The study is based on sensitivity analyses of turbulent channel flow simulations by means of a Discontinuous Galerkin approach. It appears that good results can be obtained without the use of a spatial or temporal averaging. The study confirms the importance of the wall function input data location and suggests to take it at the bottom of the second off-wall element.
These data being available through the ghost element, the suggested method prevents the loss of computational scalability experienced in unstructured WMLES. The study also highlights the influence of the polynomial degree used in the wall-adjacent element. It should preferably be of even degree as using polynomials of degree two in the first off-wall element provides, surprisingly, better results than using polynomials of degree three. Kangaroo transport instead of incubator transport.
Compared with in utero transport , incubator transport for preterm infants has several disadvantages including instability during transport with increased mortality and morbidity, lack of adequate systems for securing the infant in the event of an accident, and separation of mother and infant. As a new kind of postnatal transportation that bears some analogy to in utero transport and may be safer than incubator transport , we investigated kangaroo transport , transporting the infant on the mother's or other caregiver's chest.
This article presents a description and preliminary data for kangaroo transport. We conducted kangaroo transports of 31 stable preterm and term infants in different settings and recorded data regarding transport conditions and cardiorespiratory stability. Eighteen transports were back transfers, and 13 were transfers in. Twenty-seven transports were conducted by the mother, 1 by the father, 2 by nurses, and 1 by a doctor. Transport distance was 2 to km. Heart rate, respiratory rate, oxygen saturation, and rectal temperature remained stable during all kangaroo transports lasting 10 to minutes.
Weight at transport was to g. Parents felt very comfortable and safe and appreciated this method of transport. Kangaroo transport promotes mother-infant closeness and might ameliorate several of the risks associated with incubator transport. Computational development, accuracy and cost. Large eddy simulation LES is computationally extremely expensive for the investigation of wall-bounded turbulent flows at high Reynolds numbers.
The properties of an optimal hybrid RANS— LES model are formulated here by taking reference to fundamental properties of fluid flow equations. The rest of the paper is organized in two parts. First, a priori and a posteriori analyses of channel flow data are used to find the optimal computational formulation of the theoretically derived unified RANS— LES model and to show that this computational model, which is referred to as linear unified model LUM , does also have all the properties of an optimal hybrid RANS— LES model.
Second, a posteriori analyses of channel flow data are used to study the accuracy and cost features of the LUM. The following conclusions are obtained. They can be used as support for face-to-face courses and self-training. The websites will be translated and will be used to create e-learning degree courses. This photograph depicts an air-breathing rocket engine prototype in the test bay at the General Applied Science Lab facility in Ronkonkoma, New York. Air-breathing engines, known as rocket based, combined-cycle engines, get their initial take-off power from specially designed rockets, called air-augmented rockets, that boost performance about 15 percent over conventional rockets.
When the vehicle's velocity reaches twice the speed of sound, the rockets are turned off and the engine relies totally on oxygen in the atmosphere to burn hydrogen fuel, as opposed to a rocket that must carry its own oxygen, thus reducing weight and flight costs. Once the vehicle has accelerated to about 10 times the speed of sound, the engine converts to a conventional rocket-powered system to propel the craft into orbit or sustain it to suborbital flight speed.
NASA's Advanced Space Transportation Program at Marshall Space Flight Center, along with several industry partners and collegiate forces, is developing this technology to make space transportation affordable for everyone from business travelers to tourists. NASA's series of hypersonic flight demonstrators currently include three air-breathing vehicles: The first railroad in space, the Mobile Transporter will allow the Station's robotic arm to travel up and down the finished truss for future assembly and maintenance.
The 27,pound S0 truss is the first of 9 segments that will make up the Station's external framework that will eventually stretch feet meters , or approximately the length of a football field. The completed truss structure will hold solar arrays and radiators to provide power and cooling for additional international research laboratories from Japan and Europe that will be attached to the Station. The transport of protons across membranes is an essential process for both bioenergetics of modern cells and the origins of cellular life.
All living systems make use of proton gradients across cell walls to convert environmental energy into a high-energy chemical compound, adenosine triphosphate ATP , synthesized from adenosine diphosphate. ATP, in turn, is used as a source of energy to drive many cellular reactions. The ubiquity of this process in biology suggests that even the earliest cellular systems were relying on proton gradient for harvesting environmental energy needed to support their survival and growth.
In contemporary cells, proton transfer is assisted by large, complex proteins embedded in membranes. The issue addressed in this Study was: The model system used in the study contained a bilayer membrane made of phospholipid, dimyristoylphosphatidylcholine DMPC which is a good model of the biological membranes forming cellular boundaries. Both sides of the bilayer were surrounded by water which simulated the environment inside and outside the cell. This protein has been shown to exhibit remarkably high rates of proton transport and, therefore, is an excellent model to study the formation of proton gradients across membranes.
Four identical protein fragments, each folded into a helix, aggregate to form small channels spanning the membrane. Protons are conducted through a narrow pore in the middle of the channel in response to applied voltage. Transportation Acronym Guide, This report compiles and identifies transportation and transportation -related acronyms throughout the Department of Transportation and other related U.
National Transportation Statistics Compiled and published by the U. National transportation statistics Department of Transportation , National Transportation Statistics presents: Department of Transportations Bureau of: Department of Transportation , National Transportation Statistics presents information on the U. Department of Transportation 's Bureau of Transportation Statistics: State Transportation Statistics This is the 12th annual edition of State Transportation Statistics, a State transportation statistics Statistics , a statistical profi le of transportation in the Statistics , a statistical profile of transportation in the 50 states and the: This document is a successor to the BTS State: Structural Aspects of Flexible Aircraft Control les Aspects structuraux du controle actif et flexible des aeronefs.
Transport de paires EPR dans des structures mesoscopiques. Dans cette these, nous nous sommes particulierement interesses a la propagation de paires EPR1 delocalisees et localisees, et a l'influence d'un supraconducteur sur le transport de ces paires. Apres une introduction de cette etude, ainsi que du cadre scientifique qu'est l'informatique quantique dans lequel elle s'inscrit, nous allons dans le chapitre 1 faire un rappel sur le systeme constitue de deux points quantiques normaux entoures de deux fils supraconducteurs.
Cela nous permettra d'introduire une methode de calcul qui sera reutilisee par la suite, et de trouver egalement le courant Josephson produit par ce systeme transforme en SQUID-dc par l'ajout d'une jonction auxiliaire. Le SQUID permet de mesurer l'etat de spin singulet ou triplet , et peut etre forme a partir d'autres systemes que nous etudierons ensuite.
Dans le chapitre 2, nous rappellerons l'etude detaillee d'un intricateur d'Andreev faite par un groupe de Bale. La matrice T, permettant d'obtenir le courant dans les cas ou les electrons sont separes spatialement ou non, sera etudiee en detail afin d'en faire usage au chapitre suivant. Le chapitre 3 est consacre a l'etude de l'influence du bruit sur le fonctionnement de l'intricateur d'Andreev.
Ce bruit modifie la forme du courant jusqu'a aboutir a d'autres conditions de fonctionnement de l'intricateur. En effet, le bruit present sur les points quantiques peut perturber le transport des paires EPR par l'intermediaire des degres de liberte. Nous montrerons que, du fait de l'"intrication" entre la charge de la paire et le bruit, la paire est detruite pour des temps longs. Cependant, le resultat le plus important sera que le bruit perturbe plus le transport des paires delocalisees, qui implique une resonance de Breit-Wigner a deux particules.
Le transport parasite n'implique pour sa part qu'une resonance de Breit-Wigner a une particule. Dans le chapitre 4, nous reviendrons au systeme constitue de deux points quantiques entoures de deux fils. This photograph depicts an air-breathing rocket engine that completed an hour or 3, seconds of testing at the General Applied Sciences Laboratory in Ronkonkoma, New York. Referred to as ARGO by its design team, the engine is named after the mythological Greek ship that bore Jason and the Argonauts on their epic voyage of discovery. Une vie saine et active: Twenty five years ago, Mott's law was established in order to describe electrical transport in disordered insulators at low temperature.
In this review, we briefly summarize the different theoretical steps involved in the rigourous derivation of Mott's law. We stress upon the fact that Mott's law gives the mean conductance of an ensemble of macroscopic samples as long as electron-electron interactions remain negligible.
We then study what happens when at least one of the key assumptions of Mott's law no longer holds. We first focus on systems whose size — at least in one dimension — is not macroscopic: Eventually, we try to gather different works dealing with electron-electron interactions. It is now established that interactions generally produce a stronger divergence for the electrical resistance than the one predicted by Mott's law at the lowest temperatures. But the exact shape of this divergence, as well as its interpretation, remain debated. We try to make a link between Efros and Shklovskii 's work and their famous "Coulomb gap" and a more recent work about granular media.
In this latter work, the size of the grains is the key parameter for the shape of the divergence of the resistance at low temperature. We suggest this could indicate a way for a model accounting for the different shapes of divergence of the electrical resistance at the lowest temperatures.
Furthermore this framework of granular media allows us to deal with non linear regime: Recent developments in large scale computer architectures allow Large Eddy Simulation LES to be considered for the prediction of turbulent reacting flows in geometries encountered in industry. To do so, various difficulties must be overcome and the first one is to ensure that proper meshes can be used for LES.
