Treatment of painful caliceal stones

Nonmobile caliceal stones cause pain more often than previously appreciated. The character and intensity of the pain differs from typical renal colic. Twenty-six patients with caliceal stones and pain underwent attempted treatment for pain control via stone removal or disintegration: 15 were treated with percutaneous stone extraction (PSE), 10 with extracorporeal shock-wave lithotripsy (ESWL), and 1 required open surgery after failing PSE. One patient had persistent pain after ESWL and subsequently underwent PSE; 25 of 26 patients had complete relief of pain. Morbidity was minimal. Patients with painful caliceal stones should be offered ESWL, followed by PSE if pain persists.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27186/1/0000189.pd

Influência do cloro, sôbre a composição do caldo da cana de açúcar Co 290, aplicado no solo, na forma de cloreto de sódio

Considering the economic importance of the sugar industry among ourselves, the authors carried out a field experiment (Latin square) with Co 290 sugar cane, on a white sandy soil of Piracicaba, State of São Paulo, Brazil, applying NaCl in increasing rates (from 6.8 to 54.5 grams per plant), in order to study the effects of chlorides, on productivity and on the composition of juice. No toxic or stimulating effect was found, and there was no change in yield, in degree of purity of the juice, in general aspect of plants or in colour of leaves and culms. No difference was observed between potassium sulphate or chloride, as source of potash for sugar cane culture. Data collected and the literature cited suggest: (a) that the use of the variety Co 290 is indicated for soils rich in chlorine, such as the saline soils of the North-east and Atlantic Coast of Brazil; (b) that it is necessary to extend studies in Research Institutes and Agricultural Experiment Stations of the country to verify the behaviour of other varieties of sugar cane in the types of soils mentioned, especially with respect their yielding capacity. The authors are already planning such investigations

Soft X-ray harmonic comb from relativistic electron spikes

We demonstrate a new high-order harmonic generation mechanism reaching the `water window' spectral region in experiments with multi-terawatt femtosecond lasers irradiating gas jets. A few hundred harmonic orders are resolved, giving uJ/sr pulses. Harmonics are collectively emitted by an oscillating electron spike formed at the joint of the boundaries of a cavity and bow wave created by a relativistically self-focusing laser in underdense plasma. The spike sharpness and stability are explained by catastrophe theory. The mechanism is corroborated by particle-in-cell simulations

Laser pulse propagation and enhanced energy coupling to fast electrons in dense plasma gradients

Laser energy absorption to fast electrons during the interaction of an ultra-intense (1020 W/cm2), picosecond laser pulse with a solid is investigated, experimentally and numerically, as a function of the plasma density scale length at the irradiated surface. It is shown that there is an optimum density gradient for efficient energy coupling to electrons and that this arises due to strong self-focusing and channeling driving energy absorption over an extended length in the preformed plasma. At longer density gradients the laser laments, resulting in significantly lower overall energy coupling. As the scale length is further increased, a transition to a second laser energy absorption process is observed experimentally via multiple diagnostics. The results demonstrate that it is possible to significantly enhance laser energy absorption and coupling to fast electrons by dynamically controlling the plasma density gradient

Sustainability of donor programs: evaluating and informing the transition of a large HIV prevention program in India to local ownership

Sustainability is the holy grail of many development projects, yet there is limited evidence about strategies that effectively support transition of programs from donor funding to national governments. The first phase of Avahan, the India AIDS Initiative supported by the Bill and Melinda Gates Foundation (2003–2009), aimed to demonstrate an HIV/AIDS prevention program at scale, primarily targeted at high-risk groups. During the second phase (2009–2013), this large-scale program will be transitioned to its natural owners: the Government of India and local communities. This paper describes the evaluation design for the Avahan transition strategy.A detailed logic model for the transition was developed. The Avahan transition strategy focuses on three activities: 1 enhancing capacities among communities, non-governmental organizations (NGOs), and government entities, in line with India's national AIDS control strategy; 2 aligning technical and managerial aspects of Avahan programs with government norms and standards; and 3 promoting and sustaining commitment to services for most-at-risk populations. It is anticipated that programs will then transfer smoothly to government and community ownership, become institutionalized within the government system, and support a sustained HIV/AIDS response.The research design evaluates the implementation and effectiveness of 1 activities undertaken by the program; 2 intermediate effects including the process of institutionalization and the extent to which key Avahan organizational procedures and behaviors are integrated into government systems; and 3 overarching effects namely the impact of the transition process on the sustained delivery of HIV/AIDS prevention services to high-risk groups. Both qualitative and quantitative research approaches are employed so that the evaluation will both assess outcomes and explain why they have occurred.It is unusual for donor-supported projects in low- and middle-income countries to carefully plan transition processes, and prospectively evaluate these. This evaluation is designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs

Injection and transport properties of fast electrons in ultraintense laser-solid interactions

