Adalimumab Injection

MedlinePlus

... causes pain, swelling, and damage) including the following: rheumatoid arthritis (a condition in which the body attacks its ... If you are using adalimumab injection to treat rheumatoid arthritis, your doctor may tell you to inject the ...

Diabetes - what to ask your doctor - type 2

MedlinePlus

... Diabetes - keeping active Diabetes - low blood sugar - self-care Diabetes - preventing heart attack and stroke Diabetes - taking care of your feet Diabetes - tests and checkups Diabetes - when you are sick ...

Golimumab Injection

MedlinePlus

... body and causes pain, swelling, and damage) including: rheumatoid arthritis (condition in which the body attacks its own ... doctor.If golimumab injection is used to treat rheumatoid arthritis, it may also be injected intravenously (into a ...

Exposure to the World Trade Center Attack and the Use of Cigarettes and Alcohol Among New York City Public High-School Students

PubMed Central

Wu, Ping; Duarte, Cristiane S.; Mandell, Donald J.; Fan, Bin; Liu, Xinhua; Fuller, Cordelia J.; Musa, George; Cohen, Michael; Cohen, Patricia; Hoven, Christina W.

2006-01-01

We examined exposure to the World Trade Center attack and changes in cigarette smoking and drinking among 2731 New York City public high-school students evaluated 6 months after the attack. Increased drinking was associated with direct exposure to the World Trade Center attack (P < .05). Increased smoking was not directly associated with exposure to the World Trade Center attack but was marginally significantly associated with posttraumatic stress disorder (P= .06). Our findings suggest that targeted substance-use interventions for youths may be warranted after large-scale disasters. PMID:16571705

When You Visit Your Doctor After a Heart Attack

MedlinePlus

... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

Rabies Exposure: When Should I Seek Medical Attention?

MedlinePlus

... Rabies and Kids! When should I seek medical attention? Language: English Spanish Recommend on Facebook Tweet Share ... with soap and water. See your doctor for attention for any trauma due to an animal attack ...

Treating Asthma in Children Ages 12 and Older

MedlinePlus

... allergy-induced asthma Your doctor may recommend allergy shots (immunotherapy) if an allergy induces asthma attacks and ... dust mites or pollens. The purpose of allergy shots is to build up a tolerance by gradually ...

Drug-Eluting Stents: Do They Increase Heart Attack Risk?

MedlinePlus

... nitrates or calcium channel blockers, as well as aspirin and cholesterol-lowering drugs called statins. With medications, ... doctor will likely also prescribe medications, such as aspirin and statins, and lifestyle changes. Angioplasty and bare- ...

A Standard Mutual Authentication Protocol for Cloud Computing Based Health Care System.

PubMed

Mohit, Prerna; Amin, Ruhul; Karati, Arijit; Biswas, G P; Khan, Muhammad Khurram

2017-04-01

Telecare Medical Information System (TMIS) supports a standard platform to the patient for getting necessary medical treatment from the doctor(s) via Internet communication. Security protection is important for medical records (data) of the patients because of very sensitive information. Besides, patient anonymity is another most important property, which must be protected. Most recently, Chiou et al. suggested an authentication protocol for TMIS by utilizing the concept of cloud environment. They claimed that their protocol is patient anonymous and well security protected. We reviewed their protocol and found that it is completely insecure against patient anonymity. Further, the same protocol is not protected against mobile device stolen attack. In order to improve security level and complexity, we design a light weight authentication protocol for the same environment. Our security analysis ensures resilience of all possible security attacks. The performance of our protocol is relatively standard in comparison with the related previous research.

The World Trade Center attack. Observations from New York's Bellevue Hospital.

PubMed

Roccaforte, J D

2001-12-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics.

Atrial Fibrillation

MedlinePlus

... pain Dizziness or fainting Fatigue Confusion AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure. Doctors diagnose AF using family and medical history, a physical exam, and a test called an ...

The World Trade Center Attack: Observations from New York's Bellevue Hospital

PubMed Central

Roccaforte, J David

2001-01-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics. PMID:11737913

[Differences in attitude toward patient-centeredness in patients and physicians].

PubMed

Kim, Min-Jeong

2013-06-01

There have been studies on the patient-centeredness of medical students and physicians in South Korea, but no result has presented the patient-centered attitude of patients and doctors. So, this study intended to compare the attitudes of patients and doctors toward the roles that patients and physicians should play in the health care process. One hundred and fifteen doctors and 264 patients participated in this survey using a structured questionnaire, including sociodemographic data and Patient Practitioner Orientation Scale (PPOS). The PPOS comprises sharing (sharing information, take part in decision making) and caring (respecting one's feelings, interpersonal relationships) subscales. The PPOS scores of the doctors and patient were 3.02 and 3.20. In detail, the doctors' sharing and caring scores were and 3.02 and 3.48, and the those of patients were 3.14 and 3.12, respectively. This results are enough to demonstrate that patients are likely to be patient-centered with regard to sharing and that doctors tend to be patient-centered in terms of caring. The patients' desire to obtain medical information and take part in decision making (sharing) are greater than those of doctors. Doctors had more patient-centered attitude than patients in terms of respects for one's feelings and interpersonal relationships (caring).

Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

PubMed

Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

2005-03-01

Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p < 0.001). Most of the 22 physicians (91%) reported that the diary enabled them to better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

Domestic Event Support Operations (DESO)

DTIC Science & Technology

2012-02-01

Examples include EOD Technicians, doctors, nurses , and signalers. The capability also needed dedicated support from DSTO, which eventually became...attacks led to the postponement of CHOGM 2001 and the suspension of Operation GUARDIAN. The activity was rescheduled for March 2002 to be held in the

Trigeminal Neuralgia

MedlinePlus

... and forehead Pain affecting one side of the face at a time, though may rarely affect both sides of the face Pain focused in one spot or spread in a wider pattern Attacks that become more frequent and intense over time When to see a doctor If you experience ...

A Novel Network Attack Audit System based on Multi-Agent Technology

NASA Astrophysics Data System (ADS)

Jianping, Wang; Min, Chen; Xianwen, Wu

A network attack audit system which includes network attack audit Agent, host audit Agent and management control center audit Agent is proposed. And the improved multi-agent technology is carried out in the network attack audit Agent which has achieved satisfactory audit results. The audit system in terms of network attack is just in-depth, and with the function improvement of network attack audit Agent, different attack will be better analyzed and audit. In addition, the management control center Agent should manage and analyze audit results from AA (or HA) and audit data on time. And the history files of network packets and host log data should also be audit to find deeper violations that cannot be found in real time.

Surveillance versus Privacy: Considerations for the San Bernardino Community

ERIC Educational Resources Information Center

Price, Robert

2017-01-01

This privacy versus security doctoral research examines existing literature, policies, and perceptions to identify the effects of the 2015 San Bernardino terrorist attack on the San Bernardino community. This study contributes to identifying factors that influence perceptions of governmental surveillance. Multiple articles contribute to the…

Migraine Variants in Children

MedlinePlus

... to tell your doctor since a new treatment approach may be needed. Live healthy Your child’s migraine attacks can be brought on by many factors, big and small—not getting enough sleep (or getting too much), stressing out about life events like a big test, family troubles, illness or death of a loved ...

The Police and Criminal Evidence Bill under attack.

PubMed

Deitch, Rodney

1983-03-26

The British Medical Association and the Royal College of General Practitioners are among groups objecting to the Police and Criminal Evidence Bill scheduled to reach the House of Lords in May 1983. A clause in the bill would allow police access, with the permission of a circuit judge, to the records of doctors, solicitors, and members of the clergy. Medical organizations are concerned about the impact on health care if the confidential physician patient relationship is threatened and doctors become reluctant to keep detailed records. Strong opposition to the bill is expected in the House of Lords.

Sipuleucel-T Injection

MedlinePlus

... doctor or nurse in a doctor's office or infusion center. It is usually given once every 2 ... injection may cause serious allergic reactions during an infusion and for about 30 minutes afterwards. A doctor ...

The Professional Doctorate in Nursing: A Position Paper

ERIC Educational Resources Information Center

Newman, Margaret A.

1975-01-01

The need for family-centered health care could be met by nurses now if they had a professional doctorate and the recognition and authority that go with it. The author distinguishes between an academic doctorate (Preparation for scholars) and a professional doctorate (a practice degree). (Author/BP)

The Wisconsin-Spencer Doctoral Research Program: An Evaluation

ERIC Educational Resources Information Center

Leonard, Mary; Fennema, Elizabeth

2008-01-01

Background/Context: At a time when educational research is recognized as capable of improving teaching and learning, it is under attack for falling short of this promise. Part of the solution lies in improving the preparation of educational researchers. Toward this goal, the UW-Madison School of Education (SOE) participated with the Spencer…

Analysis of the influence location of the fiber optic sensor on the measurement and determination the heart rate of the human body

NASA Astrophysics Data System (ADS)

Nedoma, Jan; Fajkus, Marcel; Martinek, Radek; Cubik, Jakub; Kepak, Stanislav; Vanus, Jan; Zboril, Ondrej; Vasinek, Vladimir

2017-10-01

Authors of this article focused on the analysis of the influence location of the fiber-optic sensor on the measurement and determination the heart rate of the human body. The sensor uses a Fiber Bragg Grating (FBG) and is encapsulated in the polymer polydimethylsiloxane (PDMS). The combination of fiber-optic technology and its encapsulation in a polymer PDMS allows the use of the sensor e.g. in magnetic resonance environments (MRI). Among currently solved doctors requirements belongs field focusing on the study of hyperventilation and panic attacks of patients during MRI examination due to their very frequent occurrence. Proposed FBG sensor can help doctors to predict (based on heart rate) hyperventilation and panic attacks of patients during MRI examinations. For the most accurate determination of the heart rate, it is necessary to know the influence location of the sensor on the human body. The sensor functionality and analysis of the sensor placement on the heart rate has been verified by a series of real experimental measurements of test subjects in laboratory environment.

Exploring the safety measures by doctors on after-hours house call services.

PubMed

Ifediora, Chris

2015-01-01

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits. The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC. A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014. There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70-14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12-0.99). Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.

Questions to Ask Your Doctor--Implantable Cardioverter Defibrillator (ICD)

MedlinePlus

... affect my family member or me because of gender? Does age have any bearing on how the ICD works? Does one kind of therapy ... brief, easy to follow and easy to read. Many topics also available in Spanish . ... 4 Warning Signs of a Heart Attack 5 How to Eat Healthy 6 What are the Symptoms ...

From downtrodden to influential: the global campaign to empower nurses.

PubMed

2017-06-07

Nurses have spent decades trying to shake off the image of being doctors' handmaidens, yet still the stereotype exists. In recent weeks their professionalism, skills and expertise have been highlighted by responses to terror attacks in Manchester and London, but dented by constant references in the general election campaign to nurses using food banks.

Running, Heart Disease, and the Ironic Death of Jim Fixx.

ERIC Educational Resources Information Center

Plymire, Darcy C.

2002-01-01

Runner Jim Fixx wrote a book about running and died young of a heart attack while running. Fixx and other authors believed heart disease resulted from overcivilization and recommended running as a way of life and cure, advising readers to listen to their bodies instead of their doctors. Fixx's adherence to that philosophy explains his behavior…

An Efficient and Practical Smart Card Based Anonymity Preserving User Authentication Scheme for TMIS using Elliptic Curve Cryptography.

PubMed

Amin, Ruhul; Islam, S K Hafizul; Biswas, G P; Khan, Muhammad Khurram; Kumar, Neeraj

2015-11-01

In the last few years, numerous remote user authentication and session key agreement schemes have been put forwarded for Telecare Medical Information System, where the patient and medical server exchange medical information using Internet. We have found that most of the schemes are not usable for practical applications due to known security weaknesses. It is also worth to note that unrestricted number of patients login to the single medical server across the globe. Therefore, the computation and maintenance overhead would be high and the server may fail to provide services. In this article, we have designed a medical system architecture and a standard mutual authentication scheme for single medical server, where the patient can securely exchange medical data with the doctor(s) via trusted central medical server over any insecure network. We then explored the security of the scheme with its resilience to attacks. Moreover, we formally validated the proposed scheme through the simulation using Automated Validation of Internet Security Schemes and Applications software whose outcomes confirm that the scheme is protected against active and passive attacks. The performance comparison demonstrated that the proposed scheme has lower communication cost than the existing schemes in literature. In addition, the computation cost of the proposed scheme is nearly equal to the exiting schemes. The proposed scheme not only efficient in terms of different security attacks, but it also provides an efficient login, mutual authentication, session key agreement and verification and password update phases along with password recovery.

Attack Detection in Sensor Network Target Localization Systems With Quantized Data

NASA Astrophysics Data System (ADS)

Zhang, Jiangfan; Wang, Xiaodong; Blum, Rick S.; Kaplan, Lance M.

2018-04-01

We consider a sensor network focused on target localization, where sensors measure the signal strength emitted from the target. Each measurement is quantized to one bit and sent to the fusion center. A general attack is considered at some sensors that attempts to cause the fusion center to produce an inaccurate estimation of the target location with a large mean-square-error. The attack is a combination of man-in-the-middle, hacking, and spoofing attacks that can effectively change both signals going into and coming out of the sensor nodes in a realistic manner. We show that the essential effect of attacks is to alter the estimated distance between the target and each attacked sensor to a different extent, giving rise to a geometric inconsistency among the attacked and unattacked sensors. Hence, with the help of two secure sensors, a class of detectors are proposed to detect the attacked sensors by scrutinizing the existence of the geometric inconsistency. We show that the false alarm and miss probabilities of the proposed detectors decrease exponentially as the number of measurement samples increases, which implies that for sufficiently large number of samples, the proposed detectors can identify the attacked and unattacked sensors with any required accuracy.

Use of Learner-Centered Instructional Strategies in Higher Education: Doctoral Student Assessments

ERIC Educational Resources Information Center

Browne-Ferrigno, Tricia; Muth, Rodney

2012-01-01

Based on multiple sources, this article concludes that, when learner-centered instructional strategies are used with doctoral students, these adult learners take charge of their individual and collective learning, become accountable for both, and enhance their ability to transfer learning to practice. The students studied skills of developed teams…

"Empathize with Me, Doctor!" Medical Undergraduates Training Project: Development, Application, Six-Months Follow-Up

ERIC Educational Resources Information Center

Kiosses, Vasileios N.; Tatsioni, Athina; Dimoliatis, Ioannis D. K.; Hyphantis, Thomas

2017-01-01

The aim of the study was to assess the effectiveness of specially designed, empathy training for medical undergraduates, based on the principles of Person-Centered Approach. Within the context of the humanistic person-centered patient care, the experiential, 60-hour "Empathize with me, Doctor!" training program contains theory, personal…

34 CFR 685.218 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., 2001, documentation of the discharge may be used as an alternative to the documentation in paragraphs... of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... a doctor of medicine or osteopathy and legally authorized to practice in a state, that the...

34 CFR 685.218 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., 2001, documentation of the discharge may be used as an alternative to the documentation in paragraphs... of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... a doctor of medicine or osteopathy and legally authorized to practice in a state, that the...

34 CFR 685.218 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., 2001, documentation of the discharge may be used as an alternative to the documentation in paragraphs... of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... a doctor of medicine or osteopathy and legally authorized to practice in a state, that the...

34 CFR 685.218 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., 2001, documentation of the discharge may be used as an alternative to the documentation in paragraphs... of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... a doctor of medicine or osteopathy and legally authorized to practice in a state, that the...

New Directions for the Ph.D.?

ERIC Educational Resources Information Center

Deener, David R.

The award rate of doctorates has tripled since 1960 and the projections indicate that by 1980 the rate will be somewhere between 60 and 70,000. In recent years every facet of the PhD has come under attack. The degree will probably be reshaped from a standard of achievement and accomplishment to a standard of potential, from a demonstration of the…

A secure biometrics-based authentication scheme for telecare medicine information systems.

PubMed

Yan, Xiaopeng; Li, Weiheng; Li, Ping; Wang, Jiantao; Hao, Xinhong; Gong, Peng

2013-10-01

The telecare medicine information system (TMIS) allows patients and doctors to access medical services or medical information at remote sites. Therefore, it could bring us very big convenient. To safeguard patients' privacy, authentication schemes for the TMIS attracted wide attention. Recently, Tan proposed an efficient biometrics-based authentication scheme for the TMIS and claimed their scheme could withstand various attacks. However, in this paper, we point out that Tan's scheme is vulnerable to the Denial-of-Service attack. To enhance security, we also propose an improved scheme based on Tan's work. Security and performance analysis shows our scheme not only could overcome weakness in Tan's scheme but also has better performance.

Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice.

PubMed

Friedman, David S; Hahn, Steven R; Quigley, Harry A; Kotak, Sameer; Kim, Elizabeth; Onofrey, Meaghan; Eagan, Corey; Mardekian, Jack

2009-12-01

To assess doctor-patient communication in patients with glaucoma. Observational cohort study. Twenty-three ophthalmologists and 50 patients with glaucoma. Doctor-patient encounters were audio- and videotaped and analyzed using validated sociolinguistic approaches. After the visit, the doctor and the patient completed questionnaires, and patients were interviewed using a semistructured, patient-centered protocol. Summary statistics about doctor-patient encounters, assessment of alignment of attitudes between patients and doctors, and patient admission to missing doses. Physicians spent an average of 8.0 (standard deviation [SD], 3.1; median, 7.8) minutes in the room with the patient and an average of 5.8 (SD, 2.4; median, 7.5) minutes talking with the patient, delivering 70% of all spoken words and asking two thirds of all questions. Glaucoma-related discussion occupied 50% of talk time and was focused primarily on examinations and treatment (25%). One third of discussions addressed ocular issues other than glaucoma. Virtually all physician questions (94%) were closed ended. Most patient questions were about intraocular pressure (20% of visits), details of the medication regimen (20%), disease status (14%), and testing (12%). Although physicians and patients were aligned in believing that the physician should control the visit agenda, physicians tended to support greater physician control of decision making than did patients. Physicians failed to identify most patients who admitted to missing doses, a surrogate for nonadherence, stating that 10 of 13 in this category were taking drops "all" or "most" of the time. Physician interviews detected 3 of the 11 patients whose postvisit questionnaire indicated missing a dose in the last week compared with 11 of the 11 detected by the postvisit research interview. Patients who stated they had missed doses recently reported being less satisfied with the doctor-patient encounter than those who did not. Doctor-patient dialogue was universally physician centered; physicians spoke 70% of the words and asked closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had questions. In contrast with the patient-centered research interview, doctors' physician-centered communication failed to identify most patients who had missed doses.

A Compilation of Necessary Elements for a Local Government Continuity of Operations Plan

DTIC Science & Technology

2006-09-01

Community Resilience in the World Trade Center Attack (Newark: Univ. of Delaware, 2003), 4. 11 Subsequently, New York City developed a COOP after... Community Resilience , 4. 27 New York City Emergency Response Task Force, Enhancing New York City’s Emergency Preparedness A Report to Mayor Michael R...Elements of Community Resilience in the World Trade Center Attack. Disaster Research Center, Univ. of Delaware, Newark, DE, 2004. Walton, Matt S

National Counterterrorism Center: 2007 Report on Terrorism

DTIC Science & Technology

2008-04-30

Approximately one half of the attacks in the NCTC database involve no loss of life. An attack that damages a pipeline and a car bomb attack that kills 100...rose by about 30 percent and 20 percent, respectively. Overall, suicide bombing attacks rose by about 50 percent and suicide car bombings about 40...January 2007, in Nukhaib, Al Anbar, Iraq, armed assailants in three cars attacked two buses transporting Shiite pilgrims back from the Hajj in Mecca to Al

Intolerance and Violence Against Doctors.

PubMed

Singh, Meharban

2017-10-01

Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise "zero tolerance" with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of "Quick response team" to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal avenues. Laws to prevent violence against doctors do exist but they need to be made more stringent and implemented properly.

DefenseLink Special: September 11, 2006

Science.gov Websites

, when terrorists attacked the World Trade Center in New York and the Pentagon. | Story | Edmund G , Sept. 11, 2001, when he first heard of a plane hitting the World Trade Center. The first reports called , servicemembers share their memories of the Sept. 11, 2001, terror attacks when airliners hit New York's World

A slow “catch and release” process prolongs immune attack on cancer cells | Center for Cancer Research

Cancer.gov

Center for Cancer Research investigators have discovered that some cancer cells catch immune signaling molecules called cytokines on their surfaces then slowly release the molecules. The results suggest that the immune system may exploit this weak spot to mount a prolonged attack on the tumor. Read more...

The management of gout in different clinical specialties in Turkey: a patient-based survey.

PubMed

Öztürk, Mehmet Akif; Mercan, Rıdvan; Gök, Kevser; Onat, Ahmet Mesut; Kısacık, Bünyamin; Kimyon, Gezmiş; Balkarlı, Ayşe; Kaya, Arif; Çobankara, Veli; Balcı, Mehmet Ali; Pamuk, ÖmerNuri; Yıldırım Çetin, Gözde; Sayarlıoğlu, Mehmet; Şenel, Soner; Tezcan, Mehmet Engin; Küçük, Adem; Üreten, Kemal; Şahin, Şafak; Tufan, Abdurrahman

2016-12-01

Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.

Temsirolimus

MedlinePlus

... as a solution (liquid) to be given by infusion (slow injection into a vein) over 30 to ... doctor or nurse in a doctor's office or infusion center. Temsirolimus is usually given once every week. ...

The Experimental Teaching Reform in Biochemistry and Molecular Biology for Undergraduate Students in Peking University Health Science Center

ERIC Educational Resources Information Center

Yang, Xiaohan; Sun, Luyang; Zhao, Ying; Yi, Xia; Zhu, Bin; Wang, Pu; Lin, Hong; Ni, Juhua

2015-01-01

Since 2010, second-year undergraduate students of an eight-year training program leading to a Doctor of Medicine degree or Doctor of Philosophy degree in Peking University Health Science Center (PKUHSC) have been required to enter the "Innovative talent training project." During that time, the students joined a research lab and…

Low speed aerodynamic characteristics of a lifting-body hypersonic research aircraft configuration

NASA Technical Reports Server (NTRS)

Penland, J. A.

1975-01-01

An experimental investigation of the low-speed longitudinal, lateral, and directional stability characteristics of a lifting-body hypersonic research airplane concept was conducted in a low-speed tunnel with a 12-foot (3.66-meter) octagonal test section at the Langley Research Center. The model was tested with two sets of horizontal and vertical tip controls having different planform areas, a center vertical tail and two sets of canard controls having trapezoidal and delta planforms, and retracted and deployed engine modules and canopy. This investigation was conducted at a dynamic pressure of 239.4 Pa (5 psf) (Mach number of 0.06) and a Reynolds number of 2 million based on the fuselage length. The tests were conducted through an angle-of-attack range of 0 deg to 30 deg and through horizontal-tail deflections of 10 deg to minus 30 deg. The complete configuration exhibited excessive positive static longitudinal stability about the design center-of-gravity location. However, the configuration was unstable laterally at low angles of attack and unstable directionally throughout the angle-of-attack range. Longitudinal control was insufficient to trim at usable angles of attack. Experiments showed that a rearward shift of the center of gravity and the use of a center-located vertical tail would result in a stable and controllable vehicle.

Quit for My Health | Smokefree 60+

Cancer.gov

Smokers age 60 and older are more likely than nonsmokers of the same age to have health problems such as coughing, trouble breathing, and getting tired more easily. Why should you quit now? I want to stay healthy or get healthier. My doctor said I should quit. I will lower my risk of many illnesses that would cut down on my freedom, such as: cancer heart attack and stroke

34 CFR 674.64 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... alternative to the documentation required in paragraphs (c)(1) through (c)(3) of this section. (5) Under... within 24 hours of the rescue; and (iii) A certification by a physician, who is a doctor of medicine or..., documentation of the discharge may be used as an alternative to the documentation required in paragraph (d)(1...

34 CFR 682.407 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(1) through..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... rescue; and (iii) A certification by a physician, who is a doctor of medicine or osteopathy and legally...

34 CFR 674.64 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2013 CFR

2013-07-01

... alternative to the documentation required in paragraphs (c)(1) through (c)(3) of this section. (5) Under... within 24 hours of the rescue; and (iii) A certification by a physician, who is a doctor of medicine or..., documentation of the discharge may be used as an alternative to the documentation required in paragraph (d)(1...

34 CFR 682.407 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(1) through..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... rescue; and (iii) A certification by a physician, who is a doctor of medicine or osteopathy and legally...

34 CFR 682.407 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(1) through..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... rescue; and (iii) A certification by a physician, who is a doctor of medicine or osteopathy and legally...

34 CFR 682.407 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(1) through..., documentation of the discharge may be used as an alternative to the documentation in paragraphs (d)(4) and (d)(5... rescue; and (iii) A certification by a physician, who is a doctor of medicine or osteopathy and legally...

34 CFR 674.64 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2014 CFR

2014-07-01

... alternative to the documentation required in paragraphs (c)(1) through (c)(3) of this section. (5) Under... within 24 hours of the rescue; and (iii) A certification by a physician, who is a doctor of medicine or..., documentation of the discharge may be used as an alternative to the documentation required in paragraph (d)(1...

34 CFR 674.64 - Discharge of student loan indebtedness for survivors of victims of the September 11, 2001, attacks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... alternative to the documentation required in paragraphs (c)(1) through (c)(3) of this section. (5) Under... within 24 hours of the rescue; and (iii) A certification by a physician, who is a doctor of medicine or..., documentation of the discharge may be used as an alternative to the documentation required in paragraph (d)(1...

Perievent panic attack and depression after the World Trade Center disaster: a structural equation model analysis.

PubMed

Adams, Richard E; Boscarino, Joseph A

2011-01-01

Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic events--are predictive of later mental health status, including the onset of depression. Using a community sample of New York City residents interviewed 1 year and 2 years after the World Trade Center Disaster, we estimated a structural equation model (SEM) using pre-disaster psychological status and post-disaster life events, together with psychosocial resources, to assess the relationship between perievent panic and later onset depression. Bivariate results revealed a significant association between perievent panic and both year-1 and year-2 depression. Results for the SEM, however showed that perievent panic was predictive of year-1 depression, but not year-2 depression, once potential confounders were controlled Year-2 stressors and year-2 psychosocial resources were the best predictors of year-2 depression onset. Pre-disaster psychological problems were directly implicated in year-1 depression, but not year-2 depression. We conclude that a conceptual model that includes pre- and post-disaster variables best explains the complex causal pathways between psychological status, stressor exposure, perievent panic attacks, and depression onset two years after the World Trade Center attacks.

Panitumumab Injection

MedlinePlus

... as a solution (liquid) to be given by infusion (injected into a vein). It is usually given ... doctor or nurse in a doctor's office or infusion center. Panitumumab is usually given once every 2 ...

From Microscope to Mirror: Doctoral Students' Evolving Positionalities through Engagement with Culturally Sensitive Research

ERIC Educational Resources Information Center

Roegman, Rachel; Knight, Michelle G.; Taylor, Ashley M.; Watson, Vaughn W. M.

2016-01-01

This study examines the experiences of doctoral students in a qualitative research course that centers culture throughout the research process. Data sources include one-on-one interviews, written documentation of course assignments, research team meetings, and doctoral students' conference proposals and publications examining civic learning and…

Implications of the World Trade Center attack for the public health and health care infrastructures.

PubMed

Klitzman, Susan; Freudenberg, Nicholas

2003-03-01

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures.

Psychological and emotional effects of the September 11 attacks on the World Trade Center--Connecticut, New Jersey, and New York, 2001.

PubMed

2002-09-06

To measure the psychological and emotional effects of the September 11, 2001, terrorist attacks on the World Trade Center (WTC), Connecticut, New Jersey, and New York added a terrorism module to their ongoing Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of the survey, which suggest widespread psychological and emotional effects in all segments of the three states' populations. The findings underscore the importance of collaboration among public health professionals to address the physical and emotional needs of persons affected by the September 11 attacks.

Implications of the World Trade Center Attack for the Public Health and Health Care Infrastructures

PubMed Central

Klitzman, Susan; Freudenberg, Nicholas

2003-01-01

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city’s response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city’s health care and social service system. The authors suggest lessons that can inform the development of a post–September 11th agenda for strengthening urban health infrastructures. PMID:12604481

Review of Studies of the Economic Impact of the September 11, 2001, Terrorist Attacks on the World Trade Center

DTIC Science & Technology

2002-05-29

of the Budget, • New York City Partnership and Chamber of Commerce , Washington, DC 20548 Report Documentation Page Report Date 29MAY2002 Report Type...700R Impact of Terrorist Attacks on the World Trade Center 10 Eight Studies (cont’d) ! New York City Partnership and Chamber of Commerce , Economic...Center 29 Observations Observations The New York City Partnership and Chamber of Commerce study generated the most comprehensive estimates—direct and

[From doctor-patient relationship to a collaborative one].

PubMed

Engeström, Yrjö

2013-01-01

In the historical development, the relationship between the patient and the doctor has gradually become increasingly objectified. Since then, a patient-centered or holistic way of thinking has become a normative model, towards which attempts have been made to change the patient-doctor relationship. The patient-doctor relationship must, however, be widened to a new type of relationship that links several doctors treating the same patient into collaboration and requires a new kind of working culture. We refer to this new concept as negotiated knotworking. Negotiation aims at an adequate, not complete mutual understanding.

A dangerous method? The German discourse on hypnotic suggestion therapy around 1900

PubMed Central

Maehle, Andreas-Holger

2017-01-01

In the late nineteenth century, German-speaking physicians and psychiatrists intensely debated the benefits and risks of treatment by hypnotic suggestion. While practitioners of the method sought to provide convincing evidence for its therapeutic efficacy in many medical conditions, especially nervous disorders, critics pointed to dangerous side effects, including the triggering of hysterical attacks or deterioration of nervous symptoms. Other critics claimed that patients merely simulated hypnotic phenomena in order to appease their therapist. A widespread concern was the potential for abuses of hypnosis, either by giving criminal suggestions or in the form of sexual assaults on hypnotized patients. Official inquiries by the Prussian Minister for Religious, Educational and Medical Affairs in 1902 and 1906 indicated that relatively few doctors practised hypnotherapy, whereas the method was increasingly used by lay healers. Although the Ministry found no evidence for serious harm caused by hypnotic treatments, whether performed by doctors or by lay healers, many German doctors seem to have regarded hypnotic suggestion therapy as a problematic method and abstained from using it.

Physical Attacks: An Analysis of Teacher Characteristics Using the Schools and Staffing Survey

ERIC Educational Resources Information Center

Williams, Thomas O., Jr.; Ernst, Jeremy V.

2016-01-01

This study investigated physical attacks as reported by public school teachers on the most recent Schools and Staffing Survey (SASS) from the National Center for Education Statistics administered by the Institute of Educational Sciences. For this study, characteristics of teachers who responded affirmatively to having been physically attacked in…

Found in Translation: Exporting Patient-Centered Communication and Small Group Teaching Skills to China

PubMed Central

Blatt, Benjamin; Kallenberg, Gene; Lang, Forrest; Mahoney, Patrick; Patterson, JoEllen; Dugan, Beverly; Sun, Shaobang

2009-01-01

The Chinese Medical Doctor's Association asked us to develop a train-the-trainers program in doctor-patient communication and in teaching skills for a select group of Chinese health care professionals, who would then serve as trainers for practicing physicians throughout China. The request came in the context of increasing doctor-patient friction related, in part, to the dissolution of the socialist health care safety net in China. In this article we recount the implementation of our 5-day training program in Beijing. We explore cross-cultural issues that arose in presenting the program's two principal training domains: small group teaching and patient-centered doctor-patient communication. We also explore the linguistic challenges we encountered as non-Chinese speaking teachers. Finally, we reflect on the lessons learned from this project that may be of value to others called upon to export Western doctor-patient communications training to other cultures. In this age of increasing globalization, cross-cultural sharing of medical education represents a growing trend. PMID:20165520

Predictors of influenza vaccination uptake among adults with a history of heart attack.

PubMed

Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; de Andres, Ana Lopez; Jimenez-Trujillo, Isabel; Esteban, Jesus; Gil, Angel; Carrasco-Garrido, Pilar

2010-07-01

Influenza vaccination can reduce morbidity and mortality caused by cardiovascular diseases. This study sought to evaluate influenza vaccination coverage among adults with a history of heart attack and to determine which variables were associated with vaccine uptake. A total of 716 adults reported having suffered a heart attack. The coverage among sufferers was 67.9% as against 35% for non sufferers. The variables that were significantly associated with a higher likelihood of receiving the vaccine among sufferers were: higher age; male gender, no smoking habit, "Physician visits in the preceding four weeks"; and, "Blood pressure control in the preceding three months". A descriptive study was conducted using individual data from adults aged ≥40 years included in the year 2006/7 Spanish Health Survey and comparing subjects with a history of heart attack with those who had not suffered this event. The number of participants surveyed was 20,060. Subjects were classified as heart attack sufferers if they answered affirmatively to the question: "Has your doctor told you that you have suffered a heart attack?" To assess influenza vaccination status we considered the response to the question, "Did you have a 'flu shot in the latest campaign?". Independent variables included sociodemographic, health-related, lifestyles and periodic control of cardiovascular risk factors. Influenza vaccination coverage among subjects who have suffered a heart attack is below desirable levels. Multiple strategies focused on providers and patients are needed to improve influenza vaccination coverage among these high risk subjects, particularly now with the emerging H1N1 pandemic.

[Communication center in public health].

PubMed

George, W; Grimminger, F; Krause, B

2002-06-01

The Communications Center's portfolio covers areas such as marketing, contacts, distribution of information, sales activities and collection of bills by telephone (encashment). A special emphasis is Customer Care Management (Customer Relationship Management) to the patient and his caregivers (relatives), the customers, especially the physicians who send their patients to the hospital and the hospital doctor. By providing communication centers, the hospital would be able to improve the communication with the G.P.s, and identify the wishes and requirements more accurately and easily from the beginning. Dealing effectively with information and communication is already also of special importance for hospital doctors today. One can assume that the demands on doctors in this respect will become even more complex in the future. Doctors who are involved in scientific research are of course fully aware of the growing importance of the Internet with its new information and communication channels. Therefore analysing the current situation, the demands on a future information management system can be formulated: A system that will help doctors to avoid dealing with little goal-oriented information and thus setting up effective communication channels; an information system which is multi-media oriented towards the interests and needs of the patients and patient's relatives and which is further developed continually and directly by those involved.

Patient perception and the barriers to practicing patient-centered communication: A survey and in-depth interview of Chinese patients and physicians.

PubMed

Ting, Xu; Yong, Bao; Yin, Liang; Mi, Tian

2016-03-01

To investigate patient perceptions of patient-centered communication (PCC) in doctor-patient consultations and explore barriers to PCC implementation in China. This study was conducted in public teaching hospital in Guiyang, Guizhou, China. In Phase 1, patient attitudes to PCC were quantitatively assessed in 317 outpatients using modified Patient-Practitioner Orientation Scale (PPOS). In Phase 2, we conducted in-depth interviews with 20 outpatients to explore their views on PCC and expose potential barriers to PCC implementation. Participants communicated "patient-centered" preferences, particularly with regard to their doctors' empathy, communication skills, time and information sharing. Patients were more concerned about doctors exhibiting caring perspective than power sharing. Younger and highly educated patients were more likely to prefer PCC and highly educated patients paid more attention to power sharing. Several factors including inadequate time for PCC resulting from doctors' high patient-load, doctor-patient communication difficulties and excessive treatment due to inappropriate medical payment system affected PCC implementation in China. Patients expressed moderate enthusiasm for PCC in China. They expressed strong preferences concerning physician respect for patient perspective, but less concern for power sharing. Government should improve health care system by implementing PCC in daily healthcare practice to improve patient awareness and preferences. Copyright © 2016. Published by Elsevier Ireland Ltd.

