Effective doses from scan projection radiographs of the head: impact of different scanning practices and comparison with conventional radiography

For CT scan planning, scan projection radiographs (SPR) are used. Tube tension and current for head SPR can be reduced to a minimum because of the small head diameter and because only high-contrast structures need to be visualized for planning. The goal of this study was to investigate SPR of the head in respect to effective doses, the influence of dose-reduction measures, and comparison with conventional x-ray.

Concepts for Contemporary Social Work: Globalization, Oppression, Social Exclusion, Human Rights, Etc.

The society wrestles with mass social change congruent with economic globalization and the communications revolution. This change creates new challenges for the social work profession in the areas of social and economic justice. This article analyzes the terminology of the new global era, words that signify a paradigm shift in outlook, most of them a reaction to the new authoritarianism of the age. Globalization, oppression, social exclusion, human rights, harm reduction, and restorative justice are the representative terms chosen.

Managing Debris Flow Risks

Debris flows represent a widespread threat to villages and small towns in the Swiss Alps. For many centuries people “managed” such risks by trying to avoid hazardous areas. However, major debris flow and flood events in the last 25 years have revealed that the degree of freedom to engage in this type of risk management has substantially decreased. This became especially evident during the 1999 disasters in a number of places in Switzerland. The winter of that year was unusually wet. In February heavy snowfall triggered destructive avalanches. In May high temperatures caused heavy snowmelt, with excessive rainfall contributing more water to the already saturated soils. Landslides, debris flows and floods were triggered in many locations, including Sörenberg. Hazard prevention and disaster management have a long tradition in Switzerland, although an integrated approach to risk management is rather new. Only in recent years have methods and tools been developed to assess hazards, define protection goals, and implement disaster reduction measures. The case of Sörenberg serves as an example of how today's approaches to disaster reduction are implemented at the local level.

High-Dose Benzodiazepine Dependence: A Qualitative Study of Patients' Perceptions on Initiation, Reasons for Use, and Obtainment

BACKGROUND High-dose benzodiazepine (BZD) dependence is associated with a wide variety of negative health consequences. Affected individuals are reported to suffer from severe mental disorders and are often unable to achieve long-term abstinence via recommended discontinuation strategies. Although it is increasingly understood that treatment interventions should take subjective experiences and beliefs into account, the perceptions of this group of individuals remain under-investigated. METHODS We conducted an exploratory qualitative study with 41 adult subjects meeting criteria for (high-dose) BZD-dependence, as defined by ICD-10. One-on-one in-depth interviews allowed for an exploration of this group's views on the reasons behind their initial and then continued use of BZDs, as well as their procurement strategies. Mayring's qualitative content analysis was used to evaluate our data. RESULTS In this sample, all participants had developed explanatory models for why they began using BZDs. We identified a multitude of reasons that we grouped into four broad categories, as explaining continued BZD use: (1) to cope with symptoms of psychological distress or mental disorder other than substance use, (2) to manage symptoms of physical or psychological discomfort associated with somatic disorder, (3) to alleviate symptoms of substance-related disorders, and (4) for recreational purposes, that is, sensation-seeking and other social reasons. Subjects often considered BZDs less dangerous than other substances and associated their use more often with harm reduction than as recreational. Specific obtainment strategies varied widely: the majority of participants oscillated between legal and illegal methods, often relying on the black market when faced with treatment termination. CONCLUSIONS Irrespective of comorbidity, participants expressed a clear preference for medically related explanatory models for their BZD use. We therefore suggest that clinicians consider patients' motives for long-term, high-dose BZD use when formulating treatment plans for this patient group, especially since it is known that individuals are more compliant with approaches they perceive to be manageable, tolerable, and effective.

Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study

BACKGROUND High-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients' failing discontinuation treatment. While there is some data supporting its effectiveness, patients' perceptions of such an intervention have not been investigated. METHODS An exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. RESULTS Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: "Only if I can try to discontinue…and please don't call it that," "More stability and less criminal activity…and that is why I would try it," and "No cure, no brain and no flash…and thus, just for everybody else!" CONCLUSIONS Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.

