Journal des États généraux de France tenus à Tours en 1484 sous le règne de Charles VIII /

Text in Latin and French on opposite pages.

The proposed "Public Health Code" : Senate bill 1484, House bill 6306, 1976 Michigan Legislature /

Cover title.

Quality issues for the National Bowel Cancer Screening Program (NBCSP)

Purpose: This two-part research project was undertaken as part of the planning process by Queensland Health (QH), Cancer Screening Services Unit (CSSU), Queensland Bowel Cancer Screening Program (QBCSP), in partnership with the National Bowel Cancer Screening Program (NBCSP), to prepare for the implementation of the NBCSP in public sector colonoscopy services in QLD in late 2006. There was no prior information available on the quality of colonoscopy services in Queensland (QLD) and no prior studies that assessed the quality of colonoscopy training in Australia. Furthermore, the NBCSP was introduced without extra funding for colonoscopy service improvement or provision for increases in colonoscopic capacity resulting from the introduction of the NBCSP. The main purpose of the research was to record baseline data on colonoscopy referral and practice in QLD and current training in colonoscopy Australia-wide. It was undertaken from a quality improvement perspective. Implementation of the NBCSP requires that all aspects of the screening pathway, in particular colonoscopy services for the assessment of positive Faecal Occult Blood Tests (FOBTs), will be effective, efficient, equitable and evidence-based. This study examined two important aspects of the continuous quality improvement framework for the NBCSP as they relate to colonoscopy services: (1) evidence-based practice, and (2) quality of colonoscopy training. The Principal Investigator was employed as Senior Project Officer (Training) in the QBCSP during the conduct of this research project. Recommendations from this research have been used to inform the development and implementation of quality improvement initiatives for provision of colonoscopy in the NBCSP, its QLD counterpart the QBCSP and colonoscopy services in QLD, in general. Methods – Part 1 Chart audit of evidence-based practice: The research was undertaken in two parts from 2005-2007. The first part of this research comprised a retrospective chart audit of 1484 colonoscopy records (some 13% of all colonoscopies conducted in public sector facilities in the year 2005) in three QLD colonoscopy services. Whilst some 70% of colonoscopies are currently conducted in the private sector, only public sector colonoscopy facilities provided colonoscopies under the NBCSP. The aim of this study was to compare colonoscopy referral and practice with explicit criteria derived from the National Health & Medical Research Council (NHMRC) (1999) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, and describe the nature of variance with the guidelines. Symptomatic presentations were the most common indication for colonoscopy (60.9%). These comprised per rectal bleeding (31.0%), change of bowel habit (22.1%), abdominal pain (19.6%), iron deficiency anaemia (16.2%), inflammatory bowel disease (8.9%) and other symptoms (11.4%). Surveillance and follow-up colonoscopies accounted for approximately one-third of the remaining colonoscopy workload across sites. Gastroenterologists (GEs) performed relatively more colonoscopies per annum (59.9%) compared to general surgeons (GS) (24.1%), colorectal surgeons (CRS) (9.4%) and general physicians (GPs) (6.5%). Guideline compliance varied with the designation of the colonoscopist. Compliance was lower for CRS (62.9%) compared to GPs (76.0%), GEs (75.0%), GSs (70.9%, p<0.05). Compliance with guideline recommendations for colonoscopic surveillance for family history of colorectal cancer (23.9%), polyps (37.0%) and a past history of bowel cancer (42.7%), was by comparison significantly lower than for symptomatic presentations (94.4%), (p<0.001). Variation with guideline recommendations occurred more frequently for polyp surveillance (earlier than guidelines recommend, 47.9%) and follow-up for past history of bowel cancer (later than recommended, 61.7%, p<0.001). Bowel cancer cases detected at colonoscopy comprised 3.6% of all audited colonoscopies. Incomplete colonoscopies occurred in 4.3% of audited colonoscopies and were more common among women (76.6%). For all colonoscopies audited, the rate of incomplete colonoscopies for GEs was 1.6% (CI 0.9-2.6), GPs 2.0% (CI 0.6-7.2), GS 7.0% (CI 4.8-10.1) and CRS 16.4% (CI 11.2-23.5). 18.6% (n=55) of patients with a documented family history of bowel cancer had colonoscopy performed against guidelines recommendations (for general (category 1) population risk, for reasons of patient request or family history of polyps, rather than for high risk status for colorectal cancer). In general, family history was inadequately documented and subsequently applied to colonoscopy referral and practice. Methods - Part 2 Surveys of quality of colonoscopy training: The second part of the research consisted of Australia-wide anonymous, self-completed surveys of colonoscopy trainers and their trainees to ascertain their opinions on the current apprenticeship model of colonoscopy in Australia and to identify any training needs. Overall, 127 surveys were received from colonoscopy trainers (estimated response rate 30.2%). Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the NBCSP. Approximately 70% of trainers also supported UK-style colonoscopy training within dedicated accredited training centres using a variety of training approaches including simulation. A collaborative approach with the private sector was seen as beneficial by 65% of trainers. Non-gastroenterologists (non-GEs) were more likely than GEs to be of the opinion that simulators are beneficial for colonoscopy training (χ2-test = 5.55, P = 0.026). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that ≥ 200 colonoscopies were needed. GEs (73.4%) were more likely than non-GEs (36.2%) to be of the opinion that the Conjoint Committee standard is insufficient to gain competence in colonoscopy (χ2-test = 16.97, P = 0.0001). The majority of trainers did not support training either nurses (73%) or GPs in colonoscopy (71%). Only 81 (estimated response rate 17.9%) surveys were received from GS trainees (72.1%), GE trainees (26.3%) and GP trainees (1.2%). The majority were males (75.9%), with a median age 32 years and who had trained in New South Wales (41.0%) or Victoria (30%). Overall, two-thirds (60.8%) of trainees indicated that they deemed the Conjoint Committee standard sufficient to gain competency in colonoscopy. Between specialties, 75.4% of GS trainees indicated that the Conjoint Committee standard for recognition of colonoscopy was sufficient to gain competence in colonoscopy compared to only 38.5% of GE trainees. Measures of competency assessed and recorded by trainees in logbooks centred mainly on caecal intubation (94.7-100%), complications (78.9-100%) and withdrawal time (51-76.2%). Trainees described limited access to colonoscopy training lists due to the time inefficiency of the apprenticeship model and perceived monopolisation of these by GEs and their trainees. Improvements to the current training model suggested by trainees included: more use of simulation, training tools, a United Kingdom (UK)-style training course, concentration on quality indicators, increased access to training lists, accreditation of trainers and interdisciplinary colonoscopy training. Implications for the NBCSP/QBCSP: The introduction of the NBCSP/QBCSP necessitates higher quality colonoscopy services if it is to achieve its ultimate goal of decreasing the incidence of morbidity and mortality associated with bowel cancer in Australia. This will be achieved under a new paradigm for colonoscopy training and implementation of evidence-based practice across the screening pathway and specifically targeting areas highlighted in this thesis. Recommendations for improvement of NBCSP/QBCSP effectiveness and efficiency include the following: 1. Implementation of NBCSP and QBCSP health promotion activities that target men, in particular, to increase FOBT screening uptake. 2. Improved colonoscopy training for trainees and refresher courses or retraining for existing proceduralists to improve completion rates (especially for female NBCSP/QBCSP participants), and polyp and adenoma detection and removal, including newer techniques to detect flat and depressed lesions. 3. Introduction of colonoscopy training initiatives for trainees that are aligned with NBCSP/QBCSP colonoscopy quality indicators, including measurement of training outcomes using objective quality indicators such as caecal intubation, withdrawal time, and adenoma detection rate. 4. Introduction of standardised, interdisciplinary colonoscopy training to reduce apparent differences between specialties with regard to compliance with guideline recommendations, completion rates, and quality of polypectomy. 5. Improved quality of colonoscopy training by adoption of a UK-style training program with centres of excellence, incorporating newer, more objective assessment methods, use of a variety of training tools such as simulation and rotations of trainees between metropolitan, rural, and public and private sector training facilities. 6. Incorporation of NHMRC guidelines into colonoscopy information systems to improve documentation, provide guideline recommendations at the point of care, use of gastroenterology nurse coordinators to facilitate compliance with guidelines and provision of guideline-based colonoscopy referral letters for GPs. 7. Provision of information and education about the NBCSP/QBCSP, bowel cancer risk factors, including family history and polyp surveillance guidelines, for participants, GPs and proceduralists. 8. Improved referral of NBCSP/QBCSP participants found to have a high-risk family history of bowel cancer to appropriate genetics services.