BTTC Doctors and Institutions | Center for Cancer Research

Cancer.gov

BTTC Doctors and Institutions Committed to Discovering New Therapies The doctors and institutions who are participating in the BTTC are compassionate experts in their respective fields and are dedicated to finding new and effective therapies for the treatment of patients with brain tumors. Feel free to contact any of these outstanding facilities to make an appointment or

Patient-doctor relationship: the practice orientation of doctors in Kano.

PubMed

Abiola, T; Udofia, O; Abdullahi, A T

2014-01-01

Attitude and orientation of doctors to the doctor-patient relationship has a direct influence on delivery of high quality health- care. No study to the knowledge of these researchers has so far examined the practice orientation of doctors in Nigeria to this phenomenon. The aims of this study were to determine the orientation of Kano doctors to the practice of doctor-patient relationship and physicians' related-factors. Participants were doctors working in four major hospitals (i.e., two federal-owned and two state-owned) servicing Kano State and its environs. The Patient-Practitioner Orientation Scale (PPOS) and a socio-demographic questionnaire were completed by the 214 participants. The PPOS has 18 items and measures three parameters of a total score and two dimension of "sharing" and "caring". The mean age of participants was 31.72 years (standard deviation = 0.87), with 22% being females, 40.7% have been practicing for ≥ 6 years and about two-third working in federal-owned health institution. The Cronbach's alpha of total PPOS scores was 0.733 and that of two sub-scale scores of "sharing" and "caring" were 0.659 and 0.546 respectively. Most of the doctors' orientation (92.5%) was towards doctor-centered (i.e., paternalistic) care, majority (75.2%) upheld the view of not sharing much information and control with patients, and showing little interest in psychosocial concerns of patients (i.e., 'caring'=93.0%). Respondents' characteristics that were significantly associated with high doctor 'caring' relationship orientation were being ≥ 30-year-old and practicing for ≥ 6 years. Working in State-owned hospitals was also significantly associated with high doctor "sharing" orientation. This paper demonstrated why patient-centered medical interviewing should be given top priority in medical training in Nigeria, and particularly for federal health institutions saddled with production of new doctors and further training for practicing doctors.

Travis Kemper | NREL

Science.gov Websites

| 303-275-4066 Dr. Travis Kemper is a post doctorate researcher in the Computational Science Center. He the University of Florida where he developed reactive force fields. During his post doctorate work at

THE PREVALENCE OF STRESS AND BURNOUT SYNDROME IN HOSPITAL DOCTORS AND FAMILY PHYSICIANS.

PubMed

Stanetic, Kosana D; Savic, Suzana M; Racic, Maja

2016-11-01

Introducti on. Burnout syndrome is the result of chronic emotional stress. It is characterized by high levels of emotional exhaustion and depersonalization, and reduced level of personal accomplishment. The aim of this study was to determine the level of stress and risk ror burnout syndrome in doctors employed in health centers and hospitals, and to investigate the impact of socio-derrdgraphic characteristics on the level of stress and the o ccurrence of burnout syndrome. A cross-sectional study was conducted in the period from October I to December 31, 2015 in three health centers and in the University Clinical Center of the Republic of Srpska. The survey was anonymous. A socio-demographic questionnaire and a questionnaire for self-assessment of the level of stress and Maslach Burnout Inventory were used as research instruments. Out of 151 doctors included in the study, 49% were family physicians, and 51% were hospital doctors. The analysis of responses to questionnaires for self-assessment of stress level revealed that 51.7% of participants had high levels of stress (52.7% of family physicians, 50.6% of doctors working in hospital). A high degree of emotional exhaustion was found in 27.2% of participants (29.7% of fam ily physicians, 24.6% of doctors working in hospital), high depersonalization was found in 23.8% of participants (25.7% of family physicians, 22. 1% of doctors working in hospital), a low level of personal accomplishment was found in 39.7% of participants (37.8% of family physicians. 41.6% of doctors working in hospital). No statistically significant difference regarding stress degree, emotional exhaustion and depersonalizaion and personal accomplishment was found between hospital doctors and family physicians. The physicians aged over 45 years had a significantly (p = 0.030) higher level of emotional exhaustion than their younger colleagues. This study found that there was a high risk of burnout syndrome in physicians in the Republic of Srpska. Although the exposure to professional stress was higher in family physicians than in hospital doctors, the obtained difference was not statistically significant.

Aerodynamic characteristics at Mach 6 of a hypersonic research airplane concept having a 70 deg swept delta wing

NASA Technical Reports Server (NTRS)

Clark, L. E.; Richie, C. B.

1977-01-01

The hypersonic aerodynamic characteristics of an air-launched, delta-wing research aircraft concept were investigated at Mach 6. The effect of various components such as nose shape, wing camber, wing location, center vertical tail, wing tip fins, forward delta wing, engine nacelle, and speed brakes was also studied. Tests were conducted with a 0.021 scale model at a Reynolds number, based on model length, of 10.5 million and over an angel of attack range from -4 deg to 20 deg. Results show that most configurations with a center vertical tail have static longitudinal stability at trim, static directional stability at angles of attack up to 12 deg, and static lateral stability throughout the angle of attack range. Configurations with wing tip fins generally have static longitudinal stability at trim, have lateral stability at angles of attack above 8 deg, and are directionally unstable over the angle of attack range.

Level I center triage and mass casualties.

PubMed

Hoey, Brian A; Schwab, C William

2004-05-01

The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.

Deaths in World Trade Center terrorist attacks--New York City, 2001.

PubMed

2002-09-11

On September 11, 2001, terrorists flew two hijacked airplanes into the World Trade Center (WTC) in lower Manhattan in New York City (NYC), destroying both towers of the WTC. This report presents preliminary vital statistics on the deaths caused by the terrorist attacks and describes the procedures developed by the New York City Department of Health and Mental Hygiene (NYCDOHMH) to issue death certificates in response to the attacks. These data underscore the need for legal mechanisms to expedite the issuance of death certificates in the absence of human remains and the need for vital registration systems that can be relocated in case of emergency.

BTTC Doctors and Institutions | Center for Cancer Research

Cancer.gov

BTTC Doctors and Institutions Committed to Discovering New Therapies The doctors and institutions who are participating in the BTTC are compassionate experts in their respective fields and are dedicated to finding new and effective therapies for the treatment of patients with brain tumors. Feel free to contact any of these outstanding facilities to make an appointment or participate in a BTTC clinical trial.

42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

Pathways to the Doctorate Degree: A Phenomenological Study of African American Women in Doctorate Degree Programs

ERIC Educational Resources Information Center

Starks, Luciana Janee'

2010-01-01

Increasing the number of advanced degree recipients is more than an educational issue; it is also a key social issue. "A college-educated population results in pivotal benefits to society" (The National Center for Public Policy and Higher Education, 2004, p. 1). Although African Americans have made steady and notable progress in doctorate degree…

Use of Learner-Centered Strategies in the Preparation of Community and Technical College Leaders: Assessments by Participating Doctoral Students

ERIC Educational Resources Information Center

Browne-Ferrigno, Tricia; Muth, Rodney

2010-01-01

This paper presents assessments by students actively engaged in a recently redesigned Doctor of Education (EdD) program, delivered at a research-extensive university participating in the the Carnegie Project on the Education Doctorate (CPED), to prepare leaders for a statewide system of community and technical colleges. Because a unique feature of…

Somatotype, Level of Competition, and Performance in Attack in Elite Male Volleyball

PubMed Central

Giannopoulos, Nikiforos; Vagenas, George; Noutsos, Konstantinos; Barzouka, Karolina; Bergeles, Nikolaos

2017-01-01

Abstract This study investigated the relationship between somatotype, level of competition, and performance in attack in elite level male volleyball players. The objective was to test for the potential covariation of competition level (Division A1 vs. A2) and playing position (hitters vs. centers vs. opposites) considering performance in attack. Anthropometric, body composition and somatotype variables were measured according to the Heath-Carter method. The attack actions of 144 players from 48 volleyball matches were analyzed and their performance was rated using a 5-point numerical scale. Results showed that players of Division A1 were taller, heavier, more muscular, and less endomorphic compared to those of Division A2. MANOVA and follow-up discriminant function analysis revealed somatotype differences among playing positions with centers and opposites being endomorph-ectomorph and hitters being central. Centers performed constantly better than hitters and opposites regardless of the division and somatotype. Multiple linear regression analysis showed that variables defining ectomorph and endomorph players, centers, and players of Division A1 significantly determined the relative performance superiority and were able to explain the variation in performance by almost 25%. These results could be taken into account by coaches when assigning players to particular playing positions or when designing individualized position-specific training programs. PMID:28828084

Somatotype, Level of Competition, and Performance in Attack in Elite Male Volleyball.

PubMed

Giannopoulos, Nikiforos; Vagenas, George; Noutsos, Konstantinos; Barzouka, Karolina; Bergeles, Nikolaos

2017-09-01

This study investigated the relationship between somatotype, level of competition, and performance in attack in elite level male volleyball players. The objective was to test for the potential covariation of competition level (Division A1 vs. A2) and playing position (hitters vs. centers vs. opposites) considering performance in attack. Anthropometric, body composition and somatotype variables were measured according to the Heath-Carter method. The attack actions of 144 players from 48 volleyball matches were analyzed and their performance was rated using a 5-point numerical scale. Results showed that players of Division A1 were taller, heavier, more muscular, and less endomorphic compared to those of Division A2. MANOVA and follow-up discriminant function analysis revealed somatotype differences among playing positions with centers and opposites being endomorph-ectomorph and hitters being central. Centers performed constantly better than hitters and opposites regardless of the division and somatotype. Multiple linear regression analysis showed that variables defining ectomorph and endomorph players, centers, and players of Division A1 significantly determined the relative performance superiority and were able to explain the variation in performance by almost 25%. These results could be taken into account by coaches when assigning players to particular playing positions or when designing individualized position-specific training programs.

Questions for Your Doctor: Your First Visit

MedlinePlus

The Testicular Cancer Resource Center Questions for your Doctor: Your First Visit This list of questions is intended to help ... cancer, be happy, but also be aware that testicular cancer is misdiagnosed as epididymitis or something similar almost ...

The business of medicine: how to overcome financial obstacles and secure financing for your private practice and ancillary services business.

PubMed

Nayor, David

2012-01-01

Doctors across the country who operate private medical practices are facing increasing financial obstacles, namely shrinking income as a result of rising costs and lower reimbursements. In addition, as hospitals have become overburdened many physicians have opened up private surgical centers; magnetic resonance imaging and computed tomography and positron emission tomography scanning facilities; pathology labs; colonoscopy/endoscopy suites; lithotripsy centers; and other medical businesses typically performed within the hospital. Moreover, many doctors seek loans to purchase existing practices or for their capital contribution in medical partnerships. The past decade has thus seen a significant increase in the number of doctors taking out small business loans. Indeed, banks view the healthcare industry as a large growth market. This article includes practical information, advice, and resources to help doctors to secure bank financing for their practices, ancillary services business, real estate, and equipment on the best possible market terms.

American hospitals react to terrorist attacks with determination.

PubMed

Rees, T

2001-01-01

In this timely special section, editor Tom Rees recounts some of the swift, supportive actions health care providers took in response to the Sept. 11 terrorist attacks on the World Trade Center and the Pentagon.

Pakistan: the new target of terrorism. Are Karachi's emergency medical response systems adequately prepared?

PubMed

Siddiqui, Muhammad Ahmed; Jawad, Ahmed; Minhas, Saeed; Ansari, Asma; Siddiqui, Afrah; Mehtab, Sana

2009-07-01

To assess the efficacy and preparedness of the pre-hospital and hospital emergency medical systems and post graduate trainees in the city to deal with a massive terrorist strike. A cross-sectional survey of postgraduate trainees was conducted at Jinnah Postgraduate Medical Center and Civil Hospital Karachi from 21st July 2007 to 24th July 2007, to evaluate the preparedness and self identified deficiencies of doctors involved in massive trauma casualty management. To assess the pre-hospital care in Karachi, structured telephonic interviews were conducted of administrators of two private run charity based ambulance services. Out of the 90 respondents questioned regarding a self assessment of their training, only 3 (3.3%) of them were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed Hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures are available in the ambulances. With an increasing number of terrorist attacks in the country, massive influx of casualties in a relatively short time span has become a regular feature of the Pakistani hospital system. Lack of adequate training at pre-hospital and in hospital levels may translate into increasing morbidities and mortalities. It is imperative that training of junior doctors and paramedical staff be conducted regularly and an effective regional communication base established for efficient interdepartmental coordination.

The San Bernardino, California, Terror Attack: Two Emergency Departments' Response.

PubMed

Lee, Carol; Walters, Elizabeth; Borger, Rodney; Clem, Kathleen; Fenati, Gregory; Kiemeney, Michael; Seng, Sakona; Yuen, Ho-Wang; Neeki, Michael; Smith, Dustin

2016-01-01

On December 2, 2015, a terror attack in the city of San Bernardino, California killed 14 Americans and injured 22 in the deadliest attack on U.S. soil since September 11, 2001. Although emergency personnel and law enforcement officials frequently deal with multi-casualty incidents (MCIs), what occurred that day required an unprecedented response. Most of the severely injured victims were transported to either Loma Linda University Medical Center (LLUMC) or Arrowhead Regional Medical Center (ARMC). These two hospitals operate two designated trauma centers in the region and played crucial roles during the massive response that followed this attack. In an effort to shed a light on our response to others, we provide an account of how these two teaching hospitals prepared for and coordinated the medical care of these victims. In general, both centers were able to quickly mobilize large number of staff and resources. Prior disaster drills proved to be invaluable. Both centers witnessed excellent teamwork and coordination involving first responders, law enforcement, administration, and medical personnel from multiple specialty services. Those of us working that day felt safe and protected. Although we did identify areas we could have improved upon, including patchy communication and crowd-control, they were minor in nature and did not affect patient care. MCIs pose major challenges to emergency departments and trauma centers across the country. Responding to such incidents requires an ever-evolving approach as no two incidents will present exactly alike. It is our hope that this article will foster discussion and lead to improvements in management of future MCIs.

A Virtual Environment for Resilient Infrastructure Modeling and Design

DTIC Science & Technology

2015-09-01

Security CI Critical Infrastructure CID Center for Infrastructure Defense CSV Comma Separated Value DAD Defender-Attacker-Defender DHS Department...responses to disruptive events (e.g., cascading failure behavior) in a context- rich , controlled environment for exercises, education, and training...The general attacker-defender (AD) and defender-attacker-defender ( DAD ) models for CI are defined in Brown et al. (2006). These models help

Exposure to Trauma and Separation Anxiety in Children after the WTC Attack

ERIC Educational Resources Information Center

Hoven, Christina W.; Duarte, Cristiane S.; Wu, Ping; Erickson, Elizabeth A.; Musa, George J.; Mandell, Donald J.

2004-01-01

The impact of exposure to the World Trade Center attack on children presenting separation anxiety disorder (SAD) 6 months after the attack was studied in a representative sample of New York City public school students (N = 8,236). Probable SAD occurred in 12.3% of the sample and was more frequent in girls, young children, and children who…

The Economic and Risk Constraints in the Feasibility Analysis of Wireless Communications in Marine Corps Combat Operation Centers

DTIC Science & Technology

2013-09-01

attacker can acquire and use against a wireless infrastructure. Wireless attack tool kits such as the “ Raspberry – PI ” (shown in Figure 10), and...still use a tool such as the Raspberry – PI to perform attacks against a network from outside the controlled area or even inside the controlled area...when considering an insider attack. Figure 10. (From www.howtodocomputing.blogspot.com, n.d.) Wireless – PI is “a collection of pre-configured

Public knowledge of heart attack in a Nepalese population survey.

PubMed

Limbu, Yuba R; Malla, Rabi; Regmi, Shyam R; Dahal, Ramesh; Nakarmi, Hari L; Yonzan, Ganesh; Gartaula, Ritu P

2006-01-01

Limited knowledge of heart attack symptoms may prevent patients from seeking time-dependent thrombolytic therapy, an intervention that offers impressive survival benefit. Previous studies carried out in developed countries demonstrated a deficit of knowledge about a wide range of heart attack symptoms. The aim of this study was to describe knowledge of heart attack, knowledge of heart attack symptoms, and anticipated first response to symptoms among the lay public in Nepal. A total of 1192 participants (657 men and 535 women age 16 to 88 years old) were interviewed in a cross-sectional manner. Those <16 years of age, all health professionals, and individuals with a history of heart attack were excluded. A total of 862 (72.3%) participants had heard of heart attack. Significantly more male than female participants had heard of heart attack (P <.001). Of the respondents, 91.7% with >or=10 years of education (ED-2) had heard of heart of attack, whereas only 54% respondents with <10 years of education or who were illiterate (unable to read and write) (ED-1) had heard of heart attack, and in both the male and female populations, a higher percentage of the ED-2 group had heard of heart attack than the ED-1 group (92.6% vs. 60% and 85.6% vs. 49.6%, respectively). A significantly higher number of respondents from 31 to 50 years of age (AGE-2) had heard of heart attack than those 16 to 30 years of age (AGE-1) and those >50 years of age (AGE-3) (P <.001). Among 862 respondents who had heard of heart attack, 21.3% could not name any heart attack symptoms. A total of 16 different heart attack symptoms were named. Fainting or collapsing (48%), chest pain (22.4%), shortness of breath (9%), dizziness (8.4%), palpitations (7.4%), and sweating (7.4%) were the leading symptoms named by respondents. Fainting or collapsing and chest pain and shortness of breath were named more frequently among the ED-2 group respondents and the AGE-3 group men. Only 3.7% could name >or=2 typical heart attack symptoms. A significantly larger number of the ED-2 group named >or=2 typical symptoms than their counterparts (P <0.001). A large number (77.6%) of respondents preferred immediate hospital referral and/or doctor consultation after a heart attack. In Nepal, better-educated men are more aware of heart attack. Fainting or collapsing and chest pain and shortness of breath were leading heart attack symptoms named by the general population. Public heart attack awareness is not adequate and knowledge of wide range of heart attack symptoms is deficient in the Nepalese general population.

Research Models Used in Doctoral Theses on Sport Management in Turkey: A Content Analysis

ERIC Educational Resources Information Center

Atalay, Ahmet

2018-01-01

The aim of this study was to examine the methodological tendencies in the doctorate theses which were prepared in the field of Sports Management in Turkish between 2007 and 2016 and which were open to access in the database of the Council of Higher Education (CHE) National Theses Center. In this context, 111 doctorate theses prepared in the last…

Organizational factors and office workers' health after the World Trade Center terrorist attacks: long-term physical symptoms, psychological distress, and work productivity.

PubMed

Osinubi, Omowunmi Y O; Gandhi, Sampada K; Ohman-Strickland, Pamela; Boglarsky, Cheryl; Fiedler, Nancy; Kipen, Howard; Robson, Mark

2008-02-01

To assess if organizational factors are predictors of workers' health and productivity after the World Trade Center attacks. We conducted a survey of 750 workers and compared those who had direct exposures to the World Trade Center attacks (south of Canal Street workers; primary victims) with those less directly exposed (north of Canal Street workers; other victims and non-victims). South of Canal Street workers reported headache more frequently than north of Canal Street workers did (P = 0.0202). Primary victims reported headache and cough more frequently than did other victims and non-victims (P = 0.0086 and 0.0043, respectively). Defensive organizational culture was an independent predictor of cough and job stress, and job stress was an independent predictor of on-the-job productivity losses. Organizational variables may modify health and productivity outcomes after a large-scale traumatic event in the workplace.

Depression and doctor-patient communication in the emergency department.

PubMed

Haerizadeh, Mytra; Moise, Nathalie; Chang, Bernard P; Edmondson, Donald; Kronish, Ian M

2016-01-01

Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS). We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status and comorbidities. Compared to nondepressed patients, depressed patients (PHQ-8≥10) were more likely (P<.05) to report suboptimal communication on five of seven communication domains: clarity, elicitation of concerns, explanations, patient-centered decision making and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, P<.001). In adjusted analyses, depressed patients remained more likely to report suboptimal doctor-patient communication (adjusted odds ratio 2.42, 95% confidence interval 1.52-3.87; P<.001). Depressed patients with ACS symptoms reported less optimal doctor-patient communication in the ED than nondepressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences. Copyright © 2016 Elsevier Inc. All rights reserved.

Mental health impact of the World Trade Center attacks on displaced Chinese workers.

PubMed

Thiel de Bocanegra, Heike; Brickman, Ellen

2004-02-01

To identify psychological sequelae of the World Trade Center attacks in immigrant Chinese displaced workers, we interviewed 77 displaced workers in May 2002. One third of the sample was classified as at least moderately depressed, and 21% met diagnostic criteria for posttraumatic stress disorder; however, few had utilized mental health services. Depression and PTSD scores were positively correlated with age, age at immigration to the United States, and prescription drug use after September 11th, among other variables. Results suggest the need for mental health outreach in this community. This outreach should target both displaced workers and their informal support networks to facilitate identification of and service access for those impacted by the attacks.

Job satisfaction among health care workers in Serbia.

PubMed

Korac, Vesna; Vasic, Milena; Krstic, Maja; Markovic, Roberta

2010-01-01

According to literature review there seems to be a general agreement that job satisfaction among doctors is declining. This study's objective was to identify job satisfaction levels and their causes among health care workers, employed at the public health institutions. A job satisfaction survey of health care workers was therefore carried out in 197 public health centers in the Republic of Serbia, 157 primary health care centers and 40 general hospitals, in 2008. A satisfaction questionnaire, containing 24 items was used to investigate job satisfaction. Respondents (23.259), working in primary health care, indicated an average job satisfaction level of 3.08 +/- 0.67 on a 5-point scale. Respondents (11.302), working in general hospitals, indicated a lower average job satisfaction level of 2.96 +/- 0.63. The reported level of satisfaction was the highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, and freedom to choose their own methods of work. Doctors, working in primary health care centers, reported higher level of job satisfaction than hospital doctors. Overall, job satisfaction of doctors and nurses is relatively low. Increased pay rate and more adequate equipment, as well as possibilities for education and career improvement, would enhance their job satisfaction.

Lethal Trap Trees and Semiochemical Repellents as Area Host Protection Strategies for Spruce Beetle (Coleoptera: Curculionidae, Scolytinae) in Utah.

PubMed

Matthew Hansen, E; Steven Munson, A; Blackford, Darren C; Wakarchuk, David; Scott Baggett, L

2016-10-01

We tested lethal trap trees and repellent semiochemicals as area treatments to protect host trees from spruce beetle (Dendroctonus rufipennis Kirby) attacks. Lethal trap tree treatments ("spray treatment") combined a spruce beetle bait with carbaryl treatment of the baited spruce. Repellent treatments ("spray-repellent") combined a baited lethal trap tree within a 16-m grid of MCH (3-methylcyclohex-2-en-1-one) and two novel spruce beetle repellents. After beetle flight, we surveyed all trees within 50 m of plot center, stratified by 10-m radius subplots, and compared attack rates to those from baited and unbaited control plots. Compared to the baited controls, spruce in the spray treatment had significantly reduced likelihood of a more severe attack classification (e.g., mass-attacked over strip-attacked or unsuccessful-attacked over unattacked). Because spruce in the spray treatment also had significantly heightened probability of more severe attack classification than those in the unbaited controls, however, we do not recommend lethal trap trees as a stand-alone beetle suppression strategy for epidemic beetle populations. Spruce in the spray-repellent treatment were slightly more likely to be classified as more severely attacked within 30 m of plot center compared to unbaited controls but, overall, had reduced probabilities of beetle attack over the entire 50-m radius plots. The semiochemical repellents deployed in this study were effective at reducing attacks on spruce within treated plots despite the presence of a centrally located spruce beetle bait. Further testing will be required to clarify operational protocols such as dose, elution rate, and release device spacing. Published by Oxford University Press on behalf of Entomological Society of America 2016. This work is written by US Government employees and is in the public domain in the US.

Treatment of Infantile Hemangioma in Regional Hospitals With eHealth Support: Evaluation of Feasibility and Acceptance by Parents and Doctors

PubMed Central

van Os-Medendorp, Harmieke; van Renselaar, Wilco; Breugem, Corstiaan C; Pasmans, Suzanne GMA

2014-01-01

Background Since beta blockers became the preferred treatment for infantile hemangiomas (IH), the number of patients eligible for treatment is increasing. Currently treatment of IH with beta blockers is mainly reserved for expert centers, where wait times are lengthening. This demonstrated the need for development of a more efficient and accessible way of providing care for children needing treatment for IH. An eHealth intervention, Hemangioma Treatment Plan (HTP), was developed to treat IH in regional hospitals with online support from an academic doctor. Objective Our goal was to evaluate the feasibility of the eHealth intervention by determining its use, acceptance, and usability. By evaluating the feasibility, usage can be predicted and points for improvement can be defined, thereby facilitating implementation of the intervention. Methods Parents of children with an IH, presenting between October 2012 and November 2013 at the tertiary expert Center for Congenital Vascular Anomalies Utrecht, requiring treatment with a beta blocker, were asked to participate in the digital HTP. Both parents and regional doctors were sent a study questionnaire. Acceptance and usability of the HTP were evaluated by using the modified Technology Acceptance Model. Results A total of 31 parents and 22 regional doctors participated in the eHealth intervention and received the questionnaire, and 25 parents and 15 doctors responded (response rates respectively 81% and 68%). A majority of the parents (96%, 24/25) and the regional doctors (87%, 13/15) considered the eHealth intervention useful in the care for IH. Most parents (76%, 19/25) and over half of the regional doctors (53%, 8/15) found the HTP easy to use. Technical problems using the HTP were reported by 28% (7/25) of the parents and 73% (11/15) of the doctors. The majority of parents (92%, 23/25) felt positive about usage of the HTP during treatment of their child. All regional doctors (100%, 15/15) felt positive about transition of treatment from the tertiary expert center to them, and 93% (14/15) felt positive about using the HTP. Conclusions Our eHealth intervention shows good feasibility, especially among parents. Improvement with respect to technical problems, training of regional doctors, and achieving organizational support might be needed for successful implementation in the future. PMID:25367558

An evaluation of the role played by remote sensing technology following the World Trade Center attack

NASA Astrophysics Data System (ADS)

Huyck, Charles K.; Adams, Beverley J.; Kehrlein, David I.

2003-06-01

Remote sensing technology has been widely recognized for contributing to emergency response efforts after the World Trade Center attack on September 11th, 2001. The need to coordinate activities in the midst of a dense, yet relatively small area, made the combination of imagery and mapped data strategically useful. This paper reviews the role played by aerial photography, satellite imagery, and LIDAR data at Ground Zero. It examines how emergency managers utilized these datasets, and identifies significant problems that were encountered. It goes on to explore additional ways in which imagery could have been used, while presenting recommendations for more effective use in future disasters and Homeland Security applications. To plan adequately for future events, it was important to capture knowledge from individuals who responded to the World Trade Center attack. In recognition, interviews with key emergency management and geographic information system (GIS) personnel provide the basis of this paper. Successful techniques should not be forgotten, or serious problems dismissed. Although widely used after September 11th, it is important to recognize that with better planning, remote sensing and GIS could have played an even greater role. Together with a data acquisition timeline, an expanded discussion of these issues is available in the MCEER/NSF report “Emergency Response in the Wake of the World Trade Center Attack; The Remote Sensing Perspective” (Huyck and Adams, 2002)

Lessons learned from the aeromedical disaster relief activities following the great East Japan earthquake.

PubMed

Matsumoto, Hisashi; Motomura, Tomokazu; Hara, Yoshiaki; Masuda, Yukiko; Mashiko, Kunihiro; Yokota, Hiroyuki; Koido, Yuichi

2013-04-01

Since 2001, a Japanese national project has developed a helicopter emergency medical service (HEMS) system ("doctor-helicopter") and a central Disaster Medical Assistance Team (DMAT) composed of mobile and trained medical teams for rapid deployment during the response phase of a disaster. In Japan, the DMAT Research Group has focused on command and control of doctor-helicopters in future disasters. The objective of this study was to investigate the effectiveness of such planning, as well as the problems encountered in deploying the doctor-helicopter fleet with DMAT members following the March 11, 2011 Great East Japan Earthquake. This study was undertaken to examine the effectiveness of aeromedical disaster relief activities following the Great East Japan Earthquake and to evaluate the assembly and operations of 15 doctor-helicopter teams dispatched for patient evacuation with medical support. Fifteen DMATs from across Japan were deployed from March 11th through March 13th to work out of two doctor-helicopter base hospitals. The dispatch center at each base hospital directed its own doctor-helicopter fleet under the command of DMAT headquarters to transport seriously injured or ill patients out of hospitals located in the disaster area. Disaster Medical Assistance Teams transported 149 patients using the doctor-helicopters during the first five days after the earthquake. The experiences and problems encountered point to the need for DMATs to maintain direct control over 1) communication between DMAT headquarters and dispatch centers; 2) information management concerning patient transportation; and 3) operation of the doctor-helicopter fleet during relief activities. As there is no rule of prioritization for doctor-helicopters to refuel ahead of other rotorcraft, many doctor-helicopters had to wait in line to refuel. The "doctor-helicopter fleet" concept was vital to Japan's disaster medical assistance and rescue activities. The smooth and immediate dispatch of the doctor-helicopter fleet must occur under the direct control of the DMAT, independent from local government authority. Such a command and control system for dispatching the doctor-helicopter fleet is strongly recommended, and collaboration with local government authorities concerning refueling priority should be addressed.

A specialist team of A&E doctors and nurses establish emergency care units in Kosovo.

PubMed

Hodgetts, Lieutenant Colonel Tim; Kenward, Gary

2000-02-01

On June 12, 1999 NATO troops led by British paratroopers of 5 Airborne Brigade entered Kosovo and secured key military sites. This multinational operation (code named 'OP AGRICOLA') was in response to the ethnic cleansing of Kosovo-Albanians, and followed a sustained period of aerial attack in Kosovo and Serbia. The ground operation required substantial medical support, and the British hospital element was provided by 22 Field Hospital RAMC.

[Passive euthanasia in clinical practice--the medical decision reflected in the legal position].

PubMed

Möller, T; Grabensee, B; Frister, H

2008-05-01

Doctors are often confronted with end-of-life decisions. When deciding on the withdrawal of medical treatment physicians have to consider the legal position. This study was done to evaluated how far doctors at the university medical center in Düsseldorf had acted in conformity with the established case law in Germany. Between April and August 2006 doctors at the university medical center in Düsseldorf filled in a standardized questionnaire about the decisions they had taken to withdraw life-support treatment. 128 of a total of 512 doctors questioned replied (25 %; 32,8 % females and 67,2 % males) . The survey showed that the judicial decision (that it is not necessary to provide treatment if life-support measures are not indicated) is largely determined by non-medical criteria. The clinical decision by doctors depended mainly on his personal opinion. Furthermore the survey showed that only a few doctors made use of the - lawful - option to withdraw medical treatment when this was not indicated. Finally the survey revealed that, in case of conflict between indication and perceived patients' wishes, the vast majority of doctors behaved in contravention of the decisions established by case law. There is the need to discuss what non-medical issues should be taken into account when determining the indication of withdrawal of life-support measures. The results also highlighted the uncertainties that exist regarding a doctor's decisions about it. Not only should legislation clarify whether "passive euthanasia" is allowed, but it would also be useful to delegate end-of-life decisions to a review board.

Fourth High Alpha Conference, volume 2

NASA Technical Reports Server (NTRS)

1994-01-01

The goal of the Fourth High Alpha Conference, held at the NASA Dryden Flight Research Center on July 12-14, 1994, was to focus on the flight validation of high angle of attack technologies and provide an in-depth review of the latest high angle of attack activities. Areas that were covered include high angle of attack aerodynamics, propulsion and inlet dynamics, thrust vectoring, control laws and handling qualities, and tactical utility.

NASA Involvement in National Priority Support for Disasters

NASA Technical Reports Server (NTRS)

McGregor, Lloyd

2002-01-01

This viewgraph presentation provides an overview of the role NASA remote sensing played in planning recovery operations in the aftermath of the September 11, 2001 terrorist attacks on the World Trade Center and the Pentagon. The presentation includes AVIRIS and satellite imagery of the attack sites, and photographs taken on the ground after the attacks. One page of the presentation addresses NASA's role in disaster management of the 2002 Winter Olympics.

A secure smart-card based authentication and key agreement scheme for telecare medicine information systems.

PubMed

Lee, Tian-Fu; Liu, Chuan-Ming

2013-06-01

A smart-card based authentication scheme for telecare medicine information systems enables patients, doctors, nurses, health visitors and the medicine information systems to establish a secure communication platform through public networks. Zhu recently presented an improved authentication scheme in order to solve the weakness of the authentication scheme of Wei et al., where the off-line password guessing attacks cannot be resisted. This investigation indicates that the improved scheme of Zhu has some faults such that the authentication scheme cannot execute correctly and is vulnerable to the attack of parallel sessions. Additionally, an enhanced authentication scheme based on the scheme of Zhu is proposed. The enhanced scheme not only avoids the weakness in the original scheme, but also provides users' anonymity and authenticated key agreements for secure data communications.

Robust anonymous authentication scheme for telecare medical information systems.

PubMed

Xie, Qi; Zhang, Jun; Dong, Na

2013-04-01

Patient can obtain sorts of health-care delivery services via Telecare Medical Information Systems (TMIS). Authentication, security, patient's privacy protection and data confidentiality are important for patient or doctor accessing to Electronic Medical Records (EMR). In 2012, Chen et al. showed that Khan et al.'s dynamic ID-based authentication scheme has some weaknesses and proposed an improved scheme, and they claimed that their scheme is more suitable for TMIS. However, we show that Chen et al.'s scheme also has some weaknesses. In particular, Chen et al.'s scheme does not provide user's privacy protection and perfect forward secrecy, is vulnerable to off-line password guessing attack and impersonation attack once user's smart card is compromised. Further, we propose a secure anonymity authentication scheme to overcome their weaknesses even an adversary can know all information stored in smart card.

Design and Implementation of a Telecardiology System for Mobile Devices.

PubMed

Cinaglia, Pietro; Tradigo, Giuseppe; Guzzi, Pietro H; Veltri, Pierangelo

2015-09-01

This paper presents the design and implementation of a system for digital telecardiology on mobile devices called Remote Cardio Consultation (RCC). Using RCC may improve first intervention procedures in case of heart attack. In fact, it allows physicians to remotely consult ECG signals from a mobile device or smartphone by using a so-called app. The remote consultation is implemented by a server application collecting physician availability to answer upon client support requests. The app can be used by first intervention clinicians and allows reducing delays and decision errors in emergency interventions. Thus, best decision, certified and supported by cardiologists, can be obtained in case of heart attacks and first interventions even by base medical doctors able to produce and send an ECG. RCC tests have been performed, and the prototype is freely available as a service for testing.

Primary care doctors faced with living organ donation.

