Basal cell adhesion to a culture substratum controls the polarized spatial organization of human epidermal keratinocytes into proliferating basal and terminally differentiating suprabasal populations

47 hlm. ; 29 cm

PLoS One

Introduction Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda. Methods A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients’ health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care. Results Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient’s health and illness experience, and the quality of the relationship between patient and health worker (range 62.1–78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes. Discussion and conclusion Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients’ expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients’ responsibilities and patient’s rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC

Development and Test of a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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Quench Protection Study of a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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Field Quality Measurements in a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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Quench Protection Study of a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

The planned upgrade of the Large Hadron Collider (LHC) collimation system will include installation of additional collimators in the dispersion suppressor areas. The longitudinal space for the collimators could be provided by replacing 15-m-long 8.33 T NbTi LHC main dipoles with shorter 11 T Nb 3Sn dipoles compatible with the LHC lattice and main systems. FNAL and CERN have started a joint program with the goal of building a 5.5-m-long twin-aperture Nb3Sn dipole prototype suitable for installation in the LHC. The first step of this program is the development of a 2-m-long single-aperture demonstrator dipole with a nominal field of 11 T at the LHC nominal current of 11.85 kA. This paper summarizes the results of quench protection studies of 11 T dipoles performed using the single-aperture Nb 3Sn demonstrator