2nd ESMO Consensus Conference on Lung Cancer : non-small-cell lung cancer first-line/second and further lines in advanced disease

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines in advanced disease, early stage disease and locally-advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on 1st line / 2nd and further lines of treatment in advanced disease. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Genome-Wide Gene Expression Analysis Reveals a Dynamic Interplay between Luteotropic and Luteolytic Factors in the Regulation of Corpus Luteum Function in the Bonnet Monkey (Macaca radiata)

Although LH is essential for survival and function of the corpus luteum (CL) in higher primates, luteolysis occurs during nonfertile cycles without a discernible decrease in circulating LH levels. Using genome-wide expression analysis, several experiments were performed to examine the processes of luteolysis and rescue of luteal function in monkeys. Induced luteolysis with GnRH receptor antagonist (Cetrorelix) resulted in differential regulation of 3949 genes, whereas replacement with exogenous LH (Cetrorelix plus LH) led to regulation of 4434 genes (1563 down-regulation and 2871 up-regulation). A model system for prostaglandin (PG) F-2 alpha-induced luteolysis in the monkey was standardized and demonstrated that PGF(2 alpha) regulated expression of 2290 genes in the CL. Analysis of the LH-regulated luteal transcriptome revealed that 120 genes were regulated in an antagonistic fashion by PGF(2 alpha). Based on the microarray data, 25 genes were selected for validation by real-time RT-PCR analysis, and expression of these genes was also examined in the CL throughout the luteal phase and from monkeys treated with human chorionic gonadotropin (hCG) to mimic early pregnancy. The results indicated changes in expression of genes favorable to PGF(2 alpha) action during the late to very late luteal phase, and expressions of many of these genes were regulated in an opposite manner by exogenous hCG treatment. Collectively, the findings suggest that curtailment of expression of downstream LH-target genes possibly through PGF(2 alpha) action on the CL is among the mechanisms underlying cross talk between the luteotropic and luteolytic signaling pathways that result in the cessation of luteal function, but hCG is likely to abrogate the PGF(2 alpha)-responsive gene expression changes resulting in luteal rescue crucial for the maintenance of early pregnancy. (Endocrinology 150: 1473-1484, 2009)

Pin-Loaded Holes in Large Orthotropic Plates

Pin-loaded holes commonly occur in engineering structures. However, accurate analysis of such holes presents formidable difficulties because of the load-dependent contact of the pin with the plate. Significant progress has recently been achieved in the analysis of holes in isotropic plates. This paper develops a simple and accurate method for the partial contact analysis of pin-loaded holes in composites. The method is based on an inverse formulation that seeks to determine loads in a given contact-separation configuration. A unified approach for all types of fit was used. Continuum solutions were obtained for infinitely large plates of various typical orthotropic properties with holes loaded by smooth rigid pins. These solutions were then compared with those for isotropic plates. The effects of orthotropy and the type of fit were studied through load-contact relationships, distribution of stresses and displacements, and their variation with load. The results are of direct relevance to the analysis and design of pin joints in composite plates.

Prosopis species

The following aspects of Prosopis spp. are reviewed: name; taxonomy; hybrids; description; history in Australia; distribution; habitat; growth and development; reproduction; population dynamics; importance; costs in Australia; legislation; and weedmanagement.

