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This work investigates the piston and die test as a means of simulating ore breakage within a lab-scale HPGR unit. This was achieved by comparing the products obtained in a piston and die test to those obtained from lab-scale HPGR tests using three different ores. This work also investigated using the piston and die test to obtain an appearance/breakage function for compressed bed breakage. One of the keys to designing and optimising a grinding circuit is to understand how the feed will behave in a particular comminution device. Cost estimates of comminution processing plants are almost exclusively based on the power required to reduce material to a certain grind size. These estimates allow designers to calculate the tonnage capabilities of a plant. Samples are then taken regularly during the life of the mine to monitor the hardness properties of future feed that will come into the processing plant. Laboratory and pilot scale comminution devices are used to assess the grinding properties and power draw of new feed so that appropriate changes can be made to full-scale processes to handle this new material. However, a problem with this approach is that a large amount of material is required to conduct such test work. For example, a single lab-scale HPGR test requires around 7 kg of material. If a laboratory test could be developed to test ore for HPGR processing based on a small amount of material such as drill core, this would be a useful tool in plant and process design. This tool could be used in collaboration with a lab-scale HPGR to conduct initial feed testing and assist in designing pilot-scale test programs. It would also provide a quick way of testing future ores from drill core samples. The results of this work conclude that the piston and die test produces breakage products which are comparable to the lab-scale HPGR unit. Data obtained from the piston and die test was used to generate HPGR models in JKSimMet and it was found that these simulation results were similar to those produced by a model created using the standard lab-scale HPGR test data. The piston and die test is now ready to be developed as a standard procedure in HPGR ore characterisation studies.

This chapter discusses narrative and theoretical evidence from teachers commenting on current educational debates. Practical visions are explored for national education systems, comparing and contrasting the United Kingdom and Finland. The effects on educational communities of political and educational visions and decisions are discussed and some differences between learning purposes and government purposes are noted. Philosophical visions, teaching values and principles for management and curricula planning are considered looking at historical examples. Now we understand neuroplasticity exists; teachers can engage in the process of explaining back to science how this works for learning. Culture and language acquisition research and its importance and influence on learning are explained. There is a discussion of assessment planning and changes in attitudes to intelligence. Relevant and current backup references are included in the references list for topics discussed in this chapter.

Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students.Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015.Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments.All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students.Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students.

Objective—To evaluate the effectiveness of a novel trimethoprim-sulfadiazine oral suspension for the treatment of naturally acquired Streptococcus equi subsp zooepidemicus infection in horses. Design—Randomized, controlled field trial. Animals—180 horses with S equi subsp zooepidemicus infection. Procedures—Horses with lower respiratory tract infections caused by S equi subsp zooepidemicus were treated with a new formulation of combined trimethoprim-sulfadiazine oral suspension at a dosage of 24 mg/kg (10.9 mg/lb) twice daily for 10 days (treatment group) or with an equivalent volume of saline (0.9% NaCl) solution (placebo group). Response to treatment, including clinical signs and fecal consistency scores, was assessed twice daily. Any adverse effects were recorded. The primary outcome variable was clinical response; the secondary outcome variable was eradication of S equi subsp zooepidemicus on study day 17 as determined by bacteriologic culture of repeated transtracheal-wash specimens. Results—Of the 119 horses allocated to the treatment group, 69 (58%) had a positive clinical response. A significantly smaller proportion of horses in the placebo group (9/61 [15%]) had a positive clinical response. By day 5, 25 of 61 (41%) placebo horses had been withdrawn from the study because of negative clinical response, compared with only 10 of 119 (8.4%) treated horses. By day 10, 28 of 61 (46%) placebo horses had been withdrawn because of negative clinical response, compared with only 13 of 119 (11%) treated horses. There were few adverse events associated with the trimethoprim-sulfadiazine suspension. There were no significant differences in fecal consistency scores between treatment and placebo groups. Conclusions and Clinical Relevance—The new oral suspension administered at 24 mg/kg twice daily effectively treated the clinical signs of S equi subsp zooepidemicus lower respiratory infection in horses and eliminated the organism from the respiratory tract. Adverse effects were minimal.

