Academic literature on the topic 'B feed down'
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Journal articles on the topic "B feed down"
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An, Xuejiao, Shengwei Zhang, Taotao Li, Nana Chen, Xia Wang, Baojun Zhang, and Youji Ma. "Transcriptomics analysis reveals the effect of Broussonetia papyrifera L. fermented feed on meat quality traits in fattening lamb." PeerJ 9 (April 27, 2021): e11295. http://dx.doi.org/10.7717/peerj.11295.
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To date, utilization of feed grains is increasing, which competes for human food. It is imperative to develop and utilize unconventional feed materials. Broussonetia papyrifera L. (B. papyrifera) is a good feeding material with high crude protein, crude fat, and low crude fiber, which is widely distributed in China. In this study, 12 Dorper ♂×Hu ♀ crossbred weaned male lambs were seleted into four groups based on the feed that ratio of the B. papyrifera fermented feed in the total mixed diet (0%, 6%, 18%, and 100%), to character the lambs’ longissimus dorsi (LD) fatty acids, morphology and transcriptome. Results showed that the muscle fiber’s diameter and area were the smallest in the 100% group. The highest content of beneficial fatty acids and the lowest content of harmful fatty acids in group 18%. RNA-seq identified 443 differentially expressed genes (DEGs) in the LD of lambs from 4 groups. Among these genes, 169 (38.1%) were up-regulated and 274 (61.9%) were down-regulated. The DEGs were mostly enriched in in fatty acid metabolism, arginine and proline metabolism, and PPAR signaling pathways. Our results provide knowledge to understand effect of different ratios of B. papyrifera fermented feed on sheep meat quality traits, also a basis for understanding of the molecular regulation mechanism of B. papyrifera fermented feed affecting on sheep meat quality.
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Isah, O. A. "In vitro fermentation and chemical constituents of urea-molasses feed - blocks made with different binders for ruminants." Nigerian Journal of Animal Production 39, no. 2 (January 1, 2021): 142–49. http://dx.doi.org/10.51791/njap.v39i2.760.
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This study was carried out to assess the chemical contents, in vitro break down, volatile fatty acids, NH3¬-N and methane concentration of urea- molasses feed - block (UMFB) using different binders. Four feed - blocks were formulated as: UMFB A (Cement only), UMFB B (cement + clay), UMFB C (cement + cassava starch), and UMFB D (cassava starch + clay). The feed - blocks were incubated in vitro for 48 hours to assess gas production and other in vitro- ecology parameters. Results of chemical analysis revealed that UMFB C (21.70%), and B (21.65%) had highest (p< 0.05) crude protein content while UMFB D (18.62%) had lowest value. Intermediate crude protein content was recorded for UMFB A (19.58%). However, highest (p<0.05) values of ADF (16.8%) and ADL (15.5%) were recorded for UMFB D. Similar value of ADF (16.70%) and ADL (15.3%) were recorded also for UMFB B. The NDF value of feed - block A (34.6%) was highest (p<0.05) while lowest value of NDF was recorded for UMFB D (32.1%). Production of volatile fatty acids indicated that propionic acid (30.5%), oleic acid (11.3%,) and lactic acid (36.5%) were highest (p<0.05) for UMFB D. Concentration of NH3-N was highest in UMFB B while significant difference (p>0.05) was not observed in the pH and methane values for various UMFB. Highest in vitro digestibility of organic matter was observed in UMFB D. The study showed that the various feed - blocks could serve as a sustainable supplement during dry season and period of scarcity for the ruminants.
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Gorleku, David Ofoe, Gloria Pearl Ami BADU, John Tennyson AFELE, James Seutra KABA, and Akwasi Adutwum ABUNYEWA. "ASSESSING THE EFFICIENCY OF MORINGA OLEIFERA LEAF MEAL ON THE GROWTH PERFORMANCE OF BROILER CHICKEN." Journal of Applied Life Sciences and Environment 54, no. 4 (2022): 370–76. http://dx.doi.org/10.46909/journalalse-2021-032.
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High cost of poultry feed and limited fishmeal are currently the major challenges in poultry production. To reduce cost while maximizing production, there is the need to use cheap but high nutritional feed sources like Moringa oleifera. The aim of the study was to assess the effects of Moringa oleifera on the growth performance of broiler chicken by measuring their live weight, rate of mortality, feed conversion ratio and benefit cost (b/c) ratio. Field experiment was carried out at the Animal Science Department farm, located in the Kwame Nkrumah University of Science and Technology, Kumasi-Ghana. A total of 30-day old chicks were raised for eight weeks under the required conditions, with all vaccines administered appropriately. The experiment was laid in a Complete Randomized Design with five treatments namely T1= 100% conventional feed only (as control), T2= 50% MoLM (Moringa oleifera Leaf Meal) + 50% conventional, T3= 75% MoLM + 25% conventional, T4= 25% MoLM + 75% conventional, T5= 80% MoLM and each treatment replicated six times. The result showed no significant differences between the various treatment for the feed conversion ratio and live weight at different growth periods. The benefit/cost ratio of T1 was more than one while the other treatments were less than one. T4 (25% MoLM) had a b/c ratio close to one. In conclusion, Moringa oleifera leaf meal at different levels can be used to supplement the fishmeal component in the poultry diet of broiler chicken to produce similar results as that of the conventional feed. The study recommends that farmers can adopt Moringa oleifera based poultry feed for their bird production when they cannot afford the conventional feed (fish meal-based feed) to cut down cost economically while increasing productivity.
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Santos, Tatiane Souza dos, Adriano Barbieri, Robert Guaracy Aparecido Cardoso Araujo, Gustavo Do Valle Polycarpo, Daniela Felipe Pinheiro, and Valquíria Cação Cruz-Polycarpo. "Performance, gut morphometry and enzymatic activity of broilers fed neonatal supplementation in housing." Acta Scientiarum. Animal Sciences 40, no. 1 (March 1, 2018): 38423. http://dx.doi.org/10.4025/actascianimsci.v40i1.38423.