PubMed

Conesa, C; Ríos, A; Ramírez, P; Sánchez, J; Sánchez, E; Rodríguez, M M; Martínez, L; Montoya, M J; Ramos, F; Parrilla, P

2006-04-01

The attitudes of health care personnel, specifically doctors, have a significant influence on public attitudes toward organ donation and transplantation. The objective herein was to analyze the attitudes of Primary Care (PC) doctors toward living organ donation and to determine the psychosocial factors that condition these attitudes. A random sample was stratified by geographical location (six health areas in our community) among PC doctors, including 155 respondents from 32 health centers. Attitudes toward donation were evaluated using a psychosocial questionnaire validated in our geographical area. Contact was made with the Doctor Coordinator in each center for distribution of the questionnaires, which were completed anonymously. The chi-square test and Student t test were applied to evaluate the data. When the living donor is not related, only 21% (n = 32) of PC doctors were in favor of living kidney donation, and only 20% (n = 31) for living liver donation (P > .05). In contrast, these percentages were 90% and 89% in favor of kidney and liver related donation, respectively. Upon analysis of the psychosocial variables affecting these attitudes, there was only an association with their partner's opinion (P = .009 for kidney and P = .000 for liver), and the possibility of needing a transplant oneself (P = .000). PC doctors have favorable attitudes toward related living donation. If living donation is promoted by transplant coordination units, such PC professionals could act as a source of positive information about the matter for the general public.

The Aerodynamic Performance of the 24 Inch Houck Configuration

DTIC Science & Technology

2007-03-01

a reference center of gravity for the aircraft must be picked . For the data reduction in this study, the center of gravity was placed at the...30 mph (Re ≈ 125K) for three different angles of attack of interest. An angle of attack of -2º was picked because lift was approximately zero at...likely be reduced with a more tapered trailing edge. The normalized turbulent kinetic energy reaches a peak value of approximately 0.012. The u

The Icatibant Outcome Survey: treatment of laryngeal angioedema attacks

PubMed Central

Aberer, Werner; Bouillet, Laurence; Caballero, Teresa; Maurer, Marcus; Fabien, Vincent; Zanichelli, Andrea

2016-01-01

Objective To characterize the management and outcomes of life-threatening laryngeal attacks of hereditary angioedema (HAE) treated with icatibant in the observational Icatibant Outcome Survey (NCT01034969) registry. Methods This retrospective analysis was based on data from patients with HAE type I/II who received healthcare professional-administered or self-administered icatibant to treat laryngeal attacks between September 2008 and May 2013. Results Twenty centers in seven countries contributed data. Overall, 42 patients with HAE experienced 67 icatibant-treated laryngeal attacks. Icatibant was self-administered for 62.3% of attacks (healthcare professional-administered, 37.7%). One icatibant injection was used for 87.9% of attacks, with rescue or concomitant medication used for 9.0%. The median time to treatment was 2.0 h (n=31 attacks) and the median time to resolution was 6.0 h (n=35 attacks). Conclusions This analysis describes successful use of icatibant for the treatment of laryngeal HAE attacks in a real-world setting. PMID:27116379

Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center.

PubMed

DiGrande, Laura; Neria, Yuval; Brackbill, Robert M; Pulliam, Paul; Galea, Sandro

2011-02-01

Although the September 11, 2001, terrorist attacks were the largest human-made disaster in US history, there is little extant research documenting the attacks' consequences among those most directly affected, that is, persons who were in the World Trade Center towers. Data from a cross-sectional survey conducted 2-3 years after the attacks ascertained the prevalence of long-term, disaster-related posttraumatic stress symptoms and probable posttraumatic stress disorder (PTSD) in 3,271 civilians who evacuated World Trade Center towers 1 and 2. Overall, 95.6% of survivors reported at least 1 current posttraumatic stress symptom. The authors estimated the probable rate of PTSD at 15.0% by using the PTSD Checklist. Women and minorities were at an increased risk of PTSD. A strong inverse relation with annual income was observed. Five characteristics of direct exposure to the terrorist attacks independently predicted PTSD: being on a high floor in the towers, initiating evacuation late, being caught in the dust cloud that resulted from the tower collapses, personally witnessing horror, and sustaining an injury. Working for an employer that sustained fatalities also increased risk. Each addition of an experience of direct exposure resulted in a 2-fold increase in the risk of PTSD (odds ratio = 2.09, 95% confidence interval: 1.84, 2.36). Identification of these risk factors may be useful when screening survivors of large-scale terrorist events for long-term psychological sequelae.

Research Problems in Data Curation: Outcomes from the Data Curation Education in Research Centers Program

NASA Astrophysics Data System (ADS)

Palmer, C. L.; Mayernik, M. S.; Weber, N.; Baker, K. S.; Kelly, K.; Marlino, M. R.; Thompson, C. A.

2013-12-01

The need for data curation is being recognized in numerous institutional settings as national research funding agencies extend data archiving mandates to cover more types of research grants. Data curation, however, is not only a practical challenge. It presents many conceptual and theoretical challenges that must be investigated to design appropriate technical systems, social practices and institutions, policies, and services. This presentation reports on outcomes from an investigation of research problems in data curation conducted as part of the Data Curation Education in Research Centers (DCERC) program. DCERC is developing a new model for educating data professionals to contribute to scientific research. The program is organized around foundational courses and field experiences in research and data centers for both master's and doctoral students. The initiative is led by the Graduate School of Library and Information Science at the University of Illinois at Urbana-Champaign, in collaboration with the School of Information Sciences at the University of Tennessee, and library and data professionals at the National Center for Atmospheric Research (NCAR). At the doctoral level DCERC is educating future faculty and researchers in data curation and establishing a research agenda to advance the field. The doctoral seminar, Research Problems in Data Curation, was developed and taught in 2012 by the DCERC principal investigator and two doctoral fellows at the University of Illinois. It was designed to define the problem space of data curation, examine relevant concepts and theories related to both technical and social perspectives, and articulate research questions that are either unexplored or under theorized in the current literature. There was a particular emphasis on the Earth and environmental sciences, with guest speakers brought in from NCAR, National Snow and Ice Data Center (NSIDC), and Rensselaer Polytechnic Institute. Through the assignments, students constructed dozens of research questions informed by class readings, presentations, and discussions. A technical report is in progress on the resulting research agenda covering: data standards; infrastructure; research context; data reuse; sharing and access; preservation; and conceptual foundations. This presentation will discuss the agenda and its importance for the geosciences, highlighting high priority research questions. It will also introduce the related research to be undertaken by two DCERC doctoral students at NCAR during the 2013-2014 academic year and other data curation research in progress by the doctoral DCERC team.

A framework for developing and integrating effective routing strategies within the emergency management decision-support system : [research brief].

DOT National Transportation Integrated Search

2012-05-01

The terrorist attacks on September 11th, as well as other coordinated attacks on transit centers in Madrid and London, have underscored the importance of evacuation planning to : transportation professionals. With computer technology advancement, urb...

Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication.

PubMed

Kenny, David A; Veldhuijzen, Wemke; Weijden, Trudy van der; Leblanc, Annie; Lockyer, Jocelyn; Légaré, France; Campbell, Craig

2010-03-01

Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters. 2009 Elsevier Ltd. All rights reserved.

An update of clinical management of acute intermittent porphyria

PubMed Central

Pischik, Elena; Kauppinen, Raili

2015-01-01

Acute intermittent porphyria (AIP) is due to a deficiency of the third enzyme, the hydroxymethylbilane synthase, in heme biosynthesis. It manifests with occasional neuropsychiatric crises associated with overproduction of porphyrin precursors, aminolevulinic acid and porphobilinogen. The clinical criteria of an acute attack include the paroxysmal nature and various combinations of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness, or mental symptoms, in the absence of other obvious causes. Intensive abdominal pain without peritoneal signs, acute peripheral neuropathy, and encephalopathy usually with seizures or psychosis are the key symptoms indicating possible acute porphyria. More than fivefold elevation of urinary porphobilinogen excretion together with typical symptoms of an acute attack is sufficient to start a treatment. Currently, the prognosis of the patients with AIP is good, but physicians should be aware of a potentially fatal outcome of the disease. Mutation screening and identification of type of acute porphyria can be done at the quiescent phase of the disease. The management of patients with AIP include following strategies: A, during an acute attack: 1) treatment with heme preparations, if an acute attack is severe or moderate; 2) symptomatic treatment of autonomic dysfunctions, polyneuropathy and encephalopathy; 3) exclusion of precipitating factors; and 4) adequate nutrition and fluid therapy. B, during remission: 1) exclusion of precipitating factors (education of patients and family doctors), 2) information about on-line drug lists, and 3) mutation screening for family members and education about precipitating factors in mutation-positive family members. C, management of patients with recurrent attacks: 1) evaluation of the lifestyle, 2) evaluation of hormonal therapy in women, 3) prophylactic heme therapy, and 4) liver transplantation in patients with severe recurrent attacks. D, follow-up of the AIP patients for long-term complications: chronic hypertension, chronic kidney insufficiency, chronic pain syndrome, and hepatocellular carcinoma. PMID:26366103

Attitudes of Doctors Working in Abant Izzet Baysal University Health Research and Application Center on Cardiopulmonary Resuscitation

PubMed Central

Yoldaş, Hamit; Kocoğlu, Hasan; Bayır, Hakan; Yıldız, İsa; Akkaya, Akcan; Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar

2016-01-01

Objective We aimed to evaluate the attitudes of doctors about cardiopulmonary resuscitation (CPR) in this research. Methods Overall, 234 doctors who were working in Abant İzzet Baysal University Health Research and Application Center and who accepted to participate in this research were included. Research data were obtained by a questionnaire containing questions about demographic characteristics of doctors and their knowledge about CPR. Questionnaires were applied between 27.02.2012 and 04.06.2012. The chi-square test was used for categorical variables. A value of p<0.05 was considered statistically significant. Results It was determined that 90% of the participants included in the study applied and/or observed CPR, and 62% of participants did not attend any CPR course. In addition, 64.1% of the doctors were found to be aware of guidelines prepared every 5 years. Although 65.2% of the doctors who attended a course previously gave a correct answer for the question about the number of cardiac compressions during adult CPR, 47.6% of the doctors who did not attend a course gave the correct answer (p=0.014). Additionally, 71.9% of participants who attended a course previously and 51.7% of participants who did not replied correctly to the question ‘What should be done immediately after defibrillation during CPR?’ And also the results for the question about how many joules is necessary to begin defibrillation with a monophasic defibrillator were statistically significant according to the attendance for a CPR course (p<0.005). Conclusion In this study, we have identified the lack of knowledge of the doctors about resuscitation. PMID:27366577

Responsibility and expectations in antiretroviral therapy--patients' versus doctors' perspective.

PubMed

Largu, Maria Alexandra; Dorobăţ, Carmen; Oprea, L; Astărăstoae, V; Manciuc, Carmen

2015-01-01

This paper aims to uncover what patients really expect form ART, and also what infectious diseases doctors expect from a patient's ART regime, thus exploring an important side of adherence to ART. From July to November 2014 we have conducted a qualitative study regarding both patients' and doctors' expectations form the ART. We interviewed 30 patients and 4 doctors. We used semi-structured interviews that were conducted in the Psychosocial Compartment of the HIV/AIDS Regional Center in Iasi. The patients we interviewed came from all 6 counties in the Moldova area. Age varied from 16 years to 59 years; 55% were female and 45% male. 30% came from a rural area. The most common expectations that patients have regarding ART are: "to help me live", "not to make me feel sick", "to be easy to take (not to big, not a lot)", "not to show on the outside what I have on the inside". The infectious diseases doctors that we interviewed work in the HIV/AIDS Regional Center in Iasi. Their expectations regarding an ART regimen for patients were: "to reduce HIV viral load", "to increase CD4 cell count" and "to have minimal impact on the proper functioning of other organs". Patients consider themselves the only factors responsible for their own ART adherence in 56.6% of cases; 20% consider the doctor to be responsible for their adherence, 16.6% feel that their family, friends, and spouse are responsible, and 6.6% (2 patients) couldn't answer. Infectious diseases doctors considered that patients are 100% responsible for adhering to the antiretroviral therapy. In order to assure adherence to the ART it is important to explore both the doctor and the patient's perspective and to find ways to find a common ground in building a healthy relationship.

Predictors of Satisfaction With Doctor and Nurse Communication: A National Study.

PubMed

McFarland, Daniel C; Johnson Shen, Megan; Holcombe, Randall F

2017-10-01

Prior research indicates that effective communication between medical providers and patients is associated with a number of positive patient outcomes, yet little research has examined how ecological factors (e.g., hospital size, local demographics) influence patients' reported satisfaction with doctor and nurse communication. Given the current emphasis on improving patient satisfaction in hospitals across the United States, understanding these factors is critical to interpreting patient satisfaction and improving patient-centered communication, particularly in diverse and dense populations. As such, this study examined county-level data including population density, population diversity, and hospital structural factors as predictors of patient satisfaction with doctor and nurse communication. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), U.S. Census data, and number of hospital beds were obtained from publicly available Hospital Compare, U.S. Census, and American Hospital Directory websites, respectively. Multivariate regression modeling was performed for the individual dimensions of HCAHPS scores assessing doctor and nurse communication. Standardized partial regression coefficients were used to assess strengths of county-level predictors. County-level factors accounted for 30% and 16% of variability in patient satisfaction with doctor and nurse communication, respectively. College education (β = 0.45) and White ethnicity (β = 0.25) most strongly predicted a favorable rating of doctor and nurse communication, respectively. Primary language (non-English speaking; β = -0.50) most strongly predicted an unfavorable rating of doctor communication, while number of hospital beds (β = -0.16) and foreign-born (β = -0.16) most strongly predicted an unfavorable rating of nurse communication. County-level predictors should be considered when interpreting patient satisfaction with doctor and nurse communication and designing multilevel patient-centered communication improvement strategies. Discordant findings with individual-level factors should be explored further.

Internships in School Psychology: Selection and Accreditation Issues

ERIC Educational Resources Information Center

Keilin, W. Gregory

2015-01-01

Doctoral students in school psychology often report unique issues and challenges when seeking a doctoral internship. The number and range of accredited internship positions available to School Psychology (SP) students in the Association of Psychology Postdoctoral and Internship Centers (APPIC) Match is quite limited, and they often obtain…

Walter Reed Army Medical Center's mental health response to the Pentagon attack.

PubMed

Cozza, Stephen J; Huleatt, William J; James, Larry C

2002-09-01

The September 11 terrorist attack on the Pentagon captured the attention and concern of America as well as the world. Given the extent of devastation, and the number of deaths at the Pentagon, it was believed that the uniformed mental health services would serve a pivotal role in the recovery and relief efforts. This article provides a synopsis of the complex and multidisciplinary mental health services provided by Walter Reed Army Medical Center in the wake of the September 11 attack on the Pentagon. This article offers an overview of the functions and roles of mental health team members, describes a constellation of services rendered, and describes how missions differed inside and outside of the Pentagon. Additionally, the authors provide the reader with how services were provided at the Family Assistance Center to family members of those killed during the attack. Liaison with civilian medical, mental health, and relief agencies and facilities will be discussed as well. The mental health response was an intensive and complicated experience and has yielded many lesson learned. To this end, the authors will provide the reader with an understanding of how the lessons learned during this mission may assist mental health commanders and leaders in planning and responding to similar deployments in the future.

Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.

PubMed

Gong, Jie; Chen, Xinguang; Li, Sijian

2015-01-01

To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP). Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention. Community-based and patient-centered self-care for behavioral intervention in urban settings of China. A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients). KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke. Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention. Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05) and stroke (5.11% vs. 9.90%, p<0.05), and moderate reduction in blood pressure (-3.72 mmHg in DBP and -2.92 mmHg in DBP) at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85) and 6-month (d = 0.45, 95% CI: 0.04, 0.85) post-intervention, respectively. The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention. ISRCTN Register ISRCTN12608966.

Patient-doctor agreement on recall of clinical trial discussion across cultures.

PubMed

Bernhard, J; Aldridge, J; Butow, P N; Zoller, P; Brown, R; Smith, A; Juraskova, I

2013-02-01

The purpose was to investigate patient-doctor agreement on clinical trial discussion cross-culturally. In the International Breast Cancer Study Group Trial 33-03 on shared decision-making for early breast cancer in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centers, doctor and patient characteristics plus doctor stress and burnout were assessed. Within 2 weeks post-consultation about treatment options, the doctor and patient reported independently, whether a trial was discussed. Odds ratios of agreement for covariables were estimated by generalized estimating equations for each language cohort, with doctor as a random effect. In ANZ, 21 doctors and 339 patients were eligible; in SGA, 41 doctors and 427 patients. In cases where the doctor indicated 'no trial discussed', 82% of both ANZ and SGA patients agreed; if the doctor indicated 'trial discussed', 50% of ANZ and 38% of SGA patients agreed, respectively. Factors associated with higher agreement were: low tumor grade and fewer patients recruited into clinical trials in SGA; public institution, patient born in ANZ (versus other), higher doctor depersonalization and personal accomplishment in ANZ. There is discordance between oncologists and their patients regarding clinical trial discussion, particularly when the doctor indicates that a trial was discussed. Factors contributing to this agreement vary by culture.

2. GENERAL VIEW, EAST FRONT, NORTHWEST VIEW Kingsway Center ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. GENERAL VIEW, EAST FRONT, NORTHWEST VIEW - Kingsway Center Commercial Area, Bounded by Kings Highway, Doctor Martin Luther King Boulevard, Page Avenue, & Euclid Avenue, Saint Louis, Independent City, MO

Cloud-assisted mutual authentication and privacy preservation protocol for telecare medical information systems.

PubMed

Li, Chun-Ta; Shih, Dong-Her; Wang, Chun-Cheng

2018-04-01

 With the rapid development of wireless communication technologies and the growing prevalence of smart devices, telecare medical information system (TMIS) allows patients to receive medical treatments from the doctors via Internet technology without visiting hospitals in person. By adopting mobile device, cloud-assisted platform and wireless body area network, the patients can collect their physiological conditions and upload them to medical cloud via their mobile devices, enabling caregivers or doctors to provide patients with appropriate treatments at anytime and anywhere. In order to protect the medical privacy of the patient and guarantee reliability of the system, before accessing the TMIS, all system participants must be authenticated.  Mohit et al. recently suggested a lightweight authentication protocol for cloud-based health care system. They claimed their protocol ensures resilience of all well-known security attacks and has several important features such as mutual authentication and patient anonymity. In this paper, we demonstrate that Mohit et al.'s authentication protocol has various security flaws and we further introduce an enhanced version of their protocol for cloud-assisted TMIS, which can ensure patient anonymity and patient unlinkability and prevent the security threats of report revelation and report forgery attacks.  The security analysis proves that our enhanced protocol is secure against various known attacks as well as found in Mohit et al.'s protocol. Compared with existing related protocols, our enhanced protocol keeps the merits of all desirable security requirements and also maintains the efficiency in terms of computation costs for cloud-assisted TMIS.  We propose a more secure mutual authentication and privacy preservation protocol for cloud-assisted TMIS, which fixes the mentioned security weaknesses found in Mohit et al.'s protocol. According to our analysis, our authentication protocol satisfies most functionality features for privacy preservation and effectively cope with cloud-assisted TMIS with better efficiency. Copyright © 2018 Elsevier B.V. All rights reserved.

Emergency Preparedness: Are You Ready?

ERIC Educational Resources Information Center

Harley, Lorraine

2012-01-01

Most Americans who consider emergency preparedness think of someone or another country attacking the United States. Most newspaper and televised accounts involve community leaders and policymakers preparing for a terrorist attack. However, anyone who operates a child care center, family child care home, or has children of her own, knows that…

Fusion Center Guidelines: Developing and Sharing Information and Intelligence in a New Era

DTIC Science & Technology

2007-07-06

and recovery efforts depend on tmely, accurate, and actonable nformaton about who the enem es are,61 where 61 Includng ther capabltes...ntentons, strengths, weaknesses. and how they operate, how they are supported, the targets the enem es ntend to attack, and the method of attack

A Taxonomy of Attacks on the DNP3 Protocol

NASA Astrophysics Data System (ADS)

East, Samuel; Butts, Jonathan; Papa, Mauricio; Shenoi, Sujeet

Distributed Network Protocol (DNP3) is the predominant SCADA protocol in the energy sector - more than 75% of North American electric utilities currently use DNP3 for industrial control applications. This paper presents a taxonomy of attacks on the protocol. The attacks are classified based on targets (control center, outstation devices and network/communication paths) and threat categories (interception, interruption, modification and fabrication). To facilitate risk analysis and mitigation strategies, the attacks are associated with the specific DNP3 protocol layers they exploit. Also, the operational impact of the attacks is categorized in terms of three key SCADA objectives: process confi- dentiality, process awareness and process control. The attack taxonomy clarifies the nature and scope of the threats to DNP3 systems, and can provide insights into the relative costs and benefits of implementing mitigation strategies.

Emergency care centers--an efficient method for mitigation of consequences after a dirty bomb attack.

PubMed

Miska, Horst

2012-08-01

For emergency preparedness and response with respect to nuclear power plant accidents, the concept of Emergency Care Centers has been developed in Germany. This setup aims at monitoring contamination, to decontaminate if needed, assess the dose, and perform an initial medical evaluation of people who might have been affected by the accident. The concept has been tested in many exercises. In response to a terrorist attack involving a dirty bomb, this concept may prove useful for attending contaminated people who are not severely injured.

Nursing at ground zero: experiences during and after September 11 World Trade Center attack.

PubMed

Dickerson, Suzanne Steffan; Jezewski, Mary Ann; Nelson-Tuttle, Christine; Shipkey, Nancy; Wilk, Nancy; Crandall, Blythe

2002-01-01

The purpose of this study is to discover shared perceptions, feelings, and common experiences of nurses after the September 11th World Trade Center terrorist attack through interpretive analysis of narrative stories of seventeen nurses. Six themes and one constitutive pattern describe the experiences: (a) Loss of a symbol and regaining new meaning, (b) Disaster without patients, (c) Coordinating with and without organizations, (d) Rediscovering the pride in nursing, (e) Traumatic Stress, and (f) Preparing for the future. The constitutive pattern is that nursing enables a humanitarian disaster response.

[Analysis of qualifications of medical and health institutions and certified doctors for providing occupational disease diagnosis in China].

PubMed

Wang, Huan-qiang; Li, Tao; Qi, Fang; Wu, Rui; Nie, Wu; Yu, Chen

2013-10-01

To investigate the qualifications and current situations of the medical and health institutions and certified doctors for providing occupational disease diagnosis in China and to provide a reference for developing relevant policies. Work reports and questionnaires survey were used to investigate the qualifications of all medical and health institutions and certified doctors for providing occupational disease diagnosis in China and their acceptance and diagnosis of occupational disease cases from 2006 to 2010. The rate for the work reports was 100%, and the response rate for the questionnaires was 71.0%. By the end of 2010, in the 31 provincial-level regions (excluding Hong Kong, Macao, and Taiwan) in China, there had been 503 medical and health institutions which were qualified for providing occupational disease diagnosis, including 207 centers for disease control and prevention, accounting for 41.2%, 145 general hospitals, accounting for 28.8%, 69 enterprise-owned hospitals, accounting for 13.7%, and 64 institutes or centers for occupational disease prevention and control, accounting for 12.7%; 4986 certified doctors got the qualification for providing occupational disease diagnosis, with 9.4 certified doctors on average in each institution, and there was 0.65 certified doctor per 100 000 employees. In addition, 16.5% of the institutions got all the qualifications for diagnosing 9 occupational diseases, and 17.1% of the institutions got the qualification for diagnosing one occupational disease. Each certified doctor accepted diagnosis of 16.8 cases of occupational diseases on average every year. A national occupational disease diagnosis network has been established in China, but the imbalance in regional distribution and specialty programs still exists among the qualified medical and health institutions and certified doctors. It is essential to further strengthen the development of regional qualified medical and health institutions and training of qualified doctors.

The Carnegie Project on the Education Doctorate

ERIC Educational Resources Information Center

Perry, Jill Alexa

2015-01-01

Beginning with 21 US schools of education, the Carnegie Project on the Education Doctorate (CPED) has created a network of education faculty who are differentiating the EdD from the PhD in order to better meet the needs of their practitioner-scholar students. Their discussions center on two questions: "What are the knowledge, skills, and…

Global Perspectives on Advocating for Change in Doctoral Education

ERIC Educational Resources Information Center

Martinez, George A.; Nerad, Maresi; Rudd, Elizabeth

2010-01-01

This paper presents a workshop report that summarises the potentially far-reaching deliberations and results of a conference of experts in doctoral education from around the world. The conference was organised jointly by the U.S. Center for Innovation and Research in Graduate Education (CIRGE) at the University of Washington, Seattle and the…

The Nazi Origins of Eduard Pernkopf's "Topographische Anatomie des Menschen:" The Biomedical Ethical Issues.

ERIC Educational Resources Information Center

Israel, Howard A.

1998-01-01

The discovery of the Nazi origins of the classic Pernkopf anatomy atlas is one example of scientific information obtained by doctors who violated the Hippocratic Oath. The ethical dilemmas that doctors and medical centers face as a result of this and other potentially tainted data is reviewed. (Author/AEF)

Untitled

Cancer.gov

First in Human The Center for Cancer Research is proud to be a part of "First in Human", a documentary capturing the real-life experiences of doctors, researchers, staff, patients and their caregivers at the NIH Clinical Center. Learn more

Shoulder injuries from attacking motion

NASA Astrophysics Data System (ADS)

Yanagi, Shigeru; Nishimura, Tetsu; Itoh, Masaru; Wada, Yuhei; Watanabe, Naoki

1997-03-01

Sports injuries have bothered professional players. Although many medical doctors try to treat injured players, to prevent sports injuries is more important. Hence, it is required to clear a kinematic mechanism of the sport injuries. A shoulder of volleyball attacker or baseball pitcher is often inured by playing motion. The injuries are mainly caused at the end of long head tendon, which is located in the upper side of scapula. Generally, a muscle and tendon have enough strength against tensile force, however, it seems that they are sometimes defeated by the lateral force. It is imagined that the effect of the lateral force has a possibility of injuring the tendon. If we find the influence of the lateral force on the injured portion, the mechanism of injuries must be cleared. In our research, volleyball attacking motion is taken by high speed video cameras. We analyze the motion as links system and obtain an acceleration of an arm and a shoulder from video image data. The generated force at a shoulder joint is calculated and resolved into the lateral and longitudinal forces. Our final goal is to discuss a possibility that the lateral force causes the injuries.

Towards A Taxonomy Of Attacks Against Energy Control Systems

NASA Astrophysics Data System (ADS)

Fleury, Terry; Khurana, Himanshu; Welch, Von

Control systems in the energy sector (e.g., supervisory control and data acquisition (SCADA) systems) involve a hierarchy of sensing, monitoring and control devices connected to centralized control stations or centers. The incorporation of commercial off-the-shelf technologies in energy control systems makes them vulnerable to cyber attacks. A taxonomy of cyber attacks against control systems can assist the energy sector in managing the cyber threat. This paper takes the first step towards a taxonomy by presenting a comprehensive model of attacks, vulnerabilities and damage related to control systems. The model is populated based on a survey of the technical literature from industry, academia and national laboratories.

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country.

PubMed

Nadir, Maha; Hamza, Muhammad; Mehmood, Nadir

2018-01-01

Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor-patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor-patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan. The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data. The study revealed four emerging themes: (1) Lack of doctor-patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients' concern with their improvement in health and doctor's demeanor. The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.

[Prevalence of anxiety disorders and depression among junior doctors and their links with their work].

PubMed

Kerrien, Margaux; Pougnet, Richard; Garlantézec, Ronan; Pougnet, Laurence; Le Galudec, Mickaël; Loddé, Brice; Dewitte, Jean-Dominique

2015-04-01

The caregivers are exposed to several occupational hazards, including psychosocial risks. Among these occupational groups, junior doctors have been little studied. The aim of this study was to evaluate the prevalence of depression and anxiety among junior doctors and their links with their work. This is a prospective study using an anonymous online questionnaire between October 2011 and June 2012. Every junior doctor of Brest medical school was included without exclusion criteria. The questionnaire asked about demographic and health data. It included four validated scales: the Center for Epidemiologic Studies Depression Scale (CES-D), the Spielberger anxiety questionnaire, the Quality of Life Questionnaire of WHO (WHO-QOL) and the Job Content Questionnaire of Karasek. One hundred and ninety-two junior doctors were included; 68.2 % of them were women. They were 13.0 % suffering from depression; 28.7 % from anxiety; 32.8 % of junior doctors were in job strain and 29.7 % in iso strain. Depression was correlated with high psychological demands and anxiety. The lack of organizational support from senior doctors and competition between junior doctors increased the junior doctors' anxiety. A part of junior doctors is anxious and depressed, somehow due to the psychological demands of work and relationships with other junior doctors and with senior doctors. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Revising School Attack Protections since 9/11

ERIC Educational Resources Information Center

Black, Susan

2004-01-01

The terrorist attacks of September 11, 2001, prompted federal officials to step up campaigns to make schools safe. After visiting Ground Zero at New York City's World Trade Center, Education Secretary Rodney Paige sent each chief state school officer suggestions for managing school crises. Many states also have school safety plans in place. New…

Subsonic Aerodynamic Characteristics of a Circular Body Earth-to-Orbit Vehicle

NASA Technical Reports Server (NTRS)

Lepsch, Roger A., Jr.; Ware, George M.; MacConochie, Ian O.

1996-01-01

A test of a generic reusable earth-to-orbit transport was conducted in the 7- by 10-Foot high-speed tunnel at the Langley Research Center at Mach number 0.3. The model had a body with a circular cross section and a thick clipped delta wing as the major lifting surface. For directional control, three different vertical fin arrangements were investigated: a conventional aft-mounted center vertical fin, wingtip fins, and a nose-mounted vertical fin. The configuration was longitudinally stable about the estimated center-of-gravity position of 0.72 body length and had sufficient pitch-control authority for stable trim over a wide range of angle of attack, regardless of fin arrangement. The maximum trimmed lift/drag ratio for the aft center-fin configuration was less than 5, whereas the other configurations had values of above 6. The aft center-fin configuration was directionally stable for all angles of attack tested. The wingtip and nose fins were not intended to produce directional stability but to be active controllers for artificial stabilization. Small rolling-moment values resulted from yaw control of the nose fin. Large adverse rolling-moment increments resulted from tip-fin controller deflection above 13 deg angle of attack. Flow visualization indicated that the adverse rolling-moment increments were probably caused by the influence of the deflected tip-fin controller on wing flow separation.

Patient satisfaction after pulmonary resection for lung cancer: a multicenter comparative analysis.

PubMed

Pompili, Cecilia; Brunelli, Alessandro; Rocco, Gaetano; Salvi, Rosario; Xiumé, Francesco; La Rocca, Antonello; Sabbatini, Armando; Martucci, Nicola

2013-01-01

Patient satisfaction reflects the perception of the customer about the level of quality of care received during the episode of hospitalization. To compare the levels of satisfaction of patients submitted to lung resection in two different thoracic surgical units. Prospective analysis of 280 consecutive patients submitted to pulmonary resection for neoplastic disease in two centers (center A: 139 patients; center B: 141 patients; 2009-2010). Patients' satisfaction was assessed at discharge through the EORTC-InPatSat32 module, a 32-item, multi-scale self-administered anonymous questionnaire. Each scale (ranging from 0 to 100 in score) was compared between the two units. Multivariable regression and bootstrap were used to verify factors associated with the patients' general satisfaction (dependent variable). Patients from unit B reported a higher general satisfaction (91.5 vs. 88.3, p = 0.04), mainly due to a significantly higher satisfaction in the doctor-related scales (doctors' technical skill: p = 0.001; doctors' interpersonal skill: p = 0.008; doctors' availability: p = 0.005, and doctors information provision: p = 0.0006). Multivariable regression analysis and bootstrap confirmed that level of care in unit B (p = 0.006, bootstrap frequency 60%) along with lower level of education of the patient population (p = 0.02, bootstrap frequency 62%) were independent factors associated with a higher general patient satisfaction. We were able to show a different level of patient satisfaction in patients operated on in two different thoracic surgery units. A reduced level of patient satisfaction may trigger changes in the management policy of individual units in order to meet patients' expectations and improve organizational efficiency. Copyright © 2012 S. Karger AG, Basel.

Do "trainee-centered ward rounds" help overcome barriers to learning and improve the learning satisfaction of junior doctors in the workplace?

PubMed

Acharya, Vikas; Reyahi, Amir; Amis, Samuel M; Mansour, Sami

2015-01-01

Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of "trainee-centered ward rounds" would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March-April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues' feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of "Legitimate peripheral participation" as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings, as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed.

78 FR 64603 - Medicare Program: Conditions of Participation (CoPs) for Community Mental Health Centers

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

... 1861(r)(1), which lists a doctor of medicine or osteopathy. The commenter believes that this will help ensure that clients in a CMHC receive quality care from appropriately trained doctors of medicine or osteopathy legally authorized to practice medicine and surgery by the State. Response: We thank the...

Bioengineering/Biophysicist Post-doctoral Fellow | Center for Cancer Research

Cancer.gov

A post-doctoral fellow position is available in the Tissue Morphodynamics Unit headed by Dr. Kandice Tanner at the National Cancer Institute. The Tanner lab combines biophysical and cell biological approaches to understand the interplay between tissue architecture and metastasis. We use a combination of imaging modalities, cell biology and animal models. It is expected that as

Suicide Bombing Attacks

PubMed Central

Almogy, Gidon; Belzberg, Howard; Mintz, Yoaz; Pikarsky, Alon K.; Zamir, Gideon; Rivkind, Avraham I.

2004-01-01

Objective: To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks. Summary Background Data: The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects. Methods: The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003. Results: Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns. Conclusions: The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities. PMID:15075644

Suicide bombing attacks: update and modifications to the protocol.

PubMed

Almogy, Gidon; Belzberg, Howard; Mintz, Yoaz; Pikarsky, Alon K; Zamir, Gideon; Rivkind, Avraham I

2004-03-01

To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks. The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects. The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003. Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns. The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities.

Previous exposure to the World Trade Center terrorist attack and posttraumatic symptoms among older adults following Hurricane Sandy.

PubMed

Shrira, Amit; Palgi, Yuval; Hamama-Raz, Yaira; Goodwin, Robin; Ben-Ezra, Menachem

2014-01-01

The present study tested the maturation and inoculation hypotheses by examining whether age and previous exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms. An online sample of 1,000 participants from affected states completed self-report questionnaires one month after Hurricane Sandy hit the East Coast. Participants reported their degree of exposure to the WTC terrorist attack and to Hurricane Sandy, and their posttraumatic stress disorder (PTSD) symptoms following Hurricane Sandy. The positive relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms was weaker among older adults. An additional significant three-way interaction suggested that both age and previous exposure to the WTC terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms. Previous high degree of exposure to the WTC terrorist attack was related to a weaker effect of current exposure to Hurricane Sandy on PTSD symptoms among older adults. However, among younger adults, previous high degree of exposure to the WTC terrorist attack was related to a stronger effect of current exposure on PTSD symptoms. When confronted by a natural disaster, American older adults are generally resilient. Supporting the inoculation hypothesis, resilience of older adults may be partly related to the strength successfully extracted from previous exposure to adverse events.

Longitudinal Aerodynamic Characteristics to Large Angles of Attack of a Cruciform Missile Configuration at a Mach Number of 2

NASA Technical Reports Server (NTRS)

Spahr, J. R.

