Human Papillomavirus: How Social Ideologies Influence Medical Policy and Care

The purpose of this paper is to discuss the ways in which new advances in the production of a vaccine against human papillomavirus (HPV) have been received by both the general public and the medical community. Despite its high prevalence in the general population, as a sexually transmitted infection, there is a great deal of shame and stigma associated with contracting the virus (Waller, et. al. 2007). HPV is a disease of disparities in that ethnic and sexual minorities are disproportionately affected. Since the HPV vaccine is most effective at both a younger age, and before the first sexual experience, it is important to protect the future sexual health of individuals. The debate is still ongoing in many states about whether the HPV vaccine should be a part of required school vaccinations for those entering the sixth grade. Many moral conservatives fear that forced vaccination infringes on parental rights and encourages sexual promiscuity before marriage. Abstinence-only messages being taught in schools has only served to amplify a sex-negative ideology in American culture. It is important for health care professionals to be aware of the social perspective of HPV and address these concerns, especially with their at risk patients. By addressing disparities, parent and provider views of vaccination, and sexual stigmas, vaccine uptake in all adolescents will be improved. Implementing a vaccine mandate for school entry will ensure that those at most risk of being affected will be reached

Surveillance des puits et galeries blindés par analyse des coups de bélier en continu

Avec demande croissante de I'énergie de pointe, les centrales hydro-électriques à accumulation opèrent de plus en plus d'une manière abrupte pour assurer avec efficacité, flexibilité et sécurité I'équilibre entre la production et la demande d'électricité. Les coups de bélier produisent des sollicitations fortement dynamiques dans les puits et galeries blindes. Par la fatigue des matériaux les marges de sécurité peuvent devenir critiques surtout avec I'utilisation des aciers de blindage à haute résistance dans les nouvelles centrales hydro-électriques. Dans Ie cadre d'un projet de recherche, une approche de dimensionnement adaptée et une méthode novatrice de surveillance ont été développé avec une attention particulière sur Ie phénomène d'interaction fluide-structure. Le modèle théorique propose peut être considère comme base pour Ie développement des nouveaux critères de dimensionnement qui considèrent la mécanique de rupture fragile dans I'analyse de la réponse du blindage. D'autre part, I'influence de la détérioration locale de la rigidité de la paroi des puits et galeries blindes sur la célérité et l’atténuation de I'onde de coup de bélier a été é étudiée expérimentalement. Une méthode de surveillance pour détecter la formation, I'endroit et la sévérité de ces faiblesses a pu être développée par une analyse en continu du signal du coups de bélier. Une série de mesures sur Ie puits blinde d'un aménagement de pompage turbinage en Suisse a été également effectuée pour valider Ie concept de surveillance propose en pratique

Monitoring of steel-lined pressure shafts and tunnels

A new-intrusive monitoring method to detect the local drop of wall stiffness of shafts and tunnels at hydro plants has been developped in Switzerland. The method is based on the waterhammer and the fluid-structure interaction phenomenon. An overview is presented here of the status of the ongoing work in this field, includes a short state-ot-the-art-review, a description of the physical scale model with some tests results, and a description of an in-situ measurement system which acquires pressure records from the shaft of a pumped-storage in the Swiss Alps

Monitoring of a Steel-Lined Pressure Shaft using Global Indicators and the Frequency Response Function”

Due to high peak energy demands, existing hydropower plants operate nowadays under rough conditions to regulate the discharge and power with relatively fast and repeated opening and closing of turbines and pumps. The local deterioration of the mechanical properties of the steel-lined pressure wall induces a change of the two global indicators: the water-hammer celerity and the wave attenuation. This deterioration may arise from the weakening of the backfill concrete and/or the surrounding rock mass. In-situ measurements of the pressure shaft of the Grimsel II pumped-storage plant in Switzerland have been carried out to monitor these global indicators and to determine its frequency response function. The prototype measurements use dynamic pressure sensors placed at both ends of the pressure shaft. The data are acquired continuously and accessed on-line via internet. Different approaches to estimate the wave speed and wave attenuation coefficient generated inside the pressure shaft during start-up and shut-down of pumps and turbines have been applied. The wave speed was assessed from the Fourier transformation spectrums while the attenuation coefficient was determined by computing the root mean square of the signal followed by an exponential regression fitting. Monitoring charts have been established based on the statistical quality control method. The control limits and the overall behavior of the pattern of future measured points will be used for on-line monitoring of the shaft. The magnitudes of the frequency response function of the system and the coherence of pressure signals have been also defined. In spite of many difficulties encountered during the in-situ measurements, the results show a stable monitoring scheme of the wave speed and wave attenuation coefficient. Longer acquisition data series are needed to consolidate the control limits. The response identification function of the pressure shaft was not very efficient in this special case because of the reflection of the major part of the wave by the junction located between the pressure and surge shafts of the plant

A review of wave celerity in frictionless and axisymmetrical steel-lined pressure tunnels