Predicting the Timing of Spikes Evoked by Tactile Stimulation of the Hand

Kim SS, Sripati AP, Bensmaia SJ. Predicting the timing of spikes evoked by tactile stimulation of the hand. J Neurophysiol 104: 1484-1496, 2010. First published July 7, 2010; doi: 10.1152/jn.00187.2010. What does the hand tell the brain? Tactile stimulation of the hand evokes remarkably precise patterns of neural activity, suggesting that the timing of individual spikes may convey information. However, many aspects of the transformation of mechanical deformations of the skin into spike trains remain unknown. Here we describe an integrate-and-fire model that accurately predicts the timing of individual spikes evoked by arbitrary mechanical vibrations in three types of mechanoreceptive afferent fibers that innervate the hand. The model accounts for most known properties of the three fiber types, including rectification, frequency-sensitivity, and patterns of spike entrainment as a function of stimulus frequency. These results not only shed light on the mechanisms of mechanotransduction but can be used to provide realistic tactile feedback in upper-limb neuroprostheses.

Composite MR image reconstruction and unaliasing for general trajectories using neural networks

In rapid parallel magnetic resonance imaging, the problem of image reconstruction is challenging. Here, a novel image reconstruction technique for data acquired along any general trajectory in neural network framework, called ``Composite Reconstruction And Unaliasing using Neural Networks'' (CRAUNN), is proposed. CRAUNN is based on the observation that the nature of aliasing remains unchanged whether the undersampled acquisition contains only low frequencies or includes high frequencies too. Here, the transformation needed to reconstruct the alias-free image from the aliased coil images is learnt, using acquisitions consisting of densely sampled low frequencies. Neural networks are made use of as machine learning tools to learn the transformation, in order to obtain the desired alias-free image for actual acquisitions containing sparsely sampled low as well as high frequencies. CRAUNN operates in the image domain and does not require explicit coil sensitivity estimation. It is also independent of the sampling trajectory used, and could be applied to arbitrary trajectories as well. As a pilot trial, the technique is first applied to Cartesian trajectory-sampled data. Experiments performed using radial and spiral trajectories on real and synthetic data, illustrate the performance of the method. The reconstruction errors depend on the acceleration factor as well as the sampling trajectory. It is found that higher acceleration factors can be obtained when radial trajectories are used. Comparisons against existing techniques are presented. CRAUNN has been found to perform on par with the state-of-the-art techniques. Acceleration factors of up to 4, 6 and 4 are achieved in Cartesian, radial and spiral cases, respectively. (C) 2010 Elsevier Inc. All rights reserved.

Electrical transport properties of 0.5Li(2)O-0.5M(2)O-2B(2)O(3) (M = Li, Na and K) glasses

Transparent glasses in the system 0.5Li(2)O-0.5M(2)O-2B(2)O(3) (M = Li, Na and K) were fabricated via the conventional melt quenching technique. The amorphous and glassy nature of the samples was confirmed via the X-ray powder diffraction and the differential scanning calorimetry, respectively. The frequency and temperature dependent characteristics of the dielectric relaxation and the electrical conductivity were investigated in the 100 Hz-10 MHz frequency range. The imaginary part of the electric modulus spectra was modeled using an approximate solution of Kohrausch-Williams-Watts relation. The stretching exponent, (3, was found to be temperature independent for 0.5Li(2)O-0.5Na(2)O-2B(2)O(3) (LNBO) glasses. The activation energy associated with DC conduction was found to be higher (1.25 eV) for 0.5Li(2)O-0.5K(2)O-2B(2)O(3) (LKBO) glasses than that of the other glass systems under study. This is attributed to the mixed cation effect. (C) 2011 Elsevier By. All rights reserved.

Evolution of Texture and Microstructure in Commercially Pure Titanium with Change in Strain Path During Rolling

The evolution of microstructure and texture in commercially pure titanium has been studied as a function of strain path during rolling using experimental techniques and viscoplastic self-consistent simulations. Four different strain paths, namely unidirectional rolling, two-step cross rolling, multistep cross rolling, and reverse rolling, have been employed to decipher the effect of strain path change on the evolution of deformation texture and microstructure. The cross-rolled samples show higher hardness with lower microstrain and intragranular misorientation compared to the unidirectional rolled sample as determined from X-ray diffraction and electron backscatter diffraction, respectively. The higher hardness of the cross-rolled samples is attributed to orientation hardening due to the near basal texture. Viscoplastic self-consistent simulations are able to successfully predict the texture evolution of the differently rolled samples. Simulation results indicate the higher contribution of basal slip in the formation of near basal texture and as well as lower intragranular misorientation in the cross-rolled samples.

