Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

Experimental petrology of basement basaltic rocks from ODP Leg 127/128 samples

The relatively fresh basement basaltic rocks cored at Sites 794 and 797 during ODP Legs 127 and 128 show compositional variations suggesting the following: (1) the aphyric rocks might be differentiated from compositional equivalents of the aphyric sample with the lowest FeO*/MgO (Sample 127-797C-12R-4, 35-37 cm); and (2) the plagioclase-phyric rocks (i.e., another constituent of the basement basaltic rocks from the sites) may be derivatives from the same parents; in this case, however, crystallized plagioclase was not effectively removed. Melting experiments were conducted for Sample 127-797C-12R-4, 35-37 cm, and the differentiation processes for the basement basaltic rocks were assessed. The high-pressure melting-phase relation can not account for the compositional variation of the aphyric rocks, suggesting that the variation was developed at relatively low pressure where olivine and plagioclase fractionation was followed by Ca-rich clinopyroxene fractionation. The density of Sample 127-797C-12R-4,35-37 cm, is comparable to that of plagioclase at some depth, but at still relatively low pressure, making it possible that the liquidus plagioclase was retained in the successive liquids to produce the plagioclase-phyric rocks. According to backtrack calculation assuming the olivine maximum fractionation, Sample 127-797C-12R-4, 35-37 cm, was differentiated from primary picritic high-Al basalt magma. The estimated primary magma composition was experimentally proved to coexist with harzburgite mantle at about 14 kbar, suggesting relatively shallow production (approximately 40-50 km below surface) of the rifting-related primary magma.

Excitación y control de IGBTs de un inversor trifásico sinusoidal

El origen del proyecto se encuentra en la mejora de un inversor trifásico sinusoidal comercial sobre la base del estudio de las técnicas de excitación óptimas para los IGBTs que lo componen en su etapa de potencia. En las primeras fases de planteamiento del proyecto se propone una idea mucho más ambiciosa, la realización de un nuevo convertidor de emergencia, destinado al sector ferroviario, para dar servicio de climatización. Este convertidor está formado por la asociación en cascada de un bloque DC/DC elevador y un bloque inversor DC/AC trifásico controlado mediante PWM con modulación sinusoidal. Se pretendía así dar solución a las siguientes problemáticas detectadas en los convertidores comercializados hasta el momento: un bloque elevador excesivamente sobredimensionado, subsistemas de control independientes para los dos bloques que configuran el convertidor, adicionalmente, la tarjeta driver se rediseña con cada cambio de especificaciones por parte de un nuevo cliente y finalmente, las comunicaciones tanto de diagnosis como de mantenimiento necesitaban una importante actualización. Inicialmente, se ha realizado un estudio teórico de los bloques elevador e inversor para poder realizar el diseño y dimensionamiento de sus componentes tanto semiconductores como electromagnéticos. Una vez completada la parte de potencia, se estudia el control que se realiza mediante medidas directas y simulación tanto de la estrategia de control del elevador como del inversor. Así se obtiene una información completa de la funcionalidad de las tarjetas existentes. Se desea realizar el diseño de una única tarjeta controladora y una única tarjeta de drivers para ambos bloques. Por problemas ajenos, en el transcurso de este proyecto se cancela su realización comercial, con lo que se decide al menos crear la placa de control y poder gobernar un convertidor ya existente, sustituyendo la tarjeta de control del bloque elevador. Para poder fabricar la placa de control se divide en dos tarjetas que irán conectadas en modo sándwich. En una tarjeta está el microcontrolador y en otra está todo el interface necesario para operar con el sistema: entradas y salidas digitales, entradas y salidas analógicas, comunicación CAN, y un pequeño DC/DC comercial que proporciona alimentación al prototipo. Se realiza un pequeño programa funcional para poder manejar el convertidor, el cual con una tensión de 110V DC, proporciona a la salida una tensión de 380V AC. Como ya se ha expuesto, debido a la cancelación del proyecto industrial no se profundiza más en su mejora y se decide proponerlo para su evaluación en su fase actual. ABSTRACT. The beginning of the project is found in the improvement of a commercial sine wave three phase inverter which is based in a study about optimal excitation techniques to IGBTs which compose in the power stage. In the early phases of project it is proposed a much more ambitious idea, the fact of a new emergency converter, proposed for the rail sector to work in an air condition unit. This converter is formed by an association of a block cascaded DC/DC booster and a block DC/AC inverter three-phase controlled by a sine wave modulation PWM. The purposed was to give a solution to following problems detected in commercial converters nowadays: an excessively oversized block boost, independent control subsystems for two blocks that configure the converter. In addition, driver board is redesigned with each specifications change demand it a new customer, and finally, the communications, diagnostic and maintenance that needed a important upgrade. Initially, it has been performed a theoretical study of boost and the inverter blocks to be able to perform the component’s design and the size (semiconductor and electromagnetic fields). Once finished power study, it is analysed the control performed using direct measures and simulation of boost control strategy and inverter. With this it is obtained complete information about existing cards functionality. The project is looking for the design of just one controller card and one drivers´ card for both blocks. By unrelated problems, during the course of this project a commercial realization. So at least its decided to create control board to be able to existing converter, replacing boost block’s control board. To be able to manufacture control board it is divided in two cards connected in sandwiching mode. In a card is microcontroller and in another is all needed interface to operate with the system: digital inputs and outputs, analogical inputs and outputs, CAN communication, and a small DC / DC business that provide power supply to the prototype. It is performed a small functional program to handle the converter, which with an input voltage 110V DC provides an output voltage 380V AC. As already has been exposed, due to industrial project cancellation it is decided no to continue with all improvements and directly to evaluate it in the current phase.