1954-01-01

The lift, pitching-moment, and drag characteristics of a missile configuration having a body of fineness ratio 9.33 and a cruciform triangular wing and tail of aspect ratio 4 were measured at a Mach number of 1.99 and a Reynolds number of 6.0 million, based on the body length. The tests were performed through an angle-of-attack range of -5 deg to 28 deg to investigate the effects on the aerodynamic characteristics of roll angle, wing-tail interdigitation, wing deflection, and interference among the components (body, wing, and tail). Theoretical lift and moment characteristics of the configuration and its components were calculated by the use of existing theoretical methods which have been modified for application to high angles of attack, and these characteristics are compared with experiment. The lift and drag characteristics of all combinations of the body, wing, and tail were independent of roll angle throughout the angle-of-attack range. The pitching-moment characteristics of the body-wing and body-wing-tail combinations, however, were influenced significantly by the roll angle at large angles of attack (greater than 10 deg). A roll from 0 deg (one pair of wing panels horizontal) to 45 deg caused a forward shift in the center of pressure which was of the same magnitude for both of these combinations, indicating that this shift originated from body-wing interference effects. A favorable lift-interference effect (lift of the combination greater than the sum of the lifts of the components) and a rearward shift in the center of pressure from a position corresponding to that for the components occurred at small angles of attack when the body was combined with either the exposed wing or tail surfaces. These lift and center-of-pressure interference effects were gradually reduced to zero as the angle of attack was increased to large values. The effect of wing-tail interference, which influenced primarily the pitching-moment characteristics, is dependent on the distance between the wing trailing vortex wake and the tail surfaces and thus was a function of angle of attack, angle of roll, and wing-tail interdigitation. Although the configuration at zero roll with the wing and tail in line exhibited the least center-of-pressure travel, the configuration with the wing and tail interdigitated had the least change in wing-tail interference over the angle-of-attack range. The lift effectiveness of the variable-incidence wing was reduced by more than 70 percent as a result of an increase in the combined angle of attack and wing incidence from 0 deg to 40 deg. The wing-tail interference (effective downwash at the tail) due to wing deflection was nearly zero as a result of a region of negative vorticity shed from the inboard portion of the wing. The lift characteristics of the configuration and its components were satisfactorily predicted by the calculated results, but the pitching moments at large angles of attack were not because of the influence of factors for which no adequate theory is available, such as the variation of the crossflow drag coefficient along the body and the effect of the wing downwash field on the afterbody loading.

KAMEDO report no. 87: bomb attack in Finnish shopping center, 2002.

PubMed

Deverell, Edward; Ortenwall, Per; Almgren, Ola; Riddez, Louis

2007-01-01

The detonation of a bomb in a shopping center in Vantaa, Finland, took place on 11 October 2002. Seven people died as a result and > 160 people required medical attention. Because the rescue teams were inadequately trained to respond to terrorist attacks, the event was handled according to protocol. A number of problems arose, including: people from different rescue agencies were difficult to distinguish from each other; there was inadequate communication between the incident site and the main hospital; relatives of victims were not kept informed; and psychiatric problems in the wake of the disaster were not addressed sufficiently.

Sequential defense against random and intentional attacks in complex networks.

PubMed

Chen, Pin-Yu; Cheng, Shin-Ming

2015-02-01

Network robustness against attacks is one of the most fundamental researches in network science as it is closely associated with the reliability and functionality of various networking paradigms. However, despite the study on intrinsic topological vulnerabilities to node removals, little is known on the network robustness when network defense mechanisms are implemented, especially for networked engineering systems equipped with detection capabilities. In this paper, a sequential defense mechanism is first proposed in complex networks for attack inference and vulnerability assessment, where the data fusion center sequentially infers the presence of an attack based on the binary attack status reported from the nodes in the network. The network robustness is evaluated in terms of the ability to identify the attack prior to network disruption under two major attack schemes, i.e., random and intentional attacks. We provide a parametric plug-in model for performance evaluation on the proposed mechanism and validate its effectiveness and reliability via canonical complex network models and real-world large-scale network topology. The results show that the sequential defense mechanism greatly improves the network robustness and mitigates the possibility of network disruption by acquiring limited attack status information from a small subset of nodes in the network.

Induction of panic attack by stimulation of the ventromedial hypothalamus.

PubMed

Wilent, W Bryan; Oh, Michael Y; Buetefisch, Cathrin M; Bailes, Julian E; Cantella, Diane; Angle, Cindy; Whiting, Donald M

2010-06-01

Panic attacks are sudden debilitating attacks of intense distress often accompanied by physical symptoms such as shortness of breath and heart palpitations. Numerous brain regions, hormones, and neurotransmitter systems are putatively involved, but the etiology and neurocircuitry of panic attacks is far from established. One particular brain region of interest is the ventromedial hypothalamus (VMH). In cats and rats, electrical stimulation delivered to the VMH has been shown to evoke an emotional "panic attack-like" escape behavior, and in humans, stimulation targeting nuclei just posterior or anterior to the VMH has reportedly induced panic attacks. The authors report findings obtained in an awake patient undergoing bilateral implantation of deep brain stimulation electrodes into the hypothalamus that strongly implicates the VMH as being critically involved in the genesis of panic attacks. First, as the stimulating electrode progressed deeper into the VMH, the intensity of stimulation required to evoke an attack systematically decreased; second, while stimulation of the VMH in either hemisphere evoked panic, stimulation that appeared to be in the center of the VMH was more potent. Thus, this evidence supports the role of the VMH in the induction of panic attacks purported by animal studies.

Research Center for Optical Physics: Education and Technology for the 21st Century

NASA Technical Reports Server (NTRS)

2003-01-01

During the past eleven years since its inception, RCOP has excelled in its two primary goals: 1) training of the scientists and engineers needed for the twenty-first century with special emphasis on underrepresented citizens and 2) research and technological development in areas of relevance to NASA. In the category of research training, as of May 2003, RCOP produced 36 Bachelors degrees, 25 Masters degrees, and 13 Doctoral degrees. Of these, all 36 Bachelors degrees, 16 of the Masters degrees and 9 of the Doctoral degrees were awarded to African Americans. Four of the Doctoral graduates and one of the Masters graduates are working at NASA Field Centers. RCOP has also provided research experiences to 130 undergraduate students and 22 high school students through a number of outreach programs held during the summer and the academic year. RCOP has also been crucial to the development of the Ph.D. program in physics at Hampton University by providing high quality research training and technical electives required for a Doctoral degree in physics. RCOP has also excelled in research and technological development. Since 1992, RCOP researchers have leveraged over 8 million dollars in additional research funding, published 152 papers in refereed journals and proceedings, and given 125 presentations at refereed international conferences in the United States and eight other countries. RCOP also developed numerous collaborations with other research centers, universities and industries. In recognition of this outstanding work, RCOP is the first research center in the United States invited to join the Joint Open Laboratory for Laser Crystals and Precise Laser Systems headed by Dr. Alexander Kaminiskii of the Russian Academy of Sciences.

Parent satisfaction with a pediatric practice in Germany: A questionnaire-based study

PubMed Central

2011-01-01

Background Parental satisfaction with a pediatric day center is essential for the medical treatment of children, since it is closely related to compliance. In order to ascertain factors which predict parental satisfaction as well as to discover possible weak points, we developed a questionnaire. Methods 127 parents visiting the pediatric day center from October to November 2010 were asked to respond to a questionnaire. The survey was given to them directly by the doctor after their visit and it provided the opportunity to determine subjective and soft factors in quality management, which is essential for a pediatric practice. The questionnaire consisted of 27 items divided into three scales. The scales were as follows: satisfaction concerning the infrastructure and organization, satisfaction concerning the communicative and empathic competence of the doctor as well as the other staff, and finally the results and the overall impression. Moreover, the survey asked the respondents for their comments on the pediatric day center and sociodemographic data were queried. Results A total of 67 parents (52,7%) responded to the survey. The mean parental satisfaction concerning infrastructure and organization achieved 3,61 (scale 1-very unsatisfied-through 4-very satisfied). The mean satisfaction with the expertise of the doctor and the staff was 3,56 and the overall satisfaction was 3,65. Ninety-one percent of the parents would visit the pediatric practice again and 84,2% would definitely recommend the practice to others. Conclusion Surveys on parental satisfaction are essential for the success of a pediatric day center. Apart from the doctors abilities to interact with the parents, other factors, such as a short waiting period, a friendly and helpful staff, as well as appealing premises are essential for a high overall level of satisfaction. PMID:21729322

Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

PubMed Central

Thomas, Nina; Tyry, Tuula; Fox, Robert J.; Salter, Amber

2017-01-01

Background: Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods: North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results: Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions: Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference. PMID:29270088

Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial

PubMed Central

Gong, Jie; Chen, Xinguang; Li, Sijian

2015-01-01

Objective To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP). Design Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention. Setting Community-based and patient-centered self-care for behavioral intervention in urban settings of China. Participants A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients). Intervention KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke. Outcome Measures Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention. Results Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05) and stroke (5.11% vs. 9.90%, p<0.05), and moderate reduction in blood pressure (-3.72mmHg in DBP and -2.92 mmHg in DBP) at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85) and 6-month (d = 0.45, 95% CI: 0.04, 0.85) post-intervention, respectively. Conclusion The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention. Trial Registration ISRCTN Register ISRCTN12608966 PMID:26426421

Experimental investigation of vortices shed by various wing fin configurations. M.S. Thesis. Final Report

NASA Technical Reports Server (NTRS)

Iversen, J.; Moghadam, M.

1981-01-01

Forty-six different fins, which were members of twelve plan-form families, were tested. A two dimensional Boeing single element airfoil at an angle of attack of eight degrees and a sweepback angle of thirty-two was used to simulate a portion of the wing of a generator aircraft. Various free stream velocities were used to test any individual fin at its particular angle of attack. While the fin itself was mounted on the upper surface of the generator model, the angle of attack of each fin was varied until stall was reached and/or passed. The relative fin vortex strengths were measured in two ways. First, the maximum angular velocity of a four blade rotor placed in the fin vortex center was measured with the use of a stroboscope. Second, the maximum rolling moment on a following wing model placed in the fin vortex center was measured by a force balance.

Countering Maritime Terrorism in the Caribbean Sea and the Atlantic Ocean: Implications of Possible Maritime Terrorism in the Caribbean

DTIC Science & Technology

2007-12-14

nationals who were arrested in June 2007, for allegedly plotting to bomb New York’s John F. Kennedy ( JFK ) Airport lends credence to this. Three of the...charges of conspiring to attack New York City’s JFK Airport by planting explosives to blow up the airport’s major jet-fuel supply tanks and pipeline. The...conspirators, the same defendant compared the plot to attack JFK airport to the attacks on the World Trade Center on 11 September and he stated that “even the

[Doctor-patient relationship in the context of a changing society].

PubMed

Siebzehner, Miriam Ines; Balik, Chaya; Matalon, Andre

2008-12-01

During the 20th century doctors gained a special status in the medical system, which is about to change as a consequence of a change in the doctor-patient relationship and in the characteristics of the labor market in health care. Some changes correspond with the adoption of business terms within the medical system. The doctor is represented as a supplier of services, while the patient is a consumer. From patient-centered care, the doctor-patient relationship changed to a costumer-supplier of services, as is the case in other fields of the consumer society. This article analyzes the changes in the patterns of the doctor-patient interactions in the light of the changes in society over the last decades such as: the creation of regulations and laws on patients' rights; the establishment of organizations that represent the sick, the distribution of knowledge and information by means of mass communication, changes in the status of the doctors, the academization of other health professionals and changes in the management of health care to a more financially viable approach to the costs of health.

The uses of the smartphone for doctors: an empirical study from samsung medical center.

PubMed

Choi, Jong Soo; Yi, Byoungkee; Park, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo; Rhee, Poong-Lyul

2011-06-01

In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements.

Prevention of birth defects in the pre-conception period: knowledge and practice of health care professionals (nurses and doctors) in a city of Southern Brazil

PubMed Central

Ferreira, Flávia Romariz; Russo Akiba, Heloisa Regina; Júnior, Edward Araujo; Figueiredo, Elisabeth Niglio; Abrahão, Anelise Riedel

2015-01-01

Background: Some congenital defects can be prevented in the pregestational stage. However, many health professionals are not prepared to provide counselling to couples regarding the same. Objective: This study aimed to assess the performance of doctors and nurses from a primary health-care unit in Florianopolis, Brazil, in preventing birth defects in the preconception period based on the recommendations of the Control Center of Disease Prevention. Materials and Methods: This descriptive cross sectional study was performed at a tertiary referral center. In this study, a semi-structured questionnaire was provided to 160 health professionals comprising doctors and nurses who were actively involved in providing primary health care in family health programs. The non-parametric Chi-square (χ2) test was used to analyse the data obtained through multiple choice questions. Results: Our results showed that although 81.9% of health professionals provided health-care assistance based on protocols, and only 46.2% professionals were aware of the presence of the topic in the protocol. Of the recommendations provided by the Control Center of Disease Prevention, the use of folic acid was the most prescribed. However, this prescription was not statistically different between nurses and doctors (P=0.85). Conclusion: This study identified the fragile nature in these professional’s knowledge about the prevention of birth defects in pre-conception period, as evidenced by the inconsistency in their responses. PMID:26644794

Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients.

PubMed

de Parades, Vincent; Etienney, Isabelle; Bauer, Pierre; Taouk, Milad; Atienza, Patrick

2007-06-01

This prospective study was designed to describe a typical attack of proctalgia fugax. Patients were recruited from May 2003 to June 2004. Whatever the reason for consultation, they were systematically asked: "Do you ever suffer intermittent and recurring anorectal pain lasting for at least three seconds?" If the answer was yes, they were interviewed with a questionnaire and had a proctologic examination. The criterion for proctalgia fugax was a positive answer with a negative examination. The study included 1,809 patients. Fifty-four of these patients (3 percent) had proctalgia fugax and 83 percent of them had never sought medical advice for this problem. The mean age was 51 (range, 18-87) years. Thirty-seven patients were females (69 percent). The onset of pain was sudden and without a trigger factor in 85 percent of cases. Attacks occurred in the daytime (33 percent) as well as at night (35 percent). The pain was described as cramping, spasm-like, or stabbing in 76 percent of cases. It did not radiate in 93 percent of cases. There were no concomitant symptoms in 81 percent of cases. Attacks stopped spontaneously in 67 percent of cases. The average duration was 15 minutes (range, 5 seconds to 90 minutes). The average annual number of attacks was 13 (range, 1-180). Proctalgia fugax affects twice as many females as males at approximately aged 50 years. Commonly the roughly once-monthly attack occurs as a sudden pain with no trigger factor, diurnally as often as nocturnally. The nonradiating cramp, spasm, or stabbing pain, without concomitant symptoms, is most severe on average after 15 minutes and declines spontaneously.

Factors influencing intercultural doctor-patient communication: a realist review.

PubMed

Paternotte, Emma; van Dulmen, Sandra; van der Lee, Nadine; Scherpbier, Albert J J A; Scheele, Fedde

2015-04-01

Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. Training for improving ICC can be developed as an extension of the existing training for patient-centered communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Doctor of nursing practice program development: reengineering health care.

PubMed

Wall, Barbra M; Novak, Julie C; Wilkerson, Sharon A

2005-09-01

In this article, we describe the developmental process of a Doctor of Nursing Practice (DNP) program that uses interdisciplinary resources to create unique DNP curriculum opportunities. Other schools may benefit from this experience in the development of their own DNP programs. The program delivers an innovative curriculum from post-baccalaureate to doctorate, emphasizing health care engineering and interdisciplinary collaboration among faculty, hospitals, community leaders, and policymakers. This DNP program is uniquely situated to provide leadership in solving complex clinical problems through its partnership with the Regenstrief Center for Healthcare Engineering, the School of Pharmacy, the Homeland Security Institute, and the Center on Aging and the Life Course. Doctoral coursework, interdisciplinary collaboration, health care engineering/systems approaches, and new knowledge result in uniquely qualified providers. Post-baccalaureate students complete the university's Adult Nurse Practitioner program or its developing Pediatric Nurse Practitioner program during the first 2 years of the 4-year curriculum. A total of 83 post-baccalaureate credit hours include 1,526 hours of supervised clinical practice, a health policy residency, and cognate residencies in an area of specialization. The seven core competencies recommended by the American Association of Colleges of Nursing are incorporated into the curriculum.

From Nuremberg to Guantanamo Bay: Uses of Physicians in the War on Terror.

PubMed

Crosby, Sondra S; Benavidez, Gilbert

2018-01-01

Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

[Added value of family practitioners' supervision of junior doctors in a walk-in clinic].

PubMed

Perdrix, J; Gubser, R; Gilgien, W; Bischoff, T

2011-05-18

The pending workforce crisis in family medicine has triggered various initiatives. This article describes the PMU-FLON walk-in clinic, a project of the Institute of General Medicine University of Lausanne. The working conditions in this clinic are close to that of a family practice. Doctors in training are supervised by family doctors who work part-time in the clinic. The objective is to improve training in the various fields of family medicine, from technical skills (improving optimal use of diagnostic tools), to integrating patients' requests in a more global patient-centered approach. This new educational model allows doctors in training to benefit from the specific approaches of different trainers. It will contribute to promoting quality family medicine in the future.

Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and clinical considerations.

PubMed

Acosta, Judith K; Levenson, Richard L

2002-01-01

Part I of this series discussed our observations of Ground Zero of the World Trade Center (WTC) immediately after the attack on September 11, 2001, as well as the stress-response of police officers on site. This paper offers a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.

Security Events and Vulnerability Data for Cybersecurity Risk Estimation.

PubMed

Allodi, Luca; Massacci, Fabio

2017-08-01

Current industry standards for estimating cybersecurity risk are based on qualitative risk matrices as opposed to quantitative risk estimates. In contrast, risk assessment in most other industry sectors aims at deriving quantitative risk estimations (e.g., Basel II in Finance). This article presents a model and methodology to leverage on the large amount of data available from the IT infrastructure of an organization's security operation center to quantitatively estimate the probability of attack. Our methodology specifically addresses untargeted attacks delivered by automatic tools that make up the vast majority of attacks in the wild against users and organizations. We consider two-stage attacks whereby the attacker first breaches an Internet-facing system, and then escalates the attack to internal systems by exploiting local vulnerabilities in the target. Our methodology factors in the power of the attacker as the number of "weaponized" vulnerabilities he/she can exploit, and can be adjusted to match the risk appetite of the organization. We illustrate our methodology by using data from a large financial institution, and discuss the significant mismatch between traditional qualitative risk assessments and our quantitative approach. © 2017 Society for Risk Analysis.

A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse.

PubMed

Corrigan, Malachy; McWilliams, Rita; Kelly, Kerry J; Niles, Justin; Cammarata, Claire; Jones, Kristina; Wartenberg, Daniel; Hallman, William K; Kipen, Howard M; Glass, Lara; Schorr, John K; Feirstein, Ira; Prezant, David J

2009-11-01

We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health-related medical leave over the first 2.5 years after the attack. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health-related medical leave. Exposure-response gradients were significant for all outcomes. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.

Not so close but still extremely loud: recollection of the World Trade Center terror attack and previous hurricanes moderates the association between exposure to hurricane Sandy and posttraumatic stress symptoms.

PubMed

Palgi, Yuval; Shrira, Amit; Hamama-Raz, Yaira; Palgi, Sharon; Goodwin, Robin; Ben-Ezra, Menachem

2014-05-01

The present study examined whether recollections of the World Trade Center (WTC) terror attack and previous hurricanes moderated the relationship between exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms. An online sample of 1000 participants from affected areas completed self-report questionnaires a month after Hurricane Sandy hit the East Coast of the United States. Participants reported their exposure to Hurricane Sandy, their PTSD symptoms, and recollections of the WTC terror attack and previous hurricanes elicited due to Hurricane Sandy. Exposure to Hurricane Sandy was related to PTSD symptoms among those with high level of recollections of the WTC terror attack and past hurricanes, but not among those with low level of recollections. The aftermath of exposure to Hurricane Sandy is related not only to exposure, but also to its interaction with recollections of past traumas. These findings have theoretical and practical implications for practitioners and health policy makers in evaluating and interpreting the impact of past memories on future natural disasters. This may help in intervention plans of social and psychological services. Copyright © 2014 Elsevier Inc. All rights reserved.

[How to make regional medicine revive from the medical crisis or collapse due to the severe paucity of medical doctors: a plan with "the magnet hospital"].

PubMed

Itoh, Tsunetoshi

2009-01-01

In 2002-2003, the practice of doctors lending their names to appear as "staff" of hospitals became known. Problems regarding funds from public hospitals were also revealed. Tohoku University asked regional societies how to improve the medical situation, and redefined its responsibilities. The Educational Development Center for Local Medicine and Department of Local Medical Service System were set up (2005-2008). A severe shortage of medical doctors prevails in Japan: the number of doctors per population is at the 4th lowest among OECD countries, and the number per hospital bed is the lowest. We have no nursing homes whose beds are not counted as hospital beds. The number of faculty staff in Japanese medical schools is 1/3 to those of Western countries. The reported number of doctors working in hospitals and offices surpasses that by census for medical doctors by >40,000. Japanese doctors work for >60 hours per week. I propose essential plans to improve Japanese situation for medical service: 1. Immediately increase the number of doctors by at least 50%. Based on our calculation, we need 450,000 doctors. 2. When the shortage of doctors is severe, establish a magnet hospital with c.a. 500 beds for every 200,000 population, capable of treating highly emergency patients and attracting doctors who need medical training. Hospitals should not belong to each city or town. 3. Establish a comprehensive organization to nurture doctors on a long-term basis. It should consist of a medical school, hospitals, and the prefectural government. It should help doctors to move between hospitals, and be responsible both for designing doctors' career paths and for allocating them appropriately.

Flight test of the X-29A at high angle of attack: Flight dynamics and controls

NASA Technical Reports Server (NTRS)

Bauer, Jeffrey E.; Clarke, Robert; Burken, John J.

1995-01-01

The NASA Dryden Flight Research Center has flight tested two X-29A aircraft at low and high angles of attack. The high-angle-of-attack tests evaluate the feasibility of integrated X-29A technologies. More specific objectives focus on evaluating the high-angle-of-attack flying qualities, defining multiaxis controllability limits, and determining the maximum pitch-pointing capability. A pilot-selectable gain system allows examination of tradeoffs in airplane stability and maneuverability. Basic fighter maneuvers provide qualitative evaluation. Bank angle captures permit qualitative data analysis. This paper discusses the design goals and approach for high-angle-of-attack control laws and provides results from the envelope expansion and handling qualities testing at intermediate angles of attack. Comparisons of the flight test results to the predictions are made where appropriate. The pitch rate command structure of the longitudinal control system is shown to be a valid design for high-angle-of-attack control laws. Flight test results show that wing rock amplitude was overpredicted and aileron and rudder effectiveness were underpredicted. Flight tests show the X-29A airplane to be a good aircraft up to 40 deg angle of attack.

Executive Summary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, James J.; Cook, Kristin A.

2005-05-09

Motivation Our country faces profound challenges that must be addressed in order to ensure our continued freedom and security. As the September 11, 2001, attacks on the Pentagon and World Trade Center illustrate, threats to the United States are present within our borders. On that day, after at least 20 months of planning and preparation, nineteen terrorists hijacked four airliners at three different airports in a coordinated attack. The hijackers crashed two planes into the World Trade Center’s twin towers and one plane into the Pentagon. The fourth plane, intended to attack another U.S. landmark, crashed in a field inmore » Pennsylvania. 2973 people lost their lives as a result of this attack. As the attack unfolded, government agencies and emergency response personnel had to respond in real time to situations for which policies and procedures did not exist. They were forced to assess situations and make decisions under extreme pressure, often without having critical information that would help them save additional lives. [National Commission on Terrorist Attacks, 2004]« less

Unexpected nerve gas exposure in the city of Matsumoto: report of rescue activity in the first sarin gas terrorism.

PubMed

Okudera, H; Morita, H; Iwashita, T; Shibata, T; Otagiri, T; Kobayashi, S; Yanagisawa, N

1997-09-01

This report describes the rescue activities and the exposure of rescue and hospital personnel from the first unexpected nerve gas terrorist attack using sarin (isopropyl methylphophonofluoridate) in the city of Matsumoto at midnight on June 27, 1994. The details of the emergency activities in the disaster were studied based on the records from emergency departments of the affiliated hospitals and records from the firehouse. About 600 people, including residents and rescue staff, were exposed to sarin gas. Fifty-eight residents were admitted to hospitals, and 7 died. Among 95 rescuers and the duty doctor from the doctor car, 8 had mild symptoms of poisoning. All the rescue activity took place without gas masks or decontamination procedures. In this case of unexpected mass exposure to sarin gas, the emergency rescue system for a large disaster in Matsumoto city, which had been established for a conflagration or a local earthquake, was effective.

Science and Math through Role-Play Centers in the Elementary School Classroom.

ERIC Educational Resources Information Center

Jarrett, Olga S.

1997-01-01

Describes role-play centers in which children can do math problems, invent, experiment, write with a purpose, and act out adult career roles. Examples of centers include a doctor's office, a supermarket, a fix-it or inventor's workshop, a post office, a pet store, a zoo, a veterinary clinic, a museum, and a restaurant. (DKM)

Consensus-Based Cooperative Spectrum Sensing with Improved Robustness Against SSDF Attacks

NASA Astrophysics Data System (ADS)

Liu, Quan; Gao, Jun; Guo, Yunwei; Liu, Siyang

2011-05-01

Based on the consensus algorithm, an attack-proof cooperative spectrum sensing (CSS) scheme is presented for decentralized cognitive radio networks (CRNs), where a common fusion center is not available and some malicious users may launch attacks with spectrum sensing data falsification (SSDF). Local energy detection is firstly performed by each secondary user (SU), and then, utilizing the consensus notions, each SU can make its own decision individually only by local information exchange with its neighbors rather than any centralized fusion used in most existing schemes. With the help of some anti-attack tricks, each authentic SU can generally identify and exclude those malicious reports during the interactions within the neighborhood. Compared with the existing solutions, the proposed scheme is proved to have much better robustness against three categories of SSDF attack, without requiring any a priori knowledge of the whole network.

Mathematical Simulation of Perturbations of Attack Angle of Asymmetric Nanosatellite Passing through Resonance

NASA Astrophysics Data System (ADS)

Lyubimov, V. V.; Kurkina, E. V.

2018-05-01

The authors consider the problem of a dynamic system passing through a low-order resonance, describing an uncontrolled atmospheric descent of an asymmetric nanosatellite in the Earth's atmosphere. The authors perform mathematical and numerical modeling of the motion of the nanosatellite with a small mass-aerodynamic asymmetry relative to the center of mass. The aim of the study is to obtain new reliable approximate analytical estimates of perturbations of the angle of attack of a nanosatellite passing through resonance at angles of attack of not more than 0.5π. By using the stationary phase method, the authors were able to investigate a discontinuous perturbation in the angle of attack of a nanosatellite passing through a resonance with two different nanosatellite designs. Comparison of the results of the numerical modeling and new approximate analytical estimates of the perturbation of the angle of attack confirms the reliability of the said estimates.

Effect of 11 September 2001 terrorist attacks in the USA on suicide in areas surrounding the crash sites.

PubMed

Claassen, Cynthia A; Carmody, Thomas; Stewart, Sunita M; Bossarte, Robert M; Larkin, Gregory L; Woodward, Wayne A; Trivedi, Madhukar H

2010-05-01

The terrorist attacks in the USA on 11 September 2001 affected suicide rates in two European countries, whereas overall US rates remained stable. The effect on attack site rates, however, has not been studied. To examine post-attack suicide rates in areas surrounding the three airline crash sites. Daily mortality rates were modelled using time series techniques. Where rate change was significant, both duration and geographic scope were analysed. Around the World Trade Center, post-attack 180-day rates dropped significantly (t = 2.4, P = 0.0046), whereas comparison condition rates remained stable. No change was observed for Pentagon or Flight 93 crash sites. The differential effect by site suggests that proximity may be less important that other event characteristics. Both temporal and geographic aspects of rate fluctuation after sentinel events appear measurable and further analyses may contribute valuable knowledge about how sociological forces affect these rates.

EC94-42645-9

NASA Image and Video Library

1994-06-27

The modified F-18 High Alpha Research Vehicle (HARV) carries out air flow studies on a flight from the Dryden Flight Research Center, Edwards, California. Using oil, researchers were able to track the air flow across the wing at different speeds and angles of attack. A thrust vectoring system had been installed on the engines' exhaust nozzles for the high angle of attack research program. The thrust vectoring system, linked to the aircraft's flight control system, moves a set of three paddles on each engine to redirect thrust for directional control and increased maneuverability at angles of attack at up to 70 degrees.

[Relations with emergency medical care and primary care doctor, home health care].

PubMed

Azuma, Kazunari; Ohta, Shoichi

2016-02-01

Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society.

The Uses of the Smartphone for Doctors: An Empirical Study from Samsung Medical Center

PubMed Central

Choi, Jong Soo; Yi, Byoungkee; Park, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo

2011-01-01

Objectives In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Methods Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. Results We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Conclusions Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements. PMID:21886874

HEALTH AND ENVIRONMENTAL CONSEQUENCES OF THE WORLD TRADE CENTER DISASTER

EPA Science Inventory

The attack on the World Trade Center (WTC) created an acute environmental disaster of enormous magnitude. This study characterizes the environmental exposures resulting from destruction of the WTC and assesses their effects on health. Methods include ambient air sampling; analyse...

Characteristics of the distribution of doctors in the Mais Médicos (More Doctors) Program in the states of Brazil's Northeast.

PubMed

Nogueira, Priscila Tamar Alves; Bezerra, Adriana Falangola Benjamin; Leite, Antonio Flaudiano Bem; Carvalho, Islândia Maria de Sousa; Gonçalves, Rogério Fabiano; Brito-Silva, Keila Silene de

2016-09-01

Inequalities in access to health, reflecting shortages and inadequate geographical distribution of health professionals, have been indicated as a challenge for Brazil. This paper analyzes the geographical distribution of professionals of the Mais Médicos Program allocated in the Northeastern Region of Brazil, through a descriptive cross-sectional study. Secondary data provided by the Health Ministry were used, and thematic maps of distribution of doctors in the Region were prepared. Data on 4,716 doctors who became members of health teams in 1,294 municipalities in six Indigenous Health Districts in the years 2013 and 2014 were analyzed. The greater part of the municipalities of the Region received between one and five doctors. The municipalities most benefited had, at least, 20% of their population in extreme poverty. 99.9% of the doctors were allocated in a Health Center or Primary Healthcare Unit. The majority were women (57%), predominantly of the 45-49 age group (24%). In spite of the advances achieved by the Program - such as distribution of the doctors in locations with greater vulnerability - some States continue to have significant shortages of healthcare.

Report on Progress Toward Security and Stability in Afghanistan

DTIC Science & Technology

2012-12-01

availability becomes more difficult further away from the cities. A lack of sufficient progress in governance and sustainable economic ...their confinement to areas away from major population centers. A small number of high-profile attacks (HPAs) occurred during the reporting period...activities were related to criminal networks. A small number of high-profiles attacks (HPAs) occurred during the reporting period. Contrary to insurgents

An exploratory, descriptive study of consumer opinions and behaviors regarding health products sales at 4 chiropractic practices in a large, western Canadian urban center.

PubMed

Page, Stacey A; Mbadiwe, Chinyere; McMorland, D Gordon; Grod, Jaroslaw P

2015-01-01

This study describes the opinions and behaviors of chiropractic patients in a large, western Canadian urban center regarding the sale of health products by doctors of chiropractic. A brief, descriptive survey consisting of both fixed-choice and open-ended questions was distributed by clinic reception staff at 4 chiropractic offices in Calgary, Alberta, Canada. Each practice sold a range of health products, including those relating to musculoskeletal care and nutrition, and served between 275 and 320 clients per week. After a 10-week recruitment interval between January and March 2013, a convenience sample of 103 chiropractic patients was obtained. Most patients supported the sale of health products by doctors of chiropractic (n = 101; 98.1%), and most had made health product purchases from a doctor of chiropractic at some point (n = 73; 70.9%). Products relating to muscular care, exercise/rehabilitation products, and pillows were purchased most often (>40%). Consumers were most supportive of doctors of chiropractic selling products they perceived to be directly related to musculoskeletal care. Some participants believed that there should be limits placed on the range of products sold including the products had to be consistent with the practitioner's area of expertise and had to have some demonstrated level of effectiveness. Primary reasons for health product purchase included the doctor's recommendations, convenience, and perception that the product would improve well-being (>50%). This study found that chiropractic patients were supportive of health product sales by doctors of chiropractic, assuming certain conditions were met. Consumers believed that product sales should be undertaken with integrity and should be consistent with the doctor's area of expertise. Consumer beliefs appeared to impact their purchasing behaviors. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11.

PubMed

Cone, James E; Li, Jiehui; Kornblith, Erica; Gocheva, Vihra; Stellman, Steven D; Shaikh, Annum; Schwarzer, Ralf; Bowler, Rosemarie M

2015-05-01

Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed. © 2015 Wiley Periodicals, Inc.

Language Use, Language Ability, and Language Development: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July through December 1985 (Vol. 46 Nos. 1 through 6).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 34 titles deal with a variety of topics, including the following: (1) object conservation and receptive language in day care center infants; (2) the syntactic incorporation of linguistic units; (3) implicit theories of meaning in…

Longitudinal Stability and Control Characteristics as Determined by the Rocket-model Technique for an Inline, Cruciform, Canard Missile Configuration with a Low-aspect-ratio Wing Having Trailing-edge Flap Controls for a Mach Number Range of 0.7 to 1.

NASA Technical Reports Server (NTRS)

Baber, Hal T , Jr; Moul, Martin T

1955-01-01

Two full-scale models of an inline, cruciform, canard missile configuration having a low-aspect-ratio wing equipped with flap-type controls were flight tested in order to determine the missile's longitudinal aerodynamic characteristics. Stability derivatives and control and drag characteristics are presented for a range of Mach number from 0.7 to 1.8. Nonlinear lift and moment curves were noted for the angle - of-attack range of this test (0 deg to 8 deg). The aerodynamic-center location for angles of attack near 50 remained nearly constant for supersonic speeds at 13.5 percent of the mean aerodynamic chord; whereas for angles of attack near 0 deg, there was a rapid forward movement of the aerodynamic center as the Mach number increased. At a control deflection of 0 deg, the missile's response to the longitudinal control was in an essentially fixed space plane which was not coincident with the pitch plane as a result of the missile rolling. As a consequence, stability characteristics were determined from the resultant of pitch and yaw motions. The damping-in-pitch derivatives for the two angle -of-attack ranges of the test are in close agreement and varied only slightly with Mach number. The horn-balanced trailing-edge flap was effective in producing angle of attack over the Mach number range.

Longitudinal Stability and Control Characteristics as Determined by the Rocket-Model Technique for an Inline, Cruciform, Canard Missile Configuration with a Low-Aspect-Ratio Wing Having Trailing-Edge Flap Controls for a Mach Number Range of 0.7 to 1.8

NASA Technical Reports Server (NTRS)

Baber, H. T., Jr.; Moul, M. T.

1955-01-01

Two full-scale models of an inline, cruciform, canard missile configuration having a low-aspect-ratio wing equipped with flap-type controls were flight tested in order to determine the missile's longitudinal aerodynamic characteristics. Stability derivatives and control and drag characteristics are presented for a range of Mach number from 0.7 to 1.8. Nonlinear lift and moment curves were noted for the angle-of-attack range of this test (0 deg to 8 deg ). The aerodynamic-center location for angles of attack near 5 deg remained nearly constant for supersonic speeds at 13.5 percent of the mean aerodynamic chord; whereas for angles of attack near O deg, there was a rapid forward movement of the aerodynamic center as the Mach number increased. At a control deflection of O deg, the missile's response to the longitudinal control was in an essentially fixed space plane which was not coincident with the pitch plane as a result of the missile rolling. As a consequence, stability characteristics were determined from the resultant of pitch and yaw motions. The damping-in-pitch derivatives for the two angle-of-attack ranges of the test are in close agreement and varied only slightly with Mach number. The horn-balanced trailing-edge flap was effective in producing angle of attack over the Mach number range.

"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong.

