the applied heat results in the generation of hydrogen from the hydrogen carrier, and an outlet configured to release the generated hydrogen. To purify hydrogen, the system includes a primary inlet to receive a starting material and an ammonia filtration subassembly, which may include anmore » absorption column configured to absorb the ammonia into water for providing purified hydrogen at a first purity level. The ammonia filtration subassembly may also include an adsorbent member configured to adsorb ammonia from the starting material into an adsorbent for providing purified hydrogen at a second purity level.« less

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System.

PubMed

Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

2016-01-01

For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Primary measure was satisfaction with one's day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2-9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction.

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

PubMed Central

Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

2016-01-01

Context: For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. Objective: To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Design: Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Main Outcome Measures: Primary measure was satisfaction with one’s day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Results: Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2–9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. Conclusion: It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction. PMID:27057819

Exemplars in the use of technology for management of depression in primary care.

PubMed

Serrano, Neftali; Molander, Rachel; Monden, Kimberley; Grosshans, Ashley; Krahn, Dean D

2012-06-01

Depression care management as part of larger efforts to integrate behavioral health care into primary care has been shown to be effective in helping patients and primary care clinicians achieve improved outcomes within the primary care environment. Central to care management systems is the use of registries which enable effective clinic population management. The aim of this article is to detail the methods and utility of technology in depression care management processes while also highlighting the real-world variations and barriers that exist in different clinical environments, namely a federally qualified health center and a Veterans Administration clinic. We analyzed descriptive data from the registries of Access Community Health Centers and the William S. Middleton Veterans Administration clinics along with historical reviews of their respective care management processes. Both registry reviews showed trend data indicating improvement in scores of depression and provided baseline data on important system variables, such as the number of patients who are not making progress, the percentage of patients who are unreachable by phone, and the kind of actions needed to ensure evidence-based and efficient care. Both sites also highlighted systemic technical barriers to more complete implementation of care management processes. Care management processes are an effective and efficient part of population-based care for depression in primary care. Implementation depends on available resources including hardware, software, and clinical personnel. Additionally, care management processes and technology have evolved over time based on local needs and are part of an integrated method to support the work of primary care clinicians in providing care for patients with depression.

[Study on the application of value of digital medical technology in the operation on primary liver cancer].

PubMed

Fang, Chi-hua; Lu, Chao-min; Huang, Yan-peng; Li, Xiao-feng; Fan, Ying-fang; Yang, Jian; Xiang, Nan; Pan, Jia-hui

2009-04-01

To study the clinical application of digital medical in the operation on primary liver cancer. The patients (n=11) with primary hepatic carcinoma treated between February and July 2008, including 9 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma, were scanned using 64 slices helicon computerized tomography (CT) and the datasets was collected. Segment and three-dimensional (3D) reconstruction of the CT image was carried out by the medical image processing system which was developed. And the 3D moulds were imported to the FreeForm Modeling System for smoothing. Then the hepatectomy in treatment of hepatoma and implanting of catheter were simulated with the force-feedback equipment (PHANToM). Finally, 3D models and results of simulation surgery were used for choosing mode of operation and comparing with the findings during the operation. The reconstructed models were true to life, and their spatial disposition and correlation were shown clearly; Blood supply of primary liver cancer could be seen easily. In the simulation surgery system, the process of virtual partial hepatectomy and implanting of catheter using simulation scalpel and catheter on 3D moulds with PHANToM was consistent with the clinical course of surgery. Life-like could be felt and power feeling can be touched during simulation operation. Digital medical benefited knowing the relationship between primary liver cancer and the intrahepatic pipe. It gave an advantage to complete primary liver cancer resection with more liver volume remained. It can improve the surgical effect and decrease the surgical risk and reduce the complication through demonstrating visualized operation before surgery.

Diagnosis and medical treatment of otitis externa in the dog and cat.

PubMed

Jacobson, L S

2002-12-01

Otitis externa is no longer viewed as an isolated disease of the ear canal, but is a syndrome that is often a reflection of underlying dermatological disease. Causes are classified as predisposing (increase the risk of otitis); primary (directly induce otitis), secondary (contribute to otitis only in an abnormal ear or in conjunction with predisposing factors) and perpetuating (result from inflammation and pathology in ear, prevent resolution of otitis). Common primary causes include foreign bodies, hypersensitivity (particularly atopy and food allergy), keratinisation disorders (most commonly primary idiopathic seborrhoea and hypothyroidism) and earmites, particularly in cats. A systematic diagnostic procedure is required to identify causes and contributing factors. This should include history, clinical examination, otoscopy and cytology in all cases and culture and sensitivity as well as otitis media assessment and biopsy in severe and recurrent cases. Ancillary tests may be required depending on the underlying cause. Treatment consists of identifying and addressing predisposing and primary factors; cleaning the ear canal; topical therapy; systemic therapy where necessary; client education; follow-up; and preventive and maintenance therapy as required.