Objective The aim of this study is to assess Latina patient understanding of noninvasive prenatal testing (NIPT) and identify what factors influence uptake/refusal to NIPT to adapt counseling to the needs and interests of this population. Methods Mixed-methods survey in English and Spanish administered to pregnant Latina patients throughout pregnancy. Results Sixty-three women participated in our study (67% response rate); 34.9% chose to do NIPT, and 65.1% declined. Approximately half of participants (44%) had an NIPT knowledge score of ≤3 out of six total questions. Two of the most significant factors influencing uptake of NIPT were a higher reported educational level (p = 0.015) and a higher NIPT knowledge score (p = 0.014); 42.9% of participants knew that NIPT only screens for certain chromosomal conditions; 39% of women who declined NIPT would never consider NIPT in the future. Conclusions One-third of Latina women elected NIPT; a higher reported educational level and language were most predictive of this choice. Overall knowledge was significantly lower for women who declined NIPT. Lower knowledge may suggest that not all women are making informed decisions because of varying degrees of informed consent. Providing culturally tailored information can help women navigate the complexities of prenatal testing in order to make decisions most aligned with their values. © 2015 John Wiley & Sons, Ltd.

Public health relies on technologies to produce and analyse data, as well as effectively develop and implement policies and practices. An example is the public health practice of epidemiology, which relies on computational technology to monitor the health status of populations, identify disadvantaged or at risk population groups and thereby inform health policy and priority setting. Critical to achieving health improvements for the underserved population of people living with rare diseases is early diagnosis and best care. In the rare diseases field, the vast majority of diseases are caused by destructive but previously difficult to identify protein-coding gene mutations. The reduction in cost of genetic testing and advances in the clinical use of genome sequencing, data science and imaging are converging to provide more precise understandings of the 'person-time-place' triad. That is: who is affected (people); when the disease is occurring (time); and where the disease is occurring (place). Consequently we are witnessing a paradigm shift in public health policy and practice towards 'precision public health'.Patient and stakeholder engagement has informed the need for a national public health policy framework for rare diseases. The engagement approach in different countries has produced highly comparable outcomes and objectives. Knowledge and experience sharing across the international rare diseases networks and partnerships has informed the development of the Western Australian Rare Diseases Strategic Framework 2015-2018 (RD Framework) and Australian government health briefings on the need for a National plan.The RD Framework is guiding the translation of genomic and other technologies into the Western Australian health system, leading to greater precision in diagnostic pathways and care, and is an example of how a precision public health framework can improve health outcomes for the rare diseases population.Five vignettes are used to illustrate how policy decisions provide the scaffolding for translation of new genomics knowledge, and catalyze transformative change in delivery of clinical services. The vignettes presented here are from an Australian perspective and are not intended to be comprehensive, but rather to provide insights into how a new and emerging 'precision public health' paradigm can improve the experiences of patients living with rare diseases, their caregivers and families.The conclusion is that genomic public health is informed by the individual and family needs, and the population health imperatives of an early and accurate diagnosis; which is the portal to best practice care. Knowledge sharing is critical for public health policy development and improving the lives of people living with rare diseases.

A novel, proprietary, oral suspension of trimethoprim plus sulfadiazine (TMP/SDZ) had no serious adverse effects on clinical, laboratory, or pathologic parameters of mature horses when administered at up to five times the intended combined dosage of 24 mg/kg twice daily for 30 consecutive days. Loose feces was the most common observation that was likely related to TMP/SDZ treatment, and the incidence of loose feces was greater in groups treated with higher dosages of TMP/SDZ. However, all episodes were self-limiting, and no horses were treated for loose feces.

