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Introduction: Peru has experienced one of the highest rates of COVID-19 with only 27% of the population vaccinated. College students must make decisions on vaccination based on their belief and knowledge about immunizations. The purpose of this study was to describe COVID-19 behaviors and beliefs toward immunization among college students in Lima, Peru. Methods: Undergraduate students from Universidad Maria Auxiliadora (UMA) participated in this descriptive study. The CDC National 2009 H1N1 Flu Survey was adapted to measure behaviors and beliefs about immunizations of COVID-19. Results: 818 students participated in the study during the 2020 academic year. Significant differences were identified about taking vaccine when it was available by age ( p = .02), gender ( p

Use of a beam-based approach is presented for establishing a rigidity calibration for the A1900 fragment separator located at the National Superconducting Cyclotron Laboratory. Also presented is why an alternative approach to the rigidity calibration – using detailed field maps of individual magnetic components – is not a feasible basis for deriving an accurate calibration. The level of accuracy achieved for the rigidity calibration is ±0.1%.

© 2016 Elsevier B.V. The γ-ray tracking array GRETINA was coupled to the S800 magnetic spectrometer for spectroscopy with fast beams of rare isotopes at the National Superconducting Cyclotron Laboratory on the campus of Michigan State University. We describe the technical details of this powerful setup and report on GRETINA's performance achieved with source and in-beam measurements. The γ-ray multiplicity encountered in experiments with fast beams is usually low, allowing for a simplified and efficient treatment of the data in the γ-ray analysis in terms of Doppler reconstruction and spectral quality. The results reported in this work were obtained from GRETINA consisting of 8 detector modules hosting four high-purity germanium crystals each. Currently, GRETINA consists of 10 detector modules.

In the UK, radioactive wastes currently planned for disposal in a geological disposal facility (GDF) include intermediate level waste, some low level waste and high level waste. Disposal of other materials, including spent fuel, uranium and plutonium is also being evaluated to inform the safety case for a GDF, if such materials were to be classified as wastes in the future. This paper describes the generic safety functions through which waste packages can contribute to the safety case of a GDF in the UK. It describes the engineering approach used or envisaged, in the UK and internationally, to ensure that waste packages retain their safety functions for the required periods of time and summarizes the scientific basis underpinning the current understanding of relevant evolution processes. Where gaps in the knowledge exist, the Nuclear Decommissioning Authority Radioactive Waste Management Directorate has identified specific research activities needed to close out such gaps to a level of maturity sufficient for this stage of the disposal programme (generic). This paper describes the latest results from their R&D programme and presents a summary of the research activities planned to meet the current needs of the disposal programme with specific reference to the topics of package evolution and criticality safety.

Twenty two patients over the age of 40 with stable spinal cord damage underwent overnight sleep studies to investigate the prevalence of sleep apnoea. Ten patients had some evidence of obstructive sleep apnoea (OSA). Hypoxic events were scored as number of dips of SaO2 more than 4% below the preceding 10 minute average (> 4% SaO2 dip rate). All the patients had more than five such dips per hour and six had clearly abnormal dip rates of more than 15 per hour. Two other patients had dip rates above 10 per hour without apnoeas but periods of central hypoventilation mainly during rapid eye movement (REM) sleep. OSA appears to be more common in older patients with spinal cord injury than in the general population. Possible relevant factors include patient selection, reduced ventilatory function secondary to spinal cord damage, sleep posture and medication.

BACKGROUND AND STUDY AIMS: Inadvertent injection of contrast agent into the pancreatic duct is believed to be an important contributor to pancreatitis occurring after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis, PEP). Our aim was to examine whether primary deep biliary cannulation with a guide wire is associated with a lower rate of PEP than conventional contrast-assisted cannulation. PATIENTS AND METHODS: From August 2003 to April 2006 all patients with an intact papilla who were referred for ERCP were eligible. Patients with pancreatic or ampullary cancer were excluded. Patients were randomized to undergo sphincterotome biliary cannulation using either contrast injection or a guide wire. The ERCP fellow attempted initially for 5 min. If unsuccessful, the consultant attempted for 5 min using the same technique, followed by crossover to the other technique in the same sequence and then needle-knife sphincterotomy where appropriate. Patients were assessed clinically after the procedure, then followed up with telephone interviews after 24 hours and 30 days, and serum amylase and lipase tests after 24 hours. RESULTS: Out of 1654 patients undergoing ERCP, 413 were included in the study. PEP occurred in 29 / 413 (7.0 %): 16 in the guide-wire arm, 13 in the contrast arm (p = 0.48). The overall cannulation success rate was 97.3 %. Cannulation was successful without crossover in 323 / 413 patients (78.2 %): 167 / 202 (81.4 %) in the guide-wire arm and 156 / 211 (73.9 %) in the contrast arm (p = 0.03). Multivariate analysis demonstrated female sex (OR = 2.7, p = 0.04), suspected sphincter of Oddi dysfunction (OR = 5.5, p = 0.01), and complete filling of the pancreatic duct with contrast agent (OR = 3.5, p = 0.02) to be independently associated with PEP. The risk of PEP increased incrementally with each attempt at the papilla (OR 1.4 per attempt, p = 0.04) to greater than 10 % after four or more attempts. CONCLUSIONS: The guide-wire technique improves the primary success rate for biliary cannulation during ERCP but does not reduce the incidence of PEP compared to the conventional contrast technique. The incidence of PEP increases incrementally with each attempt at the papilla.