PubMed

Siu, Judy Yuen-Man

2014-02-06

Although having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients' illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior. My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong. My study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants' social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients' unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants' sense of mismatch with these doctors, which induced them to shop for another doctor. Overactive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors' understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients.

Patient-centered interviewing is associated with decreased responses to painful stimuli: an initial fMRI study.

PubMed

Sarinopoulos, Issidoros; Hesson, Ashley M; Gordon, Chelsea; Lee, Seungcheol A; Wang, Lu; Dwamena, Francesca; Smith, Robert C

2013-02-01

To identify the functional magnetic resonance imaging (fMRI) changes associated with a patient-centered interview (PCI) and a positive provider-patient relationship (PPR). Nine female patients participated, five randomly selected to undergo a replicable, evidence-based PCI, the other four receiving standard clinician-centered interviews (CCI). To verify that PCI differed from CCI, we rated the interviews and administered a patient satisfaction with the provider-patient relationship (PPR) questionnaire. Patients were then scanned as they received painful stimulation while viewing pictures of the interviewing doctor and control images (unknown doctor). Interview ratings and questionnaire results confirmed that PCIs and CCIs were performed as planned and PCIs led to a much more positive PPR. We found significantly reduced pain-related neural activation in the left anterior insula region in the PCI group when the interviewing doctor's picture was shown. This study identifies an association between a PCI that produced a positive PPR and reduced pain-related neural responses in the anterior insula. This is an initial step in understanding the neural underpinnings of a PCI. If confirmed, our results indicate one neurobiological underpinning of an effective PCI, providing an additional scientific rationale for its use clinically. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Barefoot Doctors and the "Health Care Revolution" in Rural China: A Study Centered on Shandong Province.

PubMed

Xu, Sanchun; Hu, Danian

2017-09-01

Barefoot doctors were rural medical personnel trained en masse, whose emergence and development had a particular political, economic, social, and cultural background. Like the rural cooperative medical care system, the barefoot doctor was a well-known phenomenon in the Cultural Revolution. Complicated regional differences and a lack of reliable sources create much difficulty for the study of barefoot doctors and result in differing opinions of their status and importance. Some scholars greatly admire barefoot doctors, whereas others harshly criticize them. This paper explores the rise and development of barefoot doctors based on a case study of Shandong province. I argue that the promotion of barefoot doctors was a consequence of the medical education revolution and an implementation of the Cultural Revolution in rural public health care, which significantly influenced medical services and development in rural areas. First, barefoot doctors played a significant role in accomplishing the first rural health care revolution by providing primary health care to peasants and eliminating endemic and infectious illnesses. Second, barefoot doctors were the agents who integrated Western and Chinese medicines under the direction of the state. As an essential part of the rural cooperative medical system, barefoot doctor personnel grew in number with the system's implementation. After the Cultural Revolution ended, the cooperative medical system began to disintegrate-a process that accelerated in the 1980s until the system's collapse in the wake of the de-collectivization. As a result, the number of barefoot doctors also ran down steadily. In 1985, "barefoot doctor" as a job title was officially removed from Chinese medical profession, demonstrating that its practice was non-universal and unsustainable. Copyright © 2017 Elsevier Ltd. All rights reserved.

How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

PubMed

Duke, Pamela; Frankel, Richard M; Reis, Shmuel

2013-01-01

Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

The World Trade Center Attack: Lessons for all aspects of health care

PubMed Central

Tamber, Pritpal S; Vincent, Jean-Louis

2001-01-01

The attack on the World Trade Center had the potential to overwhelm New York's health services. Sadly, however, the predicted thousands of treatable patients failed to materialize. Horror and sadness has now been replaced by anger, fear, and the determination to be better prepared next time. This determination not only exists in politics but also in health care, and as with all attempts to enforce change there needs to be a period of collecting opinions and data. This article introduces nine reviews in Critical Care offering varied health care perspectives of the events of 11 September 2001 from people who were there and from experts in disaster management. PMID:11737910

Plasma Control of Separated Flows on Delta Wings at High Angles of Attack

DTIC Science & Technology

2009-03-18

of Attack 5a. CONTRACT NUMBER ISTC Registration No: 3646 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Dr. Anatoly Alexandrovich...NUMBER(S) ISTC 06-7002 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution is unlimited. 13. SUPPLEMENTARY...This work is supported financially by EOARD and performed under the agreement with the International Science and Technology Center ( ISTC ), Moscow

Fire As A Weapon: High Rise Structures

DTIC Science & Technology

2017-12-01

Trade Center, Happyland fire, Taj Mahal Fire, fire bombing , inferno terror, terrorist arsonists, counter-terrorism, arson attacks 15. NUMBER OF PAGES...kill civilians throughout the building without the attackers setting bombs throughout. However, the literature does not reflect the emerging threat...requiring the expertise to build bombs or anything of that nature; in other words, everyone can burn a house down, but it takes time and skill to blow it up

Joint Center for Operational Analysis Quarterly Bulletin. Volume 8, Issue 3, September 2006

DTIC Science & Technology

2006-09-01

Kuwait drove planning for Operation Desert Storm. The Dayton Peace Accord included an agreement by warring factions not to attack coalition forces as they...informants.29 Pinpointing the insurgent strongholds substantially helps the military shape its plan of attack. The government prepares the political...campaign plan . The use of informants, sting operations, and undercover internal affairs officers to name the most salient means, is effective in

Responding to Terrorism: Challenges for Democracy. Teacher's Resource Book [and Student Text]. Public Policy Debate in the Classroom. Choices for the 21st Century Education Program.

ERIC Educational Resources Information Center

Blackadar, Andy

This curriculum material, part of a continuing series on current and historical international issues, addresses the issues arising from the September 11, 2001, attacks on the World Trade Center and the Pentagon. On the morning of September 11, 2001, as people watched in horror, terrorist attacks were successfully launched against the United…

Flight calibration tests of a nose-boom-mounted fixed hemispherical flow-direction sensor

NASA Technical Reports Server (NTRS)

Armistead, K. H.; Webb, L. D.

1973-01-01

Flight calibrations of a fixed hemispherical flow angle-of-attack and angle-of-sideslip sensor were made from Mach numbers of 0.5 to 1.8. Maneuvers were performed by an F-104 airplane at selected altitudes to compare the measurement of flow angle of attack from the fixed hemispherical sensor with that from a standard angle-of-attack vane. The hemispherical flow-direction sensor measured differential pressure at two angle-of-attack ports and two angle-of-sideslip ports in diametrically opposed positions. Stagnation pressure was measured at a center port. The results of these tests showed that the calibration curves for the hemispherical flow-direction sensor were linear for angles of attack up to 13 deg. The overall uncertainty in determining angle of attack from these curves was plus or minus 0.35 deg or less. A Mach number position error calibration curve was also obtained for the hemispherical flow-direction sensor. The hemispherical flow-direction sensor exhibited a much larger position error than a standard uncompensated pitot-static probe.

Estimation of Static Longitudinal Stability of Aircraft Configurations at High Mach Numbers and at Angles of Attack Between 0 deg and +/-180 deg

NASA Technical Reports Server (NTRS)

Dugan, Duane W.

1959-01-01

The possibility of obtaining useful estimates of the static longitudinal stability of aircraft flying at high supersonic Mach numbers at angles of attack between 0 and +/-180 deg is explored. Existing theories, empirical formulas, and graphical procedures are employed to estimate the normal-force and pitching-moment characteristics of an example airplane configuration consisting of an ogive-cylinder body, trapezoidal wing, and cruciform trapezoidal tail. Existing wind-tunnel data for this configuration at a Mach number of 6.86 provide an evaluation of the estimates up to an angle of attack of 35 deg. Evaluation at higher angles of attack is afforded by data obtained from wind-tunnel tests made with the same configuration at angles of attack between 30 and 150 deg at five Mach numbers between 2.5 and 3.55. Over the ranges of Mach numbers and angles of attack investigated, predictions of normal force and center-of-pressure locations for the configuration considered agree well with those obtained experimentally, particularly at the higher Mach numbers.

A Computerized, Self-Administered Questionnaire to Evaluate Posttraumatic Stress Among Firefighters After the World Trade Center Collapse

PubMed Central

Corrigan, Malachy; McWilliams, Rita; Kelly, Kerry J.; Niles, Justin; Cammarata, Claire; Jones, Kristina; Wartenberg, Daniel; Hallman, William K.; Kipen, Howard M.; Glass, Lara; Schorr, John K.; Feirstein, Ira

2009-01-01

Objectives. We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health–related medical leave over the first 2.5 years after the attack. Methods. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and “loss of a co-worker while working at the collapse.” We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. Results. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health–related medical leave. Exposure–response gradients were significant for all outcomes. Conclusions. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources. PMID:19890176

Improving performance of HVAC systems to reduce exposure to aerosolized infectious agents in buildings; recommendations to reduce risks posed by biological attacks.

PubMed

Hitchcock, Penny J; Mair, Michael; Inglesby, Thomas V; Gross, Jonathan; Henderson, D A; O'Toole, Tara; Ahern-Seronde, Joa; Bahnfleth, William P; Brennan, Terry; Burroughs, H E Barney; Davidson, Cliff; Delp, William; Ensor, David S; Gomory, Ralph; Olsiewski, Paula; Samet, Jonathan M; Smith, William M; Streifel, Andrew J; White, Ronald H; Woods, James E

2006-01-01

The prospect of biological attacks is a growing strategic threat. Covert aerosol attacks inside a building are of particular concern. In the summer of 2005, the Center for Biosecurity of the University of Pittsburgh Medical Center convened a Working Group to determine what steps could be taken to reduce the risk of exposure of building occupants after an aerosol release of a biological weapon. The Working Group was composed of subject matter experts in air filtration, building ventilation and pressurization, air conditioning and air distribution, biosecurity, building design and operation, building decontamination and restoration, economics, medicine, public health, and public policy. The group focused on functions of the heating, ventilation, and air conditioning systems in commercial or public buildings that could reduce the risk of exposure to deleterious aerosols following biological attacks. The Working Group's recommendations for building owners are based on the use of currently available, off-the-shelf technologies. These recommendations are modest in expense and could be implemented immediately. It is also the Working Group's judgment that the commitment and stewardship of a lead government agency is essential to secure the necessary financial and human resources and to plan and build a comprehensive, effective program to reduce exposure to aerosolized infectious agents in buildings.

Ke Wang, a Chinese television soap opera with a message.

PubMed

Wang, M; Singhal, A

1992-01-01

The Chinese soap opera, Ke Wang, was created by Li Xiaoming between August 1989 and June 1990 and produced at a cost of US$4650 per episode. The characters were drawn from everyday ordinary Chinese life: a traditional and open-minded and caring woman, a typical mother who works hard and loves her children, a highly educated upwardly mobile man who divorces his wife, a professor criticized during the Cultural Revolution, a doctor prejudiced against ordinary people, a kind honest man who marries the divorcee, a friend of the divorcee, a man who is optimistic in spite of bad experiences during the Cultural Revolution, and an excellent medical doctor who also resolves conflicts. The program was very popular, even among Communists, because of its value-based content, the real-life nature of the show, the change from highly restricted programming, the elaborate and supportive media coverage, and dialogue which closely matches audience preferences. The show has been aired by over 100 stations to date and has reached a total estimated audience of 550 million. The sale of television sets has increased since the show's appearance. The script reflects the conflicts between traditional and modern Chinese values. Pro-social values and behaviors are learned from the role models depicted; examples are given of immediate social impact. Ke Wang was a by-product of the Beijing Television Arts Center's interest in designing television programs that are relevant to the lives of ordinary people. The 60-minute scripts dealt with issues such as the status of women, social morality, family harmony, class conflict, responsible parenthood, maintenance of traditional culture, volunteerism, child development, and coping with physical disability. The Chinese government hailed Ke Wang as model television and awarded US$20,000 in prize money to the producers. The Chinese government is planning to produce other entertainment-education soap operas, which raises the problem of blatant, political propaganda. In 1989, after the Tinanmen Square events, the controversial He Shang, which attacked cultural symbols, was denounced and banned.

KSC-2012-1850

NASA Image and Video Library

2012-02-17

Dr. Kurt H. Debus, Kennedy Space Center's First Director: A doctor of philosophy in engineering from Darmstadt University, Debus was selected by Dr. Wernher von Braun to direct the Experimental Missile Firing Branch which began launching missiles from Cape Canaveral in 1953. Dr. Debus became the first Center Director for the new independent Launch Operations Center, and it was his job to put Saturn/Apollo into space. His tenure at Kennedy Space Center spanned 13 years, from 1962 to 1974. Poster designed by Kennedy Space Center Graphics Department/Greg Lee. Credit: NASA

Lessons Learned Going Back to School

ERIC Educational Resources Information Center

Wernet, Jamie L. W.

2016-01-01

When the author returned to teaching after several years in graduate school, she came armed with knowledge and visions of a student-centered classroom. Her experiences in a doctoral program taught her much about effective mathematics instruction and rekindled her desire to teach. However, a student-centered classroom reflected a major shift in…

Print campaign. Branding through print for Corpus Christi (TX) Medical Center.

PubMed

2007-01-01

Corpus Christi Medical Center, a 582-bed healthcare system consisting of four hospitals throughout south Texas, launched a print branding effort at the beginning of the year featuring its own doctors. The print ads promote several of the various service lines offered at the hospitals, including cardiac care.

9/11 Event

NASA Image and Video Library

2015-09-11

A memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks stands at Fire Station 1 at NASA's Kennedy Space Center during its dedication on Sept. 11, 2015. A section of steel I-beam from the World Trade Center in New York forms the centerpiece of the monument.

ACHP | News

Science.gov Websites

Efforts at 9/11 Historic Sites FEMA debris specialist overlooking work at World Trade Center site - photo , terrorist attacks on the Pentagon and World Trade Center, the Advisory Council on Historic Preservation community," said Milford Wayne Donaldson, FAIA, ACHP chairman. "Yesterday, the world began to see

"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong

PubMed Central

2014-01-01

Background Although having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients’ illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior. Methods My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong. Results My study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants’ social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients’ unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants’ sense of mismatch with these doctors, which induced them to shop for another doctor. Conclusions Overactive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors’ understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients. PMID:24502367

Application of Piloted Simulation to High-Angle-of-Attack Flight-Dynamics Research for Fighter Aircraft

NASA Technical Reports Server (NTRS)

Ogburn, Marilyn E.; Foster, John V.; Hoffler, Keith D.

2005-01-01

This paper reviews the use of piloted simulation at Langley Research Center as part of the NASA High-Angle-of-Attack Technology Program (HATP), which was created to provide concepts and methods for the design of advanced fighter aircraft. A major research activity within this program is the development of the design processes required to take advantage of the benefits of advanced control concepts for high-angle-of-attack agility. Fundamental methodologies associated with the effective use of piloted simulation for this research are described, particularly those relating to the test techniques, validation of the test results, and design guideline/criteria development.

Supersonic aerodynamic characteristics of a circular body Earth-to-Orbit vehicle

NASA Technical Reports Server (NTRS)

Ware, George M.; Engelund, Walter C.; Macconochie, Ian O.

1994-01-01

The circular body configuration is a generic single- or multi-stage reusable Earth-to-orbit transport. A thick clipped-delta wing is the major lifting surface. For directional control, three different vertical fin arrangements were investigated: a conventional aft-mounted center fin, wingtip fins, and a nose-mounted fin. The tests were conducted in the Langley Unitary Plan Wind Tunnel. The configuration is longitudinally stable about the estimated center of gravity of 0.72 body length up to a Mach number of about 3.0. Above Mach 3.0, the model is longitudinally unstable at low angles of attack but has a stable secondary trim point at angles of attack above 30 deg. The model has sufficient pitch control authority with elevator and body flap to produce stable trim over the test range. The model with the center fin is directionally stable at low angles of attack up to a Mach number of 3.90. The rudder-like surfaces on the tip fins and the all-movable nose fin are designed as active controls to produce artificial directional stability and are effective in producing yawing moment. The wing trailing-edge aileron surfaces are effective in producing rolling moment, but they also produce large adverse yawing moment.

Meaning reconstruction in the face of terror: An examination of recovery and posttraumatic growth among victims of the 9/11 World Trade Center attacks.

PubMed

Richardson, Katherine M

2015-01-01

This study examines the relationship between meaning reconstruction with posttraumatic growth and depreciation in the aftermath of terrorist trauma and loss. A group of individuals (n=118) who were personally affected by the September 11, 2001 terrorist attacks were surveyed about their experiences and administered the Posttraumatic Growth Inventory and Impact of Event scales. Subjects were volunteer docents at the Tribute World Trade Center Visitor Center. Results revealed that ability to make sense of one's 9/11 experience was related to recovery but not to posttraumatic growth, whereas ability to find some benefit in the experience was related to growth. In addition, location in downtown Manhattan on September 11, 2001 was related to higher levels of posttraumatic depreciation. Findings suggest that two aspects of meaning reconstruction are differentially related to recovery and posttraumatic growth.

Chronic Physical Health Consequences of Being Injured During the Terrorist Attacks on World Trade Center on September 11, 2001

PubMed Central

Brackbill, Robert M.; Cone, James E.; Farfel, Mark R.; Stellman, Steven D.

2014-01-01

Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003−2004 and 2006−2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5–6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002–2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons. PMID:24561992

Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001.

PubMed

Brackbill, Robert M; Cone, James E; Farfel, Mark R; Stellman, Steven D

2014-05-01

Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China.

PubMed

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer; Dong, Hengjin

2013-01-01

The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. To understand village doctors' perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.

Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor?

PubMed

Street, Richard L; Gordon, Howard; Haidet, Paul

2007-08-01

Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

Find a Doctor

MedlinePlus

... Wellness Healthy Living Alcohol Awareness Tobacco Cessation Preventive Services FAQs Publications Resources Disaster Information Go Paperless My Military Health Records Multimedia Center Recoupment of Overpayments Rights and Responsibilities About ...

Exposure and Human Health Evaluation of Airborne Pollution from the World Trade Center Disaster

EPA Science Inventory

In the days following the September 11, 2001, terrorist attack on New York City's World Trade Center (WTC) towers, many Federal agencies, including the U.S. Environmental Protection Agency (EPA), were called upon to bring their technical and scientific expertise to the national e...

9/11 Event

NASA Image and Video Library

2015-09-11

Firefighters stand at attention as a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks is dedicated at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. A section of steel I-beam from the World Trade Center in New York forms the centerpiece of the monument.

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks.

PubMed

Neria, Yuval; Gross, Raz; Litz, Brett; Maguen, Shira; Insel, Beverly; Seirmarco, Gretchen; Rosenfeld, Helena; Suh, Eun Jung; Kishon, Ronit; Cook, Joan; Marshall, Randall D

2007-06-01

A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.

Controlling forebody asymmetries in flight: Experience with boundary layer transition strips

NASA Technical Reports Server (NTRS)

Fisher, David F.; Cobleigh, Brent R.

1994-01-01

The NASA Dryden Flight Research Center has an ongoing program to investigate aircraft flight characteristics at high angles of attack. As part of this investigation, longitudinal boundary layer transition strips were installed on the F-18 HARV forebody, a preproduction F/A-18 radome with a nose-slice tendency, and the X-31 aircraft forebody and noseboom to reduce asymmetric yawing moments at high angles of attack. The transition strips were effective on the F-18 HARV at angles of attack above 60 deg. On the preproduction F/A-18 radome at an angle of attack near 50 deg the strips were not effective. When the transition strips were installed on the X-31 noseboom, a favorable effect was observed on the yawing moment dynamics but the magnitude of the yawing moment was not decreased.

SIGAR Special Inspector General For Afghanistan Reconstruction

DTIC Science & Technology

2017-07-30

soldiers. One of the worst terror attacks of the Afghan war occurred on May 31, when a truck bomb exploded in the center of Kabul’s diplomatic quarter...RISK-FREE A devastating bomb attack near Afghanistan’s presidential palace in Kabul on May 31, 2017, killed more than 150 people and wounded hundreds...truck- bomb explosion heavily damaged several embassies and injured staff from the German, Japanese, and Pakistani embassies, as well as some U.S

Effects of the World Trade Center Attack on NYC Public School Students: Initial Report to the New York City Board of Education.

ERIC Educational Resources Information Center

2002

This study investigated the mental health needs of New York City (NYC) public school students 6 months after the September 11, 2001 attack. A needs assessment survey was conducted on 8,266 students in grades 4-12 from 94 schools in the Ground Zero area, other presumed high risk areas, and the remainder of NYC. The survey assessed such factors as…

Overcoming Information Overload in the Cockpit

DTIC Science & Technology

2009-07-15

has much dierent information needs than a Chinook pi- lot does ying an air assault mission. The former is concerned primarily with angle of attack...pi- lots with an altitude tracking cue. The device conveys path angle error, the error angle between the current ight path and the interception path... angle of attack, NASA’s Dryden Flight Research Center developed a Pressure Cu that utilized a number of inatable, pneumatic bladders, held to the

Cyber attacks against state estimation in power systems: Vulnerability analysis and protection strategies

NASA Astrophysics Data System (ADS)

Liu, Xuan

Power grid is one of the most critical infrastructures in a nation and could suffer a variety of cyber attacks. With the development of Smart Grid, false data injection attack has recently attracted wide research interest. This thesis proposes a false data attack model with incomplete network information and develops optimal attack strategies for attacking load measurements and the real-time topology of a power grid. The impacts of false data on the economic and reliable operations of power systems are quantitatively analyzed in this thesis. To mitigate the risk of cyber attacks, a distributed protection strategies are also developed. It has been shown that an attacker can design false data to avoid being detected by the control center if the network information of a power grid is known to the attacker. In practice, however, it is very hard or even impossible for an attacker to obtain all network information of a power grid. In this thesis, we propose a local load redistribution attacking model based on incomplete network information and show that an attacker only needs to obtain the network information of the local attacking region to inject false data into smart meters in the local region without being detected by the state estimator. A heuristic algorithm is developed to determine a feasible attacking region by obtaining reduced network information. This thesis investigates the impacts of false data on the operations of power systems. It has been shown that false data can be designed by an attacker to: 1) mask the real-time topology of a power grid; 2) overload a transmission line; 3) disturb the line outage detection based on PMU data. To mitigate the risk of cyber attacks, this thesis proposes a new protection strategy, which intends to mitigate the damage effects of false data injection attacks by protecting a small set of critical measurements. To further reduce the computation complexity, a mixed integer linear programming approach is also proposed to separate the power grid into several subnetworks, then distributed protection strategy is applied to each subnetwork.

Interprofessional Rivalry in Nigeria's Health Sector: A Comparison of Doctors and Other Health Workers' Views at a Secondary Care Center.

PubMed

Omisore, Akinlolu G; Adesoji, Richard O; Abioye-Kuteyi, Emmanuel A

2017-10-01

To examine interprofessional rivalry (IPR) between doctors and other health workers and their understanding of its effects. IPR in Nigeria's health system is a burgeoning issue with apparent adverse effects. The most profound rivalry appears to be between doctors and other health workers. A descriptive cross-sectional study involving 120 health workers (24 doctors and 96 other health workers) at the State Specialist Hospital, Okitipupa, Ondo State, Nigeria. Pertinent data were collected via semistructured questionnaire and analyzed using SPSS Version17.0. IPR is perceived to be the leading cause of conflicts among health workers by 70% of respondents. Doctors and other workers had significantly divergent opinions on the leadership of the health team, patient management, establishment positions, and monetary issues as well as on the effects of IPR with more doctors recognizing its hazards. Nearly half of the respondents believe that strikes are justifiable and the most recommended antidote is for the government to attempt to meet group needs. IPR has reached unprecedented levels in Nigeria. However, its adverse effects have not been duly recognized, especially by nondoctors. There is an urgent need for education of health workers on the deleterious effects of IPR.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

PubMed

Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

2018-01-01

Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

PubMed Central

Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

2018-01-01

Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

Model studies in cytochrome P-450-mediated toxicity of halogenated compounds: radical processes involving iron porphyrins.

PubMed Central

Brault, D

1985-01-01

Haloalkane toxicity originates from attack on biological targets by reactive intermediates derived from haloalkane metabolism by a hemoprotein, cytochrome P-450. Carbon-centered radicals and their peroxyl derivatives are most likely involved. The reactions of iron porphyrin--a model for cytochrome P-450--with various carbon-centered and peroxyl radicals generated by pulse radiolysis are examined. Competition between iron porphyrin and unsaturated fatty acids for attack by peroxyl radicals is pointed out. These kinetic data are used to derive a model for toxicity of haloalkanes with particular attention to carbon tetrachloride and halothane. The importance of local oxygen concentration and structural arrangement of fatty acids around cytochrome P-450 is emphasized. PMID:3007100

National Center for Multisource Information Fusion

DTIC Science & Technology

2009-04-01

discipline.    The  center  has  focused  its  efforts  in  solving   the  growing  problems  of  exploiting  massive quantities of diverse,  and often...development  of  a  comprehensive   high  level  fusion framework that includes the addition of Levels 2, 3 and 4 type tools to the ECCARS...correlate  IDS alerts  into  individual attacks and provide a  threat assessment  for  the  network.  A  comprehensive  review of attack graphs was conducted

The Third ACCLAIM Research Symposium. Mathematics Education: Reform and Resistance in the Life-Worlds of Rural Schools and Communities. A Proceedings Document (3rd, Newark, Ohio, May 18-20, 2006). Occasional Paper No. 14

ERIC Educational Resources Information Center

Appalachian Collaborative Center for Learning, Assessment, and Instruction in Mathematics (ACCLAIM), 2006

2006-01-01

This document summarizes the proceedings of the Third ACCLAIM Research Symposium, which took place over three days from May 18 through May 20, 2006. The Center's doctoral students took prominent roles, especially the entire second cohort of doctoral students. Three members of the first cohort also participated in events. Overall, the symposium…

Treatment-Based Classification versus Usual Care for Management of Low Back Pain

DTIC Science & Technology

2014-08-01

Doctoral Fellowship in Orthopaedic Manual Physical Therapy , San Antonio Military Medical Center, Fort Sam Hous- ton, Texas. N.W. Gill, PT, DSc, OCS, FAAOMPT...US Army–Baylor Uni- versity Doctor of Physical Therapy Program, Fort Sam Houston, Texas. [Rhon DI, Deyle GD, Gill NW. Clin- ical reasoning and...1234–1243.] © 2013 American Physical Therapy Association Published Ahead of Print: February 7, 2013 Accepted: February 4, 2013 Submitted: March 30, 2012

Aspects of physician-patient communication in the program of smoking cessation.

PubMed

Nemeş, Roxana-Maria; Postolache, Paraschiva; Tintilă, Adeline; Mihălţan, F D; Petrariu, F D

2015-01-01

The doctor-smoker patient communication is essential for smokers to realize the harmful effects of tobacco on health and the benefits of smoking cessation. Nicotine found in cigarettes is a powerful drug and a direct dependency generator, which makes smoking cessation difficult, the withdrawal syndrome being hard to overcome for many smokers. The doctor-smoker patient communication is a complex process of data, information and knowledge transmission, subjected to some semiotic rules. In the Counseling Center for Smoking Cessation (CCSC) from the Rehabilitation Clinical Hospital of Iasi the medical and psychological counseling and the pharmacologic therapy for smoking cessation is ensured by the qualified personnel. CCSC was founded in 2005, when the hospital was included in European Program: "European Network Smoke-Free Hospital", and experienced an important development in 2007 with the initiation "Stop Smoking" National Program of Ministry of Health. The doctor-smoker patient communication in the CCSC was conducted during the smoker's recruitment, therapeutic and post therapeutic period, a special place being occupied by the doctor-medical staff communication, including smoker medical students. The number of people who became nonsmokers after being counseled at our center was the evidence of the effectiveness of this communication. The obtained results determined us to join the global fight against smoking and to propose the introduction of the smoking cessation program in the curriculum of the medical education institutions.

Reputation strength as a determinant of faculty employment: a test of the step-down thesis among clinical psychology doctoral programs.

PubMed

Roberts, Michael C; Ilardi, Stephen S; Johnson, Rebecca J

2006-07-01

This study tested the folkloristic belief that doctoral degree recipients who pursue academic careers typically wind up at institutions ranked lower in prestige than the institutions at which they trained (the step-down thesis). We used a database of faculty members in 150 clinical psychology doctoral programs accredited by the American Psychological Association, and compared each faculty member's training institution with the current employing institution on three distinct reputation ranking systems: The Center (University of Florida, Gainesville) for overall university reputation, the National Research Council (Washington, DC) for doctoral degree department reputation, and the news magazine, U.S. News and World Report ranking for clinical psychology training program reputation. Although support for the step-down thesis was found across all three ranking systems, a disproportionately large number of professors were also observed to move laterally in terms of their employing institution's reputation.

Power imbalance and consumerism in the doctor-patient relationship: health care providers' experiences of patient encounters in a rural district in India.

PubMed

Fochsen, Grethe; Deshpande, Kirti; Thorson, Anna

2006-11-01

The aim of this study is to explore health care providers' experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor's dominance. A patient-centered approach, acknowledging patients' own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.

Security attack detection algorithm for electric power gis system based on mobile application

NASA Astrophysics Data System (ADS)

Zhou, Chao; Feng, Renjun; Wang, Liming; Huang, Wei; Guo, Yajuan

2017-05-01

Electric power GIS is one of the key information technologies to satisfy the power grid construction in China, and widely used in power grid construction planning, weather, and power distribution management. The introduction of electric power GIS based on mobile applications is an effective extension of the geographic information system that has been widely used in the electric power industry. It provides reliable, cheap and sustainable power service for the country. The accurate state estimation is the important conditions to maintain the normal operation of the electric power GIS. Recent research has shown that attackers can inject the complex false data into the power system. The injection attack of this new type of false data (load integrity attack LIA) can successfully bypass the routine detection to achieve the purpose of attack, so that the control center will make a series of wrong decision. Eventually, leading to uneven distribution of power in the grid. In order to ensure the safety of the electric power GIS system based on mobile application, it is very important to analyze the attack mechanism and propose a new type of attack, and to study the corresponding detection method and prevention strategy in the environment of electric power GIS system based on mobile application.

An avatar based education application to improve patients' knowledge of and response to heart attack symptoms: a pragmatic randomized controlled trial protocol.

PubMed

Tongpeth, Jintana; Du, Huiyun; Clark, Robyn

2018-06-19

To evaluate the effectiveness of an interactive, avatar based education application to improve knowledge of and response to heart attack symptoms in people who are at risk of a heart attack. Poor knowledge of heart attack symptoms is recognised as a significant barrier to timely medical treatment. Numerous studies have demonstrated that technology can assist in patient education to improve knowledge and self-care. A single-center, non-blinded, two parallel groups, pragmatic randomized controlled trial. Seventy patients will be recruited from the coronary care unit of a public hospital. Eligible participants will be randomised to either the usual care or the intervention group (usual care plus avatar-based heart attack education app). The primary outcome of this study is knowledge. Secondary outcomes include response to heart attack symptoms, health service use and satisfaction. Study participants will be followed-up for six months. This study will evaluate the avatar based education app as a method to deliver vital information to patients. Participants' knowledge of and response to heart attack symptoms, as well as their health service use, will be assessed to evaluate the intervention effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

French Ministry of Health's response to Paris attacks of 13 November 2015.

PubMed

Philippe, Jean-Marc; Brahic, Olivier; Carli, Pierre; Tourtier, Jean-Pierre; Riou, Bruno; Vallet, Benoit

2016-04-01

On Friday November 13th at 9:20 pm, three kamikaze bombs went off around the Stade de France a stadium in Saint-Denis just outside Paris, 4 different shootings took place and bombings in Paris and hundreds of people were held hostage in a theater.This multi-site terrorist attack was the first of this magnitude in France. Drawing the lessons of these attacks and those which occurred in other countries from a health perspective is essential to continuously adapt and improve the French response to possible future attacks. Several issues would need to be further explored: Management of uncertainties: When to trigger the plans: after the 1st attack, the 2nd? When do attacks end and when to release mobilized resources? Management of victims: How to ensure that all victims are secured or taken care of? How to provide assistance when attacks are ongoing? Management of teams: Proper follow-up of persons involved in the response: health professionals, police and firemen, emergency call centers but also civil servants within administration that contributed to the response. Communication: Reactivity of all is a key element to secure appropriate resource is mobilized for the response. All actors have to be able to communicate quickly in a secured way.

[The medical treatment of Kim Phúc at the BG Unfallklinik Ludwigshafen].

PubMed

Kiefer, J; Daigeler, A; Lehnhardt, M

2012-08-01

The Vietnam War was a military conflict in Vietnam during the Cold War that followed the First Indochina War. This war was fought between North Vietnam, supported by its communist allies, and the government of South Vietnam, supported by the USA and other anti-communist countries. Kim Phúc is the child depicted in the Pulitzer Prize winning photograph taken on June 8, 1972 by AP photographer Nick Út. The iconic photo shows her at about nine years of age running naked on a road amid the chaos after being severely burned by a napalm attack. After 14 months of hospital stay and 17 surgical procedures Kim Phúc was able to return home. Since then, she was used as a propaganda symbol by the communist government of Vietnam. To continue her studies, Kim was granted permission to move to Cuba where she met her future husband. However, the sequelae of her burn wounds affected her everyday life enormously. In 1984, with the support of the international aid organization "terre des hommes" and the German magazine "STERN", Kim Phúc got the opportunity to meet and get treated by Professor Zellner. Professor Peter Rudolph Zellner was the first chief of the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, and one of the founder members of the German Society of Plastic Surgeons. The reconstructive surgeries provide Kim Phúc an almost normal life. Later on, she was involved in international aid organizations; she was named a UNESCO Goodwill Ambassador and she was awarded several honorary Doctorates of Law. Kim Phúc became a Canadian citizen. Today, she lives with her husband and two children in Ontario, Canada. © Georg Thieme Verlag KG Stuttgart · New York.

Low-subsonic stability and control characteristics of a 0.015-scale remotely controlled elevon model (44-0) of the space shuttle orbiter in the Langley Research Center low turbulence pressure tunnel (LA61B)

NASA Technical Reports Server (NTRS)

1976-01-01

A Langley-built 0.015-scale SSV orbiter configuration with remote independently operated left and right elevon surfaces was tested in the NASA/Langley Research Center Low Turbulence Pressure Tunnel. A detailed aerodynamic data base was obtained for the current shuttle orbiter configuration. Special attention was directed to definition of Reynolds number effects on nonlinear aerodynamic characteristics of the orbiter. Small increments in angle of attack, sideslip, and elevon/aileron position were studied in order to better define areas where nonlinearities may occur. Force and moment, and elevon position data were recorded over an angle of attack range -2 deg to 20 deg at angles of sideslip of 0 deg , + or - 2 deg, and + or - 4 deg. Tests were also made over an angle of sideslip range of -6 deg to 6 deg at selected angles of attack and elevon/aileron position. The test Mach numbers were from 0.15 to 0.30 at Reynolds numbers from 2.0 to 13.5 million per foot.

Securing electronic medical record in Near Field Communication using Advanced Encryption Standard (AES).

PubMed

Renardi, Mikhael Bagus; Basjaruddin, Noor Cholis; Rakhman, Edi

2018-01-01

Doctors usually require patients' medical records before medical examinations. Nevertheless, obtaining such records may take time. Hence, Near Field Communication (NFC) could be used to store and send medical records between doctors and patients. Another issue is that there could be a threat such as, Man In The Middle Attack and eavesdropping, thus, a security method is required to secure the data. Furthermore, the information regarding the key and initialisation vector in NFC cannot be sent using one data package, hence, the data transmission should be done several times. Therefore, the initialisation vector that changed in each transmission is implemented, and the key utilised is based on the component agreed by both parties. This study aims at applying the cryptography process that does disturb and hinder the speed of data transmission. The result demonstrated that the data transmitted could be secured and the encryption process did not hinder data exchange. Also, different number of characters in plaintexts required different amount of time for encryption and decryption. It could be affected by the specifications of the devices used and the processes happening in the devices.