Indeed, the quality of meshes is known to be a critical factor in LES of reacting flows. This issue becomes even more crucial when LES is used to compute large configurations such as full annular combustion chambers. Various analysis of mesh effects on LES results have been published before but all are limited to single-sector computational domains. However, real annular gas-turbine engines contain ten to twenty of such sectors and LES must also be used in such full chambers for the study of ignition or azimuthal thermo-acoustic interactions.
Instabilities mostly azimuthal modes involving the full annular geometry remain a critical issue to aeronautical or power-generation industries and LES seems to be a promising path to properly apprehend such complex unsteady couplings. Based on these observations, mesh effects on LES in a full annular gas-turbine combustion chamber including its casing is studied here in the context of its azimuthal thermo-acoustic response.
To do so, a fully compressible, multi-species reacting LES is used on two meshes yielding two fully unsteady turbulent reacting predictions of the same configuration. The two tetrahedra meshes contain respectively 38 and 93 millions cells. Limit-cycles as obtained by the two LES are gauged against each other for various flow quantities such as mean velocity profiles, flame position and temperature fields.
The thermo-acoustic limit-cycles are observed to be relatively indepedent of the grid resolution which comforts the use of LES tools to provide insights and understanding of the mechanisms triggering the coupling between the system acoustic eigenmodes and combustion. Unlike pollutant transport over flat terrain, the mechanism and plume dispersion over urban areas is not well known. This study is therefore conceived to examine how urban morphology modifies the pollutant transport over urban areas.
The computational domain and boundary condition used in this study is shown in Figure 1. The LES shows that inside the street canyon, the ground-level pollutants are carried to roof-level by the re-circulating flow, which are then removed from the street canyon to the UBL. Right above the roof level, narrow high-speed air masses in the streamwise flows and intensive downdrafts have been found in the shear layer. Different from the flows over a smooth surface, the maximum turbulence intensities descend that are peaked near the top of the building roughness.
The pollutant is rather uniformly distributed inside a street canyon but disperses rapidly over the buildings exhibiting a Gaussian-plume form in the UBL. The mean component of vertical pollutant flux shows that the mean wind contributes to pollutant removal and entrainment simultaneously. Whereas, the fluctuating component demystifies that pollutant removal is mainly governed by atmospheric turbulence.
Over the roof level, atmospheric flows slow down rapidly in the wake behind leeward building, suggesting the momentum entrainment into the street canyons. The decelerating streamwise flows in turn lead to upward flows carrying pollutants away from the street canyons, illustrating the basic pollutant removal mechanism in the skimming flow regime. Computational domain and boundary conditions Figure 2: Ensemble average vertical pollutant flux along the roof level.
LES on unstructured deforming meshes: Towards reciprocating IC engines. Computations have been made for three canonical flows, progressing towards the intended application of in-cylinder flow in a reciprocating engine. Grid sizes were selected to be comparable to the coarsest meshes used in earlier spectral LES studies. Quantitative results are reported for decaying homogeneous isotropic turbulence, and for a planar channel flow. Generally satisfactory evolution of first and second moments is found on these coarse meshes; deviations are attributed to insufficient mesh resolution.
Issues include mesh resolution and computational requirements for a specified level of accuracy, analytic characterization of the filtering implied by the numerical method, wall treatment, and inflow boundary conditions. To resolve these issues, finer-mesh simulations and computations of a simplified axisymmetric reciprocating piston-cylinder assembly are in progress. High speed turbulent reacting flows: Work on understanding the mechanisms of mixing and reaction in high speed turbulent reacting flows was continued. Efforts, in particular, were concentrated on taking advantage of modern computational methods to simulate high speed turbulent flows.
In doing so, two methodologies were used: In the work related with LES the objective is to study the behavior of the probability density functions pdfs of scalar properties within the subgrid in reacting turbulent flows. The data base obtained by DNS for a detailed study of the pdf characteristics within the subgrid was used. Simulations are performed for flows under various initializations to include the effects of compressibility on mixing and chemical reactions.
Simulations were performed with different magnitudes of the convective Mach numbers and with different chemical kinetic parameters for the purpose of examining the isolated effects of the compressibility and the heat released by the chemical reactions on the structure of the layer. A full compressible code was developed and utilized, so that the coupling between mixing and chemical reactions is captured in a realistic manner. Le surpoids touche l'ensemble de cette population. Prototypage virtuel pour les programmes navals Virtual Prototyping in Naval Ships.
Davis is making her first flight in space. In the background, a technician looks through OV side hatch. A material transporting system comprises a material transporting apparatus including a material transporting apparatus hopper structure , , which comprises at least one rotary transporting apparatus; a stationary hub structure constraining and assisting the at least one rotary transporting apparatus; an outlet duct configuration configured to permit material to exit therefrom and comprising at least one diverging portion , ' ; an outlet abutment configuration configured to direct material to the outlet duct configuration; an outlet valve assembly from the material transporting system venting the material transporting system; and a moving wall configuration in the material transporting apparatus capable of assisting the material transporting apparatus in transporting material in the material transporting system.
Material can be moved from the material transporting apparatus hopper structure to the outlet duct configuration through the at least one rotary transporting apparatus, the outlet abutment configuration, and the outlet valve assembly. Les calculs urinaires de l'enfant au Burkina Faso: La symptomatologie de la lithiase urinaire est polymorphe.
Wake Vortex Transport in Proximity to the Ground. A sensitivity study for aircraft wake vortex transport has been conducted using a validated large eddy simulation LES model. The study assumes neutrally stratified and nonturbulent environments and includes the consequences of the ground. The numerical results show that the nondimensional lateral transport is primarily influenced by the magnitude of the ambient crosswind and is insensitive to aircraft type.
In most of the simulations, the ground effect extends the lateral position of the downwind vortex about one initial vortex spacing b sub o in the downstream direction. Further extension by as much as one b sub o occurs when the downwind vortex remains 'in ground effect' IGE for relatively long periods of time. Results also show that a layer-averaged ambient wind velocity can be used to bound the time for lateral transport of wake vortices to insure safe operations on a parallel runway.
Statewide Transportation Plan - Intermodalism Georgia has benefited from a comprehensive multimodal transportation network. The availability of road, air, rail and port transportation facilities has been a magnet for business development and economic activity. The ability to connect goods to mar Growth in wind power production has motivated investigation of wind-farm impacts on in situ flow fields and downstream interactions with agriculture and other wind farms.
We examined the performance of each scheme in both convective and stable conditions. While wake growth slowed in the latter half of the WFP array as expected, wakes did not approach steady state by the end of the array as simulated by the GAD model. A sensitivity test involving the deactivation of explicit TKE production by the WFP resulted in turbulence levels within the array well that were below those produced by the GAD in both stable and unstable conditions.
Describe the relevant anatomy needed to understand wrist pathologies Description: Developing the knowledge and skills necessary to become an effective teacher also helps fulfill some of the requirements of the CanMEDS-FM competency framework, particularly the Scholar role. Over 70 countries were included as members of the KPCS at the end of At the end of their first year and at the end of their training, all FM residents were asked to fill out a survey and photo quiz to verify their knowledge. In this paper, we reported the construction of a binary vector pKO1-HPH containing a positive selective gene hygromycin phosphotransferase hph , a reporter gene gfp conferring green fluorescent protein, and an efficient protocol for V. Aaviantyarori cametsa, ayotacotero aavintarontsiyetatsiri osamani antzimaventero ishtoriatacotaro, aajatzi osheki opinata ampinaventero aparopaye inchashi, acoviriqui ayotacotero, osaretsikipaye.
Finally, the WFP overestimated downwind power production deficits in stable conditions because of the lack of wake stabilization in the latter half of the array. The Transportation Librarians Toolkit is a product of the Transportation Library Connectivity pooled fund study, TPF- 5 , a collaborative, grass-roots effort by transportation libraries to enhance information accessibility and professional expert State University serves to attract high school students to participate in an innovative summer: Advanced Transportation Institute The seventh version of the Advanced Transportation Institute ATI was conducted in to encourage high school students to pursue careers in the field of transportation engineering.
The University Transportation Center for Alabama partnered wit The eighth version of the Advanced Transportation Institute ATI was conducted in to encourage high school students to pursue careers in the field of transportation engineering. The University Transportation Center for Alabama partnered with On June 24 and 25, , Secretary of Transportation Rodney Slater brought together nearly leaders from the transportation and technology communities to explore these questions at The Spirit of Innovation in Transportation conference at the Depar Passenger transportation usually receives more attention for safety and security than freight transportation , and since the tragic events that occurred on September 11th, , passenger air transportation has been receiving a great deal of attention Workshop for transportation forecasters.
On September , , the U. Department of Transportation , Research and Innovative Technology Administration's - Bureau of Transportation Statistics is hosted an international workshop on transportation forecasting in Washington, D. Transportation energy data book. This report presents statistics that characterize transportation activities and data on other factors that affect transportation energy use. The 12 chapters of the 19th edition of the Data Book focus on various aspects of the transportation industry Innovative Technologies in Transportation.
An historical overview of the transportation infrastructure of the United States and Texas is provided.