Nonlinear dynamical systems for theory and research in ergonomics.

PubMed

Guastello, Stephen J

2017-02-01

Nonlinear dynamical systems (NDS) theory offers new constructs, methods and explanations for phenomena that have in turn produced new paradigms of thinking within several disciplines of the behavioural sciences. This article explores the recent developments of NDS as a paradigm in ergonomics. The exposition includes its basic axioms, the primary constructs from elementary dynamics and so-called complexity theory, an overview of its methods, and growing areas of application within ergonomics. The applications considered here include: psychophysics, iconic displays, control theory, cognitive workload and fatigue, occupational accidents, resilience of systems, team coordination and synchronisation in systems. Although these applications make use of different subsets of NDS constructs, several of them share the general principles of the complex adaptive system. Practitioner Summary: Nonlinear dynamical systems theory reframes problems in ergonomics that involve complex systems as they change over time. The leading applications to date include psychophysics, control theory, cognitive workload and fatigue, biomechanics, occupational accidents, resilience of systems, team coordination and synchronisation of system components.

The Referral System between Primary and Secondary Health Care in Saudi Arabia for Patients with Type 2 Diabetes: A Systematic Review

PubMed Central

Senitan, Mohammed; Alhaiti, Ali Hassan; Gillespie, James; Alotaibi, Badar Faiz

2017-01-01

Background In Saudi Arabia, the mortality of diabetes is currently reported at 6%. A well-administered referral system is crucial in aiding the management of this disease. Method A single reviewer employed a systematic approach to searching the literature databases with regard to the question: what are the attributes of referral systems in Saudi Arabia for patients with type 2 diabetes (T2D)? The results were analysed in order to provide recommendations to improve the Saudi health system. Results Twelve primary studies were identified from a systematic search. Overall, the 12 studies did not clearly mention any of the factors of a good referral system. The referral problems identified by this study included patients' unnecessary requests for referral, unstructured referral letters, and unclear dissemination guidelines for referral. Conclusions This research attempted to identify the efficiency of the referral processes that were implemented for patients with T2D. The majority of the included studies were completely silent on the main referral factors for patients. If this review is representative of the referral system in Saudi Arabia, then, in the context of T2D, current referrals are unsafe. Further research on the quality of the referral system, taking into account at least some of the WHO referral guidelines, is required. PMID:28634586

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.

PubMed

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-06-01

Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

An interstellar precursor mission

NASA Technical Reports Server (NTRS)

Jaffe, L. D.; Ivie, C.; Lewis, J. C.; Lipes, R. G.; Norton, H. N.; Stearns, J. W.; Stimpson, L.; Weissman, P.

1977-01-01

A mission out of the planetary system, with launch about the year 2000, could provide valuable scientific data as well as test some of the technology for a later mission to another star. Primary scientific objectives for the precursor mission concern characteristics of the heliopause, the interstellar medium, stellar distances (by parallax measurements), low energy cosmic rays, interplanetary gas distribution, and mass of the solar system. Secondary objectives include investigation of Pluto. Candidate science instruments are suggested. Individual spacecraft systems for the mission were considered, technology requirements and problem areas noted, and a number of recommendations made for technology study and advanced development. The most critical technology needs include attainment of 50-yr spacecraft lifetime and development of a long-life NEP system.

Liquid Rocket Propulsion Technology: An evaluation of NASA's program. [for space transportation systems

NASA Technical Reports Server (NTRS)

1981-01-01

The liquid rocket propulsion technology needs to support anticipated future space vehicles were examined including any special action needs to be taken to assure that an industrial base in substained. Propulsion system requirements of Earth-to-orbit vehicles, orbital transfer vehicles, and planetary missions were evaluated. Areas of the fundamental technology program undertaking these needs discussed include: pumps and pump drives; combustion heat transfer; nozzle aerodynamics; low gravity cryogenic fluid management; and component and system life reliability, and maintenance. The primary conclusion is that continued development of the shuttle main engine system to achieve design performance and life should be the highest priority in the rocket engine program.

Primary ovarian Burkitt's lymphoma: a rare oncological problem in gynaecology: a review of literature.