Public health relies on technologies to produce and analyse data, as well as effectively develop and implement policies and practices. An example is the public health practice of epidemiology, which relies on computational technology to monitor the health status of populations, identify disadvantaged or at risk population groups and thereby inform health policy and priority setting. Critical to achieving health improvements for the underserved population of people living with rare diseases is early diagnosis and best care. In the rare diseases field, the vast majority of diseases are caused by destructive but previously difficult to identify protein-coding gene mutations. The reduction in cost of genetic testing and advances in the clinical use of genome sequencing, data science and imaging are converging to provide more precise understandings of the ‘person-time-place’ triad. That is: who is affected (people); when the disease is occurring (time); and where the disease is occurring (place). Consequently we are witnessing a paradigm shift in public health policy and practice towards ‘precision public health’.

Precision public health is a new field driven by technological advances that enable more precise descriptions and analyses of individuals and population groups, with a view to improving the overall health of populations. This promises to lead to more precise clinical and public health practices, across the continuum of prevention, screening, diagnosis, and treatment. A phenotype is the set of observable characteristics of an individual resulting from the interaction of a genotype with the environment. Precision (deep) phenotyping applies innovative technologies to exhaustively and more precisely examine the discrete components of a phenotype and goes beyond the information usually included in medical charts. This form of phenotyping is a critical component of more precise diagnostic capability and 3-dimensional facial analysis (3DFA) is a key technological enabler in this domain. In this paper, we examine the potential of 3DFA as a public health tool, by viewing it against the 10 essential public health services of the “public health wheel,” developed by the US Centers for Disease Control. This provides an illustrative framework to gage current and emergent applications of genomic technologies for implementing precision public health.

The objective of this study was to identify variables that may influence the decision to terminate or continue a pregnancy affected by a chromosome abnormality. We performed a retrospective cohort analysis of 286 pregnancies diagnosed with a chromosome abnormality following genetic counseling and prenatal diagnosis. Data obtained included procedure type, chromosome results, ethnicity, maternal age, use of fertility treatments, and uptake of genetic counseling after results, among other factors. Wilcoxon rank sum test, Fisher’s exact test, and univariate and multivariate logistic regression models were used for data analysis. The overall termination rate in this study was 82.9 %. A lower likelihood to terminate was found in pregnancies with a diagnosis of a sex chromosome abnormality (OR 0.05, p

On the basis of the principles of management and leadership, our organization has worked over the years to formalize the orientation program for new nurse managers. This program meets the needs of new nurse managers and responds to today’s complex health care system needs. This article describes the components of a nurse manager orientation program for the novice nurse manager and methods for evaluating nurse manager effectiveness.

The aim of this study is to assess Latina patient understanding of noninvasive prenatal testing (NIPT) and identify what factors influence uptake/refusal to NIPT to adapt counseling to the needs and interests of this population.Mixed-methods survey in English and Spanish administered to pregnant Latina patients throughout pregnancy.Sixty-three women participated in our study (67% response rate); 34.9% chose to do NIPT, and 65.1% declined. Approximately half of participants (44%) had an NIPT knowledge score of ≤3 out of six total questions. Two of the most significant factors influencing uptake of NIPT were a higher reported educational level (p = 0.015) and a higher NIPT knowledge score (p = 0.014); 42.9% of participants knew that NIPT only screens for certain chromosomal conditions; 39% of women who declined NIPT would never consider NIPT in the future.One-third of Latina women elected NIPT; a higher reported educational level and language were most predictive of this choice. Overall knowledge was significantly lower for women who declined NIPT. Lower knowledge may suggest that not all women are making informed decisions because of varying degrees of informed consent. Providing culturally tailored information can help women navigate the complexities of prenatal testing in order to make decisions most aligned with their values.

This article describes an empirical study that was undertaken to see whether lawyers possess the statistical and, more particularly, probabilistic understanding that they need for their professional duties. Their earlier training in mathematics might have been expected to provide them with the relevant understanding, but was found to be wanting. The implications for legal decision making are discussed, and recommendations are made for preparing lawyers with the necessary skills.

