912 resultados para Drop-In Clinics


Relevância:

90.00% 90.00%

Publicador:

Resumo:

Three triblock copolymers of poly[styrene-b-(ethylene-co-butylene)-b-styrene] (SEBS) of different molecular weights and one diblock copolymer of poly[styrene-b-(ethylene-co-butylene)] (SEB) were used to compatibilize high density polyethylene/syndiotactic polystyrene (HDPE/sPS, 80/20) blend. Morphology observation showed that phase size of the dispersed sPS particles was significantly reduced on addition of all the four copolymers and the interfacial adhesion between the two phases was dramatically enhanced. Tensile strength of the blends increased at lower copolymer content but decreased with increasing copolymer content. The elongation at break of the blends improved and sharply increased with increments of the copolymers. Drop in modulus of the blend was observed on addition of the rubbery copolymers. The mechanical performance of the modified blends is strikingly dependent not only on the interfacial activity of the copolymers but also on the mechanical properties of the copolymers, particularly at the high copolymer concentration. Addition of compatibilizers to HDPE/sPS blend resulted in a significant reduction in crystallinity of both HDPE and sPS. Measurements of Vicat softening temperature of the HDPE/sPS blends show that heat resistance of HDPE is greatly improved upon incorporation of 20 wt% sPS.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

OBJECTIVE: To assess potential diagnostic and practice barriers to successful management of massive postpartum hemorrhage (PPH), emphasizing recognition and management of contributing coagulation disorders. STUDY DESIGN: A quantitative survey was conducted to assess practice patterns of US obstetrician-gynecologists in managing massive PPH, including assessment of coagulation. RESULTS: Nearly all (98%) of the 50 obstetrician-gynecologists participating in the survey reported having encountered at least one patient with "massive" PPH in the past 5 years. Approximately half (52%) reported having previously discovered an underlying bleeding disorder in a patient with PPH, with disseminated intravascular coagulation (88%, n=23/26) being identified more often than von Willebrand disease (73%, n=19/26). All reported having used methylergonovine and packed red blood cells in managing massive PPH, while 90% reported performing a hysterectomy. A drop in blood pressure and ongoing visible bleeding were the most commonly accepted indications for rechecking a "stat" complete blood count and coagulation studies, respectively, in patients with PPH; however, 4% of respondents reported that they would not routinely order coagulation studies. Forty-two percent reported having never consulted a hematologist for massive PPH. CONCLUSION: The survey findings highlight potential areas for improved practice in managing massive PPH, including earlier and more consistent assessment, monitoring of coagulation studies, and consultation with a hematologist.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Background: Interprofessional education (IPE) introduced at the beginning of pre-registration training for healthcare professionals attempts to prevent the formation of negative interprofessional attitudes which may hamper future interprofessional collaboration. However, the potential for IPE depends, to some extent, on the readiness of healthcare students to learn together. Objectives: To measure changes in readiness for interprofessional learning, professional identification, and amount of contact between students of different professional groups; and to examine the influence of professional group, student characteristics and an IPE course on these scores over time. Design: Annual longitudinal panel questionnaire survey at four time-points of pre-registration students (n = 1683) drawn from eight healthcare groups from three higher education institutions (HEIs) in the UK. Results: The strength of professional identity in all professional groups was high on entry to university but it declined significantly over time for some disciplines. Similarly students’ readiness for interprofessional learning was high at entry but declined significantly over time for all groups, with the exception of nursing students. A small but significant positive relationship between professional identity and readiness for interprofessional learning was maintained over time. There was very minimal contact between students from different disciplines during their professional education programme. Students who reported gaining the least from an IPE course suffered the most dramatic drop in their readiness for interprofessional learning in the following and subsequent years; however, these students also had the lowest expectations of an IPE course on entry to their programme of study. Conclusion: The findings provide support for introducing IPE at the start of the healthcare students’ professional education to capitalise on students’ readiness for interprofessional learning and professional identities, which appear to be well formed from the start. However, this study suggests that students who enter with negative attitudes towards interprofessional learning may gain the least from IPE courses and that an unrewarding experience of such courses may further reinforce their negative attitudes.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