PubMed

Stepniak, Anna; Czuczwar, Piotr; Szkodziak, Piotr; Wozniakowska, Ewa; Wozniak, Slawomir; Paszkowski, Tomasz

2017-10-01

This review presents the information about epidemiology, clinical manifestation, diagnosis and treatment of primary ovarian Burkitt's lymphoma (BL), including a literature search of available BL cases. The purpose of this review is to draw clinicians' attention to the possibility of ovarian BL occurrence, which may be important in the differential diagnosis of ovarian tumours. PubMed and Web of Science databases were searched using the keywords ''Burkitt's'', ''Lymphoma'', ''Ovarian'', ''Primary'', ''Burkitt's lymphoma''. Only cases with histopathologically confirmed diagnosis of primary ovarian BL were included in this review. Fifty articles, reporting cases with an ovarian manifestation of primary non-Hodgkin's lymphoma, were found. Twenty-one cases with a histopathologically confirmed BL were evaluated to compare various manifestations, treatment and prognosis in ovarian BL. Primary ovarian BL is a rare condition, included in the entity of non-Hodgkin lymphoma. The tumour can occur uni- or bilaterally in the ovaries with major symptoms such as abdominal pain or a large abdominal mass. Differential diagnosis, based on imaging features and pathological examination of the specimens, is essential for further treatment due to various aetiology of ovarian tumours. Although most of the patients suffering from ovarian BL underwent surgery after the ovarian tumour had been detected, surgical treatment is not the treatment of choice in patients with ovarian lymphoma. The mainstay of therapy is chemotherapy without further surgery. The prognosis is better if the chemotherapy protocol is more aggressive and followed by prophylactic central nervous system chemotherapy. Nowadays, multiagent protocols are administered, which improves the survival rate.

Comprehensive evaluation of the revised international staging system in multiple myeloma patients treated with novel agents as a primary therapy.

PubMed

Cho, Hyungwoo; Yoon, Dok Hyun; Lee, Jung Bok; Kim, Sung-Yong; Moon, Joon Ho; Do, Young Rok; Lee, Jae Hoon; Park, Yong; Lee, Ho Sup; Eom, Hyeon Seok; Shin, Ho-Jin; Min, Chang-Ki; Kim, Jin Seok; Jo, Jae-Cheol; Kang, Hye Jin; Mun, Yeung-Chul; Lee, Won Sik; Lee, Je-Jung; Suh, Cheolwon; Kim, Kihyun

2017-12-01

The revised International Staging System (R-ISS) has recently been developed to improve the risk stratification of multiple myeloma (MM) patients over the ISS. We assessed the R-ISS in MM patients who were treated with novel agents as a primary therapy and evaluated its discriminative power and ability to reclassify patients from the ISS. A total of 514 newly diagnosed MM patients treated with novel agents including thalidomide, bortezomib, and lenalidomide as a primary therapy were included in this retrospective analysis. With a median follow-up duration of 42.3 months (range, 40.5-44.1), the median overall survival (OS) was 61.0 months. There was a significant difference in median OS (not reached, 60.9, and 50.1 months for stages 1, 2, and 3, respectively, P < 0.001) among the three stages of R-ISS. The C-statistic was significantly greater for R-ISS than for ISS (0.769 vs. 0.696, P < 0.001). The event NRI was -0.08 (95% confidence interval [CI], -0.18-0.01) and the non-event NRI was 0.05 (95% CI, -0.03-0.10), resulting in a total NRI of -0.03 (95% CI, -0.14-0.08, P = 0.602). The R-ISS performs well and has significantly better discriminative power than the ISS in MM patients treated with novel agents as a primary therapy. However, it does not better reclassify patients from the ISS, suggesting that there is still room to improve the staging system. Moreover, new statistical measures for assessing and quantifying the risk prediction of new prognostic models are necessary in future studies. © 2017 Wiley Periodicals, Inc.

Primary Care–Mental Health Integration Programs in the Veterans Affairs Health System Serve a Different Patient Population Than Specialty Mental Health Clinics

PubMed Central

Szymanski, Benjamin R.; Zivin, Kara; McCarthy, John F.; Valenstein, Marcia; Pfeiffer, Paul N.