Hepatitis C and human immunodeficiency virus infections in injecting drug users in drug treatment centers in Vietnam

Background. Injecting drug users (IDUs) are at risk of infection with Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Independently, each of these viruses is a serious threat to health, with HIV ravaging the body’s immune system, and HCV causing cirrhosis, liver cancer and liver failure. Co-infection with HIV/HCV weakens the response to antiretroviral therapy in HIV patients. IDUs with HIV/HCV co-infection are at a 20 times higher risk of having liver-related morbidity and mortality than IDUs with HIV alone. In Vietnam, studies to ascertain the prevalence of HIV have found high rates, but little is known about their HCV status. ^ Purpose. To measure the prevalence of HCV and HIV infection and identify factors associated with these viruses among IDUs at drug treatment centers in northern Vietnam. ^ Methods. A cross-sectional study was conducted from November 2007 to February 2008 with 455 injecting drug users aged 18 to 39 years, admitted no more than two months earlier to one of four treatment centers in Northern Vietnam (Hatay Province) (response rate=95%). Participants, all of whom had completed detoxification and provided informed consent, completed a risk assessment questionnaire and had their blood drawn to test for the presence of antibody-HCV and antibody-HIV with enzyme immuno assays. Univariate and multivariable logistic regression models were utilized to explore the strength of association using HIV, HCV infections and HIV/HCV co-infection as outcomes and demographic characteristics, drug use and sexual behaviors as factors associated with these outcomes. Unadjusted and adjusted odds ratios and 95% confidence intervals were calculated. ^ Results. Among all IDU study participants, the prevalence of HCV alone was 76.9%, HIV alone was 19.8%. The prevalence of HIV/HCV co-infection was 92.2% of HIV-positive and 23.7% of HCV-positive respondents. No sexual risk behaviors for lifetime, six months or 30 days prior to admission were significantly associated with HCV or HIV infection among these IDUs. Only duration of injection drug use was independently associated with HCV and HIV infection, respectively. Longer duration was associated with higher prevalence. Nevertheless, while HCV infection among IDUs who reported being in their first year of injecting drugs were lower than longer time injectors, their rates were still substantial, 67.5%. ^ Compared with either HCV mono-infection or HIV/HCV non-infection, HIV/HCV co-infection was associated with the length of drug injection history but was not associated with sexual behaviors. Higher education was associated with a lower prevalence of HIV/HCV co-infection. When compared with HIV/HCV non-infection, current marriage was associated with a lower prevalence of HIV/HCV co-infection. ^ Conclusions. HCV was prevalent among IDUs from 18 to 39 years old at four drug treatment centers in northern Vietnam. Co-infection with HCV was predominant among HIV-positive IDUs. HCV and HIV co-infection were closely associated with the length of injection drug history. Further research regarding HCV/HIV co-infection should include non-injecting drug users to assess the magnitude of sexual risk behaviors on HIV and HCV infection. (At these treatment centers non-IDUs constituted 10-20% of the population.) High prevalence of HCV prevalence among IDUs, especially among HIV-infected IDUs, suggests that drug treatment centers serving IDUs should include not only HIV prevention education but they should also include the prevention of viral hepatitis. In addition, IDUs who are HIV-positive need to be tested for HCV to receive the best course of therapy and achieve the best response to HIV treatment. These data also suggest that because many IDUs get infected with HCV in the first year of their injection drug career, and because they also engaged in high risk sexual behaviors, outreach programs should focus on harm reduction, safer drug use and sexual practices to prevent infection among drug users who have not yet begun injecting drugs and to prevent further spread of HCV, HIV and co-infection. ^

XCO2 and XCH4 total column measurement during POLARSTERN cruise PS83 (ANT-XXIX/10), north-south gradient

A portable Fourier transform spectrometer (FTS), model EM27/SUN, was deployed onboard the research vessel Polarstern to measure the column-average dry air mole fractions of carbon dioxide (XCO2) and methane (XCH4) by means of direct sunlight absorption spectrometry. We report on technical developments as well as data calibration and reduction measures required to achieve the targeted accuracy of fractions of a percent in retrieved XCO2 and XCH4 while operating the instrument under field conditions onboard the moving platform during a 6-week cruise on the Atlantic from Cape Town (South Africa, 34° S, 18° E; 5 March 2014) to Bremerhaven (Germany, 54° N, 19° E; 14 April 2014). We demonstrate that our solar tracker typically achieved a tracking precision of better than 0.05° toward the center of the sun throughout the ship cruise which facilitates accurate XCO2 and XCH4 retrievals even under harsh ambient wind conditions. We define several quality filters that screen spectra, e.g., when the field of view was partially obstructed by ship structures or when the lines-of-sight crossed the ship exhaust plume. The measurements in clean oceanic air, can be used to characterize a spurious air-mass dependency. After the campaign, deployment of the spectrometer alongside the TCCON (Total Carbon Column Observing Network) instrument at Karlsruhe, Germany, allowed for determining a calibration factor that makes the entire campaign record traceable to World Meteorological Organization (WMO) standards. Comparisons to observations of the GOSAT satellite and concentration fields modeled by the European Centre for Medium-Range Weather Forecasts (ECMWF) Copernicus Atmosphere Monitoring Service (CAMS) demonstrate that the observational setup is well suited to provide validation opportunities above the ocean and along interhemispheric transects.

