Iowa Health Benefit Exchange Consumer Outreach & Education Report, December 2012

This report was developed by the Iowa Department of Public Health (IDPH) and it outlines consumer education and outreach research and strategies for Iowa’s Health Benefit Exchange. It reflects an initial draft plan for further discussion and amendment. Iowa’s Health Benefit Exchange will only succeed if there is stakeholder involvement in the planning process, extensive consumer education and engagement, and continued outreach.

The role of interval nodes in sentinel lymph node mapping and dissection for melanoma patients.

In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This study aimed to review the incidence, lymphatic anatomy, and metastatic risk of interval SNs. METHODS: SN biopsy was performed at a tertiary center by a single surgical team on a cohort of 402 consecutive patients with primary melanoma. The triple technique of localization was used-that is, lymphoscintigraphy, blue dye, and gamma-probe. Otolaryngologic melanoma and mucosal melanoma were excluded from this analysis. SNs were examined by serial sectioning and immunohistochemistry. All patients with metastatic SNs were recommended to undergo a radical selective lymph node dissection. RESULTS: The primary locations of the melanomas included the trunk (188), an upper limb (67), or a lower limb (147). Overall, 97 (24.1%) of the 402 SNs were metastatic. Interval SNs were observed in 18 patients, in all but 2 of whom classic SNs were also found. The location of the primary was truncal in 11 (61%) of the 18, upper limb in 5, and lower limb in 2. One patient with a dorsal melanoma had drainage exclusively in a cervicoscapular area that was shown on removal to contain not lymph node tissue but only a blue lymph channel without tumor cells. Apart from the interval SN, 13 patients had 1 classic SN area and 3 patients 2 classic SN areas. Of the 18 patients, 2 had at least 1 metastatic interval SN and 2 had a classic SN that was metastatic; overall, 4 (22.2%) of 18 patients were node-positive. CONCLUSION: We found that 2 of 18 interval SNs were metastatic: This study showed that preoperative lymphoscintigraphy must review all known lymphatic areas in order to exclude an interval SN.

Gas exchange rates, plant height, yield components, and productivity of upland rice as affected by plant regulators

The objective of this work was to evaluate gas exchange rates, plant height, yield components, and productivity of upland rice, as affected by type and application time of plant growth regulators. A randomized block design, in a 4x2 factorial arrangement, with four replicates was used. Treatments consisted of three growth regulators (mepiquat chloride, trinexapac-ethyl, and paclobutrazol), besides a control treatment applied at two different phenological stages: early tillering or panicle primordial differentiation. The experiment was performed under sprinkler-irrigated field conditions. Net CO2 assimilation, stomatal conductance, plant transpiration, and water-use efficiency were measured four times in Primavera upland rice cultivar, between booting and milky grain phenophases. Gas exchange rates were neither influenced by growth regulators nor by application time. There was, however, interaction between these factors on the other variables. Application of trinexapac-ethyl at both tillering and differentiation stages reduced plant height and negatively affected yield components and rice productivity. However, paclobutrazol and mepiquat chloride applied at tillering, reduced plant height without affecting rice yield. Mepiquat chloride acted as a growth stimulator when applied at the differentiation stage, and significantly increased plant height, panicle number, and grain yield of upland rice.

Différences induites par la définition des périodes diurnes et nocturnes sur la pression artérielle et le dipping lors d'une mesure ambulatoire de la pression artérielle [Effects of nighttime and daytime interval definition on blood pressure and dipping in patients referred for ambulatory blood pressure measurement].

Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined. OBJECTIVE: To compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods. PATIENTS AND METHOD: ABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband(®)) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7a.m.-10p.m.) and nighttime (10p.m.-7a.m.) periods. RESULTS: Data from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08±4.50mmHg; diastolic BP: 1.84±2.99mmHg, P<0.05) and dipping was more marked (systolic BP: 1.54±3.76%; diastolic BP: 2.27±3.48%, P<0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07±2.81mmHg; diastolic BP: 1.34±2.50mmHg) than daytime BP defined by a fixed period. CONCLUSION: Diurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.