2012-01-01

Objective: To assess whether Primary Care–Mental Health Integration (PC-MHI) programs within the Veterans Affairs (VA) health system provide services to patient subgroups that may be underrepresented in specialty mental health care, including older patients and women, and to explore whether PC-MHI served individuals with less severe mental health disorders compared to specialty mental health clinics. Method: Data were obtained from the VA National Patient Care Database for a random sample of VA patients, and primary care patients with an ICD-9-CM mental health diagnosis (N = 243,806) in 2009 were identified. Demographic and clinical characteristics between patients who received mental health treatment exclusively in a specialty mental health clinic (n = 128,248) or exclusively in a PC-MHI setting (n = 8,485) were then compared. Characteristics of patients who used both types of services were also explored. Results: Compared to patients treated in specialty mental health clinics, PC-MHI service users were more likely to be aged 65 years or older (26.4% vs 17.9%, P < .001) and female (8.6% vs 7.7%, P = .003). PC-MHI patients were more likely than specialty mental health clinic patients to be diagnosed with a depressive disorder other than major depression, an unspecified anxiety disorder, or an adjustment disorder (P < .001) and less likely to be diagnosed with more severe disorders, including bipolar disorder, posttraumatic stress disorder, psychotic disorders, and alcohol or substance dependence (P < .001). Conclusions: Primary Care–Mental Health Integration within the VA health system reaches demographic subgroups that are traditionally less likely to use specialty mental health care. By treating patients with less severe mental health disorders, PC-MHI appears to expand upon, rather than duplicate, specialty care services. PMID:23106026

Performance indicators used to assess the quality of primary dental care.

PubMed

González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M

2006-12-01

An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.

The Emergency Medical System in Greece: Opening Aeolus' Bag of Winds.

PubMed

Kotsiou, Ourania S; Srivastava, David S; Kotsios, Panagiotis; Exadaktylos, Aristomenis K; Gourgoulianis, Konstantinos I

2018-04-13

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. This manuscript aims to present the structure of the Greek EMS system and the impact of the current economic recession on it. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination. Patients are also facing economic limitations that lead to difficulties in using healthcare services. The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes. Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary–hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care.

Energy storage considerations for a robotic Mars surface sampler

NASA Technical Reports Server (NTRS)

O'Donnell, P. M.; Cataldo, R. L.; Gonzalez-Sanabria, O. D.

1988-01-01

The characteristics of various energy storage systems (including Ni-Cd, Ni-H2, Ag-Zn, Li-XS, Na-S, PbSO4, and regenerative fuel cell systems) considered for a robotic Mars surface sampler are reviewed. It is concluded that the bipolar nickel-hydrogen battery and the sodium-sulfur battery are both viable candidates as storage systems for the rover's Radioisotope Thermoelectric Generator. For a photovoltaic storage system, the regenerative fuel cell and the bipolar nickel-hydrogen battery are the primary candidates.

Sour pressure swing adsorption process

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

Bhadra, Shubhra Jyoti; Wright, Andrew David; Hufton, Jeffrey Raymond

Methods and apparatuses for separating CO.sub.2 and sulfur-containing compounds from a synthesis gas obtained from gasification of a carbonaceous feedstock. The primary separating steps are performed using a sour pressure swing adsorption (SPSA) system, followed by an acid gas enrichment system and a sulfur removal unit. The SPSA system includes multiple pressure equalization steps and a rinse step using a rinse gas that is supplied from a source other than directly from one of the adsorber beds of the SPSA system.

Cold Vacuum Drying facility civil structural system design description (SYS 06)

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

PITKOFF, C.C.

This document describes the Cold Vacuum Drying (CVD) Facility civil - structural system. This system consists of the facility structure, including the administrative and process areas. The system's primary purpose is to provide for a facility to house the CVD process and personnel and to provide a tertiary level of containment. The document provides a description of the facility and demonstrates how the design meets the various requirements imposed by the safety analysis report and the design requirements document.

Space station data system analysis/architecture study. Task 3: Trade studies, DR-5, volume 1

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 3 is to provide additional analysis and insight necessary to support key design/programmatic decision for options quantification and selection for system definition. This includes: (1) the identification of key trade study topics; (2) the definition of a trade study procedure for each topic (issues to be resolved, key inputs, criteria/weighting, methodology); (3) conduct tradeoff and sensitivity analysis; and (4) the review/verification of results within the context of evolving system design and definition. The trade study topics addressed in this volume include space autonomy and function automation, software transportability, system network topology, communications standardization, onboard local area networking, distributed operating system, software configuration management, and the software development environment facility.

Near-term lander experiments for growing plants on Mars: requirements for information on chemical and physical properties of Mars regolith.