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The objective was to evaluate the performance, relative organ weight, morphometry, intestinal length and pancreatic enzyme activity of broilers receiving neonatal supplementation. A total of 900 Cobb 500 broiler chicks was housed in 30 boxes of 2.5 m². The treatments were divided in a completely randomized design with six replications, and consisted of five inclusion levels (0.0, 2.5, 5.0, 7.5 and 10 grams per bird). The supplement used was based of amino acids, vitamins and minerals, which was provided on the ration on the first day in the housing. Statistical analysis was performed using SAS (2008) and when significant broken down using a polynomial regression. Due to the inclusion of the neonatal supplement in the period from one to seven and one to 21 days of age, the feed intake presented a linear effect and the weight gain, a quadratic effect. The relative weights of the gizzard and liver showed a quadratic effect, and the inclusions of 4.18 and 3.41 grams/bird provided the lowest weights, respectively. The jejunum villi height decreased with supplementation as well as the activity of pancreatic lipase. It can be concluded that neonatal supplementation benefited the performance of birds up to 21 days of age.
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Sissener, Nini H., Gro-Ingunn Hemre, Santosh P. Lall, Anita Sagstad, Kjell Petersen, Jason Williams, Jens Rohloff, and Monica Sanden. "Are apparent negative effects of feeding GM MON810 maize to Atlantic salmon,Salmo salar, caused by confounding factors?" British Journal of Nutrition 106, no. 1 (March 21, 2011): 42–56. http://dx.doi.org/10.1017/s0007114510005726.
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The present study was conducted to follow up on apparent differences in growth, relative organ sizes, cellular stress and immune function in Atlantic salmon fed feed containing GMBacillus thuringiensismaize compared with feed containing the non-modified parental maize line. Gene expression profiling on the distal intestinal segment and liver was performed by microarray, and selected genes were followed up by quantitative PCR (qPCR). In the liver, qPCR revealed some differentially regulated genes, including up-regulation of gelsolin precursor, down-regulation of ferritin heavy subunit and a tendency towards down-regulation of metallothionein (MT)-B. This, combined with the up-regulation of anti-apoptotic protein NR13 and similar tendencies for ferritin heavy chain and MT-A and -B in the distal intestine, suggests changes in cellular stress/antioxidant status. This corresponds well with and strengthens previous findings in these fish. To exclude possible confounding factors, the maize ingredients were analysed for mycotoxins and metabolites. The GM maize contained 90 μg/kg of deoxynivalenol (DON), while the non-GM maize was below the detection limit. Differences were also observed in the metabolite profiles of the two maize varieties, some of which seemed connected to the mycotoxin level. The effects on salmon observed in the present and previous studies correspond relatively well with the effects of DON as reported in the literature for other production animals, but knowledge regarding effects and harmful dose levels in fish is scarce. Thus, it is difficult to conclude whether the observed effects are caused by the DON level or by some other aspect of the GM maize ingredient.
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Chang, J. Y., and S. M. You. "Enhanced Boiling Heat Transfer From Micro-Porous Cylindrical Surfaces in Saturated FC-87 and R-123." Journal of Heat Transfer 119, no. 2 (May 1, 1997): 319–25. http://dx.doi.org/10.1115/1.2824226.
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The present research is an experimental study of pool boiling heat transfer from cylindrical heater surfaces immersed in saturated FC-87 and R-123. The baseline heater surfaces tested are plain, integral-fin with 709 fins/m, and commercial enhanced (High-Flux and Turbo-B). In addition, a highly effective micro-scale enhancement coating is applied to the plain and integral-fin surfaces to augment nucleate boiling heat transfer. Experiments are performed to understand the effects of surface micro- and macro-geometries on boiling heat transfer. The boiling performance of the micro-porous enhanced plain and integral-fin surfaces are compared with the High-Flux and the Turbo-B surfaces. At high heat flux conditions, the break down of the bulk liquid feed mechanism reduces boiling enhancement from the cylindrical surfaces.
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SUN, YAN, JIANMING LU, and TAKASHI YAHAGI. "CLASSIFICATION OF CIRRHOSIS FROM B-SCAN IMAGES USING PYRAMID NEURAL NETWORK." International Journal of Computational Intelligence and Applications 05, no. 04 (December 2005): 457–70. http://dx.doi.org/10.1142/s1469026805001696.
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This paper proposes a system applying a pyramid neural network for classifying the hepatic parenchymal diseases in ultrasonic B-scan texture. The conventional multilayer neural network emphasizing on the data carried by the last hidden layer has the drawback of not fully utilizing the information carried by the input data. A pyramid network can solve the problem successfully. To solve the common problem of neural network, which is time-consuming in computation, FDWT (Fast Discrete Wavelet Transform) is a key technique used during preprocessing to cut down the size of patterns feed to the network. The B-scan patterns are wavelet transformed, and then the compressed data is fed into a pyramid neural network to diagnose the type of cirrhotic diseases. The performance of the proposed system and that of a system based on the conventional multilayer network architecture is compared. The result shows that compared to the conventional 3-layer neural network, the performance of the proposed pyramid neural network is improved by effectively utilizing the lower layer of the neural network.
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Andersen, R. Charles, Trevor A. Branch, Anoma Alagiyawadu, Robert Baldwin, and Francis Marsac. "Seasonal distribution, movements and taxonomic status of blue whales (Balaenoptera musculus) in the northern Indian Ocean." J. Cetacean Res. Manage. 12, no. 2 (February 8, 2023): 203–18. http://dx.doi.org/10.47536/jcrm.v12i2.578.