Effector dynamics of rhythmic wrist activity and its implications for (modeling) bimanual coordination

To examine the role of the effector dynamics of the wrist in the production of rhythmic motor activity, we estimated the phase shifts between the EMG and the task-related output for a rhythmic isometric torque production task and an oscillatory movement, and found a substantial difference (45-52degrees) between the two. For both tasks, the relation between EMG and task-related output (torque or displacement) was adequately reproduced with a physiologically motivated musculoskeletal model. The model simulations demonstrated the importance of the contribution of passive structures to the overall dynamics and provided an account for the observed phase shifts in the dynamic task. Additional simulations of the musculoskeletal model with added load suggested that particular changes in the phase relation between EMG and movement may follow largely from the intrinsic muscle dynamics, rather than being the result of adaptations in the neural control of joint stiffness. The implications of these results are discussed in relation to (models of) interlimb coordination in rhythmic tasks. (C) 2004 Elsevier B.V. All rights reserved.

Beach face and berm morphodynamics fronting a coastal lagoon

This study documents two different modes of berm development: (I) vertical growth at spring tides or following significant beach cut due to substantial swash overtopping, and (2) horizontal progradation at neap tides through the formation of a proto-berm located lower and further seaward of the principal berm. Concurrent high-frequency measurements of bed elevation and the associated wave runup distribution reveal the details of each of these berm growth modes. In mode I sediment is eroded from the inner surf and lower swash zone where swash interactions are prevalent. The net transport of this sediment is landward only, resulting in accretion onto the upper beach face and over the berm crest. The final outcome is a steepening of the beach face gradient, a change in the profile shape towards concave and rapid vertical and horizontal growth of the berm. In mode 2 sediment is eroded from the lower two-thirds of the active swash zone during the rising tide and is transported both landward and seaward. On the falling tide sediment is eroded from the inner surf and transported landward to backfill the zone eroded on the rising tide. The net result is relatively slow steepening of the beach face, a change of the profile shape towards convex, and horizontal progradation through the formation of a neap berm. The primary factor determining which mode of berm growth occurs is the presence or absence of swash overtopping at the time of sediment accumulation on the beach face. This depends on the current phase of the spring-neap tide cycle, the wave runup height (and indirectly offshore wave conditions) and the height of the pre-existing berm. A conceptual model for berm morphodynamics is presented, based on sediment transport shape functions measured during the two modes of berm growth. (c) 2006 Elsevier B.V. All rights reserved.