PubMed

Schuerger, Andrew C; Ming, Douglas W; Newsom, Horton E; Ferl, Robert J; McKay, Christopher P

2002-01-01

In order to support humans for long-duration missions to Mars, bioregenerative Advanced Life Support (ALS) systems have been proposed that would use higher plants as the primary candidates for photosynthesis. Hydroponic technologies have been suggested as the primary method of plant production in ALS systems, but the use of Mars regolith as a plant growth medium may have several advantages over hydroponic systems. The advantages for using Mars regolith include the likely bioavailability of plant-essential ions, mechanical support for plants, and easy access of the material once on the surface. We propose that plant biology experiments must be included in near-term Mars lander missions in order to begin defining the optimum approach for growing plants on Mars. Second, we discuss a range of soil chemistry and soil physics tests that must be conducted prior to, or in concert with, a plant biology experiment in order to properly interpret the results of plant growth studies in Mars regolith. The recommended chemical tests include measurements on soil pH, electrical conductivity and soluble salts, redox potential, bioavailability of essential plant nutrients, and bioavailability of phytotoxic elements. In addition, a future plant growth experiment should include procedures for determining the buffering and leaching requirements of Mars regolith prior to planting. Soil physical tests useful for plant biology studies in Mars regolith include bulk density, particle size distribution, porosity, water retention, and hydraulic conductivity.

Near-term lander experiments for growing plants on Mars: requirements for information on chemical and physical properties of Mars regolith

NASA Technical Reports Server (NTRS)

Schuerger, Andrew C.; Ming, Douglas W.; Newsom, Horton E.; Ferl, Robert J.; McKay, Christopher P.

2002-01-01

In order to support humans for long-duration missions to Mars, bioregenerative Advanced Life Support (ALS) systems have been proposed that would use higher plants as the primary candidates for photosynthesis. Hydroponic technologies have been suggested as the primary method of plant production in ALS systems, but the use of Mars regolith as a plant growth medium may have several advantages over hydroponic systems. The advantages for using Mars regolith include the likely bioavailability of plant-essential ions, mechanical support for plants, and easy access of the material once on the surface. We propose that plant biology experiments must be included in near-term Mars lander missions in order to begin defining the optimum approach for growing plants on Mars. Second, we discuss a range of soil chemistry and soil physics tests that must be conducted prior to, or in concert with, a plant biology experiment in order to properly interpret the results of plant growth studies in Mars regolith. The recommended chemical tests include measurements on soil pH, electrical conductivity and soluble salts, redox potential, bioavailability of essential plant nutrients, and bioavailability of phytotoxic elements. In addition, a future plant growth experiment should include procedures for determining the buffering and leaching requirements of Mars regolith prior to planting. Soil physical tests useful for plant biology studies in Mars regolith include bulk density, particle size distribution, porosity, water retention, and hydraulic conductivity.

Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project.

PubMed

Bailie, Ross; Si, Damin; Connors, Christine; Weeramanthri, Tarun; Clark, Louise; Dowden, Michelle; O'Donohue, Lynette; Condon, John; Thompson, Sandra; Clelland, Nikki; Nagel, Tricia; Gardner, Karen; Brown, Alex

2008-09-17

A growing body of international literature points to the importance of a system approach to improve the quality of care in primary health care settings. Continuous Quality Improvement (CQI) concepts and techniques provide a theoretically coherent and practical way for primary care organisations to identify, address, and overcome the barriers to improvements. The Audit and Best Practice for Chronic Disease (ABCD) study, a CQI-based quality improvement project conducted in Australia's Northern Territory, has demonstrated significant improvements in primary care service systems, in the quality of clinical service delivery and in patient outcomes related to chronic illness care. The aims of the extension phase of this study are to examine factors that influence uptake and sustainability of this type of CQI activity in a variety of Indigenous primary health care organisations in Australia, and to assess the impact of collaborative CQI approaches on prevention and management of chronic illness and health outcomes in Indigenous communities. The study will be conducted in 40-50 Indigenous community health centres from 4 States/Territories (Northern Territory, Western Australia, New South Wales and Queensland) over a five year period. The project will adopt a participatory, quality improvement approach that features annual cycles of: 1) organisational system assessment and audits of clinical records; 2) feedback to and interpretation of results with participating health centre staff; 3) action planning and goal setting by health centre staff to achieve system changes; and 4) implementation of strategies for change. System assessment will be carried out using a System Assessment Tool and in-depth interviews of key informants. Clinical audit tools include two essential tools that focus on diabetes care audit and preventive service audit, and several optional tools focusing on audits of hypertension, heart disease, renal disease, primary mental health care and health promotion. The project will be carried out in a form of collaborative characterised by a sequence of annual learning cycles with action periods for CQI activities between each learning cycle. Key outcome measures include uptake and integration of CQI activities into routine service activity, state of system development, delivery of evidence-based services, intermediate patient outcomes (e.g. blood pressure and glucose control), and health outcomes (complications, hospitalisations and mortality). The ABCD Extension project will contribute directly to the evidence base on effectiveness of collaborative CQI approaches on prevention and management of chronic disease in Australia's Indigenous communities, and to inform the operational and policy environments that are required to incorporate CQI activities into routine practice.

Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project

PubMed Central

Bailie, Ross; Si, Damin; Connors, Christine; Weeramanthri, Tarun; Clark, Louise; Dowden, Michelle; O'Donohue, Lynette; Condon, John; Thompson, Sandra; Clelland, Nikki; Nagel, Tricia; Gardner, Karen; Brown, Alex

2008-01-01

Background A growing body of international literature points to the importance of a system approach to improve the quality of care in primary health care settings. Continuous Quality Improvement (CQI) concepts and techniques provide a theoretically coherent and practical way for primary care organisations to identify, address, and overcome the barriers to improvements. The Audit and Best Practice for Chronic Disease (ABCD) study, a CQI-based quality improvement project conducted in Australia's Northern Territory, has demonstrated significant improvements in primary care service systems, in the quality of clinical service delivery and in patient outcomes related to chronic illness care. The aims of the extension phase of this study are to examine factors that influence uptake and sustainability of this type of CQI activity in a variety of Indigenous primary health care organisations in Australia, and to assess the impact of collaborative CQI approaches on prevention and management of chronic illness and health outcomes in Indigenous communities. Methods/design The study will be conducted in 40–50 Indigenous community health centres from 4 States/Territories (Northern Territory, Western Australia, New South Wales and Queensland) over a five year period. The project will adopt a participatory, quality improvement approach that features annual cycles of: 1) organisational system assessment and audits of clinical records; 2) feedback to and interpretation of results with participating health centre staff; 3) action planning and goal setting by health centre staff to achieve system changes; and 4) implementation of strategies for change. System assessment will be carried out using a System Assessment Tool and in-depth interviews of key informants. Clinical audit tools include two essential tools that focus on diabetes care audit and preventive service audit, and several optional tools focusing on audits of hypertension, heart disease, renal disease, primary mental health care and health promotion. The project will be carried out in a form of collaborative characterised by a sequence of annual learning cycles with action periods for CQI activities between each learning cycle. Key outcome measures include uptake and integration of CQI activities into routine service activity, state of system development, delivery of evidence-based services, intermediate patient outcomes (e.g. blood pressure and glucose control), and health outcomes (complications, hospitalisations and mortality). Conclusion The ABCD Extension project will contribute directly to the evidence base on effectiveness of collaborative CQI approaches on prevention and management of chronic disease in Australia's Indigenous communities, and to inform the operational and policy environments that are required to incorporate CQI activities into routine practice. PMID:18799011

Primary Payer at DX: Issues with Collection and Assessment of Data Quality.

PubMed

Sherman, Recinda L; Williamson, Laura; Andrews, Patricia; Kahn, Amy

2016-01-01

An individual's access to health insurance influences the amount and type of health services a patient receives for prevention and treatment, and, ultimately, influences survival. The North American Association of Central Cancer Registries (NAACCR) Item #630, Primary Payer at DX, is a required field intended to document health insurance status for the purpose of supporting patterns-of-care studies and other research. However, challenges related to the uniformity of collection and availability of data needed to populate this field diminish the value of the Primary Payer at DX data. A NAACCR taskforce worked on issues surrounding the collection of Primary Payer at DX; including proposing a crosswalk between Primary Payer at DX and the new Public Health Payment Typology standard, often available in hospital discharge databases. However, there are issues with compatibility between coding systems, intent of data collection, timelines for coding insurance, and changes in insurance coverage (partly due to the Affordable Care Act) that continue to complicate the collection and use of Primary Payer at DX data.