Barriers to the use of islet transplantation as a practical treatment for diabetes include the limited number of available donor pancreata. This project was designed to determine whether the size of the islet could influence the success rate of islet transplantations in rats. Islets from adult rats were divided into two groups containing small (diameter 150 μm) islets. An average pancreas yielded three times more small islets than large. Smaller islets were ∼20% more viable, with large islets containing a scattered pattern of necrotic and apoptotic cells or central core cell death. Small islets in culture consumed twice as much oxygen as large islets when normalized for the same islet equivalents. In static incubation, small islets released three times more insulin under basal conditions than did large islets. During exposure to high glucose conditions, the small islets released four times more insulin than the same islet equivalencies of large islets, and five times more insulin was released by the small islets in response to glucose and depolarization with K+. Most importantly, the small islets were far superior to large islets when transplanted into diabetic animals. When marginal islet equivalencies were used for renal subcapsular transplantation, large islets failed to produce euglycemia in any recipient rats, whereas small islets were successful 80% of the time. The results indicate that small islets are superior to large islets in in vitro testing and for transplantation into the kidney capsule of diabetic rats.

BaF 2 detectors for picosecond gamma-ray decay lifetime measurements have been installed into the 8π gamma-ray spectrometer as a proof-of-principle for a possible installation of a full array of ten detectors. Using four detectors a test measurement of the half-life of the 2 + state in 152 Sm resulted in a value of 1.33(6) ns, compared with a published value of 1.396 ns. Measurements with a 26 Na stopped beam were performed with various master-trigger conditions. Using a master trigger of germanium-SCEPTAR-BaF 2 OR BaF 2 -BaF 2 , the FWHM of the BaF 2 -BaF 2 triggered events was found to be ∼290 ps compared with ∼ 1.9 ns for the germanium-SCEPTAR-BaF 2 triggered events. Simulations using GEANT4 of a suggested BaF 2 lifetime measurement system have been carried out. These illustrate the considerable gain in spectrum quality which can be expected using simple add-back protocols.

Sport- and exercise-related headaches have been recognized over the last 20 years, but their prevalence is unknown. A nine-page questionnaire was used to study the prevalence of sports headaches among two contrasting populations of Otago University students: medical students (n = 178) and physical education students (n = 190). Both populations had a similar response rate of approximately 80%. It was found that 35% of respondents had experienced sport- and exercise-related headaches among the two populations, with similar rates for men and women seen in both. Comparison of the two populations showed no significant difference in the rate of sports headache among women, whereas the men physical education students has a significantly higher rate of sports headache than the men medical students. A high frequency of trauma-related headaches in contact sports accounted for this higher rate among the men physical education students. This study demonstrated that sport-and exercise-related headaches are a common problem among university students.

A group of 129 subjects (67 men and 62 women) experiencing sports headache was established using a questionnaire. A wide range of information was gathered, focusing on the mode of onset, time course, characteristic features and associated symptoms of sports-related headache. Criteria for the varieties of sports headaches were established using head trauma and then migraine to divide subgroups of sports headaches. Cases were classified into four categories: effort migraine, trauma-triggered migraine, effort-exertion headache, and post-traumatic headache. The percentages of each sports-related headache found were: effort migraine 9%, trauma-triggered migraine 6%, effort-exertion headache 60%, post-traumatic headache 22% and miscellaneous 3%. Sports migraine accounted for 15% of the total sports headache sample. Effort-exertion headache was the most common type of sports headache. Although effort-exertion headache could be separated into subjects who had an acute severe headache induced by anaerobic exercise (exertion headache) from those having a substantial headache lasting hours initiated by aerobic exercise (effort headache), most subjects with effort-exertion headache in this study appeared not to fall into any discrete subgroups. Trauma-related headaches were experienced mainly by men in contact sports, while women more commonly had non-trauma-related headache in running and jogging.