All marine organisms are affected to some extent by the movement and thermal properties of oceanic currents. However phytoplankton, because of its small size is most directly coupled to the physical environment. The intense hydrodynamic activity observed in the Northwest Atlantic Shelves Province makes this region especially intriguing from the point of view of physical-biological interactions. In the present work, remote sensed data of Sea Surface Height (SSH) anomalies, Sea-surface chlorophyll a concentrations (SeaWiFS), and Sea Surface Temperature (SST) are used to complement the Continuous Plankton Recorder (CPR) survey that continuously sampled a route between Norfolk (Virginia, USA; 39° N, 71° W) and Argentia (Newfoundland; 47° N, 54° W) over the period 1995–1998. Over this period, we examined physical structures (i.e. SST and SSH) and climatic forcing associated with space-time phytoplankton structure. Along this route, the phytoplankton structures were mainly impacted by the changes in surface flow along the Scotian Shelf rather than significantly influenced by the mesoscale features of the Gulf Stream. These changes in water mass circulation caused a drop in temperature and salinity along the Scotian Shelf that induced changes in phytoplankton and zooplankton abundance.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Sediment contaminants were monitored in Milford Haven Waterway (MHW) since 1978 (hydrocarbons) and 1982 (metals), with the aim of providing surveillance of environmental quality in one of the UK’s busiest oil and gas ports. This aim is particularly important during and after large-scale investment in liquefied natural gas (LNG) facilities. However, methods inevitably have changed over the years, compounding the difficulties of coordinating sampling and analytical programmes. After a review by the MHW Environmental Surveillance Group (MHWESG), sediment hydrocarbon chemistry was investigated in detail in 2010. Natural Resources Wales (NRW) contributed their MHW data for 2007 and 2012, collected to assess the condition of the Special Area of Conservation (SAC) designated under the European Union Habitats Directive. Datasets during 2007-2012 have thus been more comparable. The results showed conclusively that a MHW-wide peak in concentrations of sediment polycyclic aromatic hydrocarbons (PAHs), metals and other contaminants occurred in late 2007. This was corroborated by independent annual monitoring at one centrally-located station with peaks in early 2008 and 2011. The spatial and temporal patterns of recovery from the 2007 peak, shown by MHW-wide surveys in 2010 and 2012, indicate several probable causes of contaminant trends, as follows: atmospheric deposition, catchment runoff, sediment resuspension from dredging, and construction of two LNG terminals and a power station. Adverse biological effects predictable in 2007 using international sediment quality guidelines, were independently tested by data from monitoring schemes of more than a decade duration in MHW (starfish, limpets), and in the wider SAC (grey seals). Although not proving cause and effect, many of these potential biological receptors showed a simultaneous negative response to the elevated 2007 contamination following intense dredging activity in 2006. Wetland bird counts were typically at a peak in the winter of 2005-2006 previous to peak dredging. In the following winter 2006-2007, shelduck in Pembroke River showed their lowest winter count, and spring 2007 was the largest ever drop in numbers of broods across MHW between successive breeding seasons. Wigeon counts in Pembroke River were again low in late 2012 after further dredging nearby. These results are strongly supported by PAH data reported previously from invertebrate bioaccumulation studies in MHW 2007-2010, themselves closely reflecting sediment

Relevância:

90.00% 90.00%

Publicador:

Resumo:

The effects of such solutes such as halides and water on the physical properties of room temperature ionic liquids (RTILs) have been extensively studied, This work examines the effect of the solute carbon dioxide on the RTIL 1-ethyl-3-methylimidazolium bis(trifluoromethane-sulfonyl)imide ([C(2)mim][NTf2]) and its influence on the electrochemical characterization of the important redox couple ferrocene/ferrocenium (Fc/Fc(+)). The system was studied using cyclic voltammetry, chronoamperometry, and electron spin resonance (ESR) spectroscopy. Addition Of 100% CO2 to a solution of Fc in [C(2)mim][NTf2] resulted in a substantial increase in both the limiting oxidative current and diffusion coefficient of Fc. Arrhenius plots of Fc diffusion coefficients in the pure and CO2-saturated ionic liquid revealed a decrease in activation energy of translational diffusion from 29.0 (+/- 0.5) kJ mol(-1) to 14.7 (+/- 1.6) kJ mol(-1), suggesting a reduction in the viscosity of the ionic liquid with addition Of CO2. ESR spectroscopy was then used to calculate the rotational correlation coefficients of a probe molecule, 2,2,6,6-tetramethyl-1-piperinyloxyl (TEMPO), to add supporting evidence to this hypothesis. Arrhenius plots of rotational correlation coefficients in the pure and CO2-saturated ionic liquid resulted in a similar drop in activation energy from 28.7 (+/- 2.1) kJ mol(-1) to 18.2 (+/- 5.6) kJ mol(-1). The effect of this solute on the ionic liquid [C(2)mim][NTf2] and on the electrochemical measurements of the Fc/Fc(+) couple emphasizes the necessity of fastidious sample preparation, as it is clear that the voltammetric currents of the electroactive species under study are influenced by the presence of CO2 in solution. The voltammetric response of the electroactive species in RTILs cannot be assumed to be independent of other solutes.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

In this study, palaeoenvironmental changes recorded in the top metre of a peat profile (Misten bog, East Belgium) were investigated using a multiproxy approach. Proxies include bulk density, Ti and Si content, pollen, macrofossils, d13C on specific Sphagnum stems, and d13C–d18O on Sphagnum leaves. A high-resolution chronology was generated using 210Pb measurements and 22 14C AMS dates on carefully selected Sphagnum macrofossils. d13C only records large change in mire surface wetness. This is partly due to the fact that the core was taken from the edge of a hummock, which may make it difficult to track small isotopic changes. The d13C signal seems to be dependent upon the Sphagnum species composition. For example, a change between Sphagnum section Cuspidata towards Sphagnum imbricatum causes a significant drop in the d13C values. On the whole, the C and O isotopes record two shallow pool phases during the 8th–9th and the 13th centuries. Pollen and atmospheric soil dust (ASD) fluxes records increased human occupation in the area. There may be some climatic signals in the ASD flux, but they are difficult to decipher from the increasing human impact (land clearance, agriculture) during the last millennium. The variations in the proxies are not always synchronous, suggesting different triggering factors (temperature, wetness, windiness) for each proxy. This study also emphasizes that, compared to studies dealing with pollution using geochemical proxies, palaeoclimatic inferences from peat bogs need as many proxies as possible, together with highly accurate and precise age-models, in order to better understand climate variability and their consequences during the Holocene.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Time-resolved DRIFTS, MS, and resistance measurements were used to study the interaction of undoped and Pd-doped SnO2 with H-2 in air and argon at 300 degrees C. Using first-order kinetics, we compare the time constants for the resistance drop and its partial recovery with those of the surface hydroxyl evolution and water formation in the gas phase upon exposure to hydrogen. In the case of the undoped oxide, resistance and bridging hydroxyls (BOHs) evolve similarly, manifesting a fast main drop followed by recovery at a similar rate. The rate of water formation for this material was found to be much slower than that of the main drop in both the resistance and BOHs. In contrast, the resistance change for SnO2-Pd appeared to be similar to that of water formation, and no correlation was found between the evolution of resistance and surface OHs. Isotopic exchange on both materials revealed that water formation occurs via fast and slow hydrogen transfer to surface oxygen species. While the former originates from just-adsorbed hydrogen, the latter appears to proceed from the preadsorbed OHs. Both surfaces exhibit close interaction between chemisorbed oxygen and existing bridging OH groups, indicating that the latter is an intermediate in the hydrogen oxidation and generation of donor states on the surface.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Maths support at the Learning Development Service takes the form of drop-in contact, one-to-one appointments and workshops. Analysis over three years from 2010/11 to 2012/13 shows that 45% of one-to-one appointments involved a mature student, defined at Queen’s University Belfast (QUB) as one who has had a break in full-time study (normally a minimum of two years). This is a very high proportion given that 4% of students at QUB are mature. Considering engineering undergraduates only, the fraction of one-to-one appointments involving mature students was also 45%. This study can report a wide variation in terms of progression of mature students in engineering and aims to consider how more traditional undergraduate learners could be persuaded to adopt the attitudes of mature students in partaking of maths support.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