Data for trends in transportation is analyzed and projections for the future are postulated. A survey of current technologies in transportation is Innovations for tomorrow's transportation. On January 9, , a compendium of U. Department of Transportation DOT , State, and Local transportation officials, as well as industry experts, convened to discuss six existing and emerging crucial transportation topics. This diverse group of tr Commerce de detail de l'essence automobile: Modelisation de l'impact a court terme des facteurs endogenes et exogenes sur les ventes d'essence dans les stations-service a Montreal.
La determination de l'impact des facteurs sous controle et hors controle qui influencent les volumes de vente des magasins de detail qui vendent des produits homogenes et fortement substituables constitue le coeur de cette these. Il s'agit d'estimer un ensemble de coefficients stables et asymtotiquement efficaces non correles avec les effets specifiques aleatoires des sites d'essence dans le marche de Montreal Quebec, Canada durant is periode Le modele econometrique qui est ainsi specifie et teste, isole un ensemble de quatre variables dont le prix de detail affiche dans un site d'essence ordinaire, la capacite de service du site pendant les heures de pointe, les heures de service et le nombre de sites concurrents au voisinage du site dans un rayon de deux kilometres.
Ces quatre facteurs influencent les ventes d'essence dans les stations-service. Les donnees en panel avec les methodes d'estimation robustes estimateur a distance minimale sont utilisees pour estimer les parametres du modele de vente. Nous partons avec l'hypothese generale selon laquelle il se developpe une force d'attraction qui attire les clients automobilistes dans chaque site, et qui lui permet de realiser les ventes.
Cette capacite d'attraction varie d'un site a un autre et cela est du a la combinaison de l'effort marketing et de l'environnement concurrentiel autour du site. Les notions de voisinage et de concurrence spatiale expliquent les comportements des decideurs qui gerent les sites. Le but de cette these est de developper un outil d'aide a la decision modele analytique pour permettre aux gestionnaires des chaines de stations-service d'affecter efficacement les ressources commerciales dans ies points de vente. Smart Growth and Transportation. Describes the relationship between smart growth and transportation , focusing smart and sustainable street design, transit-oriented development, parking management, sustainable transportation planning, and related resources.
We have developed a suitable heterologous cell expression system to study the localization, trafficking, and site s of function of the human ABCG1 transporter. Transfer of ABCG1-mobilized cholesterol from the cytoplasmic face of LEs to the PM and concomitant removal of cholesterol from the outer leaflet of the PM bilayer by extracellular acceptors suggests that ABCG1 mobilizes cholesterol on both sides of the lipid bilayer for removal by acceptors. Hybrid acoustic prediction methods have an important advantage over the current Reynolds averaged Navier-Stokes RANS based methods in that they only involve modeling of the relatively universal subscale motion and not the configuration dependent larger scale turbulence.
Unfortunately, they are unable to account for the high frequency sound generated by the turbulence in the initial mixing layers.
The resulting prediction method would then be intermediate between the current noise prediction codes and previously proposed hybrid noise prediction methods. Wall modeled LES of wind turbine wakes with geometrical effects. This study focuses on prediction of wind turbine wakes when geometrical effects such as nacelle, tower, and built environment, are taken into account. The wind turbine rotor is modeled using an Actuator Line Model ALM while the geometrical details are explicitly meshed thanks to the use of an unstructured grid. As high Reynolds number flows are considered, sub-grid scale models as well as wall modeling are required.
The first test case investigated concerns a wind turbine flow located in a wind tunnel that allows to validate the proposed methodology using experimental data. The second test case concerns the simulation of a wind turbine wake in a complex environment e. Passeport pour les deux infinis: The Pass2i cornerstone is a reversible book - where each side explores one of the two infinities - and which is given for free to science high school teachers who request it, thanks to the support of French funding agencies.
The Pass2i non-profit association wants to be a bridge between science and education: Generally good agreement with experimental mole fraction, stagnation temperature, and Pitot pressure profiles is obtained for non-reactive mixing of the hydrogen jet with a non-vitiated air stream. A lifted flame, stabilized between 10 and 22 cm downstream of the hydrogen jet, is formed for hydrogen injected into a vitiated air stream. Flame stabilization occurs closer to the hydrogen injection location when a three-dimensional combustor geometry with boundary layer development resolved on all walls is considered.
Volumetric expansion of the reactive shear layer is accompanied by the formation of large eddies which interact strongly with the reaction zone. Time averaged predictions of the reaction zone structure show an under-prediction of the peak water concentration and stagnation temperature, relative to experimental data and to results from a Reynolds-averaged Navier-Stokes calculation.
Instead, energy is concentrated in the very largest scales, which provide an over-mixing effect that excessively cools and strains the flame. Predictions improve with the use of a low-dissipation version of the baseline piecewise parabolic advection scheme, which captures the formation of smaller-scale structures superimposed on larger structures of the order of the shear-layer width.
Comparison of two LES codes for wind turbine wake studies. For the third time a blind test comparison in Norway , was conducted comparing numerical simulations for the rotor Cp and Ct and wake profiles with the experimental results. As the only large eddy simulation study among participants, results of the Technical University of Denmark DTU using their in-house CFD solver, EllipSys3D, proved to be more reliable among the other models for capturing the wake profiles and the turbulence intensities downstream the turbine.
It was therefore remarked in the workshop to investigate other LES codes to compare their performance with EllipSys3D. Two types of simulations are performed: Results are compared in terms of velocity deficit, turbulence kinetic energy and eddy viscosity. It is seen that both codes predict similar near-wake flow structures with the exception of OpenFoam's simulations without the subgrid-scale model.
The differences begin to increase with increasing the distance from the upstream rotor. From the single rotor simulations, EllipSys3D is found to predict a slower wake recovery in the case of uniform laminar flow. From the 3-rotor computations, it is seen that the difference between the codes is smaller as the disturbance created by the downstream rotors causes break down of the wake structures and more homogenuous flow structures. Le cannabis et les enfants et adolescents canadiens. Turbulence and sediment transport over sand dunes and ripples. Several bedforms are present near to the surfzone of natural beaches.
Dunes and ripples are frequently observed. Understanding the turbulence over these forms is essential for the sediment transport. The turbulent flow and the suspended sand particles interact with each other. At the moment, the modelling strategy for turbulence is still a challenge. We have adapted this method, initially developed for atmospheric flow, to the oceanic flow. LES is currently the best way to simulate turbulent flow but its higher cost prevents it from being used for large scale applications.
It allows us minimize the computational cost and ensure a better accuracy of the results than with a fully RANS model. In the case of megaripples, the validation step was performed with two sets of field data Sandy Duck'97 and Forsoms'13 but also with the data from Dune2D model which uses only RANS for turbulence. The main findings are: Toutefois, leurs avantages ne sont pas sans risques: Computation of unsteady turbomachinery flows: Part 2— LES and hybrids. The choice of turbulence model can have a strong impact on results for many turbomachinery zones.
Palliative corrections to them and also transition modeling can have a further profound solution impact. The spectral gaps necessary for theoretically valid URANS solutions are also lacking in certain turbomachinery zones. Understand the basic principles of wound closure Description: The program will present a basic introduction into surgical instruments including, the naming, basic parts, and functions of basic office based surgical equipment.
The differences between the basic uses of instruments, including selection of instrument and of scalpel blades will be addressed in the lecture. The lecture will discuss the different types of cutting, grasping, clamping, retracting and needle holding instruments. The second part of the lecture will focus on the principles of suture and needle selection, and basic principles of wound closure.
The differences between absorbable, and non-absorbable sutures, the differences within suture types and the sizes of suture material, will be explored. Similarly the differences between the needle types, cutting, reverse cutting, tapered, traumatic and non traumatic needles will be discussed. The attendee will be given guidance as what factors should be considered when making the selection of material and needle. Finally the lecture will discuss the various suture patterns used in wound closure and the principles of suture placement and knot tying. Differentiate between quality improvement, scientific research, and quality assurance 2.
Evaluate the completeness of an aim statement in a quality improvement project 3. Identify common challenges students and residents encounter in completing quality improvement projects Description: The importance of quality improvement QI concepts in health care are affecting both undergraduate and postgraduate curricula. Medical students and family medicine residents are increasingly being required to design, lead, and conduct QI projects. This session is designed for teachers who supervise the completion of these projects.
QI basics including defining quality improvement, writing aim statements, developing project measures, using common QI tools, and developing Plan-Do-Study-Act cycles will be discussed. Ideas for generating project topics and guidelines for publication will be reviewed. The session will include case studies of actual student and resident projects to provide the opportunity to apply the concepts discussed. Dans cet atelier, les participants apprendront comment tirer avantage de cet outil. Managing Uncertainty in Medical Education and Practice: Highlights advanced concepts for clinical preceptors.
Define uncertainty in the context of science, family medicine, and medical education 2. Learn techniques to leverage the management of uncertainty to increase the resilience of learners and teachers in practice Description: In our current competency-based educational environment learners are required to gain a certain set of clinical skills.
Often overlooked are the consultation skills required to synthesize history taking and information gathered during the physical exam, and to incorporate this with the broad variety of external factors in a therapeutic plan. Finding effective ways to help our learners manage uncertainty can assist with problems such as time management, selectivity, and early diagnostic closure.