Clean Coal Technologies Scenario and Evaluation of Present CO2 Dwindling Initiatives to Approach Zero Emission Power Stations By Coal Combustion. Deployment Situation and Evaluation Study

In the present uncertain global context of reaching an equal social stability and steady thriving economy, power demand expected to grow and global electricity generation could nearly double from 2005 to 2030. Fossil fuels will remain a significant contribution on this energy mix up to 2050, with an expected part of around 70% of global and ca. 60% of European electricity generation. Coal will remain a key player. Hence, a direct effect on the considered CO2 emissions business-as-usual scenario is expected, forecasting three times the present CO2 concentration values up to 1,200ppm by the end of this century. Kyoto protocol was the first approach to take global responsibility onto CO2 emissions monitoring and cap targets by 2012 with reference to 1990. Some of principal CO2emitters did not ratify the reduction targets. Although USA and China spur are taking its own actions and parallel reduction measures. More efficient combustion processes comprising less fuel consuming, a significant contribution from the electricity generation sector to a CO2 dwindling concentration levels, might not be sufficient. Carbon Capture and Storage (CCS) technologies have started to gain more importance from the beginning of the decade, with research and funds coming out to drive its come in useful. After first researching projects and initial scale testing, three principal capture processes came out available today with first figures showing up to 90% CO2 removal by its standard applications in coal fired power stations. Regarding last part of CO2 reduction chain, two options could be considered worthy, reusing (EOR & EGR) and storage. The study evaluates the state of the CO2 capture technology development, availability and investment cost of the different technologies, with few operation cost analysis possible at the time. Main findings and the abatement potential for coal applications are presented. DOE, NETL, MIT, European universities and research institutions, key technology enterprises and utilities, and key technology suppliers are the main sources of this study. A vision of the technology deployment is presented.

Modelling agro-forestry scenarios for ammonia abatement in the landscape

Ammonia emissions from livestock production can have negative impacts on nearby protected sites and ecosystems that are sensitive to eutrophication and acidification. Trees are effective scavengers of both gaseous and particulate pollutants from the atmosphere making tree belts potentially effective landscape features to support strategies aiming to reduce ammonia impacts. This research used the MODDAS-THETIS a coupled turbulence and deposition turbulence model, to examine the relationships between tree canopy structure and ammonia capture for three source types?animal housing, slurry lagoon, and livestock under a tree canopy. By altering the canopy length, leaf area index, leaf area density, and height of the canopy in the model the capture efficiencies varied substantially. A maximum of 27% of the emitted ammonia was captured by tree canopy for the animal housing source, for the slurry lagoon the maximum was 19%, while the livestock under trees attained a maximum of 60% recapture. Using agro-forestry systems of differing tree structures near ?hot spots? of ammonia in the landscape could provide an effective abatement option for the livestock industry that complements existing source reduction measures.

