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71.
Adopted children are emotionally vulnerable. Adoptive parents must cope with more complex problems than biologic parents. The family physician can provide valuable counseling. Preadoption counseling focuses on motivation and ambivalence. After adoption, however, serious, sometimes predictable, issues arise, such as: how and when to tell the child he is adopted; the child's search for knowledge; the problem of subsequent divorce; the birth of a natural sibling, and the involvement of other family members. New concepts include "open adoption" and "single parent adoption."  相似文献   
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Nowadays islanded microgrids mostly rely on diesel generator. In order to reduce greenhouse emissions, two islanded microgrids with hydrogen storage have been installed and are currently working autonomously in Reunion Island and France. Energy management implemented on these stations fall in the myopic control category. This study aims to determine the performance improvement that could be achieve on such stations using model predictive control. Ability to supply to the loads and energy losses minimisation are our main objectives. Lifetime degradation is also taken in consideration. Simulations shows that significant improvement can be brought, with a 76% decrease of the station's defaults time and better fill rate of hydrogen tank and batteries. In the meantime, chemical and electrical losses are reduced by 38 and 11%, and the batteries degradations are decreased by around 1%. The relevance of taking into account the electrolyser and fuel cell degradations depends on the time-step of the control. These results give a performance target in order to implement a real-time model predictive control in the microgrids, and eventually can be used to better sizing of future microgrids with similar architecture.  相似文献   
74.
Kaolinites with various degrees of structural order and iron content were heated and subsequently analyzed via electron paramagnetic resonance. Iron was present in two different states in the heated materials, either as dilute structural Fe3+ ions or in concentrated Fe3+ phases. During metakaolinization, the environment of dilute Fe3+ ions changed, following modifications of the Al3+ coordination, and the Fe3+ concentration increased. With the breakdown of metakaolinite, the diffusion of Fe3+ ions induced their exsolution in superparamagnetic iron-rich domains (Fe3+ clusters in γ-Al2O3 and/or Fe3+ oxide nanophases), which produced a decrease in the dilute Fe3+ concentration. The subsequent breakdown of γ-Al2O3 and the formation of mullite made the dilute Fe3+ concentration increase again, because of the incorporation of Fe3+ ions in the mullite structure.  相似文献   
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Snowboarding is a popular winter sport that involves riding a single board down a ski slope or on a half-pipe snow ramp. Compared with injuries resulting from traditional alpine skiing, snowboarding injuries occur more frequently in the upper extremities and ankles and less frequently in the knees. Different types of snowboard equipment, rider stance and snowboarding activity tend to result in different types of injury. Snowboarder's ankle, a fracture of the lateral talus, must be considered in a snowboarder with a "severe ankle sprain" that has not responded to treatment. Risk of injury may be lowered by using protective equipment, such as a helmet and wrist guards.  相似文献   
77.
HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   
78.
1. A major issue facing nursing, and society as a whole, is the longstanding and continuing nursing shortage in long-term care. 2. The demand for RNs in nursing homes will continue to intensify into the next century as the population of older adults with complex care needs continues to grow. 3. The findings of this study suggest that RN recruitment needs in long-term care include having enough qualified and dedicated staff, supportive and competent administration; competitive salaries and benefits; functional, attractive facilities; improved professional and public image; a caring, supportive environment; realistic regulations; decreased paperwork; progressive nurse practice models; and opportunities for educational advancement and career growth.  相似文献   
79.
Different extracellular matrix (ECM) molecules, when presented to hippocampal neurons in culture in a substrate-bound form, exert strikingly similar effects on the establishment of neuronal polarity, i.e., the growth of axon-like major neurites is favored, whereas extension of dendrite-like minor neurites is inhibited. To gain insight into the underlying signal transduction processes, we have investigated the effects of modulators of protein kinase activity on the morphology of neurons cultured on tenascin-R, tenascin-C, and laminin-entactin substrates. We found differential effects of broad-spectrum protein kinase inhibitors: H-7 promoted the growth of minor neurites, whereas H-8 reduced the growth of major neurites on ECM but not control substrates. In contrast, chelerythrine, a specific inhibitor of protein kinase C, selectively affected growth of both minor and major neurites on control, but not on ECM substrates. Finally, reagents which elevate intracellular cAMP levels facilitated growth of minor neurites and inhibited growth of major neurites and thus interfered with the establishment of a polarized phenotype on both ECM and control substrates. Our results suggest that protein kinases mediate the effects of ECM molecules on neuronal polarity and that different kinases control extension of axons and dendrites.  相似文献   
80.
Bioassay-directed fractionation of an EtOH extract of Curcuma zedoaria led to isolation of an active curcuminoid, which was identified as demethoxycurcumin (2) by comparison of its 1H and 13C NMR spectra with literature data and by direct comparison with synthetic material. Curcumin (1) and bisdemethoxycurcumin (3) were also obtained. Curcuminoids (1-3) were synthesized and demonstrated to be cytotoxic against human ovarian cancer OVCAR-3 cells. The observed CD50 values of 1, 2, and 3 were 4.4, 3.8, and 3.1 microg/mL, respectively. Three additional novel compounds, 3, 7-dimethylindan-5-carboxylic acid (4), curcolonol (5), and guaidiol (6), were also isolated from the EtOH extract. The structures and relative stereochemistry of 4-6 were determined by spectroscopic methods and X-ray crystallographic analysis.  相似文献   
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