Classification, representation, and automatic extraction of deformation features in sheet metal parts

This paper presents classification, representation and extraction of deformation features in sheet-metal parts. The thickness is constant for these shape features and hence these are also referred to as constant thickness features. The deformation feature is represented as a set of faces with a characteristic arrangement among the faces. Deformation of the base-sheet or forming of material creates Bends and Walls with respect to a base-sheet or a reference plane. These are referred to as Basic Deformation Features (BDFs). Compound deformation features having two or more BDFs are defined as characteristic combinations of Bends and Walls and represented as a graph called Basic Deformation Features Graph (BDFG). The graph, therefore, represents a compound deformation feature uniquely. The characteristic arrangement of the faces and type of bends belonging to the feature decide the type and nature of the deformation feature. Algorithms have been developed to extract and identify deformation features from a CAD model of sheet-metal parts. The proposed algorithm does not require folding and unfolding of the part as intermediate steps to recognize deformation features. Representations of typical features are illustrated and results of extracting these deformation features from typical sheet metal parts are presented and discussed. (C) 2013 Elsevier Ltd. All rights reserved.

流化床中RDF焚烧时CO、SO_2和HCl的生成

垃圾衍生燃料 (Refuse-Derived Fuels-RDF)具有热值高、易燃烧的优点。RDF的一个潜在应用是与煤进行混烧，替代一部分锅炉燃烧用煤。由于RDF挥发份相当高，因此燃烧时的污染物排放不易控制。本文在非均匀布风流化床中进行了RDF与煤的混烧试验，测量了H_2O、CO、CO_2、NO、N_2O、HCl、SO_2等污染物质的排放特性。结果表明与单纯燃烧RDF相比，混烧时的CO生成量大大下降；SO2生成浓度较低，而HCl的生成量比单纯烧煤时明显增加。

Influencia de rotación de cultivos y métodos de control sobre la dinámica de las malezas y el crecimiento, desarrollo y rendimiento del sorgo (Sorghum bicolor (L) Moench) var. D-55)

En la Estación Experimental de Las Mercedes municipio de Managua, se inició en la época de postrera en 1991, un experimento de rotación de cultivos bajo diferentes niveles de control de malezas. El presente trabajo evaluó el efecto de los cultivos antecesores sorgo, maíz y pepino con tres niveles de control de malezas : químico, período crítico y limpias periódicas a la dinámica de la cenosis de malezas, crecimiento y rendimiento del cultivo sucesor sorgo. Cuando antecedió el pepino la abundancia de maleza fue mayor con 504 Ind/m2 reduciéndose considerablemente a la cosecha obteniendo una biomasa promedio de 133.9 gr/m2. Sucedió lo contrario con maíz como cultivo antecesor ya que al principio la abundancia fue de 201 Ind/m2 y se obtuvo la mayor biomasa con 259.8 gr/m2 y para sorgo-sorgo tuvo valores de 232 Ind/m2 y a la cosecha en menor valor en biomasa de sorgo 130.0 gr/m2. En el rendimiento se enmarcó una tendencia a favor de maíz como cultivo antecesor con 1878 Kg/ha de sorgo, mientras sorgo-sorgo obtuvo un rendimiento de 1839 Kg/ha comparándose con pepino como antecesor con 1832 Kg/ha de sorgo. Comparando los controles aquí hubo diferencias significativas y en mayor valor le correspondió al control químico con 2048.0 Kg/ha, control período crítico con 1786 Kg/ha y el menor valor le correspondió a limpia periódica con sólo 1715 Kg/ha. En el control período crítico presentó mayor abundancia la maleza al inicio con 444 Ind/m2, teniendo una reducción hasta 62 Ind/m2 en la cosecha. El control químico tuvo un comportamiento similar que el control período crítico con 295 Ind/m2, reduciendo al final del ciclo con 135 Ind/m2. El control limpias periódicas tuvo al inicio la menor abundancia con 200 Ind/m2, reduciendo a la cosecha a 3 Ind/m2.