By broadening our teaching approaches to address thinking strategies we can broaden their cognitive apprenticeship, support their passage from novice to expert, and increase their confidence levels. We will also explore possible effects on resilience during and after residency. Teaching Residents to Teach: Highlights novice concepts for educational leaders. Describe distributed learning strategies used to teach family medicine residents how to become effective teachers 2.
Discuss the drawbacks and possibilities with technology-enhanced learning 3. Apply practical strategies to develop curricula for teaching family medicine residents how to teach Description: Family medicine residents have important roles to play as both role models for and teachers of medical students, resident peers, and other health care professionals. Developing the knowledge and skills necessary to become an effective teacher also helps fulfill some of the requirements of the CanMEDS-FM competency framework, particularly the Scholar role. Although residents are expected to teach, only a few might have had any formal training on how to teach effectively.
Residents often voice the need for some instructional approaches, particularly regarding their readiness for clinical teaching. Educational leaders must ensure there is a curriculum available to teach residents how to teach and provide them with opportunities to develop their teaching skills. Residents should also receive formal assessment of their clinical teaching to facilitate their achievement of the relevant competencies.
There is no one-size-fits-all educational approach to teaching family medicine residents how to teach. The use of interactive instructional strategies such as distributed online modules should emphasize for residents the key concepts they need in their roles as teachers. This workshop will highlight how distributed educational strategies can bring new ideas to an old topic. Moreover, the educational principles used in developing curricula for teaching residents to teach can be used to address educational needs in designing curricula for other CanMEDS-FM roles.
Participants are encouraged to bring questions and perspectives from their own work. Organization and method of presentation: Introduction 15 minutes ; interactive practical application 75 minutes ; and large group discussion and wrap-up 30 minutes. Beginner and intermediate clinical teachers, program directors, residents, and others who are planning to develop, or are implementing, a curriculum to support family medicine residents in their role as teachers. Adolescents and Adults with ASD: Describe anticipatory primary care, as well as accessible, patient-centred medical homes for transitional-age youth and adults with autism spectrum disorder ASD 2.
Describe the family physician, caregiver, and patient roles in supporting transition from pediatric to adult health care Description: Autism spectrum disorders ASD are an important condition to recognize and manage in family practice, with prevalence reports as high as 1: This session will review management of common physical comorbidities such as genetic conditions, developmental feeding disorder, gastroenterology issues, mental health issues, and epilepsy.
Participants will be introduced to a new tool for anticipatory care for adult patients with ASD designed specifically for primary care providers as well as a helpful tools and processes for supporting transition from pediatric to adult health care. Understand the need for, and purpose of, a national repository of resources for family medicine teachers 2.
Apply tools from the current faculty development resource repository 3. Discover additional tools that are useful in developing teaching competencies Description: This interactive session is meant for teachers at all levels of experience working in diverse family medicine contexts. The session will begin with a plenary discussion on the utility of a national repository of resources for family physician teachers with participants using their own teaching experiences. The current online repository as it exists on the CFPC website will be presented, and participants will try using it to develop approaches to common teaching scenarios.
Potential barriers to its use, and strategies to overcome them, will be discussed. Finally, participants will be invited to identify additional tools and resources that could be added to the repository by the committee. The CanMEDS-FM Competency Framework has specifically been designed for family physicians, articulating a comprehensive definition of the abilities needed throughout the training and practice lifetime.
It can be applied across the entire continuum of learning, from undergraduate through to continuing professional development. This workshop will explore the application of the framework to the various roles of a family physician—learner, teacher, practitioner, administrator, and leader. Based on multi-source feedback received over the past year, the framework has undergone significant revisions. The workshop will focus on small group discussion, providing further consultation and exploration of the use of the framework and its impact on the various roles of the family physician.
In addition, suggestions for dissemination across the educational continuum, and overcoming any identified barriers to implementation with be discussed. Highlights advanced concepts for educational leaders. Describe and explain the principles of assessment 2. Choose assessment tools and strategies that align with the purpose of assessment 3.
Describe and explain educational leadership strategies to help address assessment challenges in your own program Description: Assessing learners is one of the greatest challenges for clinical preceptors. The difficulties arise due to the lack of understanding of the assessment role in both accelerating learning coaching and feedback and in ensuring that learners focus on those skills they have not yet mastered.
The crux of assessment is the learner-teacher relationship whereby expert family physicians help learners achieve competence. The preceptor is the most important and effective assessment tool in authentic work-based learning. This course is designed specifically for those new to assessment and have educational leadership responsibilities to engage preceptors in effective assessment.
This includes addressing and overcoming those barriers both personal and institutional to reliable assessment. Thirty-two percent of Canadians are vitamin D insufficient. This figure is particularly high in those of childbearing age, and pregnant women tend to be relatively vitamin D insufficient during the first trimester. Low levels of vitamin D have been linked with higher levels of depression, and vitamin D supplementation may have a therapeutic effect on depressive symptoms. We sought to answer the hypothesis that low levels of vitamin D in women in the antepartum period are associated with postpartum depression, and in doing so to assess the value of vitamin D screening in pregnancy and the value of supplementing vitamin D to prevent postpartum depression.
Systematic review of the literature yielded four cohort studies, of which three were fully published; two randomize controlled trials; and one case-control study. Of the six fully published papers, three gave statistically significant results in favour of a link between vitamin D deficiency in pregnancy and postpartum depression. Analysis of vitamin D supplementation was possible in two papers, both of which demonstrated a statistically significant reduction in postpartum depressive scores in patients who received supplements of at least 1, IU daily.
Due to heterogeneity between the studies, a meta-analysis was not obtained. The studies were not representative of a typical cross-section of Canadian pregnant women in terms of demographics, but similar in terms of vitamin D exposure at baseline. Overall, the risk of bias in the studies was low. The balance of evidence neither supports nor refutes the initial hypothesis. There is some evidence that supplementation of vitamin D is protective against later development of postpartum depression.
Further research is required to establish the presence and nature of the association between vitamin D deficiency and postpartum depression. Further experimental studies are required to reproduce the preventative effect of vitamin D supplementation in pregnancy. In our experience as primary care physicians, complaints of ankle swelling are more common in the summer, often patients with no obvious cardiovascular disease and do not go on to develop such disease.
To our knowledge, this trend has never been reported in the literature. To determine if there is any seasonal pattern in the prevalence of ankle swelling. Using the Google Trends search engine, we obtained data on search volume related to ankle swelling and similar terms from the United States between January 4, and August 16, We plotted the data as a time series and performed regressions with a seasonal model and a straight-line model null hypothesis. We used a sum-of-squares F test to assess for statistically significant different in fit between the models.
Peak searches occurred in mid-June mid-summer and troughs occurred in mid-December mid-winter. Internet searches for ankle swelling and related terms are highly seasonal, with interest peaking in mid-summer. To estimate the cost savings that could result from implementation of a rational prescribing model for drug classes that are equivalent in terms of efficacy, toxicity, and convenience.
The top 10 drug classes based on annual spending were gathered from the Canadian Institute for Health Information. They were reviewed for potential inclusion in the study based on the ability to compare intraclass medications. When equivalence in efficacy, toxicity, and convenience was determined from a literature review, annual prescribing data were gathered from the National Prescription Drug Utilization Information Systems Database.
The potential cost savings were then calculated by comparing current market shares with potential future market shares. Estimated differences in spending produced by a rational prescribing model. Statins, proton pump inhibitors, angiotensin-converting enzyme inhibitors, and selective serotonin reuptake inhibitors were determined to have class equivalence for efficacy, toxicity, and convenience. Most of the potential savings are derived from deprescribing the newest patentprotected medications in each class.
Avoiding prescribing the newest intraclass drug, particularly in the absence of research to support its superiority in relevant clinical outcomes, could lead to considerable savings in health care expenditures and might push the pharmaceutical industry to innovate rather than imitate. Can Fam Physician ; Routine collection of sociodemographic data in primary care Andrew D. Detailed data on social determinants of health can facilitate the identification of inequities in access to health care.
We report on a sociodemographic data collection tool used in a family medicine clinic. Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of patients in the waiting room of a primary care clinic.
Data were uploaded directly to the electronic medical record. Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10, patients have been surveyed; only 6. A modified survey is now administered to all patients. Such data are now being used to identify health inequities, develop novel interventions and evaluate their impact on health outcomes. For clinicians and patients, the Internet constitutes a common source of information. This presentation will outline few key aspects and results of a year research program on information outcomes in a primary care context.
This program is based on a theoretical model and the Information Assessment Method IAM that were developed and validated by our research group integrating information studies and health sciences. We commonly use participatory research in partnership with governmental, professional and philanthropic organizations synergy with existing interventions.
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Considering the complexity of human information interactions, we usually conduct systematic mixed studies reviews and mixed methods research. First, results of observational studies may encourage family physicians to search information more often. For example, they suggest the number of patients for whom medical information has to be retrieved by family physicians in order for one patient to benefit might be 14 Number Needed to Benefit from Information: Second, more than 15, Canadian pharmacists and physicians use the IAM to rate and comment educational emails reflective learning activity , and earn continuing education credits.