In order to provide the best genetic counseling possible for women who learn of a diagnosis of Down syndrome prenatally, we sought to assess the timing of the decision to continue a pregnancy and the satisfaction these women had with learning this information. Fifty-six mothers of children with Down syndrome diagnosed prenatally between 2007 and 2010 completed a survey regarding their experience with decision-making after prenatal diagnosis. Approximately one third (17/56) of participants reported they knew before getting pregnant that they would not terminate for any reason, and almost half of the participants (24/56) reported they did not decide to continue their pregnancy until after the diagnosis. Many participants (82 %; 42/56) stated that learning the diagnosis during pregnancy increased their anxiety. The majority (88 %; 45/56) also reported that if they could do it over again, they would undergo prenatal testing for preparation purposes, despite increased anxiety. Religious and spiritual beliefs as well as feeling attached to the baby were the personal factors that had the greatest impact on most women’s decision-making. Despite increased anxiety caused by learning the diagnosis prenatally, most women favored prenatal diagnosis as it allowed them time to process the information and prepare for the birth of their child.

A patient whose dysmorphism at birth was not diagnostic for Pallister–Killian syndrome (PKS) was found to have mosaic tetrasomy 12p by an array-based comparative genomic hybridization of peripheral blood DNA. He was determined to be mosaic for 46,XY,trp(12)(p11.2 p13) in cultured skin fibroblasts. His appearance was typical for PKS at 4 months of age. © 2007 Wiley-Liss, Inc.

From the West Virginia University School of Nursing, Counseling Center, School of Medicine, and Mylan Puskar Health Right, Morgantown, West Virginia. Address reprint requests to Susan McCrone, RN, PhD, APRN, BC, West Virginia University School of Nursing, 6500 Health Sciences South, Morgantown, West Virginia 26506-9630. E-mail address: smccrone@hsc.wu.edu n 2007 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$30.00/0 doi:10.1016/j.apnu.2007.06.009 D EPRESSIVE DISORDERS ARE common, often chronic, and associated with decreased productivity as well as increased use of health care services. The World Health Organization (WHO) estimates that by 2020, depression will be second only to heart disease as a cause of disability worldwide (WHO World Mental Health Survey Consortium, 2004). Primary health care professionals provide much of the mental health care in the United States, and 24% of frequent users of primary health care meet the criteria for a depressive mood disorder (Karlsson, Lehtinen, & Joukamaa, 1995). Despite the high prevalence of depression in primary care, it often remains undiagnosed and inadequately treated. The rate of nondetection in depressed primary care patients ranges from 30% to 70% (Liu et al., 2006). The US Preventive Services Task Force confirmed that routine screening of adults for depression in primary care is important for reducing morbidity and mortality when systems are in place for the assessment, treatment, and monitoring of patients (Agency for Healthcare Research and Quality, 2002). Approximately 2.6 million rural adults suffer from depression. Although rural residents are more likely to experience circumstances that challenge health and increase the prevalence of depression (Probst et al., 2006), little is known about this population. The purposes of this study were to determine the prevalence of moderate to severe depression in a rural free primary care clinic and to identify factors predictive of depression in this population.

Case Description—A sudden onset of extreme dysgalactia in gilts and sows in a 1,000-head farrow-to-wean herd was observed in December 2009. Signs of dysgalactia were identified in sows beginning 1 day after parturition and lasted 4 to 6 days. This resulted in a mean piglet preweaning mortality rate of 18% because of starvation. Clinical Findings—Sows were neither off feed nor febrile. Udders were not inflamed or congested. Feed sample analysis did not find ergotamine, mycotoxin contamination, or ration formulation errors. Management practices were acceptable. Piglets attempted to stimulate milk production but none was elicited. Oxytocin (20 U) caused milk ejection but the effect was short-lived. Blood samples from sows with affected litters were positive for Mycoplasma suis (formerly Eperythrozoon suis) by PCR assay, and blood samples from sows with unaffected litters were negative. Treatment and Outcome—Chlortetracycline fed to the entire sow herd at 22 mg/kg/d (10 mg/lb/d) for 2 weeks resulted in a near complete absence of dysgalactia in sows farrowing within 5 weeks after the start of treatment. Dysgalactia did occur in sows that received chlortetracycline > 5 weeks prior to farrowing. Currently, gestating sows and gilts receive chlortetracycline in feed at a dosage of 22 mg/kg/d for 2 weeks beginning 3 weeks prior to farrowing. Conclusions and Clinical Relevance—M suis is spread primarily by blood contact from animal to animal, and diagnosis of infection with this organism can be easily missed by means of standard diagnostic protocols unless PCR assays or specific stains are used. Therefore, its current prevalence and impact are likely to be greatly underestimated.