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There is a distinct population of blue whales, Balaenoptera musculus, in the northern Indian Ocean. The taxonomic status of these animals has long been uncertain, with debate over whether this population represents a distinct subspecies, and if so which name should apply. They have most frequently been assigned to B. musculus brevicauda, but are currently considered to be B. m. indica. The movements of these blue whales within the northern Indian Ocean are poorly understood. This paper reviews catches (n = 1,288), sightings (n = 448, with a minimum of 783 animals), strandings (n = 64) and acoustic detections (n = 6 locations); uses ocean colour data to estimate seasonality of primary productivity in different areas of the northern Indian Ocean; and develops a migration hypothesis. It is suggested that most of these whales feed in the Arabian Sea off the coasts of Somalia and the Arabian peninsula during the period of intense upwelling associated with the southwest monsoon (from about May to October). At the same time some blue whales also feed in the area of upwelling off the southwest coast of India and west coast of Sri Lanka. When the southwest monsoon dies down in about October–November these upwellings cease. The blue whales then disperse more widely to eke out the leaner months of the northeast monsoon (during about December to March) in other localised areas with seasonally high productivity. These include the east coast of Sri Lanka, the waters west of the Maldives, the vicinity of the Indus Canyon (at least historically), and some parts of the southern Indian Ocean. The data are consistent with the hypothesis that at least some of the blue whales that feed off the east coast of Sri Lanka in the northeast monsoon also feed in the Arabian Sea during the southwest monsoon. These whales appear to migrate eastwards past the north of Maldives and south of Sri Lanka in about December–January, returning westwards in about April–May
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Anbazhagan, Kolandaswamy, Vincent Fuentes, Eliane Bissac, Remy Nyga, Naomi Taylor, Jacques Rochette, and Kaiss Lassoued. "The Human Pre-B Cell Receptor Signaling Cascade Is Regulated Via PI-3Kinase and MAPK Pathway." Blood 118, no. 21 (November 18, 2011): 1314. http://dx.doi.org/10.1182/blood.v118.21.1314.1314.
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Abstract Abstract 1314 Background: Pre-B cell receptor (pre-BCR) constitutes a major check point in the early steps of mouse and human B cell development. Several functions have been attributed to this receptor which include a delivery of proliferation and survival signals, increased sensitivity to interleukin-7 (IL-7) and down modulation of recombinase activating genes (RAG) and surrogate light chain (SLC) encoding genes. Pre-BCR is also involved in shaping the VH repertoire and preventing autoimmunity. Finally, there is increasing evidence that pre-BCR might be implicated in leukemogenesis. Most of the functions of pre-BCR have been predicted based on studies in knockout mice and leukemic cell lines. In a previous study we have shown that pre-BCR aggregation resulted in the activation of src and Syk kinases which in turn activated the PI-3K/Akt, Btk, PLCγ-2 and Ras/MAPK. In this study, we examined the pre-BCR signalling cascade using human normal primary pre-B cells with a particular focus on transcription factors activation and Rag modulation and their regulatory aspects. Methods: Pre-B cells were sorted from adult human bone marrow samples, treated or not with inhibitors of Syk (BAY61–3606), Akt (LY294002) and MEKK1 (UO126) prior to crosslink the pre-BCR by means of F(ab')2 anti-μHC. The effect of Pre-BCR signaling was examined by quantifying the transcript levels of Rag1, Rag2, E2A, EBF1, Pax5, FoxO1 and FoxO3, IRF4/8. Activation of transcription factors such as NF-κB p50, c-Fos, IRF4 and FoxO3A, was assessed by analyzing their nuclear translocation by immunofluorescence microscopy. Results: We show that NF-κB p50 is translocated into nucleus within 3h after pre-BCR stimulation. Crosslinking of pre-BCR also resulted in an enhancement of nuclear c-Fos translocation. BAY61-3606 (Syk inhibitor) treatment resulted in complete apoptosis (100 % cell death within 48h). Although treatment of normal pre-B cells with LY294002 or U0126 did not alter cell survival, nuclear translocation of pre-BCR-induced p50 NF-κB was prevented by former and enhanced by later. Conversely, c-Fos nuclear expression was inhibited by U0126 and slightly but consistently enhanced by LY294002 in association with a decrease in its cytoplasmic location. Pre-BCR stimulation also induced IRF4 translocation to the nucleus. Pre-BCR stimulation also resulted in the down regulation of Rag1 (− 48 %, P<0.01), Pax5 (− 40%, P<0.01) and E2A (− 35 %, P< 0.01) transcripts, whereas EBF1 and FoxO1 and 3 expression remained unchanged. In LY294002-treated cells, Rag1/Rag2 expression was up regulated (+130%, P< 0.01 and +251%, P< 0.01, respectively) following pre-BCR crosslinking, whereas in the presence of U0126 the pre-BCR induced Rag1/Rag2 down modulation remained unchanged. Conclusion: Our results indicate that the pre-BCR has the potential to promote pre-B cell proliferation, survival and differentiation by activating NF-kB, c-Fos and IRF4. It also has the ability to protect pre-B cells from genome instability by down-regulating Rag1/2, probably through down modulation of Pax5 and E2A. We bring evidence that PI-3 K/Akt pathway plays a crucial role in the regulation of the pre-BCR signaling cascade and that Akt-mediated NF-kB and c-Fos activation is antagonized by MAPK. Up-regulation of Rag transcripts upon Akt inhibition suggests either a feed-back negative loop or a dual effect of pre-BCR on Rag expression with an Akt-dependent Rag down regulation and an accessory pathway that enhances Rag expression. Disclosures: No relevant conflicts of interest to declare.
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Dematheis, Flavia, Mathias C. Walter, Daniel Lang, Markus Antwerpen, Holger C. Scholz, Marie-Theres Pfalzgraf, Enrico Mantel, Christin Hinz, Roman Wölfel, and Sabine Zange. "Machine Learning Algorithms for Classification of MALDI-TOF MS Spectra from Phylogenetically Closely Related Species Brucella melitensis, Brucella abortus and Brucella suis." Microorganisms 10, no. 8 (August 17, 2022): 1658. http://dx.doi.org/10.3390/microorganisms10081658.
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(1) Background: MALDI-TOF mass spectrometry (MS) is the gold standard for microbial fingerprinting, however, for phylogenetically closely related species, the resolution power drops down to the genus level. In this study, we analyzed MALDI-TOF spectra from 44 strains of B. melitensis, B. suis and B. abortus to identify the optimal classification method within popular supervised and unsupervised machine learning (ML) algorithms. (2) Methods: A consensus feature selection strategy was applied to pinpoint from among the 500 MS features those that yielded the best ML model and that may play a role in species differentiation. Unsupervised k-means and hierarchical agglomerative clustering were evaluated using the silhouette coefficient, while the supervised classifiers Random Forest, Support Vector Machine, Neural Network, and Multinomial Logistic Regression were explored in a fine-tuning manner using nested k-fold cross validation (CV) with a feature reduction step between the two CV loops. (3) Results: Sixteen differentially expressed peaks were identified and used to feed ML classifiers. Unsupervised and optimized supervised models displayed excellent predictive performances with 100% accuracy. The suitability of the consensus feature selection strategy for learning system accuracy was shown. (4) Conclusion: A meaningful ML approach is here introduced, to enhance Brucella spp. classification using MALDI-TOF MS data.
Dissertations / Theses on the topic "B feed down"
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Rossi, Andrea. "Charm production in proton-proton collisions at the LHC with the ALICE detector." Doctoral thesis, Università degli studi di Trieste, 2010. http://hdl.handle.net/10077/3584.
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2008/2009The ALICE experiment at CERN will study the medium formed in very high energy lead-lead collisions at the LHC. According to the Quantum Chromo Dynamics theory of the strong interaction, a phase transition to a state where quarks and gluons are not confined into hadrons (Quark-Gluon Plasma) can occur in these collisions. Heavy quarks (charm and beauty) are produced in hard scattering processes in the first stages of the collisions. While travelling through the medium they can lose energy by means of gluon radiation. This affects the momentum spectra of the hadrons produced in the subsequent hadronization. To study the energy loss mechanism and its dependence on the parton nature (quark/gluon) and mass (light/heavy quark), hadron momentum spectra observed in heavy-ion collisions are compared to the same spectra observed in proton-proton collisions, where the formation of a thermalized medium is not expected. In this thesis, the measurement of charm production in proton-proton collisions via the exclusive reconstruction of the D0 meson (cū) decay in the D0->Kπ channel is presented. An invariant mass analysis of selected pairs of particles with opposite charges is performed, exploiting the high spatial resolution of the Inner Tracking System silicon detector, that assures the tracking precision needed to resolve the D0 decay vertices from the interaction point of the colliding protons (primary vertex). The estimate of the fraction of secondary D0 mesons coming from the decay of B mesons, if based on theoretical calculations, introduces a relevant systematic error. A method to extract this contribution directly from data, via the analysis of the impact parameter distribution, i.e. the distance between the reconstructed meson trajectory and the primary vertex, is presented. The presence of the ITS assures the possibility to highlight the different shape of the impact parameter distribution typical of secondary D0 mesons, influenced by the relative long lifetime of B mesons (cτ~460-490 μm). Due to construction and mounting finite precision, the modules composing the ITS can be displaced from their designed positions by large amounts if compared with the expected spatial resolutions, of the order of tens of micron. This deteriorates the detector performances, in particular the tracking spatial and momentum resolutions. The alignment of the ITS, that is, the a posteriori determination of more than 13000 parameters defining the real position and orientation in space of the modules, is extensively discussed. The results obtained with 2008 cosmic-ray data are presented. The promising alignment status allowed to test the analysis for the D0 reconstruction on proton-proton collision data simulated with realistic detector properties.
L'esperimento ALICE al CERN studierà il mezzo formato in collisioni piombo-piombo ad altissime energie a LHC. Secondo la Cromodinamica Quantistica, teoria che descrive l'interazione forte, in queste collisioni può avvenire una transizione di fase ad uno stato in cui quark e gluoni non siano confinati dentro gli adroni (Quark-Gluon Plasma). I quark pesanti (charm e beauty) vengono prodotti negli istanti iniziali delle collisioni, in processi con alto momento trasferito. Attraversando il mezzo possono perdere energia tramite radiazione di gluone. Per studiare il meccanismo con cui la perdita di energia avviene, in particolare la sua dipendenza dalla natura del partone (quark/gluone) e dalla sua massa (quark leggeri/pesanti), gli spettri in momento degli adroni osservati in collisioni tra ioni pesanti vengono confrontati con gli stessi spettri osservati in collisioni protone-protone, dove non ci si aspetta la formazione di un mezzo termalizzato. In questa tesi è presentata la misura della produzione di charm in collisioni protone-protone tramite la ricostruzione esclusiva del decadimento del mesone D0 (cū) nel canale D0->Kπ. A questo scopo viene effettuata un'analisi in massa invariante di coppie di tracce con carica opposta opportunamente selezionate, sfruttando l'elevata precisione spaziale dell'Inner Tracking System, rivelatore al silicio che assicura la precisione di tracciamento necessaria per risolvere i vertici di decadimento dei mesoni D0 dal punto di interazione dei protoni dei fasci (vertice primario). La stima della frazione di D0 secondari, provenienti dal decadimento di un mesone B, introduce un errore sistematico consistente, se basata su calcoli teorici. Viene presentato un metodo per valutare questo contributo direttamente dai dati, tramite l'analisi della distribuzione del parametro d'impatto, cioè la distanza tra la traiettoria ricostruita del mesone e il vertice primario. La presenza dell'ITS assicura la possibilità di evidenziare la diversa forma della distribuzione in parametro d'impatto tipica dei D0 secondari, influenzata dalla vita media relativamente lunga dei mesoni B (cτ~460-490 μm). A causa della precisione finita nelle operazioni di costruzione e montaggio, la posizione e l'orientazione dei moduli che compongono l'ITS possono differire da quelle di progetto. Se paragonate alle risoluzioni spaziali attese, dell'ordine di decine di micron, le differenze possono essere notevoli. Questo degrada le prestazioni del rivelatore, soprattutto le risoluzioni spaziale e in momento del tracciamento. L'allineamento dell'ITS, ovvero la determinazione a-posteriori dei più di 13000 parametri necessari per definire le reali posizioni e orientazioni dei moduli viene discussa in dettaglio nella tesi e vengono presentati i risultati ottenuti utilizzando i dati da raggi cosmici raccolti nel 2008. Il promettente stato dell'allineamento ha permesso di testare l'analisi per la ricostruzione del mesone D0 su dati da simulazioni di collisioni protone-protone in cui le proprietà del rivelatore fossero descritte realisticamente.
XXII Ciclo
1981
Books on the topic "B feed down"
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Office, General Accounting. Medicare: Change in contigency reserve funding held down increase in Part B premium : briefing report to the Chairman, Special Committee on Aging, U.S. Senate. Washington, D.C: The Office, 1987.
Find full textBook chapters on the topic "B feed down"
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Rezaee, Arman. "Monitoring the Monitors in Punjab, Pakistan." In Introduction to Development Engineering, 513–32. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-86065-3_19.
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AbstractAbsenteeism of government frontline health workers can prevent access to primary care, including outpatient care, pre- and postnatal care, deliveries, and vaccinations. As rates of absenteeism tend to be higher in lower-income areas, this issue has the potential to exacerbate the socioeconomic divide. Specifically in Punjab, Pakistan, government doctors posted to rural health clinics, called Basic Health Units (BHUs), were found to be absent two-thirds of the time. Health inspectors are employed to visit BHUs at least once a month to collect data from a paper-based register located at each BHU and ensure doctors are present. However, absenteeism of the government inspectors causes this system to break down. This case study follows the implementation of the “Monitoring the Monitors” program, which aimed to replace the paper-based record-keeping system with an app-based system that feeds an online dashboard system (for real-time aggregation and presentation of data). Conducting a large-scale randomized controlled trial, inspection rates increased from 25.5% to 51.9% after 6 months. After a year of operation, inspection rates were 33.8% in the treatment districts and 23.5% in control districts. An A/B test was used to measure the effect of a simple flagging system that notified senior health officials when health workers were absent during an inspection and showed an increase in doctor attendance from 23.6% to 41.3%. The government eventually adopted this system (rebranded as HealthWatch), and it is now one of the many apps being used to monitor frontline service providers.
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Johnson, Julie B. "From Warm-up to Dobale in Philadelphia." In Hot Feet and Social Change, 56–72. University of Illinois Press, 2019. http://dx.doi.org/10.5622/illinois/9780252042959.003.0004.
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From an experiential perspective, Julie B. Johnson charts the five main components of a West African dance class in West Philadelphia as a lens through which to explore the varied understandings of community that can emerge through engagement with African dance traditions. Each component – the warm up, the lesson, dancing down the floor, the circle, and the concluding ritual to honor the musicians (Dobale) – outlines a narrative through which students construct shared understandings of community through collective experiences at each phase of the class’s procedural structure. Employing poetry and vignettes, Johnson provides a participatory ethnography of African dance in Philadelphia rooted in scholarship and first-hand experience.
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Church, Joseph. "Musical Values in Rock Theatre Songs." In Rock in the Musical Theatre, 61–88. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190943462.003.0005.
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Here the nature of rock music is broken down into its components, with an emphasis on rhythm. In rock, the melody and the accompaniment are both rhythmic; this chapter contains an extensive discussion of how melody and accompaniment interact to create the essential rock element of groove. The notions of rhythmic accuracy and rhythmic freedom are discussed at length from both aesthetic and technical standpoints. Among the primary topics are meter, tempo, feel, improvisation, tension and resolution, and underlying rhythmic motors in rock. A singer’s approach to melody is examined by genre, including extensive examples: rock ’n’ roll, hard rock, pop and pop-rock, blues and gospel, soul and r&b, rap, and ballads.
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Santangelo, Lauren C. "Becoming “A Lover of the Metropolis,” 1895–1906." In Suffrage and the City, 33–49. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190850364.003.0003.
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Rather than grinding to a standstill following defeat at the 1894 New York State Constitutional Convention, city work continued and new organizations emerged. Lillie Devereux Blake and her peers more regularly decided to hold suffrage events in elegant spaces like the Waldorf-Astoria at century’s turn, capitalizing on the city’s haute geography to enhance the movement’s respectability. At the same time, they divided over how to respond to the good government initiatives reconfiguring the metropolitan government. Whether supporting them or remaining ambivalent, many inserted discussion of women’s rights into conversations about improving the municipality. A personal feud between Susan B. Anthony and Lillie Devereux Blake in the succeeding years produced a power vacuum in Gotham at century’s close. The resultant vacuum ensured that Gotham’s campaign would not be bogged down by outsiders’ mandates.
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Lane, Belden C. "Justice: The Meramec River at Times Beach and Mohandas Gandhi." In Backpacking with the Saints. Oxford University Press, 2015. http://dx.doi.org/10.1093/oso/9780199927814.003.0025.
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The spring-fed Meramec River wanders for 218 miles through six Missouri counties before it flows into the Mississippi eighteen miles south of St. Louis. It cuts across the northeastern corner of the Ozark Plateau, carving out bluffs of white dolomite limestone along its way. The stream passes by Onondaga Cave, Meramec State Park, and Meramec Caverns, becoming a lazy river fed by smaller tributaries and floated by weekend adventurers. Overhanging sycamores and cottonwoods crowd its banks. Springs and caves invite floaters to tie up their canoes and explore. Mussel beds are plentiful, as are crappie, rainbow trout, and channel cat. The name “Meramec,” in fact, comes from an Algonquin word meaning “ugly fish” or “catfish.” I’ve put the kayak into the water at the river’s Allenton access south of I-44 near Eureka, Missouri. Paddling eight miles downstream, I’ve stopped for the night just past the old Route 66 bridge near Times Beach. Today Times Beach is a ghost town, but it’s still remembered as the site of the worst environmental disaster in Missouri history. In the early 1970s, the country’s largest civilian exposure to dioxin (TCDD) occurred here along the banks of the Meramec. Waste oil containing the toxic chemical used in making Agent Orange was spread on the town streets in order to keep down the dust. The Environmental Protection Agency ended up buying out the entire town and incinerating everything. All that’s left of Times Beach today is what locals refer to as the “town mound,” a long raised embankment of incinerated dirt covered with grass. Since 1999, the site has been turned into Route 66 State Park, commemorating the Mother Road of public highways, begun in 1926. Historic Route 66 was the first of America’s cross-country highways, extending from Chicago to Los Angeles. It crossed the Meramec River at this point. Known as “The Main Street of America,” the road symbolized the nation’s fascination with the automobile and the movement west. “Get your kicks on Route Sixty- Six” crooned Nat King Cole in his R & B classic of the 1940s. Today the old concrete bridge over the river goes nowhere.
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Thrall, Grant Ian. "Hotel and Motel." In Business Geography and New Real Estate Market Analysis. Oxford University Press, 2002. http://dx.doi.org/10.1093/oso/9780195076363.003.0012.
Full textAbstract:
The key concepts, proceeding top-down, for market analysis for the hospitality industry are market segmentation, demand, and supply. Location or trade area comes into the analysis as an umbrella over these three concepts. Market niche and segmentation, demand, and supply are primary determinants to establishing the criteria for locating hospitality facilities. Whenever there have been sufficient numbers of travelers in search of food and shelter, some form of hostelry industry has arisen.1 The Code of Hammurabi (1800 B.C.E) referred to innkeeping (Winfree 1996). In the western countries, as the Romans established an extensive roadway system, taverns and inns followed at strategically spaced locations. The Roman roads were used for military travel, trade and commerce, and pilgrimage and tourism. These are the primary reasons we use roads today. The early inns were largely run by religious orders. However, in Europe, as commerce grew in the fifteenth century, lodging as a commercial activity began to replace innkeeping as a charitable activity. In the American colonial period during the seventeenth and eighteenth centuries, inns and taverns were an important part of commerce and cultural exchange. These facilities were designed after the inns and taverns of England, which were closely integrated into their communities. Inns and taverns did not intrude or disrupt the neighborhood; instead, they were thought of as being an integral part of the culture and activities of the neighborhood. Architecturally, early inns and taverns conformed to the look and feel of the surrounding neighborhood environment. Survivors of these early inns are the contemporary bed-and-breakfasts (B&Bs). The term hotel arose early in the nineteenth century and was used to distinguish a greater level of commercial activity than an inn. Hotels offered food, drink, retail shopping, and lodging. Hotels were also more intrusive in their neighborhoods. Instead of less than 10 rooms that typified many inns of the era, early hotels contained as many as 200 rooms, and rose to 6 floors in height. Many nineteenth-century hotels were the tallest buildings in town. Thus, the hospitality industry began its first cautious attempts at market segmentation and diversification. Inns remained, but hotels offered an alternative experience via amenity differentiation.
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"held not to be a building (Norfolk Constabulary v Seekings [1986] Crim LR 167); but a freezer which was 25 feet long, weighed three tons, was connected to the electricity supply and had been in place for at least two years, was held to be a building (B v Leathley [1979] Crim LR 314). The test is that laid down by Byles J in Stevens v Gourley (1859) CBNS 99 at 112, that the structure must be ‘of considerable size and intended to be permanent or at least to endure for a considerable period’. That entry into part of a building may amount to burglary means that a person may become a burglar (if the other elements of the offence are satisfied) by going from a part in which he is lawful visitor to a part in which he is not: see R v Walkington (extracted below). R v Walkington [1979] 1 WLR 1169 (CA)." In Sourcebook Criminal Law, 1066–67. Routledge-Cavendish, 1996. http://dx.doi.org/10.4324/9781843143093-201.
Full textConference papers on the topic "B feed down"
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Nnanna, A. G. Agwu, Chenguang Sheng, Kimberly Conrad, and Greg Crowley. "Performance Assessment of Pre-Filtration Strainer of an Ultrafiltration Membrane System by Particle Size Analysis." In ASME 2015 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2015. http://dx.doi.org/10.1115/imece2015-53447.
Full textAbstract:
One of the industrial applications of ultrafiltration membrane system is water purification and wastewater treatment. Membranes act as physical barriers by eliminating particles such as pollen, yeast, bacteria, colloids, viruses, and macromolecules from feed water. The effectiveness of the membrane to separate particles is determined by its molecular weight cut-off and feed water characteristics. Typically, pre-filtration strainers are installed upstream of an ultrafiltration membrane system to separate large particles from the flow stream. The criteria for selection of the strainer pore size is unclear and is often determined by the feed water average particle size distribution. This paper is motivated by the hydraulic loading failure of a 125 μm strainer by average feed water particle size of 1.6 μm when the volumetric flow is at or greater than 40% of the rated design flow capacity. The objective of this paper are to: a) determine if the feed particle size distribution is a sufficient parameter for selection of pre-filtration strainer, b) evaluate the effect of feed flow velocity on strainer performance, and c) enhance strainer performance using vortex generator. In this experimental study, a Single Particle Optical Sensing, Accusizer, was used to analyze particle size distribution of five water samples collected at strainer feed, strainer filtrate, and strainer backwash. All samples were analyzed using a lower detection limit of 0.5 μm. In order to capture more counts of the larger particles present in the sample, a second analysis was done for each sample at a higher detection limit, 5.09 μm for feed sample, and 2.15 μm for the rest of the samples. Particle size data based on individual detection limits were statistically combined to generate comprehensive blended results of total number and total volume. The volume was determined based on assumption that each particle is spherically shaped. The Particle Size Distribution Measurement Accuracy is ±0.035 μm. Results showed that the feed particle size diameter and volume was insufficient to determine strainer size. Particle size distribution is needed at the feed, filtrate, and backwash to evaluate the strainer particle separation efficiency. It was observed that the total particle count in the filtrate (4.4 × 106) was an order of magnitude higher than the feed (3.2 × 105). Specifically, the total count for particles with diameter less than 7.22 μm were higher in the filtrate while larger particle size ≥ 7.22 μm were more in the feed stream. It appears that the large particles in the feed breaks down into smaller particles at the strainer interface and the small particles (≤ 7.22μm) passed through the pore into the filtrate. The particle breakdown, detachment of particles in the strainer pore into the filtrate, and particle to particle interactions are enhanced by increase in flow velocity hence increasing the hydrodynamic shear that acts on attached particles. A vortex generator inserted in to the strainer reduced pore clogging and pressure drop.
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Denton, Mark S., and William D. Bostick. "New Innovative Electrocoagulation (EC) Treatment Technology for BWR Colloidal Iron Utilizing the Seeding and Filtration Electronically (SAFE™) System." In The 11th International Conference on Environmental Remediation and Radioactive Waste Management. ASMEDC, 2007. http://dx.doi.org/10.1115/icem2007-7186.
Full textAbstract:
The presence of iron (iron oxide from carbon steel piping) buildup in Boiling Water Reactor (BWR) circuits and wastewaters is decades old. In, perhaps the last decade, the advent of precoatless filters for condensate blow down has compounded this problem due to the lack of a solid substrate (e.g., powdex resin pre-coat) to help drop the iron out of solution. The presence and buildup of this iron in condensate phase separators (CPS) further confounds the problem when the tank is decanted back to the plant. Iron carryover here is unavoidable without further treatment steps. The form of iron in these tanks, which partially settles and is pumped to a de-waterable high integrity container (HIC), is particularly difficult and time consuming to dewater (low shear strength, high water content). The addition upstream from the condensate phase separator (CPS) of chemicals, such as polymers, to carry out the iron, only produces an iron form even more difficult to filter and dewater (even less shear strength, higher water content, and a gel/slime consistency). Typical, untreated colloidal material contains both sub-micron particles up to, let’s say 100 micron. It is believed that the sub-micron particles penetrate filters, or sheet filters, thus plugging the pores for what should have been the successful filtration of the larger micron particles. Like BWR iron wastewaters, fuel pools/storage basins (especially in the decon. phase) often contain colloids which make clarity and the resulting visibility nearly impossible. Likewise, miscellaneous, often high conductivity, wastesteams at various plants contain such colloids, iron, salts (sometimes seawater intrusion and referred to as Salt Water Collection Tanks), dirt/clay, surfactants, waxes, chelants, etc. Such wastestreams are not ideally suited for standard dead-end (cartridges) or cross-flow filtration (UF/RO) followed even by demineralizers. Filter and bed plugging are almost assured. The key to solving these dilemmas is 1) to break the colloid (i.e., break the outer radius repulsive charges of the similar charged colloidal particles), 2) allow these particles to now flocculate (floc), and 3) form a type of floc that is more readily filterable, and, thus, dewaterable. This task has been carried out with the innovative application of electronically seeding the feed stream with the metal of choice, and without the addition of chemicals common to ferri-floccing, or polymer addition. This patent-pending new system and technique is called Seeding And Filtration Electronically, or the SAFE™ System. Once the colloid has been broken and flocking has begun, removal of the resultant floc can be carried out by standard, backwashable (or, in simple cases, dead-end) filters; or simply in dewaterable HICs or liners. Such applications include low level radwaste (LLW) from both PWRs and BWRs, fuel pools, storage basins, salt water collection tanks, etc. For the removal of magnetic materials, such as some BWR irons, an ElectroMagnetic Filter (EMF) was developed to couple with the ElectroCoagulation (EC), (or metal-Floccing) Unit. In the advent that the wastestream primarily contains magnetic materials (e.g., boiler condensates and magnetite, and hemagnetite from BWRs), the material was simply filtered using the EMF. Bench-, pilot- and full-scale systems have been assembled and applied on actual plant waste samples quite successfully. The effects of initial feed pH and conductivity, as well as flocculation retention times was examined prior to applying the production equipment into the field. Since the initial studies (Denton, et al, EPRI, 2006), the ultimate success of field applications is now being demonstrated as the next development phase. For such portable field demonstrations and demand systems, a fully self enclosed (secondary containment) EC system was first developed and assembled in a modified B 25 Box (Floc-In-A-Box) and is being deployed to a number of NPP sites. Finally, a full-scale SAFE™ System has been deployed to Exelon’s Dresden NPP as a vault cleanup demand system. This is a 30 gpm EC system to convert vault solids/sludges to a form capable of being collected and dewatered in a High Integrity Container (HIC). This initial vault work will be on-going for approximately three months, before being moved to additional vaults. During the past year, additional refinements to the patent pending SAFE™ System have included the SAFER™ System (Scalant and Foulant Electronic Removal) for the removal by EC of silica, calcium and magnesium. This has proven to be an effective enabler for RO, NF and UF as a pretreatment system. Advantages here include smaller, more efficiently designed systems and allowed lower removal efficiencies with the removal of the limiting factor of scalants. Similarly, the SAFE™ System has been applied in the form of a BAC-UP™ System (Boric Acid Clean-Up) as an alternative to more complex RO or boric acid recycle systems. Lastly, samples were received from two different DOE sites for the removal of totally soluable, TDS, species (e.g., cesium, Cs, Sr, Tc, etc.). For these applications, an ion-specific seed (an element of the SMART™ System) was coupled with the Cs prior to EC and subsequent filtration and dewatering, for the effective removal of the cesium complex and the segregation of low level and high waste (LLW & HLW) streams.
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Mali, Prasanna, Abdulmuhsen Yousef Abdulmuhsen Hashim Al-Ali, Srinivas Rao Kommaraju, Ali Mussaed Al-Rushoud, Jignesh Shah, Mariam Zerai, and Hashem Fouzi Al-Abdullah. "Pilot Trial of New ES-HR-PCP Technology for Heavy Oil Reservoir." In International Petroleum Technology Conference. IPTC, 2016. http://dx.doi.org/10.2523/iptc-18859-ms.
Full textAbstract:
Abstract Kuwait Oil Company (KOC) has a vast pool of heavy oil reservoirs. Cost-effective artificial lift technologies, are required to produce these reservoirs, optimally. With this strategic objective, pilot of newly developed ‘ES-HR-PCP’ (Electrical Submersible Hydraulically Regulated PCP) technology, is carried out in KOC. Scope of this technical paper is to highlight significance of this technology and to share results of our pilot studies, which are carried out to maximize cold heavy oil production. With regard to our methodology, initially, techno-economic evaluation of ‘ES-HR-PCP’ system, is carried out. Selected well for the pilot, is having horizontal completion, with 3-1/2″ tubing and 7″ casing. Perforation is at 1900 feet MD (TVD at 686 feet). Oil API gravity is 17. Target liquid production rate is 200 b/d. After finalization of design, pilot of ‘ES-HR-PCP’ system is commissioned and pump performance is monitored for 6 months. Results are analyzed to determine success of the pilot. This study is based on actual field implementation and does not include lab studies. Technology evaluation has shown that ‘ES-HR-PCP’ system has definite edge over conventional PCP system. Standard PCP can handle only 25% of free gas; while ‘ES-HR-PCP’ can handle 90% of free gas, due to its unique design concept. ‘ES-HR-PCP’ system uses electric cable (and not sucker rods) and down- hole permanent magnet motor (PMM), to transmit power. PMM system can deliver more production, at higher speed; while expending less power. All these factors enable ‘ES-HR-PCP’, to be installed, near to the perforation zone, especially, in horizontal wells, thereby, allowing to attain lowest possible pump intake pressure and maximize production. During the pilot, peak liquid rate of 270 b/d (at 220 rpm), is achieved with installed ‘ES-HR-PCP’ system. Simulation studies also indicated that this technology could handle more than 40% of free gas, for given operating conditions. It is relevant to note that peak liquid rate of 223 b/d (at 375 rpm), is achieved, when this particular well, was installed with standard PCP, earlier. Substantial savings in power consumption is also witnessed by using ‘ES-HR-PCP’ system. Overall, performance of ‘ES-HR-PCP’ system, is observed highly encouraging during the pilot period. It is inferred from our studies that ‘ES-HR-PCP’ technology can offer distinct advantages over standard PCP, to accomplish, enhanced oil gain, operational flexibility and savings in operating expenses. Findings of this study can serve, as a valuable reference, for effective exploitation of heavy oil reservoirs of similar nature.
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Mamaev, B. I., M. M. Petukhovsky, and A. V. Pozdnyakov. "Shrouding the First Blade of High Temperature Turbines." In ASME 2013 Turbine Blade Tip Symposium. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/tbts2013-2001.
Full textAbstract:
Blade shrouding gives an opportunity to increase the HPT (high pressure turbine) first stage efficiency by 2–3 %. However, if high gas temperature and high circumferential velocity are at the stage, shrouding can be problematic due to load increasing at blade/disk attachment and high temperature of the shroud itself. To make blade/disk attachment more reliable the shroud axial width has to be decreased by increasing a relative pitch of airfoil cascades t (t = t / b, where t – pitch, b – chord) at the blade tip span. According to experience for a flow with β1 = 50 – 85°, M2 = 0.8 – 1, and Re = (0.8 – 1)•106 high efficient cascades with t = 0.93 – 1.05 can be designed. Application of such a profiling for GTE (gas turbine engine) turbine is demonstrated here. In the turbine meridian flow path the blade was drastically tapered to the tip (tip width was 53 % of the mean width and 46 % of the hub width). To lighten the blade a partial shrouding can be also applied. Model turbine tests showed that local cuts at the front shroud area and the aft shroud area at the airfoil pressure side influenced the efficiency weakly. Required shroud temperature is provided with a cooling. The aircraft turbine with a governed cooling system and a radial clearance control is an example here. In this case the shroud had 3 labyrinth ribs. The shrouding decreased radial clearance by 0.8 mm at main design modes that increased efficiency by ∼ 1.5 %. To cool down the shroud the air downstream the compressor was fed into the cavity behind the front labyrinth rib. At maximal mode with full cooling the relative coolant mass flow (to the compressor mass flow) was mc = 1.3 % and gas leakages through the labyrinth were 0.2 %. It gave acceptable mixed temperature of 530°C in the cavity over the shroud. At cruise high altitude mode and a lower gas temperature and partial cooling with mc = 0.4 % and gas leakages of 0.1 % the mixed temperature also did not exceed 530°C over the shroud. The assessment with taking into account changes of the clearance, the coolant mass flow, and gas leakages showed that the shrouding provided the engine economy improvement by 0.7 – 0.9 % for both modes. For GTPU (gas turbine power unit) the first blade shrouding can be more complicated. However, even the slight turbine efficiency increase provides considerable profits due to GTPU huge power output and long term running. So, when GTE and GTPU designing starts, it is reasonable to consider the turbine first blade shrouding. Here the integral evaluation criterion, which includes the assessment of a possible income from the unit full life cycle running, has to be applied.
Reports on the topic "B feed down"
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Kanner, Joseph, Edwin Frankel, Stella Harel, and Bruce German. Grapes, Wines and By-products as Potential Sources of Antioxidants. United States Department of Agriculture, January 1995. http://dx.doi.org/10.32747/1995.7568767.bard.
Full textAbstract:
Several grape varieties and red wines were found to contain large concentration of phenolic compounds which work as antioxidant in-vitro and in-vivo. Wastes from wine production contain antioxidants in large amounts, between 2-6% on dry material basis. Red wines but also white wines were found to prevent lipid peroxidation of turkey muscle tissues stored at 5oC. The antioxidant reaction of flavonoids found in red wines against lipid peroxidation were found to depend on the structure of the molecule. Red wine flavonoids containing an orthodihydroxy structure around the B ring were found highly active against LDL and membrane lipid peroxidation. The antioxidant activity of red wine polyphenols were also found to be dependent on the catalyzer used. In the presence of H2O2-activated myoglobin, the inhibition efficiency was malvidin 3-glucoside>catechin>malvidin>resveratol. However, in the presence of an iron redox cycle catalyzer, the order of effectiveness was resveratol>malvidin 3-glucoside = malvidin>catechin. Differences in protein binding were found to affect antioxidant activity in inhibiting LDL oxidation. A model protein such as BSA, was investigated on the antioxidant activity of phenolic compounds, grape extracts, and red wines in a lecithin-liposome model system. Ferulic acid followed by malvidin and rutin were the most efficient in inhibiting both lipid and protein oxidation. Catechin, a flavonal found in red-wines in relatively high concentration was found to inhibit myoglobin catalyzed linoleate membrane lipid peroxidation at a relatively very low concentration. This effect was studied by the determination of the by-products generated from linoleate during oxidation. The study showed that hydroperoxides are catalytically broken down, not to an alcohol but most probably to a non-radical adduct. The ability of wine-phenolics to reduce iron and from complexes with metals were also demonstrated. Low concentration of wine phenolics were found to inhibit lipoxygenase type II activity. An attempt to understand the bioavailability in humans of antocyanins from red wine showed that two antocyanins from red wine were found unchanged in human urine. Other antocyanins seems to undergo molecular modification. In hypercholesterolemic hamsters, aortic lipid deposition was significantly less in animals fed diets supplemented with either catechin or vitamin E. The rate of LDL accumulation in the carotid arteries was also significantly lower in the catechin and vitamin E animal groups. These results suggested a novel mechanism by which wine phenolics are associated with decreased risk of coronary heart diseases. This study proves in part our hypothesis that the "French Paradox" could be explained by the action of the antioxidant effects of phenolic compounds found at high concentration in red wines. The results of this study argue that it is in the interest of public health to increase the consumption of dietary plant falvonoids. Our results and these from others, show that the consumption of red wine or plant derived polyphenolics can change the antioxidant tone of animal and human plasma and its isolated components towards oxidative reactions. However, we need more research to better understand bioavailability and the mechanism of how polyphenolics affect health and disease.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.
Full textAbstract:
As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.