Salt tolerance and regulation of gas exchange and hormonal homeostasis by auxin-priming in wheat

The objective of this work was to assess the regulatory effects of auxin-priming on gas exchange and hormonal homeostasis in spring wheat subjected to saline conditions. Seeds of MH-97 (salt-intolerant) and Inqlab-91 (salt-tolerant) cultivars were subjected to 11 priming treatments (three hormones x three concentrations + two controls) and evaluated under saline (15 dS m-1) and nonsaline (2.84 dS m-1) conditions. The priming treatments consisted of: 5.71, 8.56, and 11.42 × 10-4 mol L-1 indoleacetic acid; 4.92, 7.38, and 9.84 × 10-4 mol L-1 indolebutyric acid; 4.89, 7.34, and 9.79 × 10-4 mol L-1 tryptophan; and a control with hydroprimed seeds. A negative control with nonprimed seeds was also evaluated. All priming agents diminished the effects of salinity on endogenous abscisic acid concentration in the salt-intolerant cultivar. Grain yield was positively correlated with net CO2 assimilation rate and endogenous indoleacetic acid concentration, and it was negatively correlated with abscisic acid and free polyamine concentrations. In general, the priming treatment with tryptophan at 4.89 × 10-4 mol L-1 was the most effective in minimizing yield losses and reductions in net CO2 assimilation rate, under salt stress conditions. Hormonal homeostasis increases net CO2 assimilation rate and confers tolerance to salinity on spring wheat.

Development of Rouble Exchange Rate in Russia

This 45th volume deals with the development of the Russian rouble, which suffered a severe depreciation crisis in 1998. In the aftermath of this event, a strong investment boom started in Russia. The new devalued rouble exchange rate gave price competitiveness to local industry. In addition to that, increasing export prices of Russian oil and natural gas deliveries have contributed to economic growth lately. Amid this boom period, inflationary pressure has remained high. Price increases have been higher than in the EU, Russia’s main trading partner. However, rouble/euro exchange rate has remained nominally rather stable in the current decade. This means, that rouble appreciates against euro in real terms, which is weakening Russia’s international competitiveness.

Preparative ion exchange for salt solutions

Työssä tutkittiin moniarvoisten metalliformiaattien valmistusta ioninvaihto-menetelmällä. Kirjallisuustutkimus käsitteleetunnettuja alumiiniformiaatin ja rautaformiaatin valmistusmenetelmiä, kationinvaihtohartsien ominaisuuksia, ioninvaihtohartsien selektiivisyyttä ja alumiinin, raudan, magnesiumin ja sinkin vesikemiaa. Laboratoriokokeiden avulla tutkittiin sinkki-, magnesium-, rauta(II)- ja alumiiniformiaattien valmistusta ioninvaihdolla. Kokeet suoritettiin kolonnissa, joka oli pakattu makrohuokoisella tai geelimäisellä vahvalla kationin-vaihtohartsilla. Hartsi vaihdettiin natriummuodosta metallimuotoon metallikloridi- tai metallisulfaattiliuoksella.Metalli eluoitiin hartsista natriumformiaatilla. Formiaattien valmistus onnistui makrohuokoista vahvaa kationinvaihtohartsia käyttämällä. Rauta(II)formiaatin valmistus oli vaikeampaa kuin muiden formiaattien, koska rauta(II) hapettui osittain rauta(III):ksi valmistuksen aikana. Alumiiniformiaattia valmistettiin käyttäen sekä makrohuokoista että geelimäistä hartsia. Makrohuokoisen hartsin havaittiin soveltuvan geelimäistä hartsia paremmin alumiiniformiaatin valmistukseen. Kungeelimäistä hartsia käytettiin, noin 30 % alumiinista jäi kiinni hartsiin eikä siten eluoitunut. Ioninvaihdon selektiivisyyskertoimien saamiseksi suoritettiin tasapainokokeita. Selektiivisyyskertoimia käytettiin ioninvaihtokolonnin dynaamisessa simuloinnissa. Ioninvaihdon simuloiminen dynaamisella kolonnimallilla onnistui hyvin.

Exchange of Product-related Data between a Pulp and Paper Machinery Supplier and Its Partners