The purpose of this pilot study was to investigate whether nurse practitioners are able to provide a level of primary health service applicable to remote/isolated settings in wound management and treatment of blunt limb trauma. It was hypothesized that there would be no significant difference in the quality of care, or the level of client satisfaction, provided by the medical officers and the nurse practitioners in the study. Two groups participated in the study, nurse practitioners and medical officers. The study used a randomized trial design. Data were collected using quantitative and qualitative methods. Two hundred and thirty-two clients participated in the study. Of this number 63 were supervised cases in the pilot trial. In the randomized trial participants were distributed between nurse practitioners and medical officers (n = 169), of which 91 were randomized to medical officers and 78 to nurse practitioners. Telephone interviews were conducted to evaluate client satisfaction. The majority of study participants were surveyed for client satisfaction (n = 132). This represents approximately 78% of the randomized sample and multivariate analysis was carried out on the data. Study results indicate that there were no significant differences between the two groups in relation to client satisfaction. Very positive outcomes of treatment were consistent across groups in the study. The study also found that there was strong support for the role of the nurse practitioner in the rural emergency setting. Recommendations include further research to measure the efficacy of nurse practitioners utilizing the selected competencies in remote/isolated settings.

Knowledge of the number of human immunodeficiency virus (HIV) seropositive people in a country and of their distribution in different transmission categories is important for health care planning, for risk estimations and for targeting public health interventions. We used data on seroprevalence of antibody to HIV in defined subgroups of the population attained from unlinked anonymous HIV testing surveys and combined these with estimates of the respective sizes of these subgroups from an interview study on sexual attitudes and lifestyles. Seroprevalence in those subgroups not covered by the HIV testing surveys was derived from a series of assumptions and approximations. The estimated numbers of HIV seropositive subjects in each subgroup were added to give an overall total for England and Wales at the end of 1991. The overall estimate was 27180 HIV seropositive people, with lower and upper bounds of 20200 and 34300 respectively. Homosexual and bisexual men were estimated to constitute about half of the total number who were seropositive, and heterosexually infected people constituted approximately a quarter. The greatest numerical uncertainties applied to the number of HIV seropositive men who have had a male partner, but not in the last 5 years, and to the number of HIV seropositive heterosexual men and women who have no recognized risk behaviour. Overlap between the various subgroups defined by unlinked anonymous testing programmes is substantial, but could partly be adjusted for with data from the interview study. The estimates of this study are in the same range as those made earlier with this and other modelling strategies.

This study compares two autobiographical descriptions of illness--the seventeenth-century John Donne's Devotions Upon Emergent Occasions and the twentieth-century Cornelius and Kathryn Ryan's A Private Battle. I begin by identifying the basic structure in both narratives as parallel to that of the case history, and then show how each individual's experience is shaped by the conditions of illness appropriate to their respective cultures. Lastly, I discuss the way in which both authors understand and represent sickness, as well as their respective therapies, in terms of a particular metaphoric construct: for Donne, it is the analogy between illness of the body and illness of the soul; for Ryan it is the analogy between illness and war. The stance of each towards his illness is conditioned by this metaphoric model: Donne's is one of acceptance, of conforming to the will of God; Ryan's is one of resistance, of fighting heroically until the very end. Thus these metaphors are functional as well as aesthetic: they serve as figural modalities whereby the patient/author hopes to transcend his illness.