osi

The Pros and Cons of Diagnosing Diabetes With A1C

Enzo Bonora
May 1, 2011; 34:S184-S190
Diabetes




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In-Hospital Prognosis of Ppatients With Fasting Hyperglycemia After First Myocardial Infarction

John J O'Sullivan
Aug 1, 1991; 14:758-760
Short Report




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Effects of Metformin, Metformin Plus Rosiglitazone, and Metformin Plus Lifestyle on Insulin Sensitivity and {beta}-Cell Function in TODAY

TODAY Study Group
Jun 1, 2013; 36:1749-1757
TODAY Study




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Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

Deborah Young-Hyman
Dec 1, 2016; 39:2126-2140
Psychosocial Research and Care in Diabetes




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Consensus Development Conference on the Diagnosis of Coronary Heart Disease in People With Diabetes: 10-11 February 1998, Miami, Florida

American Diabetes Association
Sep 1, 1998; 21:1551-1559
Consensus Development Conference Report




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Memo: Prior COVID-19 diagnosis 'permanently disqualifying' for U.S. military service

Military Entrance Processing Stations won't process individuals who have had COVID-19 for military service, even if they've fully recovered from the virus, the Pentagon confirmed this week.




osi

The Pros and Cons of Diagnosing Diabetes With A1C

Enzo Bonora
May 1, 2011; 34:S184-S190
Diabetes




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Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council

Ofri Mosenzon
Aug 1, 2016; 39:S146-S153
II. Diabetes Treatment Options




osi

Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

Deborah Young-Hyman
Dec 1, 2016; 39:2126-2140
Psychosocial Research and Care in Diabetes




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Hoosiers welcome young dental patients for Give Kids A Smile national kickoff

Indianapolis -- Seven-year-old Jordan Randle made a big promise after visiting Give Kids A Smile for the first time during the national kickoff event Feb. 7 in Indianapolis.




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Study investigates cellular mechanism behind dental fluorosis

Results from a NYU College of Dentistry study suggest how excess fluoride exposure affects the cells forming tooth enamel — possibly explaining how dental fluorosis arises.




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Study: Dental fluorosis generally less noticeable over time

Results from a University of Iowa College of Dentistry study suggest that mild and moderate dental fluorosis is generally less noticeable over time, validating the beliefs of some supporters of community water fluoridation that there have been overestimates of fluorosis prevalence made by anti-fluoridation activists.




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OCR warns of imposter posing as investigator

Washington — The Office for Civil Rights released a statement April 3 warning of an individual posing as an OCR investigator. The imposter has been calling entities covered by the Health Insurance Portability and Accountability Act of 1996 in an attempt to get patient information.




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Crude prices rise after positive news from China

Oil prices rose early Tuesday, after Monday declines, possibly helped by some positive news from China -- but doubts remain as to whether that direction will hold.




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Poverty, lack of insurance can make heart failure prognosis worse, AHA says

Poverty and poor or non-existent health insurance coverage might worsen the effects of heart failure, the American Heart Association said Thursday.




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Suicide risk high in first year after brain cancer diagnosis

People with brain cancer are at increased risk for suicide compared to the general population, particularly within the first year following diagnosis, a new analysis has found.




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Clinical and Public Health Implications of 2019 Endocrine Society Guidelines for Diagnosis of Diabetes in Older Adults

OBJECTIVE

Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.

RESEARCH DESIGN AND METHODS

We included 2,236 adults aged ≥65 years without known diabetes from the 2005–2016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7–6.4% or FPG 100–125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7 to ≥9%). OGTT screening costs were estimated using Medicare fee schedules.

RESULTS

Diabetes prevalence was 15.7% (~5.0 million) using the Endocrine Society’s approach and 7.3% (~2.3 million) using the standard approach. Treatment eligibility ranged from 5.4 to 0.06% and 11.8–1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c <6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c/FPG (~18.3 million) with OGTT could cost between $737 million and $1.7 billion.

CONCLUSIONS

Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.