Groundwater quality in the Santa Clara River Valley, California

USGS Publications Warehouse

Burton, Carmen A.; Landon, Matthew K.; Belitz, Kenneth

2011-01-01

The Santa Clara River Valley (SCRV) study unit is located in Los Angeles and Ventura Counties, California, and is bounded by the Santa Monica, San Gabriel, Topatopa, and Santa Ynez Mountains, and the Pacific Ocean. The 460-square-mile study unit includes eight groundwater basins: Ojai Valley, Upper Ojai Valley, Ventura River Valley, Santa Clara River Valley, Pleasant Valley, Arroyo Santa Rosa Valley, Las Posas Valley, and Simi Valley (California Department of Water Resources, 2003; Montrella and Belitz, 2009). The SCRV study unit has hot, dry summers and cool, moist winters. Average annual rainfall ranges from 12 to 28 inches. The study unit is drained by the Ventura and Santa Clara Rivers, and Calleguas Creek. The primary aquifer system in the Ventura River Valley, Ojai Valley, Upper Ojai Valley, and Simi Valley basins is largely unconfined alluvium. The primary aquifer system in the remaining groundwater basins mainly consists of unconfined sands and gravels in the upper portion and partially confined marine and nonmarine deposits in the lower portion. The primary aquifer system in the SCRV study unit is defined as those parts of the aquifers corresponding to the perforated intervals of wells listed in the California Department of Public Health (CDPH) database. Public-supply wells typically are completed in the primary aquifer system to depths of 200 to 1,100 feet below land surface (bls). The wells contain solid casing reaching from the land surface to a depth of about 60-700 feet, and are perforated below the solid casing to allow water into the well. Water quality in the primary aquifer system may differ from the water in the shallower and deeper parts of the aquifer. Land use in the study unit is approximately 40 percent (%) natural (primarily shrubs, grassland, and wetlands), 37% agricultural, and 23% urban. The primary crops are citrus, avocados, alfalfa, pasture, strawberries, and dry beans. The largest urban areas in the study unit are the cities of Ventura, Oxnard, Camarillo, Simi Valley, Newhall, and Santa Clarita. Currently, groundwater pumping for agricultural use accounts for the greatest amount of discharge from the aquifer system in the SCRV study unit, followed by municipal use. Recharge to the groundwater system is through stream-channel infiltration from the three main river systems and by direct infiltration of precipitation and irrigation. Recharge facilities in the Oxnard forebay play an important role in recharging the local aquifer systems.

CRYOTE (Cryogenic Orbital Testbed) Concept

NASA Technical Reports Server (NTRS)

Gravlee, Mari; Kutter, Bernard; Wollen, Mark; Rhys, Noah; Walls, Laurie

2009-01-01

Demonstrating cryo-fluid management (CFM) technologies in space is critical for advances in long duration space missions. Current space-based cryogenic propulsion is viable for hours, not the weeks to years needed by space exploration and space science. CRYogenic Orbital TEstbed (CRYOTE) provides an affordable low-risk environment to demonstrate a broad array of critical CFM technologies that cannot be tested in Earth's gravity. These technologies include system chilldown, transfer, handling, health management, mixing, pressure control, active cooling, and long-term storage. United Launch Alliance is partnering with Innovative Engineering Solutions, the National Aeronautics and Space Administration, and others to develop CRYOTE to fly as an auxiliary payload between the primary payload and the Centaur upper stage on an Atlas V rocket. Because satellites are expensive, the space industry is largely risk averse to incorporating unproven systems or conducting experiments using flight hardware that is supporting a primary mission. To minimize launch risk, the CRYOTE system will only activate after the primary payload is separated from the rocket. Flying the testbed as an auxiliary payload utilizes Evolved Expendable Launch Vehicle performance excess to cost-effectively demonstrate enhanced CFM.

A scoping literature review of collaboration between primary care and public health.

PubMed

Martin-Misener, Ruth; Valaitis, Ruta; Wong, Sabrina T; Macdonald, Marjorie; Meagher-Stewart, Donna; Kaczorowski, Janusz; O-Mara, Linda; Savage, Rachel; Austin, Patricia

2012-10-01

The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success. Collaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone. The study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English. The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

African leaders' views on critical human resource issues for the implementation of family medicine in Africa.

PubMed

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert

2014-01-17

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.

Operational alternatives for LANDSAT in California

NASA Technical Reports Server (NTRS)

Wilson, P.; Gialdini, M. J.

1981-01-01

Data integration is defined and examined as the means of promoting data sharing among the various governmental and private geobased information systems in California. Elements of vertical integration considered included technical factors (such as resolution and classification) and institutional factors (such as organizational control, and legal and political barriers). Attempts are made to fit the theoretical elements of vertical integration into a meaningful structure for looking at the problem from a statewide focus. Both manual (mapped) and machine readable data systems are included. Special attention is given to LANDSAT imagery because of its strong potential for integrated use and its primary in the California Integrated Remote Sensing System program.

Batteries used to Power Implantable Biomedical Devices

PubMed Central

Bock, David C.; Marschilok, Amy C.; Takeuchi, Kenneth J.; Takeuchi, Esther S.

2012-01-01

Battery systems have been developed that provide years of service for implantable medical devices. The primary systems utilize lithium metal anodes with cathode systems including iodine, manganese oxide, carbon monofluoride, silver vanadium oxide and hybrid cathodes. Secondary lithium ion batteries have also been developed for medical applications where the batteries are charged while remaining implanted. While the specific performance requirements of the devices vary, some general requirements are common. These include high safety, reliability and volumetric energy density, long service life, and state of discharge indication. Successful development and implementation of these battery types has helped enable implanted biomedical devices and their treatment of human disease. PMID:24179249

Batteries used to Power Implantable Biomedical Devices.