Generally applicable approaches for estimating the‘‘quasi-static’’, which means without fluid–structure interaction and frequency-dependent water-hammer wave speed in steel-lined pressure tunnels are analyzed. The external constraints and assumptions of these approaches are discussed in detail. The reformulated formulas are then compared to commonly used expressions. Some special cases of wave speed calculation such as unlined pressure tunnels and open-air penstocks are investigated. The quasi-static wave speed is significantly influenced by the state of the back fill concrete and the near-field rock zone (crackedoruncracked). In the case when the set wo layers are cracked, the quasi-static wave speed is over estimated in between 1% and 8%compared to uncracked concrete and near field rocklayers. Depending on the stiff ness of steel liner and penstock, the fluid–structure interaction leads to significant difference in wave speeds values. Compared to the quasi-staticcase, the fluid–structure interaction approach, applied to steel-lined tunnels, results up to 13%higher wave speed values in the high-frequency range (higher than 600Hz)and up to 150% lower values for frequencies between 150 and 300 Hz in the considered test case

Physical and numerical modeling of harbors and shore protection measures / Modélisation physique et numérique de mesures de protection portuaires et d’aménagement de plages

The expansion project of the ‘’Port de la Nautique’’ and the creation of adjacent new beaches on the ‘’Lac Léman’’ in Geneva is currently under survey. In the conceptual and study phase, numerical- and physicalscaled models have been exploited at the Ecole Polytechnique Fédérale de Lausanne (EPFL). The objectives are to analyze the courantology and the wave’s field inside the protected zone of the harbor and their influence on the stability of the new beaches. The numerical modeling is driven by two models at different scales. The large scale model provides the boundary conditions to the small one which is used to estimate the circulation of water in the new harbor and to predict the erosion and deposition processes inside the harbor and along the beaches. The physical model is built using distorted scale factors inside an experimental wave tank that covers the same area as the small numerical model. It aims to optimize the project and to confirm the numerical results concerning notably the wave heights inside the harbor and the sediment transportation processes all along the beaches. The results obtained by the complicity of the numerical and physical simulations helped to converge toward an optimal design locations, orientations, and types of the protective dikes of the port as well as the geometric configuration and number of groins and the choice of the suitable backfill grain size for the new beaches

Experimental design of a diversion structure of granular debris flows

Many alpine torrents convey regularly debris flows of high destructive hazard. After several granular events observed in Bruchji?s torrent near the Blatten village in the Swiss Alps, it was decided to manage the risk of similar debris flows by designing and constructing a control structure inside the torrent bed. Associated with a breach in the right bank side of the torrent, this control structure should divert part of the moderate and high debris flow events toward the original alluvial cone. Two different configurations of the control structure were tested and optimized through a series of physical tests. The basic concept of this structure is to create a local lateral contraction of the torrent section topped by a horizontal rack or by a deflector beam. A physical model at the scale of 1:20 was built and granular debris flows were simulated by four successive discrete pulses. The behavior of the structure was tested inside the linear part and inside the bend of the channel reach. The geometry and dimensions of the control structure were also optimized to divert laterally a maximum volume of debris flow materials.This paper describes the physical model experiments, presents and discusses the main test results, and proposes an optimized geometry of the control structure. The most efficient configuration consists of a unilateral contract of the channel flow section inside a channel bend and to install a deflector beam

Expertise hydraulique d’un projet lacustre

Dans la phase d'étude de la création de plages et de l'agrandissement de l'adjacent Port de la Nautique sur le Léman à Genève, la complémentarité des modèles numérique et physique a permis de converger vers une solution optimale pour cet aménagement complexe

The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related to higher satisfaction and higher rates of treatment compliance, past research has been limited to evaluating the relationship between readmissions and satisfaction at an organizational level. This retrospective, cross-sectional study will examine the relationship between communication and discharge HCAHPS questions and readmissions at 30 days, specifically at the patient level. Of the eight HCAHPS questions analyzed, higher scores on questions regarding “nurses listening” and “doctors explaining information” were linked to a decreased risk of readmission, while higher scores regarding “help after discharge” were linked to an increased risk for readmission. These results show the importance that a patient’s severity of illness and hospital procedures have on explaining HCAHPS results. This study’s seemingly paradoxical findings suggest the need to recognize potential trade-offs when reviewing HCAHPS results and using them to drive patient experience initiatives

Gestion du charriage sur le torrent de Milibach pour la protection contre les inondations – optimisation sur modèle physique / Management of the bedload transport of the Milibach torrent for flood protection purpose – a physically-based model study

Le torrent du Milibach présente une capacité hydraulique insuffisante conduisant à des débordements fréquents dans le village de Meiringen notamment. Ce manque de capacité est dû essentiellement à l’accumulation de sédiments dans le lit du cours d’eau pendant les crues. Une solution pour retenir une partie des sédiments charriés et ainsi réduire le flux solide à l’amont de la région à risque a été proposée. Elle consiste en un réaménagement du cours d’eau et en la création de terrasses de déposition sédimentaire sur la rive gauche adjacente. Un modèle physique a été réalisé pour optimiser le projet expérimentalement. Les améliorations ont essentiellement porté sur l’intégration de seuils dans le cours d’eau et de digues transversales sur les terrasses d’alluvionnemen