A case of Cholangitis Glandularis Proliferans (CAGP) in association with a cholangiocarcinoma of the common bile duct as described. This is the eighth case of CAGP described and the second association with cholangiocarcinoma.

Thyroxine replacement dose in 70 patients with post-radioiodine (for Graves' thyrotoxicosis) hypothyroidism was compared with that in 34 patients with autoimmune hypothyroidism matched for age and sex and diagnosed during the same period. Median replacement dose in the post-radioiodine group (100 micrograms daily) was significantly lower (P = 0.006) than in the autoimmune hypothyroid group (137.5 micrograms daily). Furthermore there was marked variation in the time elapsing from onset of post-radioiodine hypothyroidism to achievement of a given maintenance dose. These findings may be explained by persistence of non-TSH mediated thyroid function, after radioiodine therapy for Graves' thyrotoxicosis. The observations indicate the potential risk of overtreatment with thyroxine in post-radioiodine hypothyroidism unless the dose is carefully titrated against serum TSH levels. Final thyroxine requirements may not be evident in the initial phase of treatment and patients with apparently low maintenance thyroxine requirements require long-term follow up.

SIR, — We would like to report the isolation of Mycobacterium bovis from a sheep submitted to the Veterinary Laboratories Agency (vla) as part of routine scanning surveillance. The flock involved comprised 200 ewes, which had been turned out after lambing in February/March 2008. During March, 15

Of 364 patients undergoing insertion of a biliary endoprosthesis in 1989, six (1·6 per cent) developed gallbladder sepsis. Three patients had cholangiocarcinoma, two had carcinoma of the pancreas and one had a benign biliary stricture. Two of the five patients with malignancy had gallbladder stones, and the patient with a benign stricture developed stones after 3 years of stenting. Three patients developed gallbladder sepsis early after endoprosthesis insertion (< 6 days), while in the other three it occurred late (> 6 months). All six patients failed to respond to antibiotics and were successfully managed by percutaneous cholecystostomy; the patient with a benign biliary stricture also had cholecystolithotomy. The gallbladder drainage tubes were removed or became dislodged at intervals varying from 2 weeks to 6 months without complications. Percutaneous cholecystostomy is the treatment of choice for gallbladder sepsis unresponsive to antibiotics in patients with a biliary endoprosthesis in situ.

Background: Preterm babies are the most vulnerable group to get adjusted to the new environment. Following birth, the first few months acts as a transitory period during which the baby adjusts from the aquatic to the aerial environment. As a result, the way in which baby is positioned throughout this time is very important and his posture dictates the level of his wellbeing. Promoting good positioning and encouraging opportunities for flexion can prevent the problems like motor coordination, balance and posture difficulties. The correct positioning will help the baby to develop good posture and improve muscle control. Method: In this study, a quasi-experimental control group pretest- posttest design was used and non probability convenience sampling technique was adopted to select 60 preterm babies, both in experimental and control group. Pilot study was conducted, the tool and study design were found to be feasible. Data were collected using structured observation checklist for posture and movement. An intervention, nesting was provided for the experimental group. The data were collected and analyzed using descriptive and inferential statistics. Results: The result of the study revealed that the significance of difference between the mean pretest and post test posture score which was statistically tested using paired 't' test and was found to be highly significant at 0.05 level of significance.(t(29) = 5.42 in post test 1, 46.14 in post test 2 and 56.82 in post test 3 ; (p < 0.05) and the significance of difference between the mean post test posture score between experimental and control group which was statistically tested using independent 't' test was found to be highly significant at 0.05 level of significance t(58) = 7.41, 7.89 and 8.49; (p < 0.05 ). The significance of difference between the mean pretest and mean post test movement score which was statistically tested using paired 't' test was found to be highly significant at 0.05 level of significance.(t(29) = 36.94 in post test 1, 15.59 in post test 2 and 22.80 in post test 3 ; p< 0.05 ) and the significance of difference between the mean post test movement score between experimental and control group which was statistically tested using independent t test was found to be highly significant at 0.05 level of significance. (t(58) = 8.12, 5.26 and 4.88 ; p < 0.05 ). The result shows that the posture and movement score had no significant association with their selected personal variables. Conclusion: Therefore, the study concluded that the nesting was an effective method to maintain the normal posture and movement of preterm babies.