Influencia de las restricciones medioambientales en el sector eléctrico

El objetivo de esta tesis es la caracterización de la generación térmica representativa de la existente en la realidad, para posteriormente proceder a su modelización y simulación integrándolas en una red eléctrica tipo y llevar a cabo estudios de optimización multiobjetivo económico medioambiental. Para ello, en primera instancia se analiza el contexto energético y eléctrico actual, y más concretamente el peninsular, en el que habiendo desaparecido las centrales de fuelóleo, sólo quedan ciclos combinados y centrales de carbón de distinto rango. Seguidamente se lleva a cabo un análisis de los principales impactos medioambientales de las centrales eléctricas basadas en combustión, representados sobre todo por sus emisiones de CO2, SO2 y NOx, de las medidas de control y mitigación de las mismas y de la normativa que les aplica. A continuación, a partir de las características de los combustibles y de la información de los consumos específicos, se caracterizan los grupos térmicos frente a las funciones relevantes que definen su comportamiento energético, económico y medioambiental, en términos de funciones de salida horarias dependiendo de la carga. Se tiene en cuenta la posibilidad de desnitrificación y desulfuración. Dado que las funciones objetivo son múltiples, y que están en conflicto unas con otras, se ha optado por usar métodos multiobjetivo que son capaces de identificar el contorno de puntos óptimos o frente de Pareto, en los que tomando una solución no existe otra que lo mejore en alguna de las funciones objetivo sin empeorarlo en otra. Se analizaron varios métodos de optimización multiobjetivo y se seleccionó el de las ε constraint, capaz de encontrar frentes no convexos y cuya optimalidad estricta se puede comprobar. Se integró una representación equilibrada de centrales de antracita, hulla nacional e importada, lignito y ciclos combinados en la red tipo IEEE-57, en la que se puede trabajar con siete centrales sin distorsionar demasiado las potencias nominales reales de los grupos, y se programó en Matlab la resolución de flujos óptimos de carga en alterna con el método multiobjetivo integrado. Se identifican los frentes de Pareto de las combinaciones de coste y cada uno de los tres tipos de emisión, y también el de los cuatro objetivos juntos, obteniendo los resultados de costes óptimos del sistema para todo el rango de emisiones. Se valora cuánto le cuesta al sistema reducir una tonelada adicional de cualquier tipo de emisión a base de desplazarse a combinaciones de generación más limpias. Los puntos encontrados aseguran que bajo unas determinadas emisiones no pueden ser mejorados económicamente, o que atendiendo a ese coste no se puede reducir más allá el sistema en lo relativo a emisiones. También se indica cómo usar los frentes de Pareto para trazar estrategias óptimas de producción ante cambios horarios de carga. ABSTRACT The aim of this thesis is the characterization of electrical generation based on combustion processes representative of the actual power plants, for the latter modelling and simulation of an electrical grid and the development of economic- environmental multiobjective optimization studies. In this line, the first step taken is the analysis of the current energetic and electrical framework, focused on the peninsular one, where the fuel power plants have been shut down, and the only ones remaining are coal units of different types and combined cycle. Then it is carried out an analysis of the main environmental impacts of the thermal power plants, represented basically by the emissions of CO2, SO2 y NOx, their control and reduction measures and the applicable regulations. Next, based on the combustibles properties and the information about the units heat rates, the different power plants are characterized in relation to the outstanding functions that define their energy, economic and environmental behaviour, in terms of hourly output functions depending on their load. Optional denitrification and desulfurization is considered. Given that there are multiple objectives, and that they go in conflictive directions, it has been decided the use of multiobjective techniques, that have the ability of identifying the optimal points set, which is called the Pareto front, where taken a solution there will be no other point that can beat the former in an objective without worsening it in another objective. Several multiobjective optimization methods were analysed and pondered, selecting the ε constraint technique, which is able to find no convex fronts and it is opened to be tested to prove the strict Pareto optimality of the obtained solutions. A balanced representation of the thermal power plants, formed by anthracite, lignite, bituminous national and imported coals and combined cycle, was integrated in the IEEE-57 network case. This system was selected because it deals with a total power that will admit seven units without distorting significantly the actual size of the power plants. Next, an AC optimal power flow with the multiobjective method implemented in the routines was programmed. The Pareto fronts of the combination of operative costs with each of the three emissions functions were found, and also the front of all of them together. The optimal production costs of the system for all the emissions range were obtained. It is also evaluated the cost of reducing an additional emission ton of any of the emissions when the optimal production mix is displaced towards cleaner points. The obtained solutions assure that under a determined level of emissions they cannot be improved economically or, in the other way, at a determined cost it cannot be found points of lesser emissions. The Pareto fronts are also applied for the search of optimal strategic paths to follow the hourly load changes.