In coral islands, groundwater is a crucial freshwater resource for terrestrial life, including human water supply. Response of the freshwater lens to expected climate changes and subsequent vegetation alterations is quantified for Grande Glorieuse, a low-lying coral island in the Western Indian Ocean. Distributed models of recharge, evapotranspiration and saltwater phytotoxicity are integrated into a variable-density groundwater model to simulate the evolution of groundwater salinity. Model results are assessed against field observations including groundwater and geophysical measurements. Simulations show the major control currently exerted by the vegetation with regards to the lens morphology and the high sensitivity of the lens to climate alterations, impacting both quantity and salinity. Long-term changes in mean sea level and climatic conditions (rainfall and evapotranspiration) are predicted to be responsible for an average increase in salinity approaching 140 % (+8 kg m-3) when combined. In low-lying areas with high vegetation density, these changes top +300 % (+10 kg m-3). However, due to salinity increase and its phytotoxicity, it is shown that a corollary drop in vegetation activity can buffer the alteration of fresh groundwater. This illustrates the importance of accounting for vegetation dynamics to study groundwater in coral islands.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Background

]In modern radiotherapy, it is crucial to monitor the performance of all linac components including gantry, collimation system and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method has been introduced in conjunction with an algorithm to investigate the stability of these systems during arc treatments with the aim of ensuring the accuracy of linac mechanical performance.


Methods

The Varian EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt, and the sag in MLC carriages as a result of linac rotation were separately investigated by acquisition of EPID images of a simple phantom comprised of 5 ball-bearings during arc delivery. A fast and robust software package was developed for automated analysis of image data. Twelve Varian linacs of different models were investigated.


Results

The average EPID sag was within 1 mm for all tested linacs. All machines showed less than 1 mm gantry sag. Changes in SDD values were within 1.7 mm except for three linacs of one centre which were within 9 mm. Values of EPID skewness and tilt were negligible in all tested linacs. The maximum sag in MLC leaf bank assemblies was around 1 mm. The EPID sag showed a considerable improvement in TrueBeam linacs.


Conclusion

The methodology and software developed in this study provide a simple tool for effective investigation of the behaviour of linac components with gantry rotation. It is reproducible and accurate and can be easily performed as a routine test in clinics.




Relevância:

90.00% 90.00%

Publicador:

Resumo:

In comparison to the rest of the United Kingdom (UK) the Northern Irish Construction Industry was disproportionately affected by the recent economic recession. During this period, use of the New Engineering Contract (NEC) has proliferated in the public sector, however no study has been undertaken to examine the impact of the recession on this contract in Northern Ireland. The aim of this paper is to explore NEC contract implementation in Northern Ireland and the impact of the recession on its operation. A qualitative methodology is adopted using a literature review and semi structured interviews with six construction professionals. A qualitative analysis identifies themes and issues arising exploring connections and links between them using thematic coding. The initial findings are that the introduction of the NEC contract in Northern Ireland makes demands of contractors and consultants in terms of additional resources and training. Some consultants show a clear lack of understanding of the contract and its provisions. Whilst there is general agreement that the contract does help to stimulate good project management, the interviewees find the contract time consuming and complicated to administer, describing it as “unforgiving for the architect and unforgiving to the contractor.” Due to the impact of the recession, both contractors and consultants are still reporting a drop in income from pre-recession levels. Project resourcing levels have dropped significantly since the onset of the recession. Adversarial and opportunistic behaviour has increased. Many consultants and contractors are struggling to adequately administer the NEC contract at current income levels. The introduction of the NEC contract and the economic recession have exerted opposing forces on the implementation of the contract, hindering its execution. As the pressures exerted by the economic recession abate and a greater understanding of the contract develops, these opposing forces will ease leading to a more consistent implementation of the contract.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Following the 1978 rural reform, a series of agricultural reforms were introduced in China with an aim to create incentives for the farmers to produce more. However, the nineties’ reforms towards liberalization eventually resulted in a huge drop in agricultural production, which apparently motivated the grain self-sufficiency program in 1998. For a dataset that covers wheat production during these reforms, we examine how and to what extent these reforms affected the Total Factor Productivity (TFP) and the welfare of wheat farmers in China, both at the national and at the regional level. We find that although the nineties' price reforms led to a relatively faster growth of the incentivized TFP of wheat production, they failed to improve profits vis a vis welfare for the farmers. A series of weather shocks in the early nineties resulted in a scarcity of cultivable land and a shortage of agricultural labour, which eventually led to a sharp increase in their relative prices. The introduction of grain self-sufficiency program stabilized these agricultural prices but destroyed the growth in TFP for most regions. However, this reform resulted in some improvement in farmers’ welfare. Wheat farmers in China therefore experienced a trade off between productivity and welfare; competition boosted their productivity and regulation improved their welfare. Not only these findings add a completely new set of results to the existing literature, they can also form a strong basis for future agricultural reforms in China.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Résumé L'accident vasculaire cérébral sensoriel pur est un des syndromes lacunaires, dû à l'occlusion de petits vaisseaux cérébraux, souvent dans le cadre d'une lésion intéressant le noyau ventro-caudal du thalamus. Il produit un hémisyndrome sensitif pur, et parfois un syndrome douloureux se développe à distance de l'événement aigu. Afin d'étudier la récupération fonctionnelle dans le cortex somatosensoriel (SI) après une telle lésion dans le thalamus, un modèle de lésion excitotoxique a été développé dans le système somatosensoriel de la souris adulte, caractérisé par la présence de formations cytoarchitectoniques dans SI appelées "tonneaux". Chacun de ces tonneaux correspond à la représentation corticale d'une vibrisse du museau. L'activité métabolique a été mesurée dans SI à différents intervalles après la lésion, à l'aide de déoxyglucose marqué radioactivement. Dans les deux premiers jours suivant celle-ci, l'activité métabolique diminue de manière importante dans toutes les couches corticales, avec une atteinte plus marquée dans la couche IV, principale projection des axones thalamo-corticaux. Une récupération de l'activité métabolique se produit ensuite, d'autant plus marquée que le délai après la lésion est grand. Cette récupération s'observe dans toutes les couches coticales, les couches I et Vb récupérant plus rapidement que les couches II, III, IV, Va et VI. Cinq semaines après la lésion, l'absence des vibrisses correspondant à la partie déafférentée de SI diminue l'activité métabolique corticale de 32% et démontre l'activation par la périphérie de cette partie de l'écorce, malgré la perte des axones thalamo-corticaux provenant du noyau ventro-caudal. Des expériences de traçage rétrograde ont montré une augmentation des projections intracorticales sur la partie déafférentée de l'écorce, en particulier de longue distance, ainsi que des projections interhémisphériques, mais n'ont pas permis de mettre en évidence de nouvelle projection thalamique, indiquant une origine corticale à la récupération fonctionnelle observée. Abstract To study the degree and time course of the functional recovery in the somatosensory cortex (SI) after an excitotoxic lesion in the adult mouse thalamus, metabolic activity was determined in SI at various times points post lesion. Immediately after the lesion, metabolic activity in the thalamically deafferented part of SI was at its lowest value but increased progressively at subsequent time points. This was seen in all cortical layers, however, layers I and Vb recover more rapidly than layers II, III, IV, Va and VI. Removal of the mystacial whiskers corresponding to the deafferented area, 5 weeks after cortical recovery, produced a subsequent 32% drop in metabolic activity, demonstrating peripheral sensory activation of this part of the cortex. Tracing experiments revealed that the deafferented cortex did not receive a novel thalamic input, but cortico-cortical and contralateral barrel cortex projections to this area were reinforced. We conclude that the cortical functional recovery after a thalamic lesion is, at least partially, due to modified cortico-cortical and callosal projections to the deafferented cortical area.

