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1.
The approach to the HIV-infected patient with pulmonary disease is summarized by the algorithms in Figures 3 and 4. These are not intended to be followed in a rigid step-wise fashion. Rather, the practitioner's knowledge of the patient with his or her accompanying medical risks influences the path taken, including the depth and the speed of the evaluation. For example, the patient with cough who is afebrile and breathing at 18 breaths a minute, with a normal chest radiograph and a CD4 count of 350 cells/mm3, is reasonably treated with a macrolide or cephalosporin for bacterial bronchitis and clinical follow-up while awaiting cultures (see Fig. 4). A febrile patient with a cough productive of thin mucus, but known to have a CD4 count of 60 cells/mm3 should be started on anti-PCP therapy while being evaluated for PCP with an induced sputum and if nondiagnostic, a bronchoscope despite a normal chest radiograph. Screening can be as simple as placing an oximeter on the patient's finger in the clinic. If the oxygen saturation of a patient with a normal chest radiograph is low, then the patient should be hospitalized and begun on treatment for PCP while diagnostic evaluation is initiated. If the oxygen saturation is normal, the patient can be exercised to elicit desaturation. If there is no desaturation, PCP is unlikely. If the results are equivocal (i.e., a decrease in saturation, but less than 3%), rest and exercise arterial blood gases can be performed, along with a Dlco-Gallium scanning can be done in patients known to have abnormal Dlco or those who cannot exercise. Patients with focal infiltrates who have acute onset of symptoms (see Fig. 4) commonly have bacterial infections, but the possibility of PCP or TB should not be dismissed. Induced sputum should be examined if TB or PCP is suspected. Patients who are severely ill might go quickly to bronchoscopy without awaiting improvement on empiric therapy. The patient with diffuse infiltrates (see Fig. 4) needs no screening because the presence of disease is apparent from the radiograph. The diagnostic part quickly leads to bronchoscopy for these patients and the initiation of therapy for PCP when suspected. In patients with known pulmonary KS, gallium scanning can be helpful to rule out acute infection, but bronchoscopy is warranted if the patient is severely ill, or at high risk for PCP. This approach should avoid unnecessary procedures in patients with simple bacterial infections, without missing opportunistic infections and tumors. 相似文献
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Although many children are technically skilled in using the Web, their competences to use it in a critical and meaningful way are usually less well developed. In this article, we report on a multiple case study focusing on the possibilities and limitations of collaborative inquiry activities as an appropriate context to acquire Web literacy skills in primary education. Four 5th grade school teachers and their students worked with collaborative inquiry activities on the subject of ‘healthy food’. The project was aimed at both the development of Web literacy skills and content knowledge building. Data from a variety of sources were collected: videotaped and written lesson observations, interviews with teachers and students, teacher diaries, student questionnaires, and student assignments. The teachers appeared to be able to carry out the program to varying degrees. Contextual factors that influenced the realization of the project’s goals and results were the adequacy of the research questions formulated by students, students’ inquiry skills, and the teachers’ teaching styles. Students’ learning results show that it is possible to teach Web literacy skills in the context of collaborative inquiry activities. All classes show knowledge gain with regard to the subject healthy food and all classes but one show knowledge gain with regard to Web literacy skills. Although many students show adequate use of particular Web searching, reading and evaluating skills after the project, inconsistency, impulsiveness and impatience are also typical of their Web behaviour. In the context of collaborative inquiry activities teachers are challenged to deal with the paradox that they want their students to be active knowledge builders with help of the Web, whereas the Web seems to invite students to be more or less passive searchers. 相似文献
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We consider broadcasting in random d-regular graphs by using a simple modification of the random phone call model introduced by Karp et al. (Proceedings of the FOCS ’00, 2000). In the phone call model, in every time step, each node calls a randomly chosen neighbour to establish a communication channel to this node. The communication channels can then be used bi-directionally to transmit messages. We show that, if we allow every node to choose four distinct neighbours instead of one, then the average number of message transmissions per node required to broadcast a message efficiently decreases exponentially. Formally, we present an algorithm that has time complexity \(O(\log n)\) and uses \(O(n\log \log n)\) transmissions per message. In contrast, we show for the standard model that every distributed algorithm in a restricted address-oblivious model that broadcasts a message in time \(O(\log n)\) requires \(\Omega (n \log n{/} \log d)\) message transmissions. Our algorithm efficiently handles limited communication failures, only requires rough estimates of the number of nodes, and is robust against limited changes in the size of the network. Our results have applications in peer-to-peer networks and replicated databases. 相似文献
5.
Quang Tri Ho Pieter Verboven Solomon W. Fanta Metadel K. Abera Moges A. Retta Els Herremans Thijs Defraeye Bart M. Nicolaï 《Food and Bioprocess Technology》2014,7(2):482-495
A multiphase pore scale network model was developed to describe mass transfer in apple fruit. The 3D microscale geometry of the tissue was reconstructed from synchrotron radiation tomography images. Individual cells and pores were identified using a watershed segmentation procedure on a Euclidean distance map of the tissue microstructure. Further morphological characteristics of each individual pore, including its volume, connections to the neighbors and the connected area between the pore and its neighbors, were determined. The tissue was represented by a network of nodes (simplified individual pores and cells) that were interconnected by tubes. The transport of the respiratory gases O2 and CO2 between two nodes was modelled using diffusion laws and irreversible thermodynamics, while respiration was taken into account in the individual cellular nodes. A numerical procedure was applied to simulate the gas transport within the discrete network and to compute the local diffusivities of the links in the network. The predicted overall gas diffusivities compared well to experimental data and results computed from a microscale continuum model, thereby validating the pore scale network model. This approach is a computationally attractive alternative to a continuum multiphase approach for modelling gas transport in fruit. 相似文献
6.
Metadel K. Abera Pieter Verboven Els Herremans Thijs Defraeye Solomon Workneh Fanta Quang T. Ho Jan Carmeliet Bart M. Nicolai 《Food and Bioprocess Technology》2014,7(2):542-555
A 3D virtual fruit tissue generator is presented that can distinctly define the microstructural components of a fruit tissue and that can be used to model important physical processes such as gas transport during controlled atmosphere storage. The model is based on the biomechanics of plant cells in tissues. The main merit of this algorithm is that it can account for typical differences in intercellular air space networks and in cell size and shape found between different fruit species and tissues. The cell is considered as a closed thin walled structure, maintained in tension by turgor pressure. The cell walls of adjacent cells are modeled as parallel, linear elastic elements which obey Hooke's law. A 3D Voronoi tessellation is used to generate the initial topology of the cells. Intercellular air spaces of schizogenous origin are generated by separating the Voronoi cells along the edges where three Voronoi cells are in contact; while intercellular air spaces of lysigenous origin are generated by deleting (killing) some of the Voronoi cells randomly. Cell expansion then results from turgor pressure acting on the yielding cell wall material. To find the sequence of positions of each vertex and thus the shape of the tissue with time, a system of differential equations for the positions and velocities of each vertex is established and solved using a Matlab ordinary differential equation solver. Statistical comparison with synchrotron tomography images of fruit tissue is excellent. The virtual tissues can be used to study tissue mechanics and exchange processes of important metabolites. 相似文献
7.
Cover Picture: Development of Potent and Metabolically Stable APJ Ligands with High Therapeutic Potential (ChemMedChem 21/2016) 下载免费PDF全文
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Jan Benjamins Monique H. Vingerhoeds Franklin D. Zoet Els H.A. de Hoog George A. van Aken 《Food Hydrocolloids》2009
This study evaluates the role of partial coalescence of whey protein-stabilized emulsions on sensory perception. The selection of fats was restricted to vegetable fats that are essentially melted at oral temperatures. The sensitivity to partial coalescence was controlled by a variation in the fat melting curve and by addition of unsaturated monoglyceride. Most fat-related sensory attributes appear to be well-correlated to an increase in viscosity and coalescence in the mouth due to partial coalescence. Moreover, it was found that in-mouth aeration induces extra coalescence, which increases the perception of fat-related sensory attributes significantly. 相似文献
10.
Cyril Caminade Jolyon M. Medlock Els Ducheyne K. Marie McIntyre Steve Leach Matthew Baylis Andrew P. Morse 《Journal of the Royal Society Interface》2012,9(75):2708-2717
The Asian tiger mosquito (Aedes albopictus) is an invasive species that has the potential to transmit infectious diseases such as dengue and chikungunya fever. Using high-resolution observations and regional climate model scenarios for the future, we investigated the suitability of Europe for A. albopictus using both recent climate and future climate conditions. The results show that southern France, northern Italy, the northern coast of Spain, the eastern coast of the Adriatic Sea and western Turkey were climatically suitable areas for the establishment of the mosquito during the 1960–1980s. Over the last two decades, climate conditions have become more suitable for the mosquito over central northwestern Europe (Benelux, western Germany) and the Balkans, while they have become less suitable over southern Spain. Similar trends are likely in the future, with an increased risk simulated over northern Europe and slightly decreased risk over southern Europe. These distribution shifts are related to wetter and warmer conditions favouring the overwintering of A. albopictus in the north, and drier and warmer summers that might limit its southward expansion. 相似文献