The Di-pentagonal Array for Nuclear Timing Experiments (DANTE) is an array of ten BaF2 detectors used in conjunction with the 8π gamma-ray spectrometer at the TRIUMF-ISAC radioactive-ion beam facility. DANTE is used to conduct direct lifetime measurements of nuclear excited states in the picosecond - nanosecond range. This, in turn, will aid in probing the collective structures of deformed nuclei. The capability of DANTE to measure nanosecond-scale lifetimes is demonstrated by using a 152Eu source. The half-life of the Iπ = 21+ state of 152Sm is measured to be 1.426 ± 0.018 ns.

582 Background: Resistance to HER2 antagonism in HER2-positive breast cancer has been associated with activation of the PI3K signaling pathway. PIK3CA mutations in exon 9 and exon 20 have been show...

SUMMARY Ten patients with metastatic pancreatic endocrine tumours were treated with the long-acting somatostatin analogue octreotide (SMS 201–995). Three patients showed no response, clinically or biochemically, and treatment was therefore withdrawn. The seven remaining patients continued treatment for a median period of 28 months (range 13–54 months). Treatment was initially effective, symptoms improved and the concentrations of tumour-related hormones were reduced. Worsening of symptoms and rising levels of tumour-related hormone concentrations occurred a median of 5 months (range 1–6 months) after the start of therapy and were initially reversed by increasing the dose of octreotide over a median of 10 months (range 6–16 months). However, after a median of 13 months (range 5–34 months) at the maximum dosage, symptoms recurred and were no longer responsive to a further increase in dosage of octreotide or other therapeutic measures. All patients died within a period of 5 months once this resistant phase of their illness had been reached.

In tetraplegia there is often paradoxical inward motion of the rib cage during inspiration. The volume of this negative contribution is difficult to estimate but can be obtained by optical mapping. The partitioning of ventilation between the rib cage and abdomen in six normal subjects, 10 stable tetraplegic patients, and one tetraplegic patient at intervals during rehabilitation has been studied by this technique. In normal subjects the tidal volume and the vital capacity were the sum of positive contributions from the rib cage and abdomen. In stable tetraplegic subjects with similar neurological levels, the rib cage contribution varied widely but the total chest wall displacement could not be predicted from the vital capacity. In the patient studied sequentially rib cage paradox reversed with time after injury, and this was associated with an absolute increase in vital capacity and an improvement in the action of the diaphragm.

1. Arterial and venous whole blood and plasma histamine concentrations and eosinophil and basophil counts were determined in five patients with acute severe asthma who had not previously received steroid therapy, in five who had been maintained on steroid therapy and in a control group of nine patients with acute non-respiratory illnesses. 2. No significant arteriovenous differences were observed for any of these measurements in any of the groups of patients. Significant net loss of arterial histamine does not therefore occur peripherally in acute asthma. 3. When compared with the values for the controls, statistically significant increases were observed, in the group not receiving steroids, for arterial and venous whole blood histamine concentrations, eosinophil counts and basophil counts, and, in those receiving steroids, for the venous basophil counts. 4. When compared with the venous plasma histamine concentration of normal subjects, that of the asthmatic subjects not receiving steroids was significantly raised. 5. The venous plasma histamine concentration of the control group was also significantly higher than that of normal subjects, but less so than in the asthmatic subjects, suggesting that acute illness per se produces an increased plasma histamine concentration. 6. Both groups of asthmatic patients were treated similarly with hydrocortisone and bronchodilators. There was a striking fall in whole blood histamine concentration and in eosinophil and basophil counts, but plasma histamine fell more slowly, especially in those who had not previously received steroids. 7. The mean histamine content of the basophil cell is 0·01 pmol and significant differences in this value did not occur within the various groups or as a result of treatment. The approximate number of molecules of histamine per basophil cell is 6·0 × 109.

We report a well tolerated endoscopic technique of administering intraluminal radiotherapy to 14 patients with inoperable cholangiocarcinoma, in which the iridium-192 wire source was inserted down a nasobiliary catheter placed within a previously inserted endoscopic biliary prosthesis, thus allowing bile flow to continue during treatment. Radiotherapy was commenced 2 weeks after biliary decompression, when the median serum bilirubin level had fallen from 213 to 34 μmol/l. A total radiation dose of 6000 cGy at 0·5 cm from the source was administered over a median of 85 h (range 77·116 h). In four patients there was a transient increase in serum bilirubin during iridium treatment and, in two cases (14 per cent), this was associated with mild cholangitis. Both cases resolved rapidly once the iridium wire and nasobiliary catheter were removed. The median hospital stay after treatment was 2·5 days (range 0·28 days). The late complications associated with stent blockage were minimized by routinely changing stents at 4–6-monthly intervals; ten of the patients have so far undergone from one to five (median three) stent changes. Five patients have died at 3·6–8·2 months (median 4·8 months) following iridium treatment; four had extensive type III hilar lesions at diagnosis. Nine patients are still alive at 5·4–31·0 months (median 16·4 months). The overall median survival after iridium therapy is 10·5 months. This technique of endoscopic biliary decompression before internal iridium administration minimizes complications by allowing biliary drainage during treatment. The role of this treatment in patients with inoperable cholangiocarcinoma awaits the results of randomized, controlled trials.