The role of texture amplitude in shape from shading: evidence from a haptic matching task

The pattern of illumination on an undulating surface can be used to infer its 3-D form (shape from shading). But the recovery of shape would be invalid if the shading actually arose from reflectance variation. When a corrugated surface is painted with an albedo texture, the variation in local mean luminance (LM) due to shading is accompanied by a similar modulation in texture amplitude (AM). This is not so for reflectance variation, nor for roughly textured surfaces. We used a haptic matching technique to show that modulations of texture amplitude play a role in the interpretation of shape from shading. Observers were shown plaid stimuli comprising LM and AM combined in-phase (LM+AM) on one oblique and in anti-phase (LM-AM) on the other. Stimuli were presented via a modified ReachIN workstation allowing the co-registration of visual and haptic stimuli. In the first experiment, observers were asked to adjust the phase of a haptic surface, which had the same orientation as the LM+AM combination, until its peak in depth aligned with the visually perceived peak. The resulting alignments were consistent with the use of a lighting-from-above prior. In the second experiment, observers were asked to adjust the amplitude of the haptic surface to match that of the visually perceived surface. Observers chose relatively large amplitude settings when the haptic surface was oriented and phase-aligned with the LM+AM cue. When the haptic surface was aligned with the LM-AM cue, amplitude settings were close to zero. Thus the LM/AM phase relation is a significant visual depth cue, and is used to discriminate between shading and reflectance variations. [Supported by the Engineering and Physical Sciences Research Council, EPSRC].

The role of texture in shape from shading: are humans biased towards seeing relief textures?

When a textured surface is modulated in depth and illuminated, the level of illumination varies across the surface, producing coarse-scale luminance modulations (LM) and amplitude modulation (AM) of the fine-scale texture. If the surface has an albedo texture (reflectance variation) then the LM and AM components are always in-phase, but if the surface has a relief texture the phase relation between LM and AM varies with the direction and nature of the illuminant. We showed observers sinusoidal luminance and amplitude modulations of a binary noise texture, in various phase relationships, in a paired-comparisons design. In the first experiment, the combinations under test were presented in different temporal intervals. Observers indicated which interval contained the more depthy stimulus. LM and AM in-phase were seen as more depthy than LM alone which was in turn more depthy than LM and AM in anti-phase, but the differences were weak. In the second experiment the combinations under test were presented in a single interval on opposite obliques of a plaid pattern. Observers were asked to indicate the more depthy oblique. Observers produced the same depth rankings as before, but now the effects were more robust and significant. Intermediate LM/AM phase relationships were also tested: phase differences less than 90 deg were seen as more depthy than LM-only, while those greater than 90 deg were seen as less depthy. We conjecture that the visual system construes phase offsets between LM and AM as indicating relief texture and thus perceives these combinations as depthy even when their phase relationship is other than zero. However, when different LM/AM pairs are combined in a plaid, the signals on the obliques are unlikely to indicate corrugations of the same texture, and in this case the out-of-phase pairing is seen as flat. [Supported by the Engineering and Physical Sciences Research Council (EPSRC)].

The War at Home

The reform of cities spaces and housing has been a key issue with campaigners on the left for more than a century. These campaigns have found allies in the work of socially committed photographers from Jacob Riis at the turn of the twentieth century to Margaret Morton and Camilo Jose Vergara today. Globally the current phase of neo-liberalism has brought its own issues to the city as ‘regeneration’ strategies dispossess the urban poor in areas that are potentially lucrative to real estate development. In this process known as ‘accumulation by dispossession’ large profits are accumulated in the process of dispossessing people of their land, rights and homes. Central to the theoretical component of this paper, is an interrogation of contemporary ideas on the production and photographic representation of urban space. The research hence questions photography’s ability to make ‘legible’ the key drivers of today’s emergent terrains and to visualize their connections to the networks of power and capital that articulate the current political economy (Sassen 2011:36). One strand here will be the ‘fleshing out’ of the cultural practices behind photographers mediating urban development (Jones 2013: 1.2). Alongside current corporate depictions historical precedents will be discussed. Photographers as far back as Charles Marville in Paris of the 1850’s have documented urban reconstruction (Kennel 2013). Often employed by those undertaking the demolition, these photographic images frequently suppress certain narratives of the unbuilding process. Acting as a propaganda tool they eliminate the impact on the lives of inhabitants or the economic realities driving the valorization of reconstruction schemes (James 2004). Reformist documentary images have also played their part in justifying large-scale urban reconstruction that involved the eventual displacement of existing communities (Rose 1997: Blaikie 2006). Focusing on the gentrification of social housing in Pendleton, Salford (Greater Manchester) the presentation will explore the artists’ own work through a critical discussion, photographic images and excerpts from site writing they’ve undertaken in the area since 2004. It asks can an alternative photographic and visual strategy provide a meaningful political counter narrative to combat persuasive corporate discourses on ‘urban revitalization’? The paper will explore strategies and techniques of witnessing and ask whether these types of record can counter neo-liberal visualizations that mediate the material transformation of city areas. Can such representations begin a critical conversation about the nature of urban change and who benefits from these transformations (Wyly 2010)? Can we develop this critical photography into a type of practice that moves beyond generalisations and talks about social relations though an ‘explicit analysis of society’ (Rosler 2004:195).