Relevância:

90.00% 90.00%

Publicador:

Resumo:

Considerable research has focused on the success of early intervention programs for children. However, minimal research has focused on the effect these programs have on the parents of targeted children. Many current early intervention programs champion family-focused and inclusive programming, but few have evaluated parent participation in early interventions and fewer still have evaluated the impact of these programs on beliefs and attitudes and parenting practices. Since parents will continue to play a key role in their child's developmental course long after early intervention programs end, it is vital to examine whether these programs empower parents to take action to make changes in the lives of their children. The goal of this study was to understand parental influences on the early development of literacy, and in particular how parental attitudes, beliefs and self efficacy impact parent and child engagement in early literacy intervention activities. A mixed method procedure using quantitative and qualitative strategies was employed. A quasi-experimental research design was used. The research sample, sixty parents who were part of naturally occurring community interventions in at- risk neighbourhoods in a south-western Ontario city participated in the quantitative phase. Largely individuals whose home language was other than English, these participants were divided amongst three early literacy intervention groups, a Prescriptive Interventionist type group, a Participatory Empowering type group and a drop-in parent- child neighbourhood Control group. Measures completed pre and post a six session literacy intervention, on all three literacy and evidence of change in parental empowerment. Parents in all three groups, on average, held beliefs about early literacy that were positive and that were compatible with current approaches to language development and emergent literacy. No significant change in early literacy beliefs and attitudes for pre to post intervention was found. Similarly, there was no significant difference between groups on empowerment scores, but there was a significant change post intervention in one group's empowerment score. There was a drop in the empowerment score for the Prescriptive Interventionist type group, suggesting a drop in empowerment level. The qualitative aspect of this study involved six in-depth interviews completed with a sub-set of the sixty research participants. Four similar themes emerged across the groups: learning takes place across time and place; participation is key; success is achieved by taking small steps; and learning occurs in multiple ways. The research findings have important implications for practitioners and policy makers who target at risk populations with early intervention programming and wish to sustain parental empowerment. Study results show the value parents place on early learning and point to the importance of including parents in the development and delivery of early intervention programs. groups, were analyzed for evidence of change in parental attitudes and beliefs about early literacy and evidence of change in parental empowerment. Parents in all three groups, on average, held beliefs about early literacy that were positive and that were compatible with current approaches to language development and emergent literacy. No significant change in early literacy beliefs and attitudes for pre to post intervention was found. Similarly, there was no significant difference between groups on empowerment scores, but there was a significant change post intervention in one group's empowerment score. There was a drop in the empowerment score for the Prescriptive Interventionist type group, suggesting a drop in empowerment level. The qualitative aspect of this study involved six in-depth interviews completed with a sub-set of the sixty research participants. Four similar themes emerged across the groups: learning takes place across time and place; participation is key; success is achieved by taking small steps; and learning occurs in multiple ways. The research findings have important implications for practitioners and policy makers who target at risk populations with early intervention programming and wish to sustain parental empowerment. Study results show the value parents place on early learning and point to the importance of including parents in the development and delivery of early intervention programs.