Industrial robots are important elements in modern Computer Integrated Manufacturing (CIM) systems. According to the British Robot Association definition, an industrial robot is “a reprogrammable device designed to both manipulate and transport parts, tools or specialised manufacturing implements through variable programmed motions for the performance of specific manufacturing tasks.” Programmability is the key to their flexibility in a modern manufacturing environment. In an ever-increasing number of potential application areas a robot's dynamic performance, whether in terms of a lack of speed or accuracy, can in some cases restrict its deployment. Servo-systems of improved design can engender better dynamic performance and for this reason “robot control” is an important research area. In this chapter we are concerned with the servo-control of industrial robots. At the outset it is instructive to consider the role of the servo-system in the framework of a robot “controller”.

This paper considers the design of an idle speed control law for a fuel injected engine. The modelling procedure, including the use of System Identification techniques, is discussed and then emphasis is placed on the control law design using an H-Infinity approach. The choice of appropriate weighting functions is crucial in H-Infinity design and design iterations are discussed. The final control law is shown to have good performance in simulation and to be robust to parameter perturbations: it represents a good starting point for future implementations.

Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution basis, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planning. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.

We studied the effect on breathing of a conventional and a newly designed abdominal binder in seven patients with complete tetraplegia. The indices of respiratory ability used were the transdiaphragmatic pressure on maximal sniff (sniff Pdi), the maximum static inspiratory mouth pressure (PImax), and the vital capacity (VC). These were measured in patients with and without binders, in the supine position, raised up to 70 degrees on a tilt table, and seated upright. When patients were raised from the supine to the 70 degrees tilt and to the seated posture, sniff Pdi and VC decreased. Both binders improved VC in the seated position and at 70 degrees tilt, and sniff Pdi at 70 degrees tilt. The new binder was as effective as but no better than the conventional binder. PImax was too variable to be a valuable index of inspiratory power. These findings support the view that abdominal binders assist breathing in tetraplegic patients who are seated or raised to near vertical positions.

Summary In view of recent reports of increased tanning in hemiplegic limbs, we have investigated ultraviolet (u.v.) minimal erythema dose (MED) in hemiplegia using the bilateral comparison technique. Seven of 10 patients had a lower MED in the hemiplegic arm compared to the normal side, the mean reduction being 16% (range 0–33%, P = 0.003). No patients had a higher MED in the hemiplegic arm. We review the literature regarding other non-neurological features of hemiplegia, in particular asymmetry of temperature, oedema, and finger clubbing, and we propose a vasomotor or trophic aetiology for these findings.

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. This paper reports on 92 patients suffering from COAD, who were interviewed in order to assess impairment, disability and handicap, and a smaller subsample of 24 of these patients who were followed-up using open-ended, semi-structured, tape-recorded interviews in order to cover in more detail some of the issues raised in the first quantitative stage of the study. Low correlations were found between lung function and disability (-0.38 p less than 0.001), accounting for only 14% of the variance, and high correlations between measures of dyspnoea and disability (-0.90 p less than 0.001). Major areas of disability and handicap included: household management, ambulation, sleep and rest, recreation and pastimes, and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper then attempts to explore the relationship between impairment, disability and handicap, drawing on both the quantitative and qualitative data collected in order to illustrate the variable nature of this relationship. The paper concludes by suggesting both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families, and for a complementary social perspective and approach to COAD and its treatment.

Five patients with metastatic pancreatic endocrine tumours injected a long acting somatostatin analogue (SMS 201-995) 50 micrograms subcutaneously every 12 hours and were followed up for three to six months. Treatment aimed at controlling excess secretion of hormone by the tumours thereby bringing symptomatic relief. Four patients showed a significant reduction in tumour related hormone concentrations but in none did values return to normal. All five patients, however, noted definite symptomatic improvement and in one this was dramatic (disappearance of life threatening diarrhoea and correction of metabolic acidosis and hypokalaemia within 48 hours). Mild worsening of symptoms and increasing fasting tumour related hormone concentrations after three to six months of treatment were reversed by doubling the 12 hourly dose. The treatment was well tolerated and had no deleterious effect on fasting blood glucose concentrations. This somatostatin analogue seems a promising non-invasive treatment for metastatic pancreatic endocrine tumours.