Fast electron injection and transport in solid foils irradiated by sub-picosecond-duration laser pulses with peak intensity equal to 4 x 10(20)W/cm(2) is investigated experimentally and via 3D simulations. The simulations are performed using a hybrid-particle-in-cell (PIC) code for a range of fast electron beam injection conditions, with and without inclusion of self-generated resistive magnetic fields. The resulting fast electron beam transport properties are used in rear-surface plasma expansion calculations to compare with measurements of proton acceleration, as a function of target thickness. An injection half-angle of similar to 50 degrees - 70 degrees is inferred, which is significantly larger than that derived from previous experiments under similar conditions

X-ray harmonic comb from relativistic electron spikes

X-ray devices are far superior to optical ones for providing nanometre spatial and attosecond temporal resolutions. Such resolution is indispensable in biology, medicine, physics, material sciences, and their applications. A bright ultrafast coherent X-ray source is highly desirable, for example, for the diffractive imaging of individual large molecules, viruses, or cells. Here we demonstrate experimentally a new compact X-ray source involving high-order harmonics produced by a relativistic-irradiance femtosecond laser in a gas target. In our first implementation using a 9 Terawatt laser, coherent soft X-rays are emitted with a comb-like spectrum reaching the 'water window' range. The generation mechanism is robust being based on phenomena inherent in relativistic laser plasmas: self-focusing, nonlinear wave generation accompanied by electron density singularities, and collective radiation by a compact electric charge. The formation of singularities (electron density spikes) is described by the elegant mathematical catastrophe theory, which explains sudden changes in various complex systems, from physics to social sciences. The new X-ray source has advantageous scalings, as the maximum harmonic order is proportional to the cube of the laser amplitude enhanced by relativistic self-focusing in plasma. This allows straightforward extension of the coherent X-ray generation to the keV and tens of keV spectral regions. The implemented X-ray source is remarkably easily accessible: the requirements for the laser can be met in a university-scale laboratory, the gas jet is a replenishable debris-free target, and the harmonics emanate directly from the gas jet without additional devices. Our results open the way to a compact coherent ultrashort brilliant X-ray source with single shot and high-repetition rate capabilities, suitable for numerous applications and diagnostics in many research fields

Identificação dos riscos de distúrbios ocupacionais em uma microempresa de confecção: contribuições da terapia ocupacional

Occupational disorders are pathologies with cumulative trauma and slow and progressive evolution, linked to occupational activities performed and/or working conditions. Such, based on the increasing number of occupational disorders in the confection branch, this study aims to identify risks of occupational disorders in a small group of seamstresses in the interior of Paraíba, and also point contributions of occupational therapy in view of the well-being these subjects in their work environment, preventing possible illnesses resulting from their work activities affecting performance in their daily occupations. As a means of evaluation we used the body map, pain scale, self-administered questionnaire professional sociodemographic and a observation script of systematic ergonomic direct and indirect, that have been applied/performed with these seamstresses. Data from these instruments were coded for the realization of individual and/or collective orientations of a preventive nature and aiming the well-being of these individuals in their working environment to not affect other occupations that may be significant.Distúrbios ocupacionais são as patologias com traumas cumulativos e de evolução lenta e progressiva, vinculadas às atividades ocupacionais desempenhadas e/ou às condições de trabalho. Assim, tendo como base o crescente aumento de distúrbios ocupacionais no ramo da confecção, o presente estudo visa identificar riscos de distúrbios ocupacionais em um pequeno grupo de costureiras no interior da Paraíba, e também apontar contribuições da Terapia Ocupacional tendo em vista o bem-estar desses sujeitos em seu ambiente de trabalho, evitando possíveis adoecimentos decorrentes de suas atividades laborais que afetem o desempenho em suas ocupações diárias. Como forma de avaliação foi utilizado o mapa corporal, escala de dor, questionário sócio demográfico profissional autoaplicável e um roteiro de observação ergonômico sistemático direto e indireto, que foram aplicados/realizados com as referidas costureiras. Os dados provenientes desses instrumentos foram codificados para a realização das orientações individuais e/ou coletivas de cunho preventivo e objetivando o bem-estar desses indivíduos em seu contexto de trabalho para não afetar outras ocupações que lhes sejam significativas

Self-help groups challenge health care systems in the US and UK

Purpose: This research considers how self-help groups (SHGs) and self- help organizations (SHOs) contribute to consumerist trends in two different societies: United States and United Kingdom. How do the health care systems and the voluntary sectors affect the kinds of social changes that SHGs/SHOs make? Methodology/approach: A review of research on the role of SHGs/SHOs in contributing to national health social movements in the UK and US was made. Case studies of the UK and the US compare the characteristics of their health care systems and their voluntary sector. Research reviews of two community level self-help groups in each country describe the kinds of social changes they made. Findings: The research review verified that SHGs/SHOs contribute to national level health social movements for patient consumerism. The case studies showed that community level SHGs/SHOs successfully made the same social changes but on a smaller scale as the national movements, and the health care system affects the kinds of community changes made. Research limitations: A limited number of SHGs/SHOs within only two societies were studied. Additional SHGs/SHOs within a variety of societies need to be studied. Originality/value of chapter Community SHGs/SHOs are often trivialized by social scientists as just inward-oriented support groups, but this chapter shows that local groups contribute to patient consumerism and social changes but in ways that depend on the kind of health care system and societal context