In turn, their feedback comments can contribute to improve informational content two-way knowledge translation. Implications of these results will be outlined. The goal of this initiative is for every family practice in each community across Canada to be able to offer comprehensive, coordinated, and continuing care to their populations through family physicians working with health care teams. Teams may involve, physically or virtually, several allied health care providers and specialists, depending on the needs of the patient community.
The PMH is where patients can present and discuss their personal and family health concerns and receive a full spectrum of care. Relationships between patients and family physicians and other health care professionals are developed and strengthened over time, enabling the best possible health outcomes for each person, the practice population, and the community being served. The presenters will demonstrate that this model aligns very well with the pillars of the PMH. Barriers to implementing such a model in the CAF will also be shared.
This interactive session will explore the usefulness of the PMH model in the context of managing occupational medicine issues, particularly in challenging scenarios, and will be aimed at sharing best practices in addressing these challenges. Areas for future development will also be proposed for discussion by and feedback from participants.
Explore approaches to initiation of early palliative care in long-term care practice 2. Describe appropriate screening practices in long-term care practice 3. Apply practising wisely principles to practice in long-term care Description: This workshop will focus on the principles of practising wisely in long-term care LTC. Care for individuals in LTC is becoming increasingly complex as patients are being admitted later in life and with more comorbidities. Prevalence of dementia in this clinical population is upwards of 70 per cent and, increasingly, people are admitted with a shortened life expectancy.
It is estimated that average length of stay for new admissions to LTC is close to 18 months with a wide variation across this spectrum. That being said, residents and families are often unaware of this and far too often discussions about prognosis and clinical expectations have not been had. The workshop will start with an exploration of attitudes and awareness of the benefits of initiating of conversations about end-of-life care. Case scenarios that focus on communicating with residents and families will be used to facilitate interactive discussions highlighting key issues challenging our approach to LTC.
The second part of this workshop will focus on discussions around appropriate prescribing and use of investigations in the LTC setting. This will build upon the newly released Choosing Wisely Canada LTC recommendations developed by the Long Term Care Medical Directors Association of Canada, as well as recommendations and adaptation of materials developed for the popular workshops of Practising Wisely.
We will present this in a case-based format to stimulate interactive discussion and practical challenges faced by clinicians in this setting. We hope to have education on a national stage by introducing this workshop at FMF, as LTC practices are not standard amongst the provinces. What are family physicians doing and why? Describe differences between physicians in the documentation of chaperone use 2. How family physicians are applying this guidance in their daily practice is unknown.
Data on documentation practices and awareness of provincial recommendations were collected by cross-sectional survey, with analysis using SPSS statistical software. Data on influencing factors were collected through individual interviews that underwent thematic analysis by constant comparison method. Survey participants included family physicians in Calgary. Interview participants included 17 family physicians in three academic, community-based Calgary teaching clinics. There were surveys used for analysis 30 per cent response rate and 17 individual interviews were completed.
Interview findings suggested physician reasoning around documentation was variable and included individual physician standard of practice, anticipation of concern, patient choice, and other patient factors. Survey results demonstrated that only 25 per cent of respondents were aware of provincial recommendations.
This was supported by interview findings, which also showed that while many did not use the recommendations in determining chaperone use, others used them as a way to counsel patients that a chaperone was required. Documentation of chaperone use and application of provincial guidance are variable.
Most physicians do not document chaperone use and physician gender may affect documentation practices. To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare their responses across three generations of alumni of one family practice program. One family medicine program in the province of Ontario. All graduates of one family medicine program between and Self-reported provision of care in office, care in-hospital, intrapartum obstetrics, house calls, palliative care, after hours care, nursing home care, minor surgery, emergency room, sport medicine, walk-in care.
In addition, gender, training stream urban or rural , size of community of practice, practice model, and satisfaction with practice were considered. Participants practised in eight provinces across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services across three generations of graduates, with newer graduates providing fewer services than the older graduates.
Significant declines across the three groups were observed in the provision of house calls, palliative care, and nursing home care. Non-significant changes were seen in the provision of intrapartum obstetrics across the three alumni groups with an initial decline then an increase in reported activity. The average number of types of procedures offered declined from the oldest to the newest graduates.
Most respondents were in a patient-enrolment practice model and those in such models reported offering significantly more services than those in either fee for service, Family Health Group, or salary models Conclusion: The normative definition of comprehensive care varies across three generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates.
A greater understanding of the forces that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved. Identify and define Choosing Wisely Recommendations applicable to primary care 2. Recognize factors associated with adherence to the Choosing Wisely recommendations 3. To assess factors associated with adherence to four Choosing Wisely CW recommendations during patient encounters with a primary care clinician. Data from clinicians in 46 clinics representing , patients.
All patients with at least one encounter to from a participating MaPCReN primary care clinician. Data relating to the following CW recommendations: Adherence to each of the four CW recommendations. Descriptive statistics and multivariable logic models with generalized estimating equations assessed adherence to the CW recommendations and association with patient, provider, and practice characteristics.
There were , primary care encounters related to one of the four CW recommendations evaluated. The most common non-adherent CW encounter related to an antibiotic prescription for viral infection Female patients had an increased odds of an encounter with an antibiotic prescription for viral infections OR 1.
Salaried physicians, older patients, patients with more frequent office visits, and patients residing in rural areas had increased odds of non-adherence. There are patient-, provider-, and practice-related factors that affect adherence to CW recommendations. Understanding factors associated with adherence is essential to designing strategies to reduce unnecessary investigations and treatments. Describe to patients what their experience with medical assistance in dying might be like 2.
To explore the experiences and perspectives of Canadians who requested and were eligible for MAID as well as the experiences of people supporting them. This was a qualitative study using semi-structured interviews and thematic analysis. Patients who had a consultation about MAID in a clinic in British Columbia and were found eligible were recruited for the study.
Basic demographics were recorded for context. Twenty-three patient experiences were explored in interviews with 11 patients and 18 support people. Most patients had a malignancy, neurological disorder, or organ failure. The major reason for requesting assisted death was a self-perceived unacceptable quality of life, most commonly due to the loss of autonomy, independence, physical function, and ability to communicate. Some patients expressed fear of future suffering and future disability. The support people included spouses, sons, daughters, and friends.
All 11 support people who were interviewed after the MAID death said the death was peaceful. They valued that they could be present, prepared, and able to say some final words. The reasons patients in our study requested assisted death were similar to the findings in other countries, namely loss of autonomy and the ability to do the things they enjoyed. Their loved ones supported their decisions and valued the chance to be prepared and present.
Evidence-based assesment and treament Enhanced Clinical Session Learn to assess the severity of alcohol withdrawal 2. Learn best practices for the medical management of alcohol withdrawal in the emergency department 3. Learn how and when to discharge patients in alcohol withdrawal safely Description: Alcohol withdrawal is a common and potentially life-threatening condition encountered in emergency departments across the country. There is a high degree of variability in the assessment and treatment of such patients. During this seminar participants will learn the current best practices involved in the safe assessment, treatment, and discharge of this vulnerable population.
The treatment protocols discussed will stress a simple, non-invasive approach that can be used for the majority of patients in most emergency department settings. Supporting Family Medicine Resident Research: Understand feasibility in resident research and identify common pitfalls impeding the success of research projects 2. Appraise a resident research proposal for scientific rigour and originality 3.
Develop a comprehensive plan to support a family medicine resident in completing a research project Description: Many Canadian family medicine residency programs require the completion of a scholarly project. In some programs this takes the form of a research project. Designing and completing a high-quality research project can be challenging in the course of a residency program. Time constraints and the process of learning research methods and study design are barriers in the context of busy clinical training programs.
One of the most significant barriers residents encounter is the Research Ethics Board REB application process, which can be difficult particularly for those without prior research experience. Our team of family physicians at North York General Hospital, an academic community hospital in Toronto, Ontario, has instituted various initiatives and processes to support residents in doing research. Our process for assisting residents in completing projects includes staff physician review, resident peer review, and deliberate engagement with the local REB to facilitate successful, expeditious reviews.
We support residents in planning for a presentation or publication, rather than merely the completion of a rote requirement of the residency program. Our strategies have been successful and well received by residents and we think they are of value to the greater academic family medicine community. This session will provide family physicians in both academic and community settings involved with supporting resident research projects with practical strategies for success. Building on what we have learned we will discuss suggestions and tips for incorporating them into your setting for this purpose.
Become familiar with the coaching model as it applies to the family medicine clinical preceptor 2. Learn how coaching techniques can be incorporated in the evaluation portfolio of our learners 3. Have you ever had the experience of working with a really good sports coach or music teacher? If so, you will probably remember how amazing it felt to have someone working with you to help you achieve at a level that was just not possible for you to do on your own.
Research suggests that learning medicine is no different. We all know that a good coach needs to observe your performance in order to help, but that does not occur often enough in medicine. As medical education moves toward a more competency-based structure, direct observation, feedback, and the facilitation of deliberate practice are becoming essential teaching competencies for faculty and learners. The Doctor as Coach framework intentionally supports the implementation of contemporary concepts in medical education. Through this workshop attendees will learn practical techniques from the coaching model to apply to the learner in the family medicine setting.