Optimising power take-off of an oscillating wave surge converter using high fidelity numerical simulations

Oscillating wave surge converters are a promising technology to harvest ocean wave energy in the near shore region. Although research has been going on for many years, the characteristics of the wave action on the structure and especially the phase relation between the driving force and wave quantities like velocity or surface elevation have not been investigated in detail. The main reason for this is the lack of suitable methods. Experimental investigations using tank tests do not give direct access to overall hydrodynamic loads, only damping torque of a power take off system can be measured directly. Non-linear computational fluid dynamics methods have only recently been applied in the research of this type of devices. This paper presents a new metric named wave torque, which is the total hydrodynamic torque minus the still water pitch stiffness at any given angle of rotation. Changes in characteristics of that metric over a wave cycle and for different power take off settings are investigated using computational fluid dynamics methods. Firstly, it is shown that linearised methods cannot predict optimum damping in typical operating states of OWSCs. We then present phase relationships between main kinetic parameters for different damping levels. Although the flap seems to operate close to resonance, as predicted by linear theory, no obvious condition defining optimum damping is found.

Konsekwencje wychowywania się w rodzinie z problemem alkoholowym - bagaż na całe życie

The article is dedicated to the problems of children raised by one or both parents addicted to alcohol who experience a negative impact of that situation in the area of their psychosocial functioning (in the current phase of their lives, as well as in adulthood).

MARS (Media Asset Retrieval System): Puget Sound’s Digital Archive

The MARS (Media Asset Retrieval System) Project is the collaborative effort of public broadcasters,libraries and schools in the Puget Sound region to create a digital online resource that provides access to content produced by public broadcasters via the public libraries. Convergence ConsortiumThe Convergence Consortium is a model for community collaboration, including organizations such as public broadcasters, libraries, museums, and schools in the Puget Sound region to assess the needs of their constituents and pool resources to develop solutions to meet those needs. Specifically, the archives of public broadcasters have been identified as significant resources for the local communities and nationally. These resources can be accessed on the broadcasters websites, and through libraries and used by schools, and integrated with text and photographic archives from other partners.MARS’ goalCreate an online resource that provides effective access to the content produced locally by KCTS (Seattle PBS affiliate) and KUOW (Seattle NPR affiliate). The broadcasts will be made searchable using the CPB Metadata Element Set (under development) and controlled vocabularies (to be developed). This will ensure a user friendly search and navigation mechanism and user satisfaction.Furthermore, the resource can search the local public library’s catalog concurrently and provide the user with relevant TV material, radio material, and books on a given subject.The ultimate goal is to produce a model that can be used in cities around the country.The current phase of the project assesses the community’s need, analyzes the current operational systems, and makes recommendations for the design of the resource.Deliverables• Literature review of the issues surrounding the organization, description and representation of media assets• Needs assessment report of internal and external stakeholders• Profile of the systems in the area of managing and organizing media assetsfor public broadcasting nationwideActivities• Analysis of information seeking behavior• Analysis of collaboration within the respective organizations• Analysis of the scope and context of the proposed system• Examining the availability of information resources and exchangeof resources among users

Algunas consideraciones en torno a la transdisciplinariedad y a la educación superior

Durante los últimos dos siglos se ha venido sosteniendo la neutralidad y apoliticidad de la ciencia, pero se ha pasado por alto que esta, como construcción humana, no puede ostentar un estatus especial. Es decir, está condicionada históricamente al igual que cualquier otra actividad. La ciencia moderna adquirió su actual división disciplinaria en el siglo XIX, en gran parte por el desarrollo del capitalismo industrial que cubrió el orbe y la conformación de estados-nación y su organización dentro del sistema interestatal, de modo que es una particular forma de entender y estudiar la realidad, pero no la única posible. Las elecciones teóricas y metodológicas hechas desde entonces se han impuesto como la forma natural de aprehender la realidad. La fase actual del proceso de la globalización ha puesto de manifiesto que el marco epistemológico decimonónico –y como parte de él, el nacionalismo metodológico– resulta insuficiente en el presente para explicar ciertos fenómenos sistémicos y ha revelado la necesidad de su superación. En el presente contexto histórico se hace más necesario que nunca superar la dependencia académica y la adopción de una actitud crítica para que la división internacional del trabajo académico y la estructuración de una agenda transnacional para la educación no operen en contra de las zonas y poblaciones pobres del mundo. Ello supone que la universidad defina su papel con respecto a la sociedad desde una dimensión política, antes de que decida y realice su propia reforma. La transdisciplinariedad juega un papel principal en la superación de los viejos modelos de la ciencia y la universidad.