Entre a saúde e a repressão - políticas públicas na região da \'Cracolândia\' SP

Um território, uma substância e três Políticas Públicas atuando sobre uma mesma população. O trabalho tem como objetivo oferecer uma análise das Políticas Públicas para usuários de Crack instaladas no território da \"Cracolândia\" paulista, localizado no Bairro da Luz (São Paulo-SP). A criação do Programa Crack É Possível Vencer em 2010, articulada à emergência de discursos que especulavam sobre uma possível epidemia e crescente interesse dos meios de comunicação sobre a população usuária, abriu a possibilidade de criação de espaços institucionais para que o Estado intervisse sobre os usuários de crack. Dentro desse contexto, e articuladas a esse Programa do Governo Federal, surgem duas Políticas Públicas: Programa Recomeço de gestão Estadual e Programa De Braços Abertos de gestão Municipal. As ações dessas duas políticas durante os anos 2014 e 2015 constituem o foco do recorte empírico do presente trabalho. O esforço de pesquisa foi no sentido de investigar como as novas Políticas Públicas que se propunham a operar no campo da Saúde Pública e do cuidado iriam se materializar no território, como o discurso institucional iria se traduzir enquanto práticas. Em especial, interessava observar se as novas ações iriam inibir o movimento histórico de higienização do território e expulsão dos usuários. Visando contemplar na pesquisa ponto de vistas, experiências e discursos que não se limitassem ao relato institucional, foram utilizadas três fontes de dados: pesquisas realizadas na região, reportagens e documentos lançados pela mídia e pesquisa de campo. Foi realizada uma leitura e descrição detalhada de três etnografias feitas na região, com o objetivo de comparar as intervenções passadas com o contexto atual; através da análise de duas personagens midiáticas, que surgiram nos meios de comunicação em 2015, traçou-se a imagem do usuário de crack que é veiculada socialmente. E através de observação participante no território, foram descritos os eventos acontecidos durante o período de tempo delimitado, distribuídos em três eixos: Saúde, Repressão e Resistência. À partir desse itinerário de pesquisa, foi elaborada uma discussão que pontua as diferenças entre o discurso e a prática. Dentre as considerações finais, destaca-se a diferença dos modelos de tratamentos propostos pelas Políticas Públicas internação e Redução de Danos e a forma como essa disputa se materializa no cuidado aos usuários de crack. Embora tenha ocorrido um crescimento de ofertas de saúde, também ocorreu um aumento progressivo no número de agentes de segurança e equipamentos de vigilância na Cracolândia, instaurando aquilo que é chamado de Confinamento dos usuários, composto de práticas de limpeza das ruas, retirada de bens dos usuários e filmagem dos usuários. Uma estratégia de gentrificação foi detectada e descrita, ação cujo protagonista é uma empresa de seguros que, no período delimitado, se mostrou excessivamente atuante no território, mobilizando as ações estatais. E por fim, também foram descritas as ações de resistência dos usuários frente à criação das Políticas Públicas e das outras formas de intervenção estatal, ações tais como a construção das favelinhas e a atuação dos profissionais e militantes da região. Espera-se que esse trabalho contribua para uma maior compreensão da Cracolândia paulista e forneça subsídios para que melhores Políticas Públicas sejam criadas no território.

Dando uma moral\' Moralidades, prazeres e poderes no caminho da adesão ao tratamento e da cura da tuberculose na população em situação de rua do município de São Paulo

A tuberculose entre pessoas em situação de rua é um grave problema de saúde pública, que carece de entendimentos e respostas melhor construídas. Questões envolvendo a dimensão coletiva do controle da doença, a dimensão individual do tratamento e o caminho para cura desta população são trazidos neste trabalho que tem como objetivo investigar os aspectos relacionados ao processo de gestão dos tratamentos e busca da cura nesta população. Para isto foram realizados estudos etnográficos junto as equipes de Consultório na Rua da cidade de São Paulo e no Hospital Leonor de Barros, em Campos do Jordão (SP), referência para internação deste grupo. A presença do uso de drogas, as co-infecções com o HIV, DSTs e as Hepatites Virais e o passado de tráfico e criminalidade são elementos presentes na história de vida dos internados, muitos dos quais já com passagem em presídios e alguns com problemas de saúde mental. Mesmo se sujeitando as regras do local em busca de um alento a seu estado de saúde, os pacientes buscam no uso de drogas escondido e no sexo discreto e não comentado, uma alternativa mediadora para suportarem as limitações a que estão expostos. A situação ainda revela uma dificuldade das instituições de internação no lidar com o tema a prática da estratégia de Redução de Danos ao uso de álcool e outras drogas, notando-se uma tendência a destacar práticas proibicionistas em qualquer ação desenvolvida. O entendimento do paciente frente à realidade encarada, revela-se principalmente pelas formas de resistência que eles desenvolvem para o período de reclusão que estarão submetidos durante o tratamento. Ao final se conclui que as diferenças sociais, oriundas de acessos dificultados, preconceitos, segregações e outros atos discriminatórios tem forte influência no processo de adesão do tratamento e cura. Além disto, percebeu-se a existência de vários enfoques de moralidades, envolvendo principalmente os profissionais de saúde e pacientes que refletem na gestão da atenção e cuidado e ainda a presença de uma diferenciação entre o conceito de ficar doente e ficar bom entre estes atores, criando um distanciamento de entendimentos e práticas.

A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis ( Start Over and Survive: SOS), comparing it with Standard Care(SC). Twenty-five in-patients aged 18 - 35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.