Describe the elements needed for managing the data associated with competency-based assessment 2. List advantages and disadvantages of paper versus online systems for competency-based assessment 3. Evaluate using a system like eCBAS 2. Competency-based medical education became an undeniable fact of curriculum and assessment in family medicine residency programs across Canada in , when the College of Family Physicians of Canada implemented the Triple C Competency-Based Curriculum.
While individual programs across Canada have approached competencybased medical education in different ways, there have been some common challenges for many programs. One of those challenges has been how best to assess and track competence. Individual programs have had to decide which actual tools and processes to use for assessment. Some programs have workable systems, but many are still struggling with how and what to do for competency-based assessment. Our program addressed the challenge of managing assessment information by developing an electronic portfolio, called the Electronic Competency-Based Achievement System eCBAS.
Regularly evaluating and monitoring eCBAS has proven to be an integral part of our change management strategy, allowing us to learn within the system, evolve, and continuously improve. In this session, we present the newest version, eCBAS 2. We will share evaluation data about the system. A system demonstration will be followed by the opportunity for participants to practise, using some of the tools in eCBAS. Table and group discussions will address issues of assessment centred around two case studies about residents—one progressing well and one encountering difficulty.
This primarily interactive workshop is excellent for anyone with questions about how to implement workable competency-based assessment, and those who are already carrying out competency-based assessment and would like to share their experiences—positive and negative—with others. Describe how to identify a learner in difficulty and the range of problems this term encompasses 2. Describe how to deal with these resident learning issues including the institution of learning, remediation, and probation plans 3.
Understand the processes involved from remediation to appeal, and recognize the inherent challenges in finding solutions that work Description: As program directors, we are sometimes faced with supporting residents in difficulty. Having a robust tracking system to identify residents in trouble early is key.
Designing an adequate learning program as well as remediation and probation plans are often challenging but should be done using an evidence-based rubric with input from multiple sources including the learner. We will discuss the definition of a problem learner, the confounding issues in making this definition, and potential strategies that can be used to assist these learners in need. We will also present a tracking system and administrative structure that help identify. Strong ties with the postgraduate medical education office helps in these situations, and having a working knowledge of the appeal process can help you design the plans.
We will then present case scenarios that will be discussed in a workshop-based format. Describe essential components of a competency-based assessment framework for an enhanced skills program 2. Explain the need for cumulative evidence of progress towards competence in the context of Certificates of Added Competence 3. Plan how to incorporate competency-based assessment into your own enhanced skills programs Description: Enhanced skills programs in Canada are currently facing two challenges: CBAS is a competency-based assessment framework, developed by researchers in family medicine at the University of Alberta, that uses formative feedback to inform summative evaluation.
CBAS offers a straightforward, learner-driven method to capture and document workplace observations of competency FieldNotes , which provides immediate feedback, tracks learner progress, and allows for early identification of learners who are encountering difficulty. With CBAS, residents guide their learning using formative feedback. For preceptors and program directors, CBAS offers a way to document workplace observations and feedback, so that summative decisions are evidence-based and defensible.
In this interactive workshop, an enhanced skills program director will present evidence of proof-of-concept for using CBAS via exploration of findings from a pilot study in the two SEM programs. Case studies will also be reviewed. A study of probabilities of origin of genes was carried out on a Dogon population in Mali , spread over four massifs separated from each other by about 20 kilometers. Within each village, the founder contributions are very disparate and show that each village has a very specific origin.
Therefore, the exchange of wives between massifs has not resulted in a homogenization of the population, which has remained strongly structured into four relatively independent isolates. Achieving Peace in Northern Mali: A third hypothesis cannot be dispelled. Niger might have simply been lucky. However, French Tuareg expert Pierre Boilley stresses that, at least initially, there was no indication of a clan- or caste-centered Malaria parasite is usually transmitted to humans by Anopheles mosquitoes but it can also be transmitted through blood transfusion.
Usually malaria transmission is low in African urban settings. In West Africa where the P. The aim of this study was to evaluate the prevalence of P. The study was conducted using a random sample of blood donors in Bamako, Mali , from January to December Screening for malaria was performed by thick smear and rapid diagnostic test RDT. Blood group was typed by Beth-Vincent and Simonin techniques. The frequency of malaria infection was 1. The pick prevalence of P. The prevalence of P. There is a seasonal prevalence of malaria among blood donors in Bamako.
A prevention strategy of transfusion malaria based on the combination of selection of blood donors through the medical interview, promoting a voluntary low-risk blood donation and screening all blood bags intended to be transfused to children under 5, pregnant women and immune-compromised patients during transmission season using thick smear will reduce the risk of transfusion malaria in Mali.
Molecular identification of Mycobacterium bovis from cattle and human host in Mali: Bovine tuberculosis BTB is a contagious, debilitating human and animal disease caused by Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex. The study objective were to estimate the frequency of BTB, examine genetic diversity of the M. Samples from suspected lesions on cattle at the slaughterhouses were collected. Mycobacterial smear, culture confirmation, and spoligotyping were used for diagnosis and species identification.
In total, cattle have been examined for lesions in the five regions of Mali. Out of cattle, 79 specimens presented lesions and then examined for the presence of M. Nineteen spoligotype patterns were identified among 79 samples with five novel patterns. One case of M. This study estimates a relatively true proportion of BTB in the regions of Mali and reveals new spoligotype patterns. Coulibaly, Oumar; Kone, Abdoulaye K. Background Dermatophytosis, and particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood.
To describe the epidemiology of dermatophytosis in distinct eco-climatic zones, three cross-sectional surveys were conducted in public primary schools located in the Sahelian, Sudanian and Sudano-Guinean eco-climatic zones in Mali. Principal Findings Among children average age 9. Tinea capitis prevalence was Trichophyton soudanense was primarily isolated from trichophytic lesions. Conclusions Tinea capitis risk increased with increasing climate humidity in this relatively homogenous schoolchild population in Mali , which suggests a significant role of climatic factors in the epidemiology of dermatophytosis.
The antifungal effect of pine needle extract prepared by a distinguishable extraction method and the dry distillation method, was examined. The effect of this extract itself was insignificant. The chemical components of pine needle extract were then investigated by gas chromatographic analysis, and four chemical components, acetol, furfural, 5-methyl furfural, and terpineol, were identified. The antifungal effects of those four chemical components against Alternaria mali A. It was observed that the minimum inhibitory concentrations MICs were 6.
MICs of furfural and 5-methyl furfural had the same order of magnitude as that of an antifungal agrochemical, chlorothalonil. Although furfural itself can not be completely substituted for an antifungal agrochemical, a partial mixture of furfural and antifungal agrochemical may be used as a substitute.
The use of agrochemicals for the prevention of plant disease caused by pathogenic fungus such as A. First report of Echinococcus granulosus genotype G6 in a dog in Bamako, Mali. Cystic echinococcosis is one of the most widespread and important helminthic zoonoses, caused by the larval stage of Echinococcus granulosus sensu lato. However, to date there is little information about the disease in West Africa. Faecal and fur samples from dogs, the main final hosts, were collected in and in Bamako, Mali.
One faecal and one fur sample from the same dog were positive for E. Three microscopically positive fur samples were negative by PCR. This is the first study to focus on the final host of E. Dermatophytosis, and particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. Among children average age 9. Tinea capitis risk increased with increasing climate humidity in this relatively homogenous schoolchild population in Mali , which suggests a significant role of climatic factors in the epidemiology of dermatophytosis.
Diarrhea and malnutrition represent leading causes of death for children in Mali. Understanding a community's needs and ideas are critical to ensure the success of prevention and treatment interventions for diarrheal disease, as well as to improve food security to help reduce malnutrition. The objective of this study was to incorporate the Community Readiness Model CRM for the issues of childhood diarrheal disease and food security in Mali to measure baseline community readiness prior to any program implementation.
Thirteen key respondents residing in Dioro, Mali were selected based on varied social roles and demographics and completed two questionnaires on these public health issues. The overall readiness score to reduce childhood diarrheal disease was 5. The overall readiness score to improve food security was 5. The preparation stage indicates that at least some of the community have basic knowledge regarding these issues, and want to act locally to reduce childhood diarrhea and improve food security and nutrition.
Proposed activities to increase community readiness on these issues are provided and are broad enough to allow opportunities to implement community- and culturally-specific activities by the Dioro community. Connection Zones, Surface Water - Groundwater: Surface water infiltration recharging Mali aquifers occurs through, underlying perched hydrogeological networks, lacustrine zones of the Central Delta or inundation valleys.
The mapping of both the Surface water and the Groundwater, their types and availabilities, are briefly presented, and the focus of the study is on the types of hydraulic connections between these water bodies. These aquifers belong to the hydrogeological Unit of Central Delta where the recharge by surface water is estimated to be five percent of the flow loss between the entry and the outlet of this hydrological system.
Some attempts of simulation along with a review based on the first studies synthetized in "Synthese Hydrogeologique du Mali " would permit to pave the way to other studies on these hydraulically connected zones in Mali. A previews simulation study, about mapping the potential rate of pumping capacity, corroborates some observed structural characteristics and leads to subdivide the area in two hydrogeological sectors, and the present simulation studies focus on the sector "Macina -Diaka" where surface water are in hydraulic relation with groundwater.