GEOTECNOLOGIAS: POTENCIALIDADES E RISCOS GEOTECHNOLOGIES: MERITS AND RISKS

Esse artigo pretende discutir como as transformações tecnológicas vêm influenciando a ciência geográfica, especificamente com o advento das geotecnologias. Diante de inúmeras potencialidades e aplicações na análise e gestão territorial, nós devemos refletir sobre seu real significado, que certamente ultrapassa o caráter meramente técnico. É necessário compreender a vasta dimensão social, política e econômica que abrangem. Atualmente as técnicas são cada vez mais utilizadas, aceitas e menos compreendidas, o que pode implicar riscos para a sociedade em função de interpretações equivocadas e muitas vezes desprovidas de princípios éticos. Vinte anos após a “unificação” do mundo com a queda do Muro de Berlim, o cenário sociocultural e político se redefine em um paradigma de contradições. As inovações tecnológicas funcionam como um instrumento emblemático subordinado ao mercado financeiro e a globalização marca a atual fase do capitalismo, que segue seu curso encontrando as limitações inerentes à tecnologia em que se sustenta. This paper intends to discuss how the technological changes have affected the geographical science, specifically with the advent of geotechnologies. Up against with great potential and applications in analysis and land management, we must to reflect on its real meaning, which certainly goes beyond the merely technical. It’s necessary to understand the broad social, political and economic dimension wich inclued. Currently, the techniques are increasingly used, accepted and least understood, which may to implicate a risk to society due to misinterpretation and often devoid of ethical principles. Twenty years after the "unification" of the world with the fall of the Berlin Wall, the cultural and political landscape was altered in a paradigm of contradictions. Technological innovations work as a emblematic instrument subordinate to financial markets and globalization marks the current phase of capitalism, which runs its course finding the limitations inherent in the technology which supports.

Ultrasound, eddy current and magnetic Barkhausen noise as tools for sigma phase detection on a UNS S31803 duplex stainless steel

Sigma phase is a deleterious one which can be formed in duplex stainless steels during heat treatment or welding. Aiming to accompany this transformation, ferrite and sigma percentage and hardness were measured on samples of a UNS S31803 duplex stainless steel submitted to heat treatment. These results were compared to measurements obtained from ultrasound and eddy current techniques, i.e., velocity and impedance, respectively. Additionally, backscattered signals produced by wave propagation were acquired during ultrasonic inspection as well as magnetic Barkhausen noise during magnetic inspection. Both signal types were processed via a combination of detrended-fluctuation analysis (DFA) and principal component analysis (PCA). The techniques used were proven to be sensitive to changes in samples related to sigma phase formation due to heat treatment. Furthermore, there is an advantage using these methods since they are nondestructive. (C) 2010 Elsevier B.V. All rights reserved.

Interlimb relation during the double support phase of gait: an electromyographic, mechanical and energy based analysis

The purpose of this study is to analyse the interlimb relation and the influence of mechanical energy on metabolic energy expenditure during gait. In total, 22 subjects were monitored as to electromyographic activity, ground reaction forces and VO2 consumption (metabolic power) during gait. The results demonstrate a moderate negative correlation between the activity of tibialis anterior, biceps femoris and vastus medialis of the trailing limb during the transition between midstance and double support and that of the leading limb during double support for the same muscles, and between these and gastrocnemius medialis and soleus of the trailing limb during double support. Trailing limb soleus during the transition between mid-stance and double support was positively correlated to leading limb tibialis anterior, vastus medialis and biceps femoris during double support. Also, the trailing limb centre of mass mechanical work was strongly influenced by the leading limbs, although only the mechanical power related to forward progression of both limbs was correlated to metabolic power. These findings demonstrate a consistent interlimb relation in terms of electromyographic activity and centre of mass mechanical work, being the relations occurred in the plane of forward progression the more important to gait energy expenditure.