Kiihtyvä kilpailu yritysten välillä on tuonut yritykset vaikeidenhaasteiden eteen. Tuotteet pitäisi saada markkinoille nopeammin, uusien tuotteiden pitäisi olla parempia kuin vanhojen ja etenkin parempia kuin kilpailijoiden vastaavat tuotteet. Lisäksi tuotteiden suunnittelu-, valmistus- ja muut kustannukset eivät saisi olla suuria. Näiden haasteiden toteuttamisessa yritetään usein käyttää apuna tuotetietoja, niiden hallintaa ja vaihtamista. Andritzin, kuten muidenkin yritysten, on otettava nämä asiat huomioon pärjätäkseen kilpailussa. Tämä työ on tehty Andritzille, joka on maailman johtavia paperin ja sellun valmistukseen tarkoitettujen laitteiden valmistajia ja huoltopalveluiden tarjoajia. Andritz on ottamassa käyttöön ERP-järjestelmän kaikissa toimipisteissään. Sitä halutaan hyödyntää mahdollisimman tehokkaasti, joten myös tuotetiedot halutaan järjestelmään koko elinkaaren ajalta. Osan tuotetiedoista luo Andritzin kumppanit ja alihankkijat, joten myös tietojen vaihto partnereiden välillä halutaan hoitaasiten, että tiedot saadaan suoraan ERP-järjestelmään. Tämän työn tavoitteena onkin löytää ratkaisu, jonka avulla Andritzin ja sen kumppaneiden välinen tietojenvaihto voidaan hoitaa. Tämä diplomityö esittelee tuotetietojen, niiden hallinnan ja vaihtamisen tarkoituksen ja tärkeyden. Työssä esitellään erilaisia ratkaisuvaihtoehtoja tiedonvaihtojärjestelmän toteuttamiseksi. Osa niistä perustuu yleisiin ja toimialakohtaisiin standardeihin. Myös kaksi kaupallista tuotetta esitellään. Tarkasteltavana onseuraavat standardit: PaperIXI, papiNet, X-OSCO, PSK-standardit sekä RosettaNet. Lisäksi työssä tarkastellaan ERP-järjestelmän toimittajan, SAP:in ratkaisuja tietojenvaihtoon. Näistä vaihtoehdoista parhaimpia tarkastellaan vielä yksityiskohtaisemmin ja lopuksi eri ratkaisuja vertaillaan keskenään, jotta löydettäisiin Andritzin tarpeisiin paras vaihtoehto.

LEAF GAS EXCHANGE CHARACTERISTICS OF FOUR PAPAYA GENOTYPES DURING DIFFERENT STAGES OF DEVELOPMENT

In this research, was used four papaya (Carica papaya L.) genotypes: three from the 'Solo ( Sunrise Solo TJ, Sunrise Solo 72/12 and Baixinho de Santa Amália) group and one from the 'Formosa' group (Know-You 01). They were grown in plastic pots containing a sandy-clay-loam soil subjected to pH correction and fertilization, under greenhouse conditions. Throughout the experimental period plants were subjected to periodic irrigation to maintain the soil humitidy around field capacity. The experiment was conducted 73 days after sowing. In all genotypes, leaf gas exchange characteristics were determined. The net photosynthetic rate (A, mumol m-2 s-1 ), stomatal conductance (g s mol m-2 s-1), leaf temperature (T I, 0C) and intercellular carbon dioxide concentration (ci, muL L-1) on the 4th, 5th, 6th, 7th, 8th and 9th leaves from the plant apex were determined. No significant differences were observed for A, g s, c i, or Tl either among the leaves sampled from any of the genotypes. A was positively correlated with g s and in the other hand T I and g s were negatively correlated. The results suggest that, for 73 DAP, all the sampled papaya leaves functioned as sources of organs.

Des maux et des cures : les transformations du champ thérapeutico-religieux en Suisse romande

Cette thèse présente les pratiques sociales et les parcours d'apprentissage d'un corps de spécialistes rituels, qui se donnent le nom générique de « médiums guérisseurs », à partir d'une ethnographie des modes de résolution des crises existentielles et des dispositifs de production de croyance permettant les moyens d'objectivation d'une « autre réalité », proposés par trois configurations en Suisse romande. L'enquête explore d'abord la structuration du champ thérapeutico-religieux en Suisse romande pour en révéler les niches favorisant les inscriptions sociales des médiums guérisseurs. Elle s'est portée ensuite sur la manière dont ces praticiens inscrivent les différents épisodes de leur vie dans un cursus de reconnaissance de compétences particulières. Et comment ces moments de vie s'articulent et s'enchaînent pour construire l'autobiographie de la métamorphose de leur personnalité en celle d'un « médium guérisseur » apaisant les souffrances des vivants et les âmes des « morts ». L'enquête a pris en compte les discours de ces médiums guérisseurs et aussi les modalités de transmissions de ces savoirs en ce qu'elles contribuent à leur construction et à leur développement. Cette recherche participe d'une interrogation plus générale, en contexte de modernité et de globalisation, sur l'« émiettement du religieux », tout en proposant de nuancer cette assertion en regard d'une stratégie d'enquête ethnographique qui met l'accent sur les logiques d'action plutôt que de représentations et privilégie l'apprentissage dialogique et la co-construction des données afin de cerner les modalités d'un travail symbolique et syncrétique.