Situational analysis of infant and young child nutrition policies and programmatic activities in Mali. Progress towards reducing mortality and malnutrition among children Mali , as one of the six targeted countries. Between June and September , key informants responsible for conducting IYCN-related activities in Mali were interviewed, and documents were examined on the following themes: Most of the key IYCN topics were addressed in national policies, training materials, and programme documents.
Information on the national coverage and impact of these programmes is generally not available. Exclusive breastfeeding Mali , but no studies identified the contributors to this increase. Despite improvements in breastfeeding practices, optimal infant, and young child feeding is still practiced among too few young children in Mali. Several research articles were identified, but few of these were linked to programme development. Some programme monitoring and evaluation reports were available, but few of these were rigorous enough to identify whether IYCN-specific programme components were implemented as designed or were achieving desired outcomes.
Therefore, we could not confirm which programmes contributed to reported improvements. Monitoring of programmes managing malnutrition identified gaps. The migratory phenomenon in Mali ]. Mali has long been affected by migration because of its location between North Africa and sub-Saharan Africa. During the rainy season, from June-October, most of the population is busy in agricultural work, but during the dry season from November to May seasonal migration in search of wage employment is common.
Seasonal migration is also part of the long tradition of commerce with neighboring countries. Economic difficulties of the last several years have encourage migration to urban centers and foreign countries. The drought that has afflicted Mali for over a decade is a further impetus to migration. Temporary migrants inside Mali are oriented from the north to the region of Sikasso and the District of Bamako in the south and primarily are young men aged There has been an increase in definitive migration from areas less favored ecologically to more desirable areas.
Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation.
To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. The performance of the BlueStar network from inception in March until December was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to franchisees; an estimated , clients received voluntary family planning services, most commonly long-acting reversible methods of contraception.
Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in were under 20 years old, and three-quarters were adopters of family planning that is, they had not been using a modern method during the 3 months prior to their visit. Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing.
The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family. Adverse Drug Reactions to Antiretroviral Therapy: Prospective Study in Children in Sikasso Mali. Their diagnosis incurs some various difficulties according to the geographic context. Our aim was to describe the frequency, nature, and preventability of adverse drug reactions ADRs due to antiretroviral treatment in Malian outpatient children.
Prior to treatment initiation, demographic characteristics, clinical history, and biologic parameters, including CD4 cell counts, were collected for each patient. The World Health Organization's adverse drug reactions classification was used to characterize the side effects. Adverse effects and toxicities were graded 1, 2, and 3. After 24 weeks of treatment, we observed that Side effects were many and varied, with the most frequent being cutaneous rash, nausea, vomiting, and diarrhea Side effects were grade 1 in most cases.
One case of grade 2 and one case of grade 3 were observed with rash. We observed one case of grade 3 side effects during our study. The treatment regimen was changed in These ADRs have an impact on quality of life for patients. We recommend a pharmacovigilance system for sustainable management of side effects in patients infected with human immunodeficiency virus in Mali. Characterization of aerosolized bacteria and fungi from desert dust events in Mali , West Africa. Millions of metric tons of African desert dust blow across the Atlantic Ocean each year, blanketing the Caribbean and southeastern United States.
Previous work in the Caribbean has shown that atmospheric samples collected during dust events contain living microbes, including plant and opportunistic human pathogens. To better understand the potential downwind public health and ecosystem effects of the dust microbes, it is important to characterize the source population.
We describe 19 genera of bacteria and 3 genera of fungi isolated from air samples collected in Mali , a known source region for dust storms, and over which large dust storms travel. Do free caesarean section policies increase inequalities in Benin and Mali? Benin and Mali introduced user fee exemption policies focused on caesarean sections C-sections in and , respectively.
These policies had a positive impact on access to C-sections and facility based deliveries among all women, but the impact on socioeconomic inequality is still highly uncertain. We evaluated trends in inequality in terms of two outcomes: C-sections and facility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facility based deliveries favoured the least advantaged categories rural, non-educated and poorest women or the most advantaged categories urban, educated and richest women.
Concentration curves were used to observe the degree of wealth-related inequality in access to C-sections and facility based deliveries. We analysed 47, childbirths 23, in Benin and 24, in Mali. In Benin, we found no significant difference in access to C-sections between urban and rural women or between educated and non-educated women.
However, the richest women had greater access to C-sections than the poorest women. There was no significant change in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the free C-section policy. Inequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present. LES of propeller crashback.
Crashback is an operating condition to quickly stop a propelled vehicle, where the propeller is rotated in the reverse direction to yield a negative thrust. In crashback, the freestream interacts with the strong reverse flow from the propeller leading to massive flow separation and highly unsteady loads. We have used Large-Eddy Simulation LES in recent years to accurately simulate the flowfield in crashback around a stand-alone open propeller, hull-attached posterior alone open propeller and a ducted propeller with stator blades.
This talk will discuss our work towards LES of crashback inclusive of the entire hull. The results will be compared to available experimental data, and the flow physics will be discussed. This work is supported by the Office of Naval Research. Monographies Innodata The Convergent Pedagogy: In this monograph, convergent pedagogy, which is a foreign language education approach to develop functional bilingualism in students, is described as a new approach to teaching language in bi- or multilingual contexts.
Convergent pedagogy was introduced to the Mali educational system as a language education experiment in This monograph is a…. Thai in-service teacher understanding of nature of science in biology teaching: This paper aimed to investigate the existing ideas of nature of science NOS teaching in Thailand biology classroom. The study reported the existing ideas of nature of science NOS teaching of one biology teacher Mrs.
Mali who had been teaching for 6 years at in a school in Khon Kaen city. Methodology regarded interpretive paradigm. Tools of interpretation included 2 months of classroom observation, interviewing, and questionnaire of NOS. The findings revealed Mali held good understanding of the nature of science in the aspect of the use of evidence, the aspect of knowledge inquiry through different observation and deduction, the aspect of creativity and imagination influencing science knowledge inquiry, and the aspect of changeable scientific knowledge.
Her biology teaching indicated that she used both the deficient nature of science approach and the implicit nature of science approach. The implicit nature of science approach was applied mostly in 7 periods and only 2 periods were arranged using the deficient nature of science approach. The paper has implication for professional development and pre-service program on NOS teaching in Thailand. Climate risk and food security in Mali: A historical perspective on adaptation.
Giannini, Alessandra; Krishnamurthy, P. We combine socioeconomic data from a large-scale household survey with historical climate data to map the climate sensitivity of availability and access dimensions of food security in Mali , and infer the ways in which at-risk communities may have been impacted by persistent climatic shift. Thirty years after , the period of most intense drought during the protracted late 20th century drying of the Sahel, the impact of drought on livelihoods and food security is still recognizable in the Sahelian center of Mali.
This impact is expressed in the larger fraction of households in this Sahelian center of the country—the agro-ecological transition between pastoralism in the north, and sedentary agriculture in the south—who practice agriculture but not livestock raising, despite environmental conditions that are suitable to their combination. These households have lower food security and rely more frequently on detrimental nutrition-based coping strategies, such as reducing the quantity or quality of meals.
In contrast, the more food secure households show a clear tendency toward livelihood diversification away from subsistence agriculture. These households produce less of what they consume, yet spend less on food in proportion. The analysis points to the value of interdisciplinary research—in this case bridging climate science and vulnerability analysis—to gain a dynamical understanding of complex systems, understanding which may be exploited to address real-world challenges, offering lessons about food security and local adaptation strategies in places among the most vulnerable to climate.
The yellow Fever epidemic in Western mali , september-november Recent yellow fever epidemics in West Africa have underlined the discrepancy between the official number of cases and deaths and those estimated by a retrospective epidemiological investigation. During the yellow fever epidemic that broke out in western Mali in September , a total of cases and deaths were officially notified, but estimates revealed true figures abut five times higher. This paper attempts to discuss the factors that hindered early case detection and more complete reporting.
They were, first, the insufficient training on the clinical diagnosis, the blood sampling method for laboratory confirmation, and the curative treatment of patients resulting in low utilization of services ; second, the lack of an action plan to prepare in advance a quick response to the epidemic, affecting reporting procedures at the peripheral level and active case-finding during the outbreak; and third, the lack of laboratory facilities for a quick confirmation of the disease.
The difficulties experienced during the yellow fever epidemic in Mali demonstrated the importance of a preparedness strategy for epidemic control, based on an integrated approach of epidemiological surveillance within basic health service activities. The need for regional collaboration and for institutionalized funds in the donor community that could be mobilized for epidemic preparedness activities is also emphasized. The impact of a family planning multimedia campaign in Bamako, Mali. An integrated multimedia campaign featuring family planning messages saturated the ,person city of Bamako, Mali , for three months during the spring of With traditional theater and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali , does not oppose family planning.
A separate sample pretest-post-test quasi-experimental research design was used to evaluate the effects of the campaign and exposure to specific messages on changes in contraceptive knowledge, attitudes, and practice.
Results indicate a high level of exposure to and agreement with the messages. A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project interventions, after controlling for relevant variables.