PubMed

Bock, David C; Marschilok, Amy C; Takeuchi, Kenneth J; Takeuchi, Esther S

2012-12-01

Battery systems have been developed that provide years of service for implantable medical devices. The primary systems utilize lithium metal anodes with cathode systems including iodine, manganese oxide, carbon monofluoride, silver vanadium oxide and hybrid cathodes. Secondary lithium ion batteries have also been developed for medical applications where the batteries are charged while remaining implanted. While the specific performance requirements of the devices vary, some general requirements are common. These include high safety, reliability and volumetric energy density, long service life, and state of discharge indication. Successful development and implementation of these battery types has helped enable implanted biomedical devices and their treatment of human disease.

Jatropha curcas L. Root Structure and Growth in Diverse Soils

PubMed Central

Valdés-Rodríguez, Ofelia Andrea; Sánchez-Sánchez, Odilón; Pérez-Vázquez, Arturo; Caplan, Joshua S.; Danjon, Frédéric

2013-01-01

Unlike most biofuel species, Jatropha curcas has promise for use in marginal lands, but it may serve an additional role by stabilizing soils. We evaluated the growth and structural responsiveness of young J. curcas plants to diverse soil conditions. Soils included a sand, a sandy-loam, and a clay-loam from eastern Mexico. Growth and structural parameters were analyzed for shoots and roots, although the focus was the plasticity of the primary root system architecture (the taproot and four lateral roots). The sandy soil reduced the growth of both shoot and root systems significantly more than sandy-loam or clay-loam soils; there was particularly high plasticity in root and shoot thickness, as well as shoot length. However, the architecture of the primary root system did not vary with soil type; the departure of the primary root system from an index of perfect symmetry was 14 ± 5% (mean ± standard deviation). Although J. curcas developed more extensively in the sandy-loam and clay-loam soils than in sandy soil, it maintained a consistent root to shoot ratio and root system architecture across all types of soil. This strong genetic determination would make the species useful for soil stabilization purposes, even while being cultivated primarily for seed oil. PMID:23844412

Jatropha curcas L. root structure and growth in diverse soils.

PubMed

Valdés-Rodríguez, Ofelia Andrea; Sánchez-Sánchez, Odilón; Pérez-Vázquez, Arturo; Caplan, Joshua S; Danjon, Frédéric

2013-01-01

Unlike most biofuel species, Jatropha curcas has promise for use in marginal lands, but it may serve an additional role by stabilizing soils. We evaluated the growth and structural responsiveness of young J. curcas plants to diverse soil conditions. Soils included a sand, a sandy-loam, and a clay-loam from eastern Mexico. Growth and structural parameters were analyzed for shoots and roots, although the focus was the plasticity of the primary root system architecture (the taproot and four lateral roots). The sandy soil reduced the growth of both shoot and root systems significantly more than sandy-loam or clay-loam soils; there was particularly high plasticity in root and shoot thickness, as well as shoot length. However, the architecture of the primary root system did not vary with soil type; the departure of the primary root system from an index of perfect symmetry was 14 ± 5% (mean ± standard deviation). Although J. curcas developed more extensively in the sandy-loam and clay-loam soils than in sandy soil, it maintained a consistent root to shoot ratio and root system architecture across all types of soil. This strong genetic determination would make the species useful for soil stabilization purposes, even while being cultivated primarily for seed oil.

Using Meta Analysis Techniques to Assess the Safety Effect of Red Light Running Cameras

DOT National Transportation Integrated Search

2002-02-01

Automated enforcement programs, including automated systems that are used to enforce red light running violations, have recently come under scrutiny regarding their value in terms of improving safety, their primary purpose. One of the major hurdles t...

Gas turbine engine control system

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

Idelchik, M.S.

1991-02-19

This paper describes a method for controlling a gas turbine engine. It includes receiving an error signal and processing the error signal to form a primary control signal; receiving at least one anticipatory demand signal and processing the signal to form an anticipatory fuel control signal.

Iowa's bridge and highway climate change and extreme weather vulnerability assessment pilot.

DOT National Transportation Integrated Search

2015-03-01

The Iowa Department of Transportation (DOT) is responsible for approximately 4,100 bridges and structures that are a part of the : states primary highway system, which includes the Interstate, US, and Iowa highway routes. A pilot study was conduct...

GEOSYNTHETIC DESIGN GUIDANCE FOR HAZARDOUS WASTE LANDFILL CELLS AND SURFACE IMPOUNDMENTS

EPA Science Inventory

The report provides guidance design procedures for the use of geosynthetic materials in hazardous waste land disposal cells. Primary geosynthetic components include flexible membrane liners (FML) used to limit the flow of leachate, and leachate collection and removal systems (LCR...