Polio

MedlinePlus

... children and adults in parts of Asia and Africa. The Centers for Disease Control and Prevention (CDC) ... is used, such as Central and South America, Africa and Asia. Additionally, call your doctor if: Your ...

Leading edge flap system for aircraft control augmentation

NASA Technical Reports Server (NTRS)

Rao, D. M. (Inventor)

1984-01-01

Traditional roll control systems such as ailerons, elevons or spoilers are least effective at high angles of attack due to boundary layer separation over the wing. This invention uses independently deployed leading edge flaps on the upper surfaces of vortex stabilized wings to shift the center of lift outboard. A rolling moment is created that is used to control roll in flight at high angles of attack. The effectiveness of the rolling moment increases linearly with angle of attack. No adverse yaw effects are induced. In an alternate mode of operation, both leading edge flaps are deployed together at cruise speeds to create a very effective airbrake without appreciable modification in pitching moment. Little trim change is required.

ASSESSMENT OF DIOXIN INHALATION EXPOSURES AND POTENTIAL HEALTH IMPACTS FOLLOWING THE COLLAPSE OF THE WORLD TRADE CENTER TOWERS

EPA Science Inventory

In the days following the September 11, 2001, terrorist attack on New York City's World Trade Center (WTC) towers, EPA, other federal agencies, and New York City and New York State public health and environmental authorities initiated numerous air monitoring activities to better ...

MONITORING TOXIC ORGANIC GASES AND PARTICLES NEAR THE WORLD TRADE CENTER AFTER SEPTEMBER 11, 2001

EPA Science Inventory

The September 11, 2001 attack on the World Trade Center (WTC) resulted in an intense fire and the subsequent, complete collapse of the two main structures and adjacent buildings, as well as significant damage to many surrounding buildings within and around the WTC complex. Thi...

9/11 Event

NASA Image and Video Library

2015-09-11

Officials and firefighters at NASA's Kennedy Space Center observe the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at Kennedy on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

A memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks stands at Fire Station 1 at NASA's Kennedy Space Center prior to its dedication on Sept. 11, 2015. Beneath the American flag is a section of steel I-beam from the World Trade Center in New York that forms the centerpiece of the monument.

9/11 Event

NASA Image and Video Library

2015-09-11

Firefighters place the American flag at half-staff during dedication services for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. A section of steel I-beam from the World Trade Center in New York forms the centerpiece of the monument.

Temporal changes in geographic disparities in access to emergency heart attack and stroke care: are we any better today?

PubMed

Busingye, Doreen; Pedigo, Ashley; Odoi, Agricola

2011-12-01

The objective of this study was to investigate temporal changes in geographic access to emergency heart attack and stroke care. Network analysis was used to compute travel time to the nearest emergency room (ER), cardiac, and stroke centers in Middle Tennessee. Populations within 30, 60, and 90 min driving time to the nearest ER, cardiac and stroke centers were identified. There were improvements in timely access to cardiac and stroke centers over the study period (1999-2010). There were significant (p<0.0001) increases in the proportion of the population with access to cardiac centers within 30 min from 29.4% (1999) to 62.4% (2009) while that for stroke changed from 5.4% (2004) to 46.1% (2010). Most (96%) of the population had access to an ER within 30 min from 1999 to 2010. Access to care has improved in the last decade but more still needs to be done to address disparities in rural communities. Copyright © 2011 Elsevier Ltd. All rights reserved.

High-Alpha Handling Qualities Flight Research on the NASA F/A-18 High Alpha Research Vehicle

NASA Technical Reports Server (NTRS)

Wichman, Keith D.; Pahle, Joseph W.; Bahm, Catherine; Davidson, John B.; Bacon, Barton J.; Murphy, Patrick C.; Ostroff, Aaron J.; Hoffler, Keith D.

1996-01-01

A flight research study of high-angle-of-attack handling qualities has been conducted at the NASA Dryden Flight Research Center using the F/A-18 High Alpha Research Vehicle (HARV). The objectives were to create a high-angle-of-attack handling qualities flight database, develop appropriate research evaluation maneuvers, and evaluate high-angle-of-attack handling qualities guidelines and criteria. Using linear and nonlinear simulations and flight research data, the predictions from each criterion were compared with the pilot ratings and comments. Proposed high-angle-of-attack nonlinear design guidelines and proposed handling qualities criteria and guidelines developed using piloted simulation were considered. Recently formulated time-domain Neal-Smith guidelines were also considered for application to high-angle-of-attack maneuvering. Conventional envelope criteria were evaluated for possible extension to the high-angle-of-attack regime. Additionally, the maneuvers were studied as potential evaluation techniques, including a limited validation of the proposed standard evaluation maneuver set. This paper gives an overview of these research objectives through examples and summarizes result highlights. The maneuver development is described briefly, the criteria evaluation is emphasized with example results given, and a brief discussion of the database form and content is presented.

Secure Fusion Estimation for Bandwidth Constrained Cyber-Physical Systems Under Replay Attacks.

PubMed

Chen, Bo; Ho, Daniel W C; Hu, Guoqiang; Yu, Li; Bo Chen; Ho, Daniel W C; Guoqiang Hu; Li Yu; Chen, Bo; Ho, Daniel W C; Hu, Guoqiang; Yu, Li

2018-06-01

State estimation plays an essential role in the monitoring and supervision of cyber-physical systems (CPSs), and its importance has made the security and estimation performance a major concern. In this case, multisensor information fusion estimation (MIFE) provides an attractive alternative to study secure estimation problems because MIFE can potentially improve estimation accuracy and enhance reliability and robustness against attacks. From the perspective of the defender, the secure distributed Kalman fusion estimation problem is investigated in this paper for a class of CPSs under replay attacks, where each local estimate obtained by the sink node is transmitted to a remote fusion center through bandwidth constrained communication channels. A new mathematical model with compensation strategy is proposed to characterize the replay attacks and bandwidth constrains, and then a recursive distributed Kalman fusion estimator (DKFE) is designed in the linear minimum variance sense. According to different communication frameworks, two classes of data compression and compensation algorithms are developed such that the DKFEs can achieve the desired performance. Several attack-dependent and bandwidth-dependent conditions are derived such that the DKFEs are secure under replay attacks. An illustrative example is given to demonstrate the effectiveness of the proposed methods.

Social support buffers the effects of terrorism on adolescent depression: findings from Sderot, Israel.

PubMed

Henrich, Christopher C; Shahar, Golan

2008-09-01

This prospective study of 29 Israeli middle school students experiencing terror attacks by Qassam rockets addressed whether higher levels of baseline social support protected adolescents from adverse psychological effects of exposure to rocket attacks. Participants were assessed at two time points 5 months apart, before and after a period of military escalation from May to September 2007. Adolescent self-reported depression was measured at both time points, using the Center for Epidemiological Studies-Child Depression Scale. Social support from family, friends, and school was measured at time 1, via a short form of the Perceived Social Support Scale. Adolescents also reported their exposure to rocket attacks at both time points. There was a significant interaction between social support and exposure to rocket attacks predicting depression over time. As hypothesized, baseline levels of social support buffered against the effect of exposure to rocket attacks on increased depression. Conversely, social support was associated with increased depression for adolescents who were not exposed to rocket attacks. Findings highlight the potential importance of community mental health efforts to bolster schools, families, and peer groups as protective resources in times of traumatic stress.

How to Prevent Type-Flaw Guessing Attacks on Password Protocols

DTIC Science & Technology

2003-01-01

How to prevent type-flaw guessing attacks on password protocols∗ Sreekanth Malladi , Jim Alves-Foss Center for Secure and Dependable Systems...respectively. R Retagging 〈−(t, f),+(t′, f)〉. The retagging strand captures the concept of receiving a message of one type and sending it, with a claim of a...referrees for insightful comments. Thanks are also due to Ricardo Corin for many helpful technical discus- sions. References [AN94] M. Abadi and R

Magnus effects on spinning transonic missiles

NASA Technical Reports Server (NTRS)

Seginer, A.; Rosenwasser, I.

1983-01-01

Magnus forces and moments were measured on a basic-finner model spinning in transonic flow. Spin was induced by canted fins or by full-span or semi-span, outboard and inboard roll controls. Magnus force and moment reversals were caused by Mach number, reduced spin rate, and angle of attack variations. Magnus center of pressure was found to be independent of the angle of attack but varied with the Mach number and model configuration or reduced spin rate.

The War Against Trucks Aerial Interdiction in Southern Laos 1968-1972

DTIC Science & Technology

2005-01-01

History and its successors.) Capt. William A. Buckingham , Jr., USAF, an intelligence specialist in Southeast Asia during the Vietnam War, unearthed a... Buckingham , Mr. Carl Berger, Mr. Van Staaveren, Dr. Wayne W. Thompson, Dr. Elizabeth H. Hartsook, Mr. Lawrence J. Paszek, Mr. Eugene P. viii The War against...attacks (top); the hard-hit Cholon area of Saigon (center); the Imperial Palace in Hue, damaged during the 1968 Tet attacks (bottom). 77 Khe Sanh

Training for Terror: A Case Study of Al-Qaida

DTIC Science & Technology

2002-03-01

Khaled Abou el Fadl, a law professor at the University of California at Los Angeles , states that bin Laden and the Taliban are selective in their... Rueda , 2001, p.20). 1. Al-Qaida Attack Chronology Al-Qaida gained notoriety in February 1993 for its bombing of the World Trade Center. This attack...overthrowing any regime that has been 35 corrupted by Western influence (Alexander, 2001, p.2). According to Alexander and Rueda , the following is a

The doctor-patient relationship as a toolkit for uncertain clinical decisions.

PubMed

Diamond-Brown, Lauren

2016-06-01

Medical uncertainty is a well-recognized problem in healthcare, yet how doctors make decisions in the face of uncertainty remains to be understood. This article draws on interdisciplinary literature on uncertainty and physician decision-making to examine a specific physician response to uncertainty: using the doctor-patient relationship as a toolkit. Additionally, I ask what happens to this process when the doctor-patient relationship becomes fragmented. I answer these questions by examining obstetrician-gynecologists' narratives regarding how they make decisions when faced with uncertainty in childbirth. Between 2013 and 2014, I performed 21 semi-structured interviews with obstetricians in the United States. Obstetricians were selected to maximize variation in relevant physician, hospital, and practice characteristics. I began with grounded theory and moved to analytical coding of themes in relation to relevant literature. My analysis renders it evident that some physicians use the doctor-patient relationship as a toolkit for dealing with uncertainty. I analyze how this process varies for physicians in different models of care by comparing doctors' experiences in models with continuous versus fragmented doctor-patient relationships. My key findings are that obstetricians in both models appealed to the ideal of patient-centered decision-making to cope with uncertain decisions, but in practice physicians in fragmented care faced a number of challenges to using the doctor-patient relationship as a toolkit for decision-making. These challenges led to additional uncertainties and in some cases to poor outcomes for doctors and/or patients; they also raised concerns about the reproduction of inequality. Thus organization of care delivery mitigates the efficacy of doctors' use of the doctor-patient relationship toolkit for uncertain decisions. These findings have implications for theorizing about decision-making under conditions of medical uncertainty, for understanding how the doctor-patient relationship and model of care affect physician decision-making, and for forming policy on the optimal structure of medical work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mortality, mauling, and maiming by vicious dogs.

PubMed

Bini, John K; Cohn, Stephen M; Acosta, Shirley M; McFarland, Marilyn J; Muir, Mark T; Michalek, Joel E

2011-04-01

Maiming and death due to dog bites are uncommon but preventable tragedies. We postulated that patients admitted to a level I trauma center with dog bites would have severe injuries and that the gravest injuries would be those caused by pit bulls. We reviewed the medical records of patients admitted to our level I trauma center with dog bites during a 15-year period. We determined the demographic characteristics of the patients, their outcomes, and the breed and characteristics of the dogs that caused the injuries. Our Trauma and Emergency Surgery Services treated 228 patients with dog bite injuries; for 82 of those patients, the breed of dog involved was recorded (29 were injured by pit bulls). Compared with attacks by other breeds of dogs, attacks by pit bulls were associated with a higher median Injury Severity Scale score (4 vs. 1; P = 0.002), a higher risk of an admission Glasgow Coma Scale score of 8 or lower (17.2% vs. 0%; P = 0.006), higher median hospital charges ($10,500 vs. $7200; P = 0.003), and a higher risk of death (10.3% vs. 0%; P = 0.041). Attacks by pit bulls are associated with higher morbidity rates, higher hospital charges, and a higher risk of death than are attacks by other breeds of dogs. Strict regulation of pit bulls may substantially reduce the US mortality rates related to dog bites.

Using exterior building surface films to assess human exposure and health risks from PCDD/Fs in New York City, USA, after the World Trade Center attacks.

PubMed

Rayne, Sierra

2005-12-09

Concentrations of tetra- through octa-chlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were determined in exterior window films from Manhattan and Brooklyn in New York City (NYC), USA, 6 weeks after the World Trade Center (WTC) attacks of 11 September 2001. High concentrations of the 2,3,7,8-substituted congeners (P(2378)CDD/Fs) were observed, at levels up to 6600 pg-TEQ g(-1) nearest the WTC site. An equilibrium partitioning model was developed to reconstruct total gas + particle-phase atmospheric concentrations of P(2378)CDD/Fs at each site. The reconstructed atmospheric and window film concentrations were subsequently used in a preliminary human health risk assessment to estimate the potential cancer and non-cancer risks posed to residents of lower Manhattan from these contaminants over the 6 week exposure period between the WTC attacks and sampling dates. Residents of lower Manhattan appear to have a slightly elevated cancer risk (up to 1.6% increase over background) and increased P(2378)CDD/F body burden (up to 8.0% increase over background) because of above-background exposure to high concentrations of P(2378)CDD/Fs produced from the WTC attacks during the short period between 11 September 2001, and window film sampling 6 weeks later.

Security management based on trust determination in cognitive radio networks

NASA Astrophysics Data System (ADS)

Li, Jianwu; Feng, Zebing; Wei, Zhiqing; Feng, Zhiyong; Zhang, Ping

2014-12-01

Security has played a major role in cognitive radio networks. Numerous researches have mainly focused on attacking detection based on source localization and detection probability. However, few of them took the penalty of attackers into consideration and neglected how to implement effective punitive measures against attackers. To address this issue, this article proposes a novel penalty mechanism based on cognitive trust value. The main feature of this mechanism has been realized by six functions: authentication, interactive, configuration, trust value collection, storage and update, and punishment. Data fusion center (FC) and cluster heads (CHs) have been put forward as a hierarchical architecture to manage trust value of cognitive users. Misbehaving users would be punished by FC by declining their trust value; thus, guaranteeing network security via distinguishing attack users is of great necessity. Simulation results verify the rationality and effectiveness of our proposed mechanism.

Development of a Flush Airdata Sensing System on a Sharp-Nosed Vehicle for Flight at Mach 3 to 8

NASA Technical Reports Server (NTRS)

Davis, Mark C.; Pahle, Joseph W.; White, John Terry; Marshall, Laurie A.; Mashburn, Michael J.; Franks, Rick

2000-01-01

NASA Dryden Flight Research Center has developed a flush airdata sensing (FADS) system on a sharp-nosed, wedge-shaped vehicle. This paper details the design and calibration of a real-time angle-of-attack estimation scheme developed to meet the onboard airdata measurement requirements for a research vehicle equipped with a supersonic-combustion ramjet engine. The FADS system has been designed to perform in flights at Mach 3-8 and at -6 deg - 12 deg angle of attack. The description of the FADS architecture includes port layout, pneumatic design, and hardware integration. Predictive models of static and dynamic performance are compared with wind-tunnel results across the Mach and angle-of-attack range. Results indicate that static angle-of-attack accuracy and pneumatic lag can be adequately characterized and incorporated into a real-time algorithm.

Development of a Flush Airdata Sensing System on a Sharp-Nosed Vehicle for Flight at Mach 3 to 8

NASA Technical Reports Server (NTRS)

Davis, Mark C.; Pahle, Joseph W.; White, John Terry; Marshall, Laurie A.; Mashburn, Michael J.; Franks, Rick

2000-01-01

NASA Dryden Flight Research Center has developed a flush airdata sensing (FADS) system on a sharp-nosed, wedge-shaped vehicle. This paper details the design and calibration of a real-time angle-of-attack estimation scheme developed to meet the onboard airdata measurement requirements for a research vehicle equipped with a supersonic-combustion ramjet engine. The FADS system has been designed to perform in flights at speeds between Mach 3 and Mach 8 and at angles of attack between -6 deg. and 12 deg. The description of the FADS architecture includes port layout, pneumatic design, and hardware integration. Predictive models of static and dynamic performance are compared with wind-tunnel results across the Mach and angle-of-attack range. Results indicate that static angle-of-attack accuracy and pneumatic lag can be adequately characterized and incorporated into a real-time algorithm.

[Patients' autonomy and doctors' duties according to the Andalusian bill of "dignified dead"].

PubMed

Díez Fernández, José Antonio

2010-01-01

The provisions of the andalusian Law on rights and guarantees of the dignity of persons in the process of death, also known as "act of dignified death", are based on two pillars: the right to the autonomy of the patient, supported, if it be, in a will expressed in instructions given in advance and the duties of doctors and health centers to give satisfaction, to the extent of their potential and respecting the law, those demands. the core of the question is to find the point of necessary balance between the wishes of the patient and the freedom and responsibility of the doctor. Together with positive aspects, such as the recognition of the right and the implementation of the palliative care, there are other questionable proposals, affecting the rights of doctors: a lack of understanding of freedom and professional responsibility, recognition of the objection of conscience and certain ethics duties, etc. As expressed by the law, remain committed substantial rights of doctors and might favor, in the care activity, introducing practices of defensive medicine.

Cat Scratch Disease

MedlinePlus

Cat scratch disease (CSD) is an illness caused by the bacterium Bartonella henselae. Almost half of all cats carry the infection ... symptoms of CSD, call your doctor. Centers for Disease Control and Prevention

Avelumab Injection

MedlinePlus

... doctor or nurse in a medical facility or infusion center. It is usually given once every 2 ... Avelumab injection may cause serious reactions during the infusion of the medication. You may be given other ...

LAM (Lymphangioleiomyomatosis)

MedlinePlus

... Take steps to care for your lungs. For example, talk with your doctor about getting a pneumococcal pneumonia vaccine and a yearly influenza or flu shot. Visit the Centers for Disease Control and Prevention ( ...

High Fidelity Simulation Experience in Emergency settings: doctors and nurses satisfaction levels.

PubMed

Calamassi, Diletta; Nannelli, Tiziana; Guazzini, Andrea; Rasero, Laura; Bambi, Stefano

2016-11-22

Lots of studies describe High Fidelity Simulation (HFS) as an experience well-accepted by the learners. This study has explored doctors and nurses satisfaction levels during HFS sessions, searching the associations with the setting of simulation events (simulation center or on the field simulation). Moreover, we studied the correlation between HFS experience satisfaction levels and the socio-demographic features of the participants. Mixed method study, using the Satisfaction of High-Fidelity Simulation Experience (SESAF) questionnaire through an online survey. SESAF was administered to doctors and nurses who previously took part to HFS sessions in a simulation center or in the field. Quantitative data were analyzed through descriptive and inferential statistics methods; qualitative data was performed through the Giorgi method. 143 doctors and 94 nurses filled the questionnaire. The satisfaction level was high: on a 10 points scale, the mean score was 8.17 (SD±1.924). There was no significant difference between doctors and nurses satisfaction levels in almost all the SESAF factors. We didn't find any correlation between gender and HFS experience satisfaction levels. The knowledge of theoretical aspects of the simulated case before the HFS experience is related to a higher general satisfaction (r=0.166 p=0.05), a higher effectiveness of debriefing (r=0,143 p=0,05), and a higher professional impact (r=0.143 p=0.05). The respondents that performed a HFS on the field, were more satisfied than the others, and experienced a higher "professional impact", "clinical reasoning and self efficacy", and "team dynamics" (p< 0,01). Narrative data suggest that HFS facilitators should improve their behaviors during the debriefing. Healthcare managers should extend the HFS to all kind of healthcare workers in real clinical settings. There is the need to improve and implement the communication competences of HFS facilitators.

Satellite medical centers project

NASA Astrophysics Data System (ADS)

Aggarwal, Arvind

2002-08-01

World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

Supersonic aerodynamic characteristics of a proposed Assured Crew Return Capability (ACRC) lifting-body configuration

NASA Technical Reports Server (NTRS)

Ware, George M.

1989-01-01

An investigation was conducted in the Langley Unitary Plan Wind Tunnel at Mach numbers from 1.6 to 4.5. The model had a low-aspect-ratio body with a flat undersurface. A center fin and two outboard fins were mounted on the aft portion of the upper body. The outboard fins were rolled outboard 40 deg from the vertical. Elevon surfaces made up the trailing edges of the outboard fins, and body flaps were located on the upper and lower aft fuselage. The center fin pivoted about its midchord for yaw control. The model was longitudinally stable about the design center-of-gravity position at 54 percent of the body length. The configuration with undeflected longitudinal controls trimmed near 0 deg angle of attack at Mach numbers from 1.6 to 3.0 where lift and lift-drag ratio were negative. Longitudinal trim was near the maximum lift-drag ratio (1.4) at Mach 4.5. The model was directionally stable over Mach number range except at angles of attack around 4 deg at M = 2.5. Pitch control deflection of more than -10 deg with either elevons or body flaps is needed to trim the model to angles of attack at which lift becomes positive. With increased control deflection, the lifting-body configuration should perform the assured crew return mission through the supersonic speed range.

Success Stories: How School Health Centers Make a Difference. A Special Report of the National Health and Education Consortium.

ERIC Educational Resources Information Center

Shearer, Christopher A.

This booklet provides examples of how students have been helped through the provision of school-based health care. The stories, submitted by principals, school nurses, nurse practitioners, doctors, health center directors, and students, illustrate the pressing health problems faced by students today. The problems addressed in these personal…

Mentoring Resulting in a New Model: Affect-Centered Transformational Leadership

ERIC Educational Resources Information Center

Moffett, David W.; Tejeda, Armando R.

2014-01-01

The authors were professor and student, in a doctoral leadership course, during fall semester of 2013-2014. Across the term the professor mentored the mentee, guiding him to the creation of the next, needed model for leadership. The new model, known as The Affect-Centered Transformational Leadership Model, came about as the result. Becoming an…

Professional Profile of National Health Service Physicians in Greece and Their Self-Expressed Training Needs

ERIC Educational Resources Information Center

Kyriopoulos, John; Gregory, Susan; Georgoussi, Eugenia; Dolgeras, Apostolos

2003-01-01

Introduction: Continuing medical education is not yet mandatory in Greece, but an increasing number of training courses is becoming available. In recent years, 32 training centers have been accredited. Method: A postal survey of a national sample of 500 National Health Service doctors, weighted toward hospitals with accredited training centers,…

The impact of tort reform on intensity of treatment: evidence from heart patients.

PubMed

Avraham, Ronen; Schanzenbach, Max

2015-01-01

This paper analyzes the effect of non-economic damage caps on the treatment intensity of heart attack victims. We focus on whether a patient receives a major intervention in the form of either a coronary artery by-pass or angioplasty. We find strong evidence that treatment intensity declines after a cap on non-economic damages. The probability of receiving a major intervention in the form of either an angioplasty or bypass declines by 1.25-2 percentage points after non-economic damage caps are enacted, and this effect is larger a year or two after reform. However, we also find clear evidence of substitution between major interventions. When doctors have discretion to perform a by-pass and patients have insurance coverage, caps on non-economic damages increase the probability that a by-pass is performed. The effect of non-economic damage caps on costs is not always statistically significant, but in models with state-specific trends, total costs decline by as much as four percent. We conclude that tort reform reduces treatment intensity overall, even though it changes the mix of treatments. Using the Center for Disease Control's Vital Statistics data, we find that tort reform is not associated with an increase in mortality from coronary heart disease; if anything, mortality declines. Copyright © 2014 Elsevier B.V. All rights reserved.

Trauma Exposure and Posttraumatic Stress Disorder Among Employees of New York City Companies Affected by the September 11, 2001 Attacks on the World Trade Center

PubMed Central

North, Carol S.; Pollio, David E.; Smith, Rebecca P.; King, Richard V.; Pandya, Anand; Surís, Alina M.; Hong, Barry A.; Dean, Denis J.; Wallace, Nancy E.; Herman, Daniel B.; Conover, Sarah; Susser, Ezra; Pfefferbaum, Betty

2013-01-01

Objective Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. Methods Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11–related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. Results The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate’s direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. Conclusions Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions. PMID:21900416

Trauma exposure and posttraumatic stress disorder among employees of New York City companies affected by the September 11, 2001 attacks on the World Trade Center.

PubMed

North, Carol S; Pollio, David E; Smith, Rebecca P; King, Richard V; Pandya, Anand; Surís, Alina M; Hong, Barry A; Dean, Denis J; Wallace, Nancy E; Herman, Daniel B; Conover, Sarah; Susser, Ezra; Pfefferbaum, Betty

2011-09-01

Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

Center for Adaptive Optics | Jobs

Science.gov Websites

, 2015 University of Geneva Adaptive Optics Scientist or Engineer March 16, 2015 NRC-Herzberg Astronomy Max Planck Institute for Astronomy (MPIA) Post-doctoral Fellowships in High-angular Resolution

Hereditary angioedema with normal C1 inhibitor in a French cohort: Clinical characteristics and response to treatment with icatibant.

PubMed

Bouillet, Laurence; Boccon-Gibod, Isabelle; Launay, David; Gompel, Anne; Kanny, Gisele; Fabien, Vincent; Fain, Oliver

2017-03-01

The clinical characteristics and icatibant-treatment outcomes of patients with hereditary angioedema with normal C1 inhibitor (HAE-nC1 INH) are limited. We retrospectively analyzed data from French HAE patients enrolled in the Icatibant Outcome Survey registry (from July 2009 to September 2013) to compare disease characteristics and the effectiveness and safety of acute icatibant-treated angioedema attacks in patients with HAE-nC1 INH, HAE with C1 INH deficiency (type I), or dysfunction (type II). One center in Grenoble contributed 22 patients with HAE-nC1 INH and a family history of HAE while 15 centers across France contributed 153 patients with HAE type I and seven patients with HAE type II. Patients with HAE-nC1 INH compared to HAE type I, respectively, were more likely to be female (88.1% vs. 63.4%), older at median age of disease onset (21 years vs. 15 years), and have a greater rate of abdominal (80% vs. 61%) and laryngeal (23% vs. 14%) attacks. Icatibant was effective in both groups though the median time to resolution of attack was significantly longer in the HAE-nC1 INH group (20.0 h, 37 attacks) versus the HAE type I group (14.0 h, 67 attacks). Icatibant was self-administered for 96.1% of attacks in patients with HAE-nC1 INH and 75.8% in patients with HAE type I. No serious adverse side effects related to icatibant were reported. These data help further define the disease characteristics of HAE-nC1 INH in the French population and extend the limited data reporting the safe and effective use of icatibant in acute treatment of angioedema in French patients diagnosed with HAE-nC1 INH.

Hereditary angioedema with normal C1 inhibitor in a French cohort: Clinical characteristics and response to treatment with icatibant

PubMed Central

Boccon‐Gibod, Isabelle; Launay, David; Gompel, Anne; Kanny, Gisele; Fabien, Vincent; Fain, Oliver

2017-01-01

Abstract Introduction The clinical characteristics and icatibant‐treatment outcomes of patients with hereditary angioedema with normal C1 inhibitor (HAE‐nC1 INH) are limited. Methods We retrospectively analyzed data from French HAE patients enrolled in the Icatibant Outcome Survey registry (from July 2009 to September 2013) to compare disease characteristics and the effectiveness and safety of acute icatibant‐treated angioedema attacks in patients with HAE‐nC1 INH, HAE with C1 INH deficiency (type I), or dysfunction (type II). Results One center in Grenoble contributed 22 patients with HAE‐nC1 INH and a family history of HAE while 15 centers across France contributed 153 patients with HAE type I and seven patients with HAE type II. Patients with HAE‐nC1 INH compared to HAE type I, respectively, were more likely to be female (88.1% vs. 63.4%), older at median age of disease onset (21 years vs. 15 years), and have a greater rate of abdominal (80% vs. 61%) and laryngeal (23% vs. 14%) attacks. Icatibant was effective in both groups though the median time to resolution of attack was significantly longer in the HAE‐nC1 INH group (20.0 h, 37 attacks) versus the HAE type I group (14.0 h, 67 attacks). Icatibant was self‐administered for 96.1% of attacks in patients with HAE‐nC1 INH and 75.8% in patients with HAE type I. No serious adverse side effects related to icatibant were reported. Conclusions These data help further define the disease characteristics of HAE‐nC1 INH in the French population and extend the limited data reporting the safe and effective use of icatibant in acute treatment of angioedema in French patients diagnosed with HAE‐nC1 INH. PMID:28250922

Orbiter entry trajectory corridors: 32000 pound payload, 67.5 percent center of gravity. [glide path data compilation

NASA Technical Reports Server (NTRS)

Treybig, J. H.

1975-01-01

Thermal and equilibrium glide boundaries were used to analyze and/or design shuttle orbiter entry trajectories. Plots are presented of orbiter thermal and equilibrium glide boundaries in the drag/mass-relative velocity dynamic pressure-relative velocity, and altitude-relative velocity planes for an orbiter having a 32,000 pound payload and a 67.5% center of gravity location. These boundaries were defined for control points 1 through 4 of the shuttle orbiter for 40 deg-30 deg and 38 deg-28 deg ramped angle of attack entry profiles and 40 deg, 38 deg, 35 deg, 30 deg, 28 deg, and 25 deg constant angle of attack entry profiles each at 20 deg, 15 deg, and 10 deg constant body flap settings.

Risk factors for hypertensive attack during pheochromocytoma resection

PubMed Central

Kwon, Se Yun; Lee, Kyung Seop; Lee, Jun Nyung; Ha, Yun-Sok; Choi, Seock Hwan; Kim, Hyun Tae; Kim, Tae-Hwan; Yoo, Eun Sang

2016-01-01

Purpose We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge. Materials and Methods Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. Results In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d. Conclusions In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma. PMID:27194549

Use of cannabis among 139 cluster headache sufferers.

PubMed

Leroux, Elizabeth; Taifas, Irina; Valade, Dominique; Donnet, Anne; Chagnon, Miguel; Ducros, Anne

2013-02-01

A case report suggested the efficacy of cannabis to treat cluster headache (CH) attacks. Our aims were to study the frequency of cannabis use in CH patients, and the reported effects on attacks. A total of 139 patients with CH attending two French headache centers filled out questionnaires. Sixty-three of the 139 patients (45.3%) had a history of cannabis use. As compared to nonusers, cannabis users were more likely to be younger (p < 0.001), male (p = 0.002) and tobacco smokers (p < 0.001). Among the 27 patients (19.4% of the total cohort) who had tried cannabis to treat CH attacks, 25.9% reported some efficacy, 51.8% variable or uncertain effects, and 22.3% negative effects. Cannabis use is very frequent in CH patients, but its efficacy for the treatment of the attacks is limited. Less than one third of self-reported users mention a relief of their attacks following inhalation. Cannabis should not be recommended for CH unless controlled trials with synthetic selective cannabinoids show a more convincing therapeutic benefit.

[The questions of improving the information-analytical component in the reform of the health care system in Ukraine].

PubMed

Беликова, Инна В; Руденко, Леся А

2016-01-01

A priority task of the development strategy of the Ukrainian health care system is the saving and improving of public health. With the development of new economic relations, health care restructuring, the introduction of new financing mechanisms to policy-makers have an important task of the organization of operational management on the basis of timely quality information. According to many authors, the ability to improve the quality of the received information is possible due to the intercalation of information technologies. The main aim of our study is to determine the main directions of modernization of information-analytical component during the health care reform. The medical institutions reporting forms (f.20, f.12, f.17, f.47) were analyzed to achieve the goal, were conducted a survey of primary care physicians. The survey was attended by 265 family doctors, 80 of whom are family doctors of family medicine clinic of the regional center, 185 - medical centers of primary health care district centers. The analysis of the sociological research indicates that the work of the family doctor is accompanied by filling a large number of records, so according to the survey, an average of doctors per day filled about 15.74 +2.2 registration forms, on average per month 333,7+ 30 a month. The necessity of reform of the information-analytical component of the health care system have noted by 94% 1.4. Do not have a automated workstation 34.5% + 5.3 physicians of the regional center and 68% + 3.4 countryside. Possession of the computer at user level observed by 92% + 1.6, which is a good basis for the introduction of information in healthcare system. The data of the sociological survey confirm the necession of structural-functional procuring of the system of information-analytical supporting of the healthcare system of Ukraine. Annual health statistics reports are still relevant, but they need to improve and adapt to the new conditions of functioning of healthcare system and should be subject to automated processing of data at all levels.

78 FR 18855 - World Trade Center Health Program Eligibility Requirements for Shanksville, Pennsylvania and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

...Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) by adding Title XXXIII, which establishes the World Trade Center (WTC) Health Program. The WTC Health Program is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), in the Department of Health and Human Services (HHS), and provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery, and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, Shanksville, Pennsylvania, and at the Pentagon, and to eligible survivors of the New York City attacks. Section 3311(a)(2)(C) of the PHS Act requires the WTC Program Administrator (Administrator) to develop eligibility criteria for enrollment of Shanksville, Pennsylvania and Pentagon responders. This interim final rule establishes those eligibility criteria.

Pitch control margin at high angle of attack - Quantitative requirements (flight test correlation with simulation predictions)

NASA Technical Reports Server (NTRS)

Lackey, J.; Hadfield, C.

1992-01-01

Recent mishaps and incidents on Class IV aircraft have shown a need for establishing quantitative longitudinal high angle of attack (AOA) pitch control margin design guidelines for future aircraft. NASA Langley Research Center has conducted a series of simulation tests to define these design guidelines. Flight test results have confirmed the simulation studies in that pilot rating of high AOA nose-down recoveries were based on the short-term response interval in the forms of pitch acceleration and rate.

A Look at Person- and Family-Centered Care Among Older Adults: Results from a National Survey [corrected].

PubMed

Wolff, Jennifer L; Boyd, Cynthia M

2015-10-01

Person-centered and family-centered care represents the pinnacle of health care quality, but delivering it is challenging, as is assessing whether it has occurred. Prior studies portray older adults as passive in health decisions and burdened by care-but emphasize age-based differences or focus on vulnerable subgroups. We aimed to examine domains of person-centered and family-centered care among older adults and whether the social context in which older adults manage their health relates to preferences for participating in health decisions and experiences with care. This was an observational study of a nationally representative survey of adults aged 65+ years, conducted in concert with the 2012 National Health and Aging Trends Study (n = 2040). Approach to managing health (self-manage, co-manage, delegate); preferences for making health care decisions with: (1) doctors, (2) family/close friends; and experiences with care pertaining to treatment burden were measured. Approximately two-thirds of older adults self-manage (69.4 %) and one-third co-manage (19.6 %) or delegate (11.0 %) health care activities. The majority prefer an independent or shared role when making health decisions with doctors (84.7 %) and family/close friends (95.9 %). Nearly four in ten older adults (37.9 %) experience treatment burden-that managing health care activities are sometimes or often hard for either them or their family/close friends, that health care activities get delayed or don't get done, or that they are cumulatively too much to do. Relative to older adults who self-manage, those who delegate health care activities are more likely to prefer to share or leave health decisions to doctors (aOR = 1.79 (95 % CI, 1.37-2.33) and family/close friends (aOR = 3.12 (95 % CI, 2.23-4.36), and are more likely to experience treatment burden (aOR = 2.37 (95 % CI, 1.61-3.47). Attaining person-centered and family-centered care will require strategies that respect diverse decision-making preferences, minimize treatment burden, and support the broader social context in which older adults manage their health.

Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship

PubMed Central

Krupat, Edward; Asma, Yumna; Fatima, Noor-E-; Attique, Rayan; Mahmood, Umar; Waqas, Ahmed

2015-01-01

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc. Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression. Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05). Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care. PMID:26157621

Emergency supply of doctors by the Mais Médicos (More Doctors) Program and the quality of the structure of primary health care facilities.

PubMed

Giovanella, Ligia; Mendonça, Maria Helena Magalhães de; Fausto, Marcia Cristina Rodrigues; Almeida, Patty Fidelis de; Bousquat, Aylene; Lima, Juliana Gagno; Seidl, Helena; Franco, Cassiano Mendes; Fusaro, Edgard Rodrigues; Almeida, Sueli Zeferino Ferreira

2016-09-01

The health policy context in Brazil has featured a series of measures to improve primary health care (PHC), including a national access and quality improvement program (Programa Nacional de Melhoria do Acesso e Qualidade, PMAQ-AB) and the Mais Médicos Program (More Doctors, PMM) and upgrading PHC centers ('Requalifica UBS'). The paper examines the PMM's placement of doctors, by quality of PHC structure, in an endeavor to identify synergies among the three programs. It reports on a transverse study based on secondary data from PMAQ-AB Cycles 1 and 2, the PMM and 'Requalifica UBS'. The PHC facilities inventoried during PMAQ-AB Cycle 1 were classified, on pre-established typology, into five groups ranked from A (best) to E (failed). They were then compared in terms of PMM personnel allocated and Requalifica UBS proposals. The results point to convergences in investments by the three programs. Incentives targeted predominantly PHC facilities of types B and C, indicating a concentration of efforts on PHC facilities with potential for structural quality improvements. In addition to expanding access, the provision of doctors by the PMM, added to infrastructure upgrades and work process improvements, contributes to addressing high turnover and guaranteeing retention of doctors in PHC.

Physician self-referral and physician-owned specialty facilities.

PubMed

Casalino, Lawrence P

2008-06-01

Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

9/11 Event

NASA Image and Video Library

2015-09-11

An honor guard folds an American flag during the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

Kelvin Manning, associate director of NASA's Kennedy Space Center, speaks during the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at Kennedy on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

An honor guard prepares to fold an American flag during the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

The honor guard for the Fire Department at NASA's Kennedy Space Center conducts the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at Kennedy on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

The Brevard Police and Fire Pipe and Drum corps open the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

The Brevard Police and Fire Pipe and Drum corps perform during the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Fire Station 1 at NASA's Kennedy Space Center on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

Angular relationships regulate coordination tendencies of performers in attacker-defender dyads in team sports.

PubMed

Esteves, Pedro T; Araújo, Duarte; Vilar, Luís; Travassos, Bruno; Davids, Keith; Esteves, Carlos

2015-04-01

This study examined the continuous interpersonal interactions of performers in dyadic systems in team sports, as a function of changing information constraints. As a task vehicle, we investigated how attackers attained success in 1v1 sub-phases of basketball by exploring angular relations with immediate opponents and the basket. We hypothesized that angular relations would convey information for the attackers to dribble past defenders. Four basketball players performed as an attacker and defender in 1v1 sub-phases of basketball, in which the co-positioning and orientation of participants relative to the basket was manipulated. After video recording performance behaviors, we digitized participant movement displacement trajectories and categorized trials as successful or unsuccessful (from the attackers' viewpoint). Results revealed that, to successfully dribble past a defender, attackers tended to explore the left hand side of the space by defenders by increasing their angular velocity and decreasing their angular variability, especially in the center of the court. Interpersonal interactions and goal-achievement in attacker-defender dyads appear to have been constrained by the angular relations sustained between participants relative to the scoring target. Results revealed the functionality of exploratory behaviors of participants attempting re-align spatial relations with an opponent in 1v1 sub-phases of team games. Copyright © 2015 Elsevier B.V. All rights reserved.

Osgood-Schlatter Disease

MedlinePlus

... many girls involved in sports — like gymnastics or soccer — develop it, too. If your doctor suspects Osgood- ... a Pain Five Ways to Avoid Sports Injuries Nutrition & Fitness Center Problems With Legs and Feet View ...

Choosing a Transplant Center

MedlinePlus

... became mother's motivation Be The Match Blog Stories Anna, transplant recipient and her daughter Every patient — from ... your doctor Clinical Trials Read results of recent studies Find a clinical trial Before Transplant Things to ...

Results of an experimental investigation to determine separation characteristics for the Orbiter/747 using a 0.0125-scale model (48-0 AX1318I-1 747) in the Ames Research center 14-foot wind tunnel (CA23B), volume 1

NASA Technical Reports Server (NTRS)

Esparza, V.

1976-01-01

Separation data were obtained at a Mach number of 0.6 and three incidence angles of 4 deg, 6 deg, and 9 deg. The orbiter angle of attack was varied from 0 to 14 degrees. Longitudinal, lateral and normal separation increments were obtained for fixed 747 angles of attack of 0 deg, 2 deg, and 4 deg while varying orbiter angle of attack. Control surface settings on the 747 carrier included rudder deflections of 0 deg and 10 deg and horizontal stabilizer deflections of -1 deg and +5 deg. Photographs of tested configurations are shown.

The Origin of Variation in Primary Care Process and Outcome Indicators: Patients, Professionals, Centers, and Health Districts.

PubMed

Orueta, Juan F; García-Alvarez, Arturo; Grandes, Gonzalo; Nuño-Solinís, Roberto

2015-08-01

Healthcare providers are often evaluated by studying variability in their indicators. However, the usefulness of this analysis may be limited if we do not distinguish the variability attributable to health professionals and organizations from that associated with their patients.Our objectives are to describe the main process and outcome indicators of primary healthcare services, analyzing the contribution to variability in these indicators from different levels: individual, health professional, health center, and health district.This is a cross-sectional study that includes all.All the individuals covered by the public Basque Health Service (children [age 0-13], n = 247,493; adults [≥14 years old], n = 1,959,682) over a 12-month period.We calculated the number of visits to primary care doctors, number of referrals, prescription costs, and potentially avoidable hospitalizations for ambulatory care sensitive conditions (ACSCs). Using multilevel analysis, we determined the percentage of variance attributable to each level.After adjusting for the characteristics of patients (demographic, socioeconomic, and morbidity), doctors (panel size), health center (size, staff satisfaction, demographic structure of the community), and health district, the variance in the indicators was mainly attributable to differences between patients, independently of the attending health professional, the center, or the healthcare organization, both in children (94.21% for visits to the doctor; 96.66% for referrals; 98.57% for prescription costs; 90.02% for potentially avoidable hospitalizations for ACSCs) and in adults (88.10%; 96.26%; 97.92%; and 93.77%, respectively).The limited contribution of health professionals and organizations to variability in indicators should be taken into account when performing evaluations and planning quality improvement strategies.

Challenges with the establishment of congenital cardiac surgery centers in Nigeria: survey of cardiothoracic surgeons and residents.

PubMed

Okonta, Kelechi E; Tobin-West, Charles I

2016-05-01

There are gaps in understanding the challenges with the establishment of pediatric cardiac surgical practices in Nigeria. The aim of this study was to examine the prospects and challenges limiting the establishment of pediatric cardiac surgical practices in Nigeria from the perspectives of cardiothoracic surgeons and resident doctors. A descriptive study was carried out to articulate the views of the cardiothoracic surgeons and cardiothoracic resident doctors in Nigeria. A self-administered questionnaire was used to generate information from the participants between December 2014 and January 2015. Data were analyzed using the SPSS version 21 statistical software package. Thirty-one of the 51 eligible participants (60.7%) took part in the survey. Twenty-one (67.7%) were specialists/consultants, and 10 (32.3%) were resident doctors in cardiothoracic surgical units. Most of the respondents, 26 (83.9%) acknowledged the enormity of pediatric patients with cardiac problems in Nigeria; however, nearly all such children were referred outside Nigeria for treatment. The dearth of pediatric cardiac surgical centers in Nigeria was attributed to weak health system, absence of skilled manpower, funds, and equipment. Although there was a general consensus on the need for the establishment of open pediatric cardiac surgical centers in the country, their set up mechanisms were not explicit. The obvious necessity and huge potentials for the establishment of pediatric cardiac centers in Nigeria cannot be overemphasized. Nevertheless, weakness of the national health system, including human resources remains a daunting challenge. Therefore, local and international partnerships and collaborations with country leadership are strongly advocated to pioneer this noble service. Copyright © 2016 Elsevier Inc. All rights reserved.

What is Metabolic Syndrome?

MedlinePlus

... 22, 2012 | News Release NIH launches trial to evaluate anti-inflammatory treatment for preventing heart attacks, strokes, ... and Usage No FEAR Act Grants and Funding Customer Service/Center for Health Information Email Alerts Jobs ...

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China

PubMed Central

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer

2013-01-01

Abstract Problem The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. Approach To understand village doctors’ perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. Local setting The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Relevant changes Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Lessons learnt Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors. PMID:23397352

Occupational factors for mood and anxiety disorders among junior medical doctors.

PubMed

Pougnet, R; Di Costanzo, Laurence Pougnet; Kerrien, Margaux; Jousset, D; Loddé, B; Dewitte, J D; Garlantézec, R

2015-09-09

Junior doctors are exposed to multiple occupational risks. The aim of this study was to assess the risk factors and protective factors for mood and anxiety disorders among junior doctors. We conducted a cross-sectional study via an anonymous online questionnaire between October 2011 and June 2012. All the junior doctors in our faculty were included. The questionnaire inquired about demographic and health data. It contained four validated scales: the Center for Epidemiologic Studies Depression Scale (CES-D), the Spielberger anxiety questionnaire, the WHO quality of life (WHO - QOL) questionnaire and the Job Content Questionnaire. Finally, it sought to clarify the conditions of professional practice and the interactions between university programmes and junior doctorate students (change of specialty, pregnancy, leave of absence, etc.). 192 juniors doctors participated in the study, 68.2% of whom were women. Out of the group, 13.0% presented a depressive syndrome, while 28.7% presented an anxiety disorder, 32.8% were experiencing Job Strain and 29.7% Iso Strain. The risk factor for anxiety was competition between junior doctors: OR=4.23 (1.06 ‒ 16.82). The protective factors for mood disorders were the help provided by senior physicians and the respect shown by patients: OR=0.21 (0.06-0.74) and 0.20 (0.06-0.75), respectively. This study demonstrated the impact of the relationships with senior physicians and patients on junior doctors' health at work. Consequently, prevention should not be focused uniquely on work organization, but should increase physicians' awareness of the importance of this relationship.

Too Late for a Flu Shot (For Parents)?

MedlinePlus

... many health care settings, including doctors' offices and public, employee, and university health clinics some pharmacies some supermarkets some community groups or centers some schools If you have an HMO insurance plan, be ...

Virtual test: A student-centered software to measure student's critical thinking on human disease

NASA Astrophysics Data System (ADS)

Rusyati, Lilit; Firman, Harry

2016-02-01

The study "Virtual Test: A Student-Centered Software to Measure Student's Critical Thinking on Human Disease" is descriptive research. The background is importance of computer-based test that use element and sub element of critical thinking. Aim of this study is development of multiple choices to measure critical thinking that made by student-centered software. Instruments to collect data are (1) construct validity sheet by expert judge (lecturer and medical doctor) and professional judge (science teacher); and (2) test legibility sheet by science teacher and junior high school student. Participants consisted of science teacher, lecturer, and medical doctor as validator; and the students as respondent. Result of this study are describe about characteristic of virtual test that use to measure student's critical thinking on human disease, analyze result of legibility test by students and science teachers, analyze result of expert judgment by science teachers and medical doctor, and analyze result of trial test of virtual test at junior high school. Generally, result analysis shown characteristic of multiple choices to measure critical thinking was made by eight elements and 26 sub elements that developed by Inch et al.; complete by relevant information; and have validity and reliability more than "enough". Furthermore, specific characteristic of multiple choices to measure critical thinking are information in form science comic, table, figure, article, and video; correct structure of language; add source of citation; and question can guide student to critical thinking logically.

Cluster headache: clinical features and therapeutic options.

PubMed

Gaul, Charly; Diener, Hans-Christoph; Müller, Oliver M

2011-08-01

Cluster headache is the most common type of trigemino-autonomic headache, affecting ca. 120 000 persons in Germany alone. The attacks of pain are in the periorbital area on one side, last 90 minutes on average, and are accompanied by trigemino-autonomic manifestations and restlessness. Most patients have episodic cluster headache; about 15% have chronic cluster headache, with greater impairment of their quality of life. The attacks often possess a circadian and seasonal rhythm. Selective literature review Oxygen inhalation and triptans are effective acute treatment for cluster attacks. First-line drugs for attack prophylaxis include verapamil and cortisone; alternatively, lithium and topiramate can be given. Short-term relief can be obtained by the subcutaneous infiltration of local anesthetics and steroids along the course of the greater occipital nerve, although most of the evidence in favor of this is not derived from randomized clinical trials. Patients whose pain is inadequately relieved by drug treatment can be offered newer, invasive treatments, such as deep brain stimulation in the hypothalamus (DBS) and bilateral occipital nerve stimulation (ONS). Pharmacotherapy for the treatment of acute attacks and for attack prophylaxis is effective in most patients. For the minority who do not gain adequate relief, newer invasive techniques are available in some referral centers. Definitive conclusions as to their value cannot yet be drawn from the available data.

Risk-based decision making for staggered bioterrorist attacks : resource allocation and risk reduction in "reload" scenarios.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lemaster, Michelle Nicole; Gay, David M.; Ehlen, Mark Andrew

2009-10-01

Staggered bioterrorist attacks with aerosolized pathogens on population centers present a formidable challenge to resource allocation and response planning. The response and planning will commence immediately after the detection of the first attack and with no or little information of the second attack. In this report, we outline a method by which resource allocation may be performed. It involves probabilistic reconstruction of the bioterrorist attack from partial observations of the outbreak, followed by an optimization-under-uncertainty approach to perform resource allocations. We consider both single-site and time-staggered multi-site attacks (i.e., a reload scenario) under conditions when resources (personnel and equipment whichmore » are difficult to gather and transport) are insufficient. Both communicable (plague) and non-communicable diseases (anthrax) are addressed, and we also consider cases when the data, the time-series of people reporting with symptoms, are confounded with a reporting delay. We demonstrate how our approach develops allocations profiles that have the potential to reduce the probability of an extremely adverse outcome in exchange for a more certain, but less adverse outcome. We explore the effect of placing limits on daily allocations. Further, since our method is data-driven, the resource allocation progressively improves as more data becomes available.« less

Inlet Distortion for an F/A-18A Aircraft During Steady Aerodynamic Conditions up to 60 deg Angle of Attack

NASA Technical Reports Server (NTRS)

Walsh, Kevin R.; Yuhas, Andrew J.; Williams, John G.; Steenken, William G.

1997-01-01

The effects of high-angle-of-attack flight on aircraft inlet aerodynamic characteristics were investigated at NASA Dryden Flight Research Center, Edwards, California, as part of NASA's High Alpha Technology Program. The highly instrumented F/A-18A High Alpha Research Vehicle was used for this research. A newly designed inlet total-pressure rake was installed in front of the starboard F404-GE-400 engine to measure inlet recovery and distortion characteristics. One objective was to determine inlet total-pressure characteristics at steady high-angle-of-attack conditions. Other objectives include assessing whether significant differences exist in inlet distortion between rapid angle-of-attack maneuvers and corresponding steady aerodynamic conditions, assessing inlet characteristics during aircraft departures, providing data for developing and verifying computational fluid dynamic codes, and calculating engine airflow using five methods. This paper addresses the first objective by summarizing results of 79 flight maneuvers at steady aerodynamic conditions, ranging from -10 deg to 60 deg angle of attack and from -8 deg to 11 deg angle of sideslip at Mach 0.3 and 0.4. These data and the associated database have been rigorously validated to establish a foundation for understanding inlet characteristics at high angle of attack.

Oil Market Assessment

EIA Publications

2001-01-01

Based on Energy Information Administration (EIA) contacts and trade press reports, overall U.S. and global oil supplies appear to have been minimally impacted by yesterday's terrorist attacks on the World Trade Center and the Pentagon.

Genetics Home Reference: Omenn syndrome

MedlinePlus

... cells attack the body's own cells and tissues, accounting for the autoimmune features of Omenn syndrome . Learn ... Immune Response Encyclopedia: Immunodeficiency Disorders Health Topic: Immune System and Disorders Genetic and Rare Diseases Information Center ( ...

Details for Manuscript Number SSM-D-06-01956R1 “Physicians” Communication and Perceptions of Patients: Is it How They Look, How They Talk, or is it Just the Doctor?”

PubMed Central

Street, Richard L.; Gordon, Howard; Haidet, Paul

2010-01-01

Although physicians’ communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians’ patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians’ characteristics, patients’ demographic characteristics, physician-patient concordance, and the patient’s communication. Physicians (N = 29) and patients (N = 207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians’ communication and affect as well as the patients’ participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians’ encounters with black patients revealed communicative difficulties that may lower quality of care for these patients. PMID:17462801

[Doctor-Patient Communication Training in Simulated Situations: Emotions and Perceptions of Simulated Patients during Patient-Centered Conversations].

PubMed

Butollo, Maria Asisa; Holzinger, Anita; Wagner-Menghin, Michaela

2018-04-13

The use of simulated patients (SPs) for doctor-patient communication training has been established in medical curricula as an important didactic method. The study addresses the question, if patients' emotions and perceptions are represented adequately in patient-centered communication. 22 of 37 SPs of the Medical University of Vienna (12 women, 10 men) were asked openly about their feelings after having acted as an SP in a semi-structured interview, which employed the Critical Incident Technique. The interviews were recorded, transcribed, separated into situational analysis units und analyzed deductively; we used the evidence based qualities of patient-centered communication and the "Nationaler Kompetenzbasierter Lernzielkatalog Medizin" as a guideline. Out of 192 analysis units, 67 were evaluated as positive and 125 as negative. The SPs reported positive feelings, such as perceiving "stability and trust in relationships" (22%), perception of congruence (15%), acceptance (27%) and empathy (36%). As to negative feelings, SPs reported "perceiving instability" (18%), "incongruence" (11%), "lack of acceptance" (40%) and "lack of empathy" (30%). Additionally, 50% of SPs were positively affected when observing students' learning success. When SPs perceived patient-centered communication, they reported positive emotions. A lack of patient centeredness, on the contrary, provoked negative emotions. An empathic attitude, as well as a "lack of acceptance" with contrary effects had the strongest influence on the SPs' mental state. The reaction of SPs to patient centeredness is sufficiently authentic to reach learning objectives, however it is also affected by reactions of SPs to the learning success of students, which is irrelevant for the real-life doctor-patient interaction. SP reactions are affected by students' attitudes. Students should therefore be prepared well before interacting with SPs in a roleplay setting. While SPs' behavior is authentic in patient-centered communication in general, SPs should be trained to hide their positive emotions concerning students' learning success during roleplay. © Georg Thieme Verlag KG Stuttgart · New York.

Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack.

PubMed

Mullett-Hume, Elizabeth; Anshel, Daphne; Guevara, Vivianne; Cloitre, Marylene

2008-01-01

Two and one-half years after the September 11, 2001 World Trade Center attack, 204 middle school students in an immigrant community located near Ground Zero were assessed for posttraumatic stress disorder (PTSD) symptoms as influenced by "dose" of exposure to the attack and accumulated lifetime traumas. Ninety percent of students reported at least one traumatic event other than 9/11 (e.g., community violence) with an average of 4 lifetime events reported. An interaction was obtained such that the dose-response effect depended on presence of other traumas. Among students with the lowest number of additional traumas, the usual dose-response pattern of increasing PTSD symptoms with increasing 9/11 exposure was observed; among those with medium to high cumulative life trauma, PTSD symptoms were substantially higher and uniformly so regardless of 9/11 exposure dose. Results suggest that traumas that precede or follow mass violence often have as much as if not greater impact on long-term symptom severity than high-dose exposure to the event. Implications regarding the presence of continuing or previous trauma exposure for postdisaster and early intervention policies are discussed. (c) 2008 APA, all rights reserved

Measuring Progress in Conflict Environments (MPICE): A Metrics Framework

DTIC Science & Technology

2010-06-04

offered by at- tendees at several peer review workshops held at the LBJ School of Public Affairs at the University of texas, the Carr Center at Harvard...at the Carr Center, Katherine Go- rove at the Center for Law and Military Operations, and Karen Guttieri at the naval Postgraduate School for their...in violent crime. QD, EK – Incidence of attacks or intimidation or discrimination against ex-combatants. QD, CA – Level of participation in the

3-Methylcyclohex-2-en-1-one for area and individual tree protection against spruce beetle (Coleoptera: Curculionidae: Scolytinae) attack in the southern Rocky Mountains.

PubMed

Hansen, E Matthew; Munson, A Steven; Blackford, Darren C; Graves, Andrew D; Coleman, Tom W; Baggett, L Scott

2017-10-01

We tested 3-methylcyclohex-2-en-1-one (MCH) and an Acer kairomone blend (AKB) as repellent semiochemicals for area and single tree protection to prevent spruce beetle (Dendroctonus rufipennis Kirby) attacks at locations in Utah and New Mexico. In the area protection study, we compared host infestation rates of MCH applications at three densities (20, 40, and 80 g MCH ha-1) against a control treatment over 0.64 ha plots centered within ~1.25 ha treatment blocks. All treatments included two baited funnel traps within the plot to assure spruce beetle pressure. Following beetle attack, plots were surveyed for new spruce beetle attacks and to quantify stand characteristics. The probability of more severe spruce beetle attacks was significantly reduced, by ~50%, in each of the MCH area treatments compared with the control treatment but there was no significant treatment difference among the MCH deployment densities. For the single tree protection study, we compared attack rates of MCH, Acer kairomone blend (AKB), and MCH plus AKB on spruce beetle-baited trees against bait-only trees. Each treatment was applied over a range of host diameters to test for host size effects. Seventy-five percent of control trees were mass-attacked, about one-third of MCH- and AKB-alone spruce was mass-attacked, and no MCH plus AKB spruce were mass-attacked. These results suggest that MCH alone is a marginal area and single tree protectant against spruce beetle but that deployment with other repellents can significantly increase treatment efficacy. Published by Oxford University Press on behalf of Entomological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Newly proposed proton-abstraction roundabout with backside attack mechanism for the SN2 reaction at the nitrogen center in F- + NH2Cl.

PubMed

Li, Yongfang; Wang, Dunyou

2018-05-07

Recent studies have improved our understanding of the mechanism and dynamics of the bimolecular nucleophilic substitution (S N 2) reaction at the carbon center. Nonetheless, the S N 2 reaction at the nitrogen center has received scarce attention and is less understood. Herein, we propose a new reaction mechanism for the S N 2 reaction at the nitrogen center in the F - + NH 2 Cl reaction using ab initio molecular dynamics calculations. The newly proposed mechanism involves the rotation of NHCl with one proton of NH 2 Cl abstracted by the nucleophile, followed by the classical backside-attack process. The double-inversion mechanism revealed recently for the S N 2 reaction at the carbon center is also observed for the title reaction at the nitrogen center. In contrast to the F - + CH 3 Cl reaction with a proton abstraction-induced first inversion transition state, the F - + NH 2 Cl reaction is a hydrogen bond-induced inversion. This newly proposed reaction mechanism opens a reaction channel to avoid the proton abstraction mechanism at low collision energy. The double-inversion mechanism of the title reaction with a negative first-inversion transition relative to the energy of the reactants is expected to have larger contribution to the reaction rate than the F - + CH 3 Cl reaction with a positive first-inversion transition state.

Patients' poor communication with their doctors in the first visit of the gynecological endocrinology outpatient clinics.

PubMed

Li, Xiao-Hong; Han, Zi-Yan; She, Wen-Jing; Lei, Hai-Ke

2016-01-01

To investigate patients' communication with their gynecologists in the first visit of the gynecological endocrinology outpatient clinics. We developed a questionnaire to evaluate 379 women' expectations of their first visit, information-giving about illness, and understanding of the consultation they encountered from April to August 2010. Descriptive statistics and multiple linear regression analysis were used to analyze the data. Before the first visit, 55% (208/379) of participants hoped to get the doctors' special attention, and 60% (227/379) of patients expected a very satisfying consultation. During the consultation, only 34% (129/379) of patients provided their case history clearly according to physicians' inquiry, 21% (81/379) of patients understood the examination and 28% (105/379) of patients understood the therapeutic regime after doctors' explanation. Correlation analysis showed that sociodemographic characteristics such as young age (under 20 years old), low level of education (primary school or less), and lack of medical knowledge affected patients' information-giving about illness and understanding of their first visit (all ps < 0.05). Patients expected a patient-centered doctor-patient communication in gynecological endocrinology outpatient clinics. They could not communicate well with their doctors, which was affected by age, education, and medical background.

9/11 Event

NASA Image and Video Library

2015-09-11

Rick Anderson, fire chief at NASA's Kennedy Space Center, on podium, left, and Lt. James Dumont lead the dedication service for a memorial to the343 first responder victims of the Sept. 11, 2001, terror attacks at Kennedy's Fire Station 1 on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

9/11 Event

NASA Image and Video Library

2015-09-11

Rick Anderson, fire chief at NASA's Kennedy Space Center, on podium, left, and Lt. James Dumont lead the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Kennedy's Fire Station 1 on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

Aftermath of World Trade Center Attack

NASA Technical Reports Server (NTRS)

2002-01-01

This true-color image was taken by the Enhanced Thematic Mapper Plus (ETM+) aboard the Landsat 7 satellite on September 12, 2001, at roughly 11:30 a.m. Eastern Daylight Savings Time. Visit the NASA home page for photos from the space station and MODIS, and GlobalSecurity.org for images from other satellites. Image courtesy USGS Landsat 7 team, at the EROS Data Center.

The first 24 hours of the World Trade Center attacks of 2001--the Centers for Disease Control and Prevention emergency phase response.

PubMed

Cruz, Miguel A; Burger, Ronald; Keim, Mark

2007-01-01

On 11 September 2001, terrorists hijacked two passenger planes and crashed them into the two towers of the World Trade Center (WTC) in New York City. These synchronized attacks were the largest act of terrorism ever committed on US soil. The impacts, fires, and subsequent collapse of the towers killed and injured thousands of people. Within minutes after the first plane crashed into the WTC, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, initiated one of the largest public health responses in its history. Staff of the CDC provided technical assistance on several key public health issues. During the acute phase of the event, CDC personnel assisted with: (1) assessing hospital capacity; (2) establishing injury and disease surveillance activities; (3) deploying emergency coordinators/liaisons to facilitate inter-agency coordination with the affected jurisdictions; and (4) arranging rapid delivery of emergency medical supplies, therapeutics, and personal protective equipment. This incident highlighted the need for adequate planning for all potential hazards and the importance of interagency and interdepartmental coordination in preparing for and responding to public health emergencies.

NASA's SR-71B and F-18 HARV aircraft left Edwards Air Force Base, Calif., on March 24, 2003

NASA Image and Video Library

2003-03-24

Dryden Flight Research Center's SR-71B Blackbird aircraft, NASA tail number 831, is destined for the Kalamazoo Air Zoo museum in Kalamazoo, Mich., and the F-18 High Angle-of-Attack Research Vehicle (HARV) aircraft, NASA tail number 840, is going to the Virginia Air and Space Center in Hampton, Va. NASA's SR-71B was one of only two SR-71 trainer aircraft built, and served NASA in that role, as well as for some high-speed research, from 1991 to 1999. The F-18 HARV provided some of the most comprehensive data on the high-angle-of-attack flight regime, flying at angles of up to 70 degrees from the horizontal. The HARV flew 385 research flights at Dryden from 1987 through 1996.

Sore Throat? Know When To Call the Doctor

MedlinePlus

... this site from a secured browser on the server. Please enable scripts and reload this page. Physicians ... Media Center The DO JAOA AOA Health Watch Professional Development AOA Board Certification Continuing Medical Education Research ...

77 FR 6805 - Eligibility Criteria for the Centers of Excellence Program in Health Professions Education for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

...: allopathic and osteopathic medicine; pharmacy; dentistry; and behavioral or mental health. Individual schools... = 1.0 percent. ``Other'' COE graduation rate eligibility threshold = 14.1 percent. DENTISTRY (Doctors...

What Questions Should I Ask My Doctor?

MedlinePlus

... Trials Database Supporting Research Raising Awareness Our Blog Patient Education Pancreas News Basics of Pancreatic Cancer FAQs The ... Detection- Goggins Lab Sol Goldman Center Discussion Board Patient Education / Basics of Pancreatic Cancer Questions What questions should ...

Cosmonauts and astronauts during medical operations training

NASA Image and Video Library

1994-06-11

Mir 18 crewmember Gennadiy M. Strekalov, center, practicies an emergency medical procedure to maintain a patient airway during training at JSC. Looking on are Dave E. Ward (right), a JSC medical doctor, and an unidentified interpreter.

Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment

PubMed Central

Rao, Krishna D.; Ryan, Mandy; Shroff, Zubin; Vujicic, Marko; Ramani, Sudha; Berman, Peter

2013-01-01

The scarcity of rural doctors has undermined the ability of health systems in low and middle-income countries like India to provide quality services to rural populations. This study examines job preferences of doctors and nurses to inform what works in terms of rural recruitment strategies. Job acceptance of different strategies was compared to identify policy options for increasing the availability of clinical providers in rural areas. In 2010 a Discrete Choice Experiment was conducted in India. The study sample included final year medical and nursing students, and in-service doctors and nurses serving at Primary Health Centers. Eight job attributes were identified and a D-efficient fractional factorial design was used to construct pairs of job choices. Respondent acceptance of job choices was analyzed using multi-level logistic regression. Location mattered; jobs in areas offering urban amenities had a high likelihood of being accepted. Higher salary had small effect on doctor, but large effect on nurse, acceptance of rural jobs. At five times current salary levels, 13% (31%) of medical students (doctors) were willing to accept rural jobs. At half this level, 61% (52%) of nursing students (nurses) accepted a rural job. The strategy of reserving seats for specialist training in exchange for rural service had a large effect on job acceptance among doctors, nurses and nursing students. For doctors and nurses, properly staffed and equipped health facilities, and housing had small effects on job acceptance. Rural upbringing was not associated with rural job acceptance. Incentivizing doctors for rural service is expensive. A broader strategy of substantial salary increases with improved living, working environment, and education incentives is necessary. For both doctors and nurses, the usual strategies of moderate salary increases, good facility infrastructure, and housing will not be effective. Non-physician clinicians like nurse-practitioners offer an affordable alternative for delivering rural health care. PMID:24376621

Dynamic Stability Testing of the Genesis Sample Return Capsule

NASA Technical Reports Server (NTRS)

Cheatwood, F. McNeil; Winchenbach, Gerald L.; Hathaway, Wayne; Chapman, Gary

2000-01-01

This paper documents a series of free flight tests of a scale model of the Genesis Sample Return Capsule. These tests were conducted in the Aeroballistic Research Facility (ARF), located at Eglin AFB, FL, during April 1999 and were sponsored by NASA Langley Research Center. Because these blunt atmospheric entry shapes tend to experience small angle of attack dynamic instabilities (frequently leading to limit cycle motions), the primary purpose of the present tests was to determine the dynamic stability characteristics of the Genesis configuration. The tests were conducted over a Mach number range of 1.0 to 4.5. The results for this configuration indicate that the models were dynamically unstable at low angles of attack for all Mach numbers tested. At Mach numbers below 2.5, the models were also unstable at the higher angles of attack (above 15 deg), and motion amplitudes of up to 40 deg were experienced. Above Mach 2.5, the models were dynamically stable at the higher angles of attack.

Disability in Meniére's disease.

PubMed

Cohen, H; Ewell, L R; Jenkins, H A

1995-01-01

The purpose of this study was to determine the level of disability among patients with Menière's disease, information needed by clinicians when evaluating patients for coverage under the Americans With Disabilities Act. We hypothesized that the unpredictability of vertiginous episodes or "Menière's attacks" would be the most disabling problem, combined with the lack of a safe place to sit down during Menière's attacks. All patients seen in the otolaryngology faculty practice at Baylor College of Medicine, Houston, Tex, and diagnosed as having Menière's disease over a 3-year period were sent a self-administered questionnaire. This practice is located at a tertiary care center. One hundred forty-nine potential subjects constituted the pool, from which data from 50 subjects provided complete data sets. The data from 50 adults suggested that the most problematic symptom was vertigo, followed by hearing loss. The unpredictability of Meniere's attacks and the lack of a safe place to rest during attacks was a significant problem for few subjects.

High angle-of-attack aerodynamics of a strake-canard-wing V/STOL fighter configuration

NASA Technical Reports Server (NTRS)

Durston, D. A.; Schreiner, J. A.

1983-01-01

High angle-of-attack aerodynamic data are analyzed for a strake-canard-wing V/STOL fighter configuration. The configuration represents a twin-engine supersonic V/STOL fighter aircraft which uses four longitudinal thrust-augmenting ejectors to provide vertical lift. The data were obtained in tests of a 9.39 percent scale model of the configuration in the NASA Ames 12-Foot Pressure Wind Tunnel, at a Mach number of 0.2. Trimmed aerodynamic characteristics, longitudinal control power, longitudinal and lateral/directional stability, and effects of alternate strake and canard configurations are analyzed. The configuration could not be trimmed (power-off) above 12 deg angle of attack because of the limited pitch control power and the high degree of longitudinal instability (28 percent) at this Mach number. Aerodynamic center location was found to be controllable by varying strake size and canard location without significantly affecting lift and drag. These configuration variations had relatively little effect on the lateral/directional stability up to 10 deg angle of attack.

Breivik--the Norwegian terrorist case.

PubMed

Syse, Aslak

2014-01-01

On July 22, 2011, there were two murderous attacks in Norway. Both assaults - the bombing of governmental buildings in Oslo City center and the lethal shooting down of young members of the Labour Party on an island - were planned and accomplished by a lone perpetrator. These episodes give rise to several interesting questions. What happened really, and how could it happen? Was the perpetrator sane or insane? What was the ideological background for the attacks? It is unnecessary to discuss in any detail whether or not these acts should be categorized as terrorism. However, there is good reason to consider what these terror attacks imply for Norwegian society at large. What significance did the attacks have for Norwegian democracy, and did they have any impact on the 2013 parliamentary elections? What will be the future for the offender, both in the short term and in years to come? What will happen to the Norwegian insanity defense? These questions are addressed in this article. Copyright © 2014 John Wiley & Sons, Ltd.

Migraine headache is present in the aura phase

PubMed Central

Hansen, Jakob M.; Lipton, Richard B.; Dodick, David W.; Silberstein, Stephen D.; Saper, Joel R.; Aurora, Sheena K.; Goadsby, Peter J.