Sexual assault rates are underestimated in Mali. This study was designed to assess the epidemiological, clinical and judicial aspects of sexual assault. A retrospective study was conducted from 1st July to 30 April in the health care centre of the 4th Commune of Bamako. The study included 37 sexual assault victims selected from the medical records and sexual assault certificates from a total of 1, patients attending the gynaecology clinic during the study period.
Victims admitted at the request of Police officers accounted for The age ranged from 2 to 40 years with a mean of 21 years; The assault was perpetrated by one person in Sexual assault is relatively frequent in Mali , particularly among students and housewives. It represents a real tragedy, which must be prevented by increasing the awareness of the population, judicial assistance to victims and prosecution of perpetrators.
Potential use of cuminic acid as a botanical fungicide against Valsa mali. Valsa canker caused by Valsa mali is commonly present in eastern Asia and cause large economic losses. Because of limited agricultural measures and chemical residues of commonly used fungicides there is an urgent need of alternative plant protecting agents. On this background the activity of cuminic acid, a plant extract from the seed of Cuminum cyminum L, was assessed.
The median effective concentration EC 50 values for inhibition of mycelial growth of seven V. The antifungal activity was the direct activity of cuminic acid instead of the influence on the pH of media by cuminic acid. After treated with cuminic acid, mycelia dissolved with decreased branches and swelling; cell membrane permeability increased while pectinases activity decreased significantly. Moreover, peroxidase POD activity of the apple leaves increased after treated with cuminic acid.
Importantly, on detached branches of apple tree, cuminic acid exhibited both protective and curative activity. These results indicated that cuminic acid not only showed the antifungal activity, but also could improve the defense capacity of the plants. Taken together, cuminic acid showed the potential as a natural alternative to commercial fungicides or a lead compound to develop new fungicides for the control of Valsa canker.
Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. Malaria during pregnancy contributes to maternal anemia and low birth weight. In East Africa, several studies have demonstrated that intermittent preventive treatment IPT with sulfadoxine-pyrimethamine SP is more efficacious than weekly chloroquine CQ chemoprophylaxis in preventing these adverse consequences.
Exploring innovative ways to conduct coverage surveys for neglected tropical diseases in Malawi, Mali , and Uganda. Currently, a cluster survey to monitor drug coverage after mass drug administration for neglected tropical diseases is the most common methodology used by control programs. We investigated alternative survey methodologies that could potentially provide an estimation of drug coverage. Three alternative survey methods market, village chief, and religious leader were conducted and compared to the cluster method in Malawi, Mali , and Uganda. In Malawi, drug coverage for the cluster, market, village chief, and religious leader methods were In Mali , results for round 1 were Uganda survey results were Further research is needed to test different coverage survey methodologies to determine which survey methods are the most scientifically rigorous and resource efficient.
Published by Elsevier B. Evaluation of direct and indirect effects of seasonal malaria chemoprevention in Mali. Randomized controlled trials have established that seasonal malaria chemoprevention SMC in children is a promising strategy to reduce malaria transmission in Sahelian West Africa. This strategy was recently introduced in a dozen countries, and about 12 million children received SMC in However, evidence on SMC effectiveness under routine programme conditions is sparse.
We aim to measure the effects of the nationwide SMC programme in Mali on the prevalence of malaria and anemia in children months. We used data from the nationally representative malaria indicator survey. A post-test only with non-randomized control group study was designed. We fitted a generalized structural equation model that controlled for potential bias on observed and non-observed variables endogenous treatment effect model.
SMC in Mali has substantial protective effects under routine nationwide programme conditions. Endogenous treatment effects analyses can contribute to rigorously measuring the effectiveness of health programmes and to bridging a widening gap in evaluation methods to measure progress towards achieving malaria elimination. The National Blindness Prevention Program in Mali has broadcast messages on the radio about trachoma as part of the country's trachoma elimination strategy since In , a radio impact survey using multi-stage cluster sampling was conducted in the regions of Kayes and Segou to assess radio listening habits, coverage of the broadcasts,….
Population numbers have remained low since then and today This performance guide is designed for teachers to use with students before and after a performance of "Sundiata: The guide, called a "Cuesheet," contains seven activity sheets for use in class, addressing: Effect of naturally occurring Wolbachia in Anopheles gambiae s.
A naturally occurring Wolbachia strain wAnga- Mali was identified in mosquitoes of the Anopheles gambiae complex collected in the Malian villages of Dangassa and Kenieroba. Phylogenetic analysis of the nucleotide sequence of two 16S rRNA regions showed that wAnga- Mali clusters with Wolbachia strains from supergroup A and has the highest homology to a Wolbachia strain isolated from cat fleas Ctenocephalides.
Quantitative analysis of Wolbachia and Plasmodium sporozoite infection in field-collected mosquitoes indicates that the prevalence and intensity of Plasmodium falciparum sporozoite infection is significantly lower in Wolbachia-infected females. The presence of Wolbachia in females from a laboratory Anopheles coluzzii A. However, Wolbachia infection significantly reduced the prevalence and intensity of sporozoite infection, as observed in the field.
This indicates that wAnga- Mali infection does not limit early stages of Plasmodium infection in the mosquito, but it has a strong deleterious effect on sporozoites and reduces malaria transmission. Dusukasi-The Heart That Cries: Perinatal mental health problems such as depression and anxiety are prevalent in low and middle-income countries. In Mali , the lack of mental health care is compounded by few studies on mental health needs, including in the perinatal period. This paper examines the ways in which perinatal women experience and express mental distress in rural Mali.
We describe a process, relying on several different qualitative research methods, to identify understandings of mental distress specific to the Malian context. Participants included perinatal women, maternal health providers, and community health workers in rural southwest Mali. These idioms of distress were described as sharing many key features and operating on a continuum of severity that could progress over time, both within and across idioms.
Our findings highlight the context dependent nature of experiences and expressions of distress among perinatal women in Mali. We compared the flight activity of Xyleborus glabratus Eichhoff, vector and symbiont of the causal agent of laurel wilt disease Raffaelea lauricola , with a native species Monarthrum mali Fitch using flight mills. During the 3-h interval experiment, the shortest time to flight initiation for X. We compared several flight parameters. Monarthrum mali flew more than five times more frequently than X. These data will be useful for development of species-specific control and monitoring protocols for these ambrosia beetles based on greater understanding of their flight capacities and associated invasion distance.
For Permissions, please email: Open source challenges for hospital information system HIS in developing countries: We are currently witnessing a significant increase in use of Open Source tools in the field of health. Our study aims to research the potential of these software packages for developing countries. After reviewing several Open Source tools in the field of hospital information systems, Mediboard software was chosen for our study.
To ensure the completeness of Mediboard in relation to the functionality required for a hospital information system, its features were compared to those of a well-defined comprehensive record management tool set up at the University Hospital "La Timone" of Marseilles in France. It was then installed on two Linux servers: After several months of use, we have evaluated the usability aspects of the system including feedback from end-users through a questionnaire.
Initial results showed the potential of Open Source in the field of health IT for developing countries like Mali. Five main modules have been fully implemented: This last component of the system has been fully developed by the local Mali team. The evaluation showed that the system is broadly accepted by all the users who participated in the study. The same proportion encourages the continuation of the experiment and its expansion throughout the hospital.
In light of the results, we can conclude that the objective of our study was reached. However, it is important to take into account the recommendations and the challenges discussed here to avoid several potential pitfalls specific to the context of. Background We are currently witnessing a significant increase in use of Open Source tools in the field of health. Methods After reviewing several Open Source tools in the field of hospital information systems, Mediboard software was chosen for our study. Results Initial results showed the potential of Open Source in the field of health IT for developing countries like Mali.
Conclusions In light of the results, we can conclude that the objective of our study was reached. However, it is important to take into account the recommendations and the challenges discussed here to avoid several. Gastrointestinal parasite egg excretion in young calves in periurban livestock production in Mali.
The effects of season, age, breed, management type, parasite control and presence of sheep on egg and oocyst counts were determined. A Bayesian model was used with a negative binomial distribution and herd and individual effects, to account for the clustering of calves in herds and the repeated sampling. Interviews were conducted to report the current control strategies. We found eggs of Strongyloides papillosus Age class month: Season and age effects occurred. Irrigation for rice cultivation increases the production of Anopheles gambiae, the main vector of malaria in Mali.
Mosquito abundance is highly variable across villages and seasons. We examined whether rice cultivation patterns mapped using remotely sensed imagery can account for some of this variance. We collected entomologic data and mapped land use around 18 villages in the two cropping seasons during two years. Estimating rice in a meter buffer area around the villages resulted in the best correlation with mosquito abundance, larger buffer areas were optimum in the October and dry season models. The quantification of the relationship between An. The dynamics of community and NGO partnership: Utilizing ethnographic research methods, this case study examines the experiences of an NGO-sponsored health care program in rural Mali.
The findings indicate that while, in principle, the organization operates from an alternative development base, it has been unable to decentralize the decision-making process and facilitate community dialogue and participation. Numerous problems resulted, including superficial forms of local participation, lack of community ownership, non-remuneration of health workers and midwives, inadequate training, and ultimately, limited program gains.
The analyses highlight the complexity and dynamic nature of health program implementation in a developing context, and suggest several factors important to project success.