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Hospitalization for Lactic Acidosis Among Patients With Reduced Kidney Function Treated With Metformin or Sulfonylureas

OBJECTIVE

To compare the risk of lactic acidosis hospitalization between patients treated with metformin versus sulfonylureas following development of reduced kidney function.

RESEARCH DESIGN AND METHODS

This retrospective cohort combined data from the National Veterans Health Administration, Medicare, Medicaid, and the National Death Index. New users of metformin or sulfonylureas were followed from development of reduced kidney function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 or serum creatinine ≥1.4 mg/dL [female] or 1.5 mg/dL [male]) through hospitalization for lactic acidosis, death, loss to follow-up, or study end. Lactic acidosis hospitalization was defined as a composite of primary discharge diagnosis or laboratory-confirmed lactic acidosis (lactic acid ≥2.5 mmol/L and either arterial blood pH <7.35 or serum bicarbonate ≤19 mmol/L within 24 h of admission). We report the cause-specific hazard of lactic acidosis hospitalization between metformin and sulfonylureas from a propensity score–matched weighted cohort and conduct an additional competing risks analysis to account for treatment change and death.

RESULTS

The weighted cohort included 24,542 metformin and 24,662 sulfonylurea users who developed reduced kidney function (median age 70 years, median eGFR 55.8 mL/min/1.73 m2). There were 4.18 (95% CI 3.63, 4.81) vs. 3.69 (3.19, 4.27) lactic acidosis hospitalizations per 1,000 person-years among metformin and sulfonylurea users, respectively (adjusted hazard ratio [aHR] 1.21 [95% CI 0.99, 1.50]). Results were consistent for both primary discharge diagnosis (aHR 1.11 [0.87, 1.44]) and laboratory-confirmed lactic acidosis (1.25 [0.92, 1.70]).

CONCLUSIONS

Among veterans with diabetes who developed reduced kidney function, occurrence of lactic acidosis hospitalization was uncommon and not statistically different between patients who continued metformin and those patients who continued sulfonylureas.




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Strict Preanalytical Oral Glucose Tolerance Test Blood Sample Handling Is Essential for Diagnosing Gestational Diabetes Mellitus

OBJECTIVE

Preanalytical processing of blood samples can affect plasma glucose measurement because on-going glycolysis by cells prior to centrifugation can lower its concentration. In June 2017, ACT Pathology changed the processing of oral glucose tolerance test (OGTT) blood samples for pregnant women from a delayed to an early centrifugation protocol. The effect of this change on the rate of gestational diabetes mellitus (GDM) diagnosis was determined.

RESEARCH DESIGN AND METHODS

All pregnant women in the Australian Capital Territory (ACT) are recommended for GDM testing with a 75-g OGTT using the World Health Organization diagnostic criteria. From January 2015 to May 2017, OGTT samples were collected into sodium fluoride (NaF) tubes and kept at room temperature until completion of the test (delayed centrifugation). From June 2017 to October 2018, OGTT samples in NaF tubes were centrifuged within 10 min (early centrifugation).

RESULTS

A total of 7,509 women were tested with the delayed centrifugation protocol and 4,808 with the early centrifugation protocol. The mean glucose concentrations for the fasting, 1-h and 2-h OGTT samples were, respectively, 0.24 mmol/L (5.4%), 0.34 mmol/L (4.9%), and 0.16 mmol/L (2.3%) higher using the early centrifugation protocol (P < 0.0001 for all), increasing the GDM diagnosis rate from 11.6% (n = 869/7,509) to 20.6% (n = 1,007/4,887).

CONCLUSIONS

The findings of this study highlight the critical importance of the preanalytical processing protocol of OGTT blood samples used for diagnosing GDM. Delay in centrifuging of blood collected into NaF tubes will result in substantially lower rates of diagnosis than if blood is centrifuged early.




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Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

OBJECTIVE

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

RESEARCH DESIGN AND METHODS

Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular End Points (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.

RESULTS

Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or in new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.

CONCLUSIONS

Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.




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Why is My Child Defiant or Explosive?

Dedicated to the lady at Walmart with the screaming kid and all of us "good parents" who have been that lady at Walmart.

One of the most difficult behaviors for parents or teachers to address is explosive behavior, a child who has little control over emotions and "melts down" in the classroom or at home.  It is frustrating, it is embarrassing, it is anxiety producing, it causes intense emotions in ourselves.  Parents agonize over why it happens or what they did wrong?  Often the parents are blamed or judged by bystanders in stores, family members, friends, or school staff.  However, I have seen parents with a variety of parenting styles have kids with poor emotional control, including those who are strict, those who are quick to give in, those who spank, those who use time out, those who take away privileges, and a whole lot of parents who feel like they have tried everything.  I know children with very little emotional control from homes that are falling apart, from homes that are loving and supportive, from poor families, from affluent families, from parents who have no clue how to parent, from parents with excellent skills, even from School Psychologists.  This is not to say that parenting styles do not have a role in this, but there IS more to it.  We have to stop judging each other and get to the root of the problem.  

What is the Root of the Problem?

The problem, the reason some children "explode" or act out with little emotional control, is because he or she is lacking a skill.  Emotional control is a skill.  Most kids will learn this skill through consistent discipline strategies, but some do not. 

Another way to look at it.

We don't tell our kids how to read and then expect them to do it.  We show them step by step.  Some kids will pick it up easy, others will need to be taught and retaught and retaught and will need extensive help in doing so.  Do we blame ourselves?  Do we look at our friends judgementally and think to ourselves "look at the book she is using, it's all wrong?"  No, we assume the child has a problem learning to read and we find a way to teach him.  WE HAVE TO START LOOKING AT BEHAVIOR IN THE SAME WAY.  When a child is exploding, the first step should not be to label the child or blame the parent.  Lets start looking for the skill that is lacking.  When we find that skill, lets teach it.

It's NOT always a control issue.  Sometimes kids act out because they have not been taught to obey and respect authority, but sometimes they act out in spite of good training at home.  The explosions lead to self esteem problems in the child and the child feeling like a "bad kid," which in turn makes explosions bigger and more frequent.  Have you ever looked at a screaming child and demanded he control himself right now or "act your age."  It's a common thing to do.  Have you ever looked at a child with a Learning Disability and said "read on your grade level, now!" or "I have told you and told you how to read, why aren't you reading?"  Of course you haven't.  We work with the reader at his level and patiently try different strategies to improve reading.  We can't demand them to be good readers and we can't demand that a child who does not have the skills to control his emotions "act his age."  These explosive kids need skills and truth be told, we who work with these kids need skills. 

If you are a parent with a child who acts "out of control" stop blaming yourself.  It isn't necessarily because you spanked or didn't spank or were too strict or too lenient.  Your child is lacking the skills she needs to control her emotions.  Also, realize you are going to need to learn new skills to help your child learn the lacking skills.  You are no longer in the Parenting 101 class, you need to move on to the Advanced skill- teaching parenting class. 

The BEST book I have read on this topic is The Explosive Child by Ross Greene.  He addresses the skills these children might be lacking and he has great strategies to address the issue. (see Amazon link below)

If you are a teacher and have an "explosive child" in your class, rethink your perspective of the student.  The child needs to learn skills, so lets focus on teaching the skills and being patient with the children who are slower to learn emotional control.  We as school staff can not make excuses or blame the parents.  We have to reach the child at her level.  We teach a child to read at her level.  We must teach a child to control emotions at her level as well. 

Challenge for Everyone
Let us stop labeling these kids with emotional skill deficits as "bad kids" and stop judging the parents.  Let's be honest with ourselves and recognize we all have shortcomings and could use skills in certain areas.  Maybe our kids need skills in emotional control, maybe we do, maybe we need skills in teaching emotional control, or maybe we need skills in some other area all together.  Let's be patient with our children and our peers and ourselves. Let's stop criticizing ourselves and others and start learning and teaching new skills.   We don't live in a world with bad kids, we live in a world will kids who need skills, so let's teach.





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Mexican Migration to Canada: Temporary Worker Programs, Visa Imposition, and NAFTA Shape Flows

Mexicans migrate to Canada in much smaller numbers than to the United States, yet over the last 30 years the country has become an increasingly attractive destination. Canada prioritizes highly skilled, educated Mexicans for permanent residency, but also attracts temporary workers from Mexico. This article examines Mexican migration to Canada and how it has been shaped by visa requirements, trade policy, and more.




osi

Andrew Cuomo says N.Y. has COVID-19 'on the run'; Mike Pence aide tests positive

Vice President Mike Pence's press secretary has tested positive for the coronavirus disease, the White House said Friday. In New York, Gov. Andrew Cuomo said the state is finally getting ahead of the virus.




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IRS sets deadline to enter direct deposit information for stimulus checks

The Internal Revenue Service said Wednesday is the last day for Americans to provide their direct deposit information to receive their stimulus checks directly to their bank accounts.




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CBS orders first seasons of 'Clarice,' 'Equalizer,' 'B Positive' for 2020-21

CBS said it has ordered first seasons of three new shows -- "Clarice," "The Equalizer" and "B Positive" for the 2020-21 television season.




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Two Views of the Same News Find Opposite Biases

You could be forgiven for thinking the television images in the experiment were from 2006. They were really from 1982: Israeli forces were clashing with Arab militants in Lebanon. The world was watching, charges were flying, and the air was thick with grievance, hurt and outrage.




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The Color of Health Care: Diagnosing Bias in Doctors

Long before word recently broke that white referees in the National Basketball Association were calling fouls at a higher rate on black athletes than on white athletes, and long before studies found racial disparities in how black and white applicants get called for job interviews, researchers no...





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Is the Door Closing? Latin American and Caribbean Responses to Venezuelan Migration

This webinar marks the release of MPI's Latin American and Caribbean Migration Portal that offers up-to-date, authoritative research and data on migration trends and policies, and a report examining the policy responses of 11 countries in Latin America and the Caribbean to increased Venezuelan and Nicaraguan migration.




osi

Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry

OBJECTIVE

Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes.

RESEARCH DESIGN AND METHODS

Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization.

RESULTS

MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7–11.6] and 3.9 [95% CI 2.8–5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21–3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%.

CONCLUSIONS

For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.




osi

Is the Door Closing? Latin American and Caribbean Responses to Venezuelan Migration

Fleeing crisis, nearly 4 million Venezuelans have moved to other Latin American and Caribbean countries over the past few years. This webinar marked the launch of a Latin American and Caribbean Migration Portal, and a report examining the migration and integration policy responses in the region. 




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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Margaret A. Powers
Apr 1, 2016; 34:70-80
Position Statements




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Opportunities and Challenges for Biosimilars: What's on the Horizon in the Global Insulin Market?

Lisa S. Rotenstein
Oct 1, 2012; 30:138-150
Features




osi

Building Therapeutic Relationships: Choosing Words That Put People First

Jane K. Dickinson
Jan 1, 2017; 35:51-54
Commentary




osi

Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment

Jennifer M. Perkins
Apr 1, 2007; 25:57-62
Feature Articles




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A campaign for period positivity | Ananya Grover

Having your period is exhausting -- and for many people across the world, menstruation is even more challenging because of stigmas and difficulty getting basic hygiene supplies, says social activist Ananya Grover. In this uplifting, actionable talk, she shares how "Pravahkriti," her campaign to spread period positivity, creatively engages with everyone to promote menstrual health, raise awareness and break taboos around periods.




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How to spark your curiosity, scientifically | Nadya Mason

Curious how stuff works? Do a hands-on experiment at home, says physicist Nadya Mason. She shows how you can demystify the world around you by tapping into your scientific curiosity -- and performs a few onstage experiments of her own using magnets, dollar bills, dry ice and more.




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Annual Interdisciplinary Symposium on Decision Neuroscience (ISDN), Philadelphia, June 5-6, 2020

DEADLINE FOR ORAL PRESENTATIONS: FEB 15, 2020 On June 5-6 2020, Temple University will host the 10th Annual Interdisciplinary Symposium on Decision Neuroscience (ISDN) in Philadelphia, PA. This symposium is unique in that it brings together a range of constituencies involved in the use of neuroscience techniques to understand consumer decision making – world renowned […]

The post Annual Interdisciplinary Symposium on Decision Neuroscience (ISDN), Philadelphia, June 5-6, 2020 appeared first on Decision Science News.




osi

Despite Fierce Teacher Opposition, West Virginia House Votes to Allow Charter Schools

The West Virginia House of Delegates passed its version of a sweeping education omnibus bill, which would allow the state's first charter schools.




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Maryland extends school closings through May 15 due to virus




osi

Thor's Ranked UDFA Signings by Position

Thor Nystrom ranks the top UDFA signings by position, plus CFL draft picks and the best available unsigned prospects. (Getty Images)




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Don't worry about the rent : choosing new office space to boost business performance / Darren Bilsborough.




osi

Luminosity.




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Understanding the Stolen Generations through their stories : from the inaugural Stolen Generation Summit Elder Abuse Prevention and Positive Aging Summit : a resource for the aged care workforce / ARAS.

Two Aboriginal Elders, one of whom had been removed from her family as a child, and the other who was affected by siblings and other family members being removed, provided consent to share their personal stories specifically for this resource, with the vision that people would be better informed and communication improved when delivering care. To respect their privacy, their stories have been de-identified.




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Interim technical report : project 3.1 : 3D seismic exploration for hard rock environments : seismic exploration of nickel deposits / Milovan Urosevic and DET CRC Project 3.1 Researchers.

"Researchers of DETCRC 3.1 project acquired substantial experience in seismic exploration of Nickel deposits across Yilgarn craton, Western Australia. There are many lessons learnt and various approaches trialled. The validity of the research conducted and the outputs achieved were verified against real field data provided by the sponsors and affiliates to DET CRC. Research quality was scrutinised by publishing in high level journals. In general high quality images are achieved over nickel rich Kambalda province that allowed for an accurate structural interpretation. Rock identification and characterisation is still challenging particularly due to lack of calibration of seismic images with borehole logs and borehole seismic. Several case histories are documented and briefly analysed. The difference between Komatiitic nickel deposit of Australia and Canada is also commented in light of seismic response and required technology for its detection" -- Executive summary.




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Interim technical report : project 3.1 : lower cost, more effective 3D seismic exploration for hard rock environments : seismic exploration for mineral deposits case study summary table / authors: Milovan Urosevic, Andrej Bona.

"This document is intended to summarise the current state, understanding and the use of seismic reflection method for mineral exploration. Its primary objective is to provide a point of reference, based on actual case studies, for mineral explorers interested in the application of seismic methods to their project. It provides summary information (including the purpose of the survey, acquisition methods, geometry and cost, processing procedures and key findings) that are intended to provide the reader with an objective means of assessing the cost effectiveness of the technique with respect to exploration objectives. It is also aimed at exchange of information between DETCRC sponsors, affiliates and researchers. Finally we hope that this table will help in shaping future research efforts and direction within Project 3.1, regarding the application of seismic for mineral exploration.This is only initial work and it is hoped that it will evolve into a document or a catalogue that will be extensively used by the mineral industry to achieve their exploration objectives in more efficient and effective way" -- Executive summary.




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Choosing Down syndrome : ethics and new prenatal testing technologies / Chris Kaposy.

Down syndrome -- Diagnosis -- Moral and ethical aspects.




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Invisible women : exposing data bias in a world designed for men / Caroline Criado Perez.

Sex discrimination against women.




osi

The diagnosis and treatment of diseases of the kidney, amenable to direct surgical interference / by W. Bruce Clarke.

London : H.K. Lewis, 1886.




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The diagnosis, prevention, & treatment of diseases of the heart, and of aneurism : with observations on rheumatism / by J.J. Furnivall.

London : J. Churchill, 1845.