2012-01-01

ABSTRACT Objectives: Migraine aura is commonly considered to be a distinct phase of a migraine attack that precedes headache. The objective of the study was to examine a large number of prospectively recorded attacks of migraine with aura and determine the timing of headache and other migraine symptoms relative to aura. Methods: As part of a clinical trial we collected prospective data on the time course of headache and other symptoms relative to the aura. Patients (n = 267) were enrolled from 16 centers, and asked to keep a headache diary for 1 month (phase I). They were asked to record headache symptoms as soon as possible after aura began and always within 1 hour of aura onset. A total of 456 attacks were reported during phase I by 201 patients. These patients were then randomized and included in phase II, during which a total of 405 attacks were reported in 164 patients. In total, we present data from 861 attacks of migraine with aura from 201 patients. Results: During the aura phase, the majority of attacks (73%) were associated with headache. Other migraine symptoms were also frequently reported during the aura: nausea (51%), photophobia (88%), and photophobia (73%). During the first 15 minutes within the onset of aura, 54% of patients reported headache fulfilling the criteria for migraine. Conclusion: Our results indicate that headaches as well as associated migraine symptoms are present early, during the aura phase of the migraine attack in the majority of patients. PMID:23115208

Aerodynamic characteristics of a hypersonic research airplane concept having a 70 degree swept double delta wing at Mach numbers from 1.50 to 2.86

NASA Technical Reports Server (NTRS)

Penland, J. A.; Fournier, R. H.; Marcum, D. C., Jr.

1975-01-01

An experimental investigation of the static longitudinal, lateral, and directional stability characteristics of a hypersonic research airplane concept having a 70 deg swept double-delta wing was conducted in the Langley unitary plan wind tunnel. The configuration variables included wing planform, tip fins, center fin, and scramjet engine modules. The investigation was conducted at Mach numbers from 1.50 to 2.86 and at a constant Reynolds number, based on fuselage length, of 3,330,000. Tests were conducted through an angle-of-attack range from about -4 deg to 24 deg with angles of sideslip of 0 deg and 3 deg and at elevon deflections of 0, -10, and -20 deg. The complete configuration was trimmable up to angles of attack of about 22 deg with the exception of regions at low angles of attack where positive elevon deflections should provide trim capability. The angle-of-attack range for which static longitudinal stability also exists was reduced at the higher Mach numbers due to the tendency of the complete configuration to pitch up at the higher angles of attack. The complete configuration was statically stable directionally up to trimmed angles of attack of at least 20 deg for all Mach numbers M with the exception of a region near 4 deg at M = 2.86 and exhibited positive effective dihedral at all positive trimmed angles of attack.

Effects of exposure to rocket attacks on adolescent distress and violence: a 4-year longitudinal study.

PubMed

Henrich, Christopher C; Shahar, Golan

2013-06-01

The effects of Israeli adolescents' exposure to rocket attacks over time were examined, focusing on anxiety, depression, aggression, and violence commission. A sample of 362 adolescents from southern Israel was followed from 2008 through 2011 with four annual assessments. Measures included exposure to rocket attacks (gauging whether children were affected by rocket attacks, both directly and indirectly, through friends and family), anxiety (items from the State Anxiety Inventory), depression (the Center for Epidemiological Studies Child Depression Scale), aggression (the Orpinas Aggression Scale), and violence commission (from the Social and Health Assessment). Concurrent and longitudinal findings differed. Wave 1 exposure to rockets attacks was associated with Wave 1 anxiety, depression, and aggression. Longitudinal results evinced only modest effects of exposure on anxiety and depression, no effects on aggression, but robust effects on violence commission. Exposure to terror attacks before the study predicted increased odds of violence commission at the fourth and final wave, controlling for violence commission at the first, second, and third wave. Exposure to rocket attacks in the second wave predicted increased odds of violence commission at the third wave. This is the first longitudinal study attesting to the prospective longitudinal effect of exposure to terrorism on adolescent violence. Findings should serve as a red flag for health care practitioners working in civil areas afflicted by terrorism and political violence. Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

AFRPL Graphite Performance Prediction Program. Improved Capability for the Design and Ablation Performance Prediction of Advanced Air Force Solid Propellant Rocket Nozzles

DTIC Science & Technology

1976-12-01

corrosive attack by both acids and alkali and, in addition, is provided with a special Dynel veil for protection against fluoride attack. 3.1.4...throat region, namely , the entrance, center, and exit. In addition, at each station, the diameters were determined at two angular positions 90° apart. The...characterization test matrix. 3.2.1.1 Rocket Motor Environments Rocket motor environments were based on three advanced MX propellants, namely , * XLDB * HTPB * PEG

Medication and Driving-Appropriate Interventions.

PubMed

Hitosugi, Masahito

2017-01-01

Sudden illness while driving has been identified as a major cause of vehicle collisions, accounting for approximately 1 in 10 collisions. Because most drivers who experience sudden illnesses while driving do not perform avoidance maneuvers, the improvement of drivers' health is being promoted as a traffic safety strategy. Although stroke, heart disease, and epilepsy are common causes of sudden illness, common symptoms, such as abdominal cramps, vertigo, and syncope can also cause problems during driving. We found that regular referral to physicians was significantly less common among drivers who experienced health-related vehicle collisions or incidents. Inadequate control of chronic disease might lead to unusual symptoms and the onset of major attacks. Medications are prescribed to patients to relieve their symptoms and/or bring their diseases under control. However, pharmacists and doctors should ensure that patients are treated with appropriate medications to avoid drivers being distracted due to adverse reactions to medications. The author suggests that it is important to keep drivers in good health and administer appropriate medications if necessary. Both pharmacists and doctors should warn drivers that sudden illness or medication-associated distractions can cause vehicle collisions. Such interventions might contribute to reducing the frequency of sudden illness-related vehicle collisions.

A novel fuzzy logic-based image steganography method to ensure medical data security.

PubMed

Karakış, R; Güler, I; Çapraz, I; Bilir, E

2015-12-01

This study aims to secure medical data by combining them into one file format using steganographic methods. The electroencephalogram (EEG) is selected as hidden data, and magnetic resonance (MR) images are also used as the cover image. In addition to the EEG, the message is composed of the doctor׳s comments and patient information in the file header of images. Two new image steganography methods that are based on fuzzy-logic and similarity are proposed to select the non-sequential least significant bits (LSB) of image pixels. The similarity values of the gray levels in the pixels are used to hide the message. The message is secured to prevent attacks by using lossless compression and symmetric encryption algorithms. The performance of stego image quality is measured by mean square of error (MSE), peak signal-to-noise ratio (PSNR), structural similarity measure (SSIM), universal quality index (UQI), and correlation coefficient (R). According to the obtained result, the proposed method ensures the confidentiality of the patient information, and increases data repository and transmission capacity of both MR images and EEG signals. Copyright © 2015 Elsevier Ltd. All rights reserved.

Risk assessment and prioritization

DOT National Transportation Integrated Search

2003-01-01

The first step to take in order to prevent and minimize the dangers of disasters or attacks, is risk assessment, followed closely by prioritization. This article discusses key vulnerability and risk assessment that Volpe Center has conducted in suppo...

Semiannual Report: Apr 1, 2003 - Sept 30, 2003

EPA Pesticide Factsheets

Semiannual Report #EPA-350-K-03-002, Nov, 2003. We recently issued a major report examining how EPA responded to the crisis at the World Trade Center following the terrorist attacks on September 11, 2001.

Biomechanical Analysis of Defensive Cutting Actions During Game Situations: Six Cases in Collegiate Soccer Competitions

PubMed Central

Sasaki, Shogo; Koga, Hideyuki; Krosshaug, Tron; Kaneko, Satoshi; Fukubayashi, Toru

2015-01-01

The strengths of interpersonal dyads formed by the attacker and defender in one-on-one situations are crucial for performance in team ball sports such as soccer. The purpose of this study was to analyze the kinematics of one-on-one defensive movements in soccer competitions, and determine the relationships between lower limb kinematics and the center of mass translation during cutting actions. Six defensive scenes in which a player was responding to an offender’s dribble attack were selected for analysis. To reconstruct the three-dimensional kinematics of the players, we used a photogrammetric model-based image-matching technique. The hip and knee kinematics were calculated from the matched skeleton model. In addition, the center of mass height was expressed as a ratio of each participant’s body height. The relationships between the center of mass height and the kinematics were determined by the Pearson’s product-moment correlation coefficient. The normalized center of mass height at initial contact was correlated with the vertical center of mass displacement (r = 0.832, p = 0.040) and hip flexion angle at initial contact (r = −0.823, p = 0.044). This suggests that the lower center of mass at initial contact is an important factor to reduce the downwards vertical center of mass translation during defensive cutting actions, and that this is executed primarily through hip flexion. It is therefore recommended that players land with an adequately flexed hip at initial contact during one-on-one cutting actions to minimize the vertical center of mass excursion. PMID:26240644

Epidemiological findings of major chemical attacks in the Syrian war are consistent with civilian targeting: a short report.

PubMed

Rodriguez-Llanes, Jose M; Guha-Sapir, Debarati; Schlüter, Benjamin-Samuel; Hicks, Madelyn Hsiao-Rei

2018-01-01

Evidence of use of toxic gas chemical weapons in the Syrian war has been reported by governmental and non-governmental international organizations since the war started in March 2011. To date, the profiles of victims of the largest chemical attacks in Syria remain unknown. In this study, we used descriptive epidemiological analysis to describe demographic characteristics of victims of the largest chemical weapons attacks in the Syrian war. We analysed conflict-related, direct deaths from chemical weapons recorded in non-government-controlled areas by the Violation Documentation Center, occurring from March 18, 2011 to April 10, 2017, with complete information on the victim's date and place of death, cause and demographic group. 'Major' chemical weapons events were defined as events causing ten or more direct deaths. As of April 10, 2017, a total of 1206 direct deaths meeting inclusion criteria were recorded in the dataset from all chemical weapons attacks regardless of size. Five major chemical weapons attacks caused 1084 of these documented deaths. Civilians comprised the majority ( n  = 1058, 97.6%) of direct deaths from major chemical weapons attacks in Syria and combatants comprised a minority of 2.4% ( n  = 26). In the first three major chemical weapons attacks, which occurred in 2013, children comprised 13%-14% of direct deaths, ranging in numbers from 2 deaths among 14 to 117 deaths among 923. Children comprised higher proportions of direct deaths in later major chemical weapons attacks, forming 21% ( n  = 7) of 33 deaths in the 2016 major attack and 34.8% ( n  = 32) of 92 deaths in the 2017 major attack. Our finding of an extreme disparity in direct deaths from major chemical weapons attacks in Syria, with 97.6% of victims being civilians and only 2.4% being combatants provides evidence that major chemical weapons attacks were indiscriminate or targeted civilians directly; both violations of International Humanitarian Law (IHL). Identifying and quantifying chemical weapons violations requires inter-disciplinary collaboration to inform international policy, humanitarian intervention and legal action.

[Risk factors in cerebrovascular disease. Do transient ischemic attacks lead to changes in lifestyle?].

PubMed

Sánchez, F; Aguilar, M; Porta, R; Urbano, F; Martínez, I; Bonaventura, I; Ribó, J M

1994-01-01

A minor stroke does not cause sufficient alarm in patients to change their lifestyles. 46 patients who suffered strokes in the previous 2 years were contacted by telephone, recording rehabilitation programs, medical therapy and modification of dietary habits. It was discovered that only 50% of those requiring motor rehabilitation actually received such treatment; and only one of twenty carried on speech exercises. Subsequent ischemic events were reported by 22 patients: 12 of whom had strokes, 8 ischemic myocardial attacks and two patients suffered both conditions. The majority of patients followed the prescribed medical treatment and advice badly. Of the 46 patients reviewed, 31 were hypertensive and only 16 follow recommended diets. Out of 15 smokers only, 6 gave up, and from 21 with dislypemia only 10 modified their diets. Of all patients only the most severely affected complied satisfactorily to medical treatments; a possible explanation for this would be that the contact between patients and physician (neurologist and family doctors) was discontinued immediately after the patients discharge from hospital. It is recommended therefore that steps be taken to insure better communication between neurologist, general practitioner and patient; thereby improving prognosis.

Should Helicopters Transport Patients Who Become Sick After a Chemical, Biological, Radiological, Nuclear, and Explosive Attack?

PubMed

Yanagawa, Youichi; Ishikawa, Kouhei; Takeuchi, Ikuto; Nagasawa, Hiroki; Jitsuiki, Kei; Ohsaka, Hiromichi; Omori, Kazuhiko

The local fire department executed a training simulation for chemical and explosive incidents at a large sports facility. In this training simulation, a physician-staffed helicopter arrived at the request of the fire department and landed just outside the cold zone in the parking area. The doctor and nurse of the helicopter were escorted to a red area in the cold zone, which was selected based on the results of postdecontamination triage. After the patients had been treated, they were air medically evacuated to the base hospital. In the Tokyo subway sarin attack in 1995, St Luke's International Hospital admitted over 600 victims. During this incident, 23.2% of medical staff suffered secondary injury from sarin exposure. If air medial crews respond with subsequent postexposure effects during flight, an affected pilot could lose control of the helicopter, resulting in a fatal crash. Based on potential safety concerns for air medical and ground personnel, our recommendation would be that air medical helicopters not be dispatched to sites of chemical, biological, radiological, nuclear, and explosive incidents. Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Wind-tunnel Tests of a Model of a Wingless Fin-controlled Missile to Obtain Static Stability and Control Characteristics Through a Range of Mach Numbers from 0.5 to 0.88

NASA Technical Reports Server (NTRS)

Burrows, Dale L; Newman, Ernest E

1954-01-01

An investigation at medium to high subsonic speeds has been conducted in the Langley low-turbulence pressure tunnel to determine the static stability and control characteristics and to measure the fin normal forces and moments for a model of a wingless fin-controlled missile. The data were obtained at Reynolds number of 2.1 x 10(6) based on the missile maximum diameter or 17.7 x 10(6) based on missile length; this Reynolds number was found to be large enough to avoid any large scale effects between the test and the expected flight Reynolds number. With the horizontal-fin deflection limited to a maximum of 6 degrees, longitudinally stable and trimmed flight could not be maintained beyond an angle of attack of 17 degrees for a Mach number of 0.88 and beyond 20 degrees for a Mach number of 0.50 for any center-of-gravity location without the use of some auxiliary stability or control device such as jet vanes. Mach number had no appreciable effect on the center-of-pressure positions and only a slight effect on neutral-point position. There was a shift in neutral-point position of about 1 caliber as the angle of attack was varied through the range for which the neutral point could be determined. Yawing the model to angles of sideslip up to 7 degrees had little effect on the longitudinal stability at angles of attack up to 15 degrees; however, above 15 degrees, the effect of sideslip was destabilizing. With the vertical fins at a plus-or-minus 6 degree roll deflection, the rolling moment caused by yawing the model at high angles of attack could be trimmed out up to angles of sideslip of 6.5 degrees and an angle of attack of 26 degrees for a Mach number of 0.50; this range of sideslip angles was reduced to 3 degrees at a Mach number of 0.88. The data indicated that, at lower angles of attack, the trim range extended to higher angles of sideslip. The total normal-force and hinge-moment coefficients for both horizontal fins were slightly nonlinear with both angle-of-attack and fin deflection. The effect of Mach number was to reduce the slopes of the hinge-moment coefficient with angle of attack and deflection angle. In general, the effort of increasing the sideslip angle was to reduce the values of the fin normal-force and hinge-moment coefficients.

History of Neurosurgery in Malaysia.

PubMed

Raffiq, Azman; Abdullah, Jafri Malin; Haspani, Saffari; Adnan, Johari Siregar

2015-12-01

The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.

History of Neurosurgery in Malaysia

PubMed Central

RAFFIQ, Azman; ABDULLAH, Jafri Malin; HASPANI, Saffari; ADNAN, Johari Siregar

2015-01-01

The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences. PMID:27006632

Assessing Uncertainties in Boundary Layer Transition Predictions for HIFiRE-1 at Non-zero Angles of Attack

NASA Technical Reports Server (NTRS)

Marek, Lindsay C.

2011-01-01

Boundary layer stability was analyzed for the HIFiRE-1 flight vehicle geometry for ground tests conducted at the CUBRC LENS I hypersonic shock test facility and the Langley Research Center (LaRC) 20- inch Mach 6 Tunnel. Boundary layer stability results were compared to transition onset location obtained from discrete heat transfer measurements from thin film gauges during the CUBRC test and spatially continuous heat transfer measurements from thermal phosphor paint data during the LaRC test. The focus of this analysis was on conditions at non-zero angles of attack as stability analysis has already been performed at zero degrees angle of attack. Also, the transition onset data obtained during flight testing was at nonzero angles of attack, so this analysis could be expanded in the future to include the results of the flight test data. Stability analysis was performed using the 2D parabolized stability software suite STABL (Stability and Transition Analysis for Hypersonic Boundary Layers) developed at the University of Minnesota and the mean flow solutions were computed using the DPLR finite volume Navier-Stokes computational fluid dynamics (CFD) solver. A center line slice of the 3D mean flow solution was used for the stability analysis to incorporate the angle of attack effects while still taking advantage of the 2D STABL software suite. The N-factors at transition onset and the value of Re(sub theta)/M(sub e), commonly used to predict boundary layer transition onset, were compared for all conditions analyzed. Ground test data was analyzed at Mach 7.2 and Mach 6.0 and angles of attack of 1deg, 3deg and 5deg. At these conditions, the flow was found to be second mode dominant for the HIFiRE-1 slender cone geometry. On the leeward side of the vehicle, a strong trend of transition onset location with angle of attack was observed as the boundary layer on the leeward side of the vehicle developed inflection points at streamwise positions on the vehicle that correlated to angle of attack. Inflection points are a strong instability mechanism that lead to rapid breakdown and transition to turbulence. The transition onset location on the windward side of the vehicle displayed no trend with angle of attack or freestream Reynolds number and transition was observed farther down the vehicle than observed on the leeward side of the vehicle. In analysis of both windward and leeward sides of the vehicle, use of the N factor methodology to develop trends to predict boundary layer transition onset showed improvements over the Re(sub theta)/M(sub e) empirical correlation methodology. Stronger correlations and less scatter in the data were observed when using the N factor method for these cases.

9/11 Event

NASA Image and Video Library

2015-09-11

Rick Anderson, fire chief at NASA's Kennedy Space Center, on podium, left, and Brevard County Sheriff Wayne Ivey take part in the dedication service for a memorial to the 343 first responder victims of the Sept. 11, 2001, terror attacks at Kennedy's Fire Station 1 on Sept. 11, 2015. The ceremony dedicated a monument that includes a section of steel I-beam from the World Trade Center in New York.

Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey.

PubMed

Wang, Jia-Na; Sun, Wei; Chi, Tie-Shuang; Wu, Hui; Wang, Lie

2010-12-01

Doctors, the major workforce in hospitals, are doing heavy emotional and physical work which may lead to depressive symptoms. However, in China, few studies are available pertaining to the prevalence and associated factors of depressive symptoms among doctors. The aim of this study was to evaluate the prevalence of depressive symptoms and to explore its associated factors among Chinese doctors in public hospitals. This cross-sectional study was performed during the period of September/October 2008. The study population comprised of 1,890 doctors registered and working in the 20 national hospitals in Liaoning province, northeast of China. A questionnaire that comprised depressive symptoms assessed by the Chinese Version of the Center for Epidemiologic Studies Depression Scale (CES-D), demographic factors, work conditions, occupational stress, and coping strategies was distributed to these doctors. A total of 1,488 effective respondents became our subjects (effective response rate 78.7%). Multivariate logistic regression was used to explore the factors related to depressive symptoms. The prevalence of depressive symptoms among doctors was 65.3%. Multivariate logistic analyses showed that high role insufficiency (OR 2.15, 95% CI 1.66-2.78), worse doctor-patient relationship (OR 2.07, 95% CI 1.62-2.64), having a chronic disease (OR 1.73, 95% CI 1.31-2.27), serious role boundary (OR 1.54, 95% CI 1.21-2.00), and role overload (OR 1.42, 95% CI 1.11-1.81) were positively associated with depressive symptoms; whereas adequate rational coping (OR 0.58, 95% CI 0.45-0.76) and social support (OR 0.75, 95% CI 0.57-0.98) were negatively associated with depressive symptoms. Most Chinese doctors probably have depressive symptoms. Role insufficiency, doctor-patient relationship, and rational coping seemed to be crucial in relation to depressive symptoms. Efficient interventions such as taking further education course, improving communications with patients, and improving the ability of rational coping should be considered by health administrators aiming at improving the quality of Chinese doctors' mental health from the view point of depressive symptoms.

Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore.

PubMed

Yek, J L J; Lee, A K Y; Tan, J A D; Lin, G Y; Thamotharampillai, T; Abdullah, H R

2017-02-02

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education (p < 0.007), being employed (p < 0.046) and younger age group (p < 0.003) are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea (64.8%), Drowsiness (62.4%) and Surgical Wound Pain (58.8%). Patients ranked Heart Attack (59.3%), Death (53.8%) and Stroke (52.7%) as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist (52.2%), instead of letting the doctor decide (37.1%) or deciding for themselves (10.7%). Discussion with the anaesthetist (61.3%) is the preferred medium of communication compared to reading a pamphlet (23.4%) or watching a video (15.4%). Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.

Human resource staffing and service functions of community health services organizations in China.

PubMed

Yang, Jun; Guo, Aimin; Wang, Yadong; Zhao, Yali; Yang, Xinhua; Li, Hang; Duckitt, Roger; Liang, Wannian

2008-01-01

We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future. A study questionnaire was completed by 712 CHS organizations distributed in 52 cities and districts in all areas of China using a multilevel stratified randomized sampling method. Data were collected on the backgrounds, human resources, and service functions of CHS organizations. We found that 68.2% of doctors and 86.5% of nurses employed in CHS centers have low-level medical training. The doctor-nurse ratio in CHS centers is 1.2 to 1 and in CHS stations is 1.3 to 1. More than 50% of CHS organizations have developed on-the-job training programs, causing cost trends for staff training to increase. Although the delivery of basic clinical services and public health services is steadily increasing, 58.6% of stations are open less than 12 hours per day. Health records are established in a high proportion of CHS organizations. Two kinds of health education--general public health education, and personal education for specific problems--have been adopted by more than 92% of CHS centers and 90% of CHS stations. Desired functions for CHS organizations have been partially achieved. Training for doctors and nurses engaged in CHS should be promoted and improved as quickly as possible. Training in basic clinical services and management of noncommunicable chronic diseases should be strongly promoted. Changes in government policies should be pursued to promote effective support for the development of CHS.

Primary Care Doctors’ Assessment of and Preferences on Their Remuneration

PubMed Central

Karakolias, Stefanos; Kastanioti, Catherine; Theodorou, Mamas; Polyzos, Nikolaos

2017-01-01

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards. PMID:28240040

General population and medical student perceptions of good and bad doctors in Mozambique.

PubMed

Pfeiffer, Annett; Noden, Bruce H; Walker, Zoë A; Aarts, Rembrant; Ferro, Josefo

2011-04-01

A key element of the doctor-patient relationship is to understand the patient's and doctor's perceptions of quality care. To assess the perceptions of good and bad doctors among first-year medical students and local community members in a semi-urban, African settings. Using open-ended and closed dichotomous questions, 115 first-year medical students in Beira, Mozambique were surveyed regarding their perceptions of a 'good' and 'bad' doctor. Students then surveyed 611 community members in a predominately poor, semi-urban neighbourhood. Answers to open-ended questions provided by both groups produced the same four most important positive characteristics, with good diagnostic and therapeutic skills and dedication ranked highest. Closed-ended questions revealed that local community members felt that being concerned/considerate and diagnosing well were equally important (19.5% and 17.5%, respectively) compared to students (17.5% and 41.2%, respectively). The most important negative characteristics to the open-ended question for both groups were discrimination and contemptuous behaviour: 29.3% for community members and 27.4% for medical students. The biggest difference between groups was poor attending skills: 17.3% by community members and 3.9% by medical students. This study highlights differences and similarities between the perceptions of medical students and community members concerning a 'good' and a 'bad' doctor. Our data suggest that perceptions are guided by the experiences and values of those interviewed. Results indicate that medical education in developing countries should focus on patient-centered care, including communication skills and attitudes, besides training knowledgeable doctors.

The Doctoral Degree in Dental Hygiene: Creating New Oral Healthcare Paradigms.

PubMed

Gurenlian, JoAnn R; Rogo, Ellen J; Spolarich, Ann Eshenaur

2016-06-01

Doctoral dental hygiene education would prepare scholars and leaders to improve population health through changes in oral health policy and delivery. Discussions about doctoral education in dental hygiene have centered on the need to create a cadre of dental hygiene researchers and scholars who will expand the body of knowledge for the profession. It has been proposed that scholars are needed to lead the development of theory and disseminate knowledge unique to the discipline of dental hygiene. Transformation to doctoral education is not a new trend as many other health care disciplines have already implemented curricular models, establishing the doctoral degree for entry level into practice. The Institute of Medicine has called for the exploration of new models for care delivery. Dental hygienists need to be prepared with leadership skills enabling them to participate and lead interprofessional teams and develop policies designed to improve the delivery of oral health care services to enhance population health. Current educational models do not adequately prepare dental hygienists to serve in this capacity. The purpose of this article is to present 2 models of doctoral education for dental hygiene that will illustrate how dental hygienists can be better prepared as scholars and leaders for the profession. These proposed models of doctoral education in dental hygiene present a paradigm shift in dental hygiene education. As with other disciplines that have evolved, both academically and professionally, dental hygiene will be positioned to achieve the hallmark of professional status with this terminal degree. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between stress at work and primary headache among nursing staff in Taiwan.

PubMed

Lin, Kao-Chang; Huang, Chin-Chang; Wu, Chiou-Chuen

2007-04-01

Stress, one of the most commonly identified triggers for primary headache in the workplace, usually leads to inefficient work during attacks. Stress-related primary headaches in the nursing staff of hospitals have received little attention. To realize the association between stress and headache, and the means of coping with this kind of headache. A cross-sectional, hospital-based study using a semi-structured questionnaire was administered to 900 nursing staffers in a tertiary medical center in southern Taiwan. Thirty-two items, including basic information, headache- and stress-related questions, work satisfaction, and coping strategies were measured. Headache sufferers with either migraine or episodic tension headache (attacks <15 days per month) based on International Headache Society (IHS) criteria were enrolled for analysis. The Student's t-test, one-way analysis of variance (ANOVA), and chi-square test were used for statistical analysis. Three hundred eighty-six out of 779 responders (49.6%) had experienced primary headaches in the previous year, and 374 (48.1%) had had episodic-type headaches (<15 days/month). A careful neurological interview of the latter group revealed that 222 (28.5%) had migraine, 104 (13.4%) had tension headache, 37 (4.8%) had mixed migraine and tension headache, and 11 (1.4%) had other causes of headache. There were no demographic differences between the sufferers and nonsufferers, although a statistically significant difference was noted in self-reported sources of stress (individual P values ranged from .021 to < .001). Headache sufferers had more stress at work than non-headache sufferers (P < .001). The youngest and least experienced of the nursing staff, the unmarried, and those with a lower level of education had a higher level of stress. The methods used to deal with headaches were sleep, taking medicine, taking a rest, visiting the doctor, and seeking psychological help. Nurses commonly used acetaminophen (panadol--500 mg) to relieve their pain. These results indicate that stress at work is associated with primary headaches among nursing staff, and that nurses rarely seek help in the beginning. Therefore, nursing staff education aimed at ameliorating the stress and coping with the headaches, thus allowing the nurses to provide better patient care, may be warranted.

Aeroheating (pressure) characteristics on a 0.10-scale version of the vehicle 3 space shuttle configuration (26-OTS) in the Langley Research Center 4-foot wind tunnel (IH4)

NASA Technical Reports Server (NTRS)

Kingsland, R. B.

1976-01-01

Results of wind tunnel tests, conducted at the Langley Research Center Unitary Plan Wind Tunnel, are presented. The model tested was an 0.010-scale version of the Vehicle 3 Space Shuttle Configuration. Pressure measurements were made on the launch configuration, Orbiter alone, external tank alone, and solid rocket booster alone, to provide heat transfer pressure data. The tests were conducted for a Mach number range from 2.36 to 4.6 and Reynolds number range from 1.2 to 5 million per foot. The model was tested at angles of attack from -10 to 20 deg for a sideslip angle range from -5 to +5 deg, and at sideslip angles from -5 to 48 deg for 0 deg angle of attack. Tabulated data are given and photographs of the test configuration are shown.

Study of optical techniques for the Ames unitary wind tunnels. Part 3: Angle of attack

NASA Technical Reports Server (NTRS)

Lee, George

1992-01-01

A review of optical sensors that are capable of accurate angle of attack measurements in wind tunnels was conducted. These include sensors being used or being developed at NASA Ames and Langley Research Centers, Boeing Airplane Company, McDonald Aircraft Company, Arnold Engineering Development Center, National Aerospace Laboratory of the Netherlands, National Research Council of Canada, and the Royal Aircraft Establishment of England. Some commercial sensors that may be applicable to accurate angle measurements were also reviewed. It was found that the optical sensor systems were based on interferometers, polarized light detector, linear or area photodiode cameras, position sensing photodetectors, and laser scanners. Several of the optical sensors can meet the requirements of the Ames Unitary Plan Wind Tunnel. Two of these, the Boeing interferometer and the Complere lateral effect photodiode sensors are being developed for the Ames Unitary Plan Wind Tunnel.

Description of a landing site indicator (LASI) for light aircraft operation

NASA Technical Reports Server (NTRS)

Fuller, H. V.; Outlaw, B. K. E.

1976-01-01

An experimental cockpit mounted head-up type display system was developed and evaluated by LaRC pilots during the landing phase of light aircraft operations. The Landing Site Indicator (LASI) system display consists of angle of attack, angle of sideslip, and indicated airspeed images superimposed on the pilot's view through the windshield. The information is made visible to the pilot by means of a partially reflective viewing screen which is suspended directly in frot of the pilot's eyes. Synchro transmitters are operated by vanes, located at the left wing tip, which sense angle of attack and sideslip angle. Information is presented near the center of the display in the form of a moving index on a fixed grid. The airspeed is sensed by a pitot-static pressure transducer and is presented in numerical form at the top center of the display.

Was there unmet mental health need after the September 11, 2001 terrorist attacks?

PubMed

Stuber, Jennifer; Galea, Sandro; Boscarino, Joseph A; Schlesinger, Mark

2006-03-01

This study examined the use of professionals for mental health problems among New York City residents who were directly affected by the September 11, 2001 terrorist attacks on the World Trade Center (WTC) or had a probable diagnosis of post-traumatic stress disorder (PTSD) or depression in its aftermath. Correlates of help seeking from professionals for mental health problems after the attacks and barriers to care were also assessed. Data were from a random digit dial telephone survey of 2,752 adults representative of the Greater New York Metropolitan area conducted 6 months after the September 11 terrorist attacks. Fifteen percent of those directly affected and 36% of those with probable PTSD or depression sought help from a professional for a mental health problem after the attacks. There was little new utilization of professionals for mental health problems after the attacks among persons who were not already receiving care prior to September 11. Barriers that prevented people from seeking help for mental health problems 6 months after the September 11 attacks included traditional barriers to care (e.g., cost) and barriers that are unique to the post-disaster context (e.g., the belief that others need the services more than oneself). This study suggests that there was potential unmet mental health need in New York City 6 months after the September 11 attacks on the WTC, but these findings should be tempered by research showing an apparent decrease in population-rates of PTSD. In the aftermath of a disaster, interventions should target persons with mental health needs who were not previously seeking help from a professional for a mental health problem.

Hemodialysis

MedlinePlus

... center, hemodialysis is usually done 3 times per week for about 4 hours at a time. People who choose to do ... at home may do dialysis treatment more frequently, 4-7 times per week for shorter hours each time. Your doctor will give you a ...

Free-Flight Investigation of the Static and Dynamic Longitudinal Stability Characteristics of 1/3.7-Scale Rocket-Powered Models of the Bell MX-776A

NASA Technical Reports Server (NTRS)

Michal, David H.

1950-01-01

An investigation of the static and dynamic longitudinal stability characteristics of 1/3.7 scale rocket-powered model of the Bell MX-776A has been made for a Mach number range from 0.8 to 1.6. Two models were tested with all control surfaces at 0 degree deflection and centers of gravity located 1/4 and 1/2 body diameters, respectively, ahead of the equivalent design location. Both models were stable about the trim conditions but did not trim at 0 degree angle of attack because of slight constructional asymmetries. The results indicated that the variation of lift and pitching moment was not linear with angle of attack. Both lift-curve slope and pitching-moment-curve slope were of the smallest magnitude near 0 degree angle of attack. In general, an increase in angle of attack was accompanied by a rearward movement of the aerodynamic center as the rear wing moved out of the downwash from the forward surfaces. This characteristic was more pronounced in the transonic region. The dynamic stability in the form of total damping factor varied with normal-force coefficient but was greatest for both models at a Mach number of approximately 1.25. The damping factor was greater at the lower trim normal-force coefficients except at a Mach number of 1.0. At that speed the damping factor was of about the same magnitude for both models. The drag coefficient increased with trim normal-force coefficient and was largest in the transonic region.

(Congressional Interest) Institute for Science, Space and Security (ISSS)

DTIC Science & Technology

2012-03-19

Studies program between UCCS and University of Zagreb , Croatia (City of Zagreb funding). Conducted three days of meetings with City/University of Zagreb ...security and assist the University of Zagreb in establishing a regional (Eastern Europe) Center of Excellence in Homeland Security. In the long-term...UCCS will assist the University of Zagreb in maturing the Center of Excellence and designing, developing and delivering masters and doctoral degrees

(Congressional Interest) Network Information and Space Security Center

DTIC Science & Technology

2011-09-30

Zagreb , Croatia (City of Zagreb funding). Conducted three days of meetings with City/University of Zagreb , Croatia officials to structure terms for a...partnership with UCCS. In the short-term, UCCS will develop and deliver several courses in homeland security and assist the University of Zagreb in... Zagreb in maturing the Center of Excellence and designing, developing and delivering masters and doctoral degrees in homeland security. Hosted a group of

Radiological and Nuclear Detection Material Science: Novel Rare-Earth Semiconductors for Solid-State Neutron Detectors and Thin High-k Dielectrics

DTIC Science & Technology

2017-11-01

Department of Physics and Astronomy , University of Nebraska Now post-doctoral associate, Department of Physics, University of California - Riverside...9320 Peter A. Dowben, Charles Bessey Professor of Physics, Nebraska Center for Materials and Nanoscience, Department of Physics and Astronomy ...pdowben@unl.edu Kirill D. Belashchenko, Associate Professor, Nebraska Center for Materials and Nanoscience, Department of Physics and Astronomy

Evaluation of Aerodynamic Drag and Torque for External Tanks in Low Earth Orbit

PubMed Central

Stone, William C.; Witzgall, Christoph

2006-01-01

A numerical procedure is described in which the aerodynamic drag and torque in low Earth orbit are calculated for a prototype Space Shuttle external tank and its components, the “LO2” and “LH2” tanks, carrying liquid oxygen and hydrogen, respectively, for any given angle of attack. Calculations assume the hypersonic limit of free molecular flow theory. Each shell of revolution is assumed to be described by a series of parametric equations for their respective contours. It is discretized into circular cross sections perpendicular to the axis of revolution, which yield a series of ellipses when projected according to the given angle of attack. The drag profile, that is, the projection of the entire shell is approximated by the convex envelope of those ellipses. The area of the drag profile, that is, the drag area, and its center of area moment, that is, the drag center, are then calculated and permit determination of the drag vector and the eccentricity vector from the center of gravity of the shell to the drag center. The aerodynamic torque is obtained as the cross product of those vectors. The tanks are assumed to be either evacuated or pressurized with a uniform internal gas distribution: dynamic shifting of the tank center of mass due to residual propellant sloshing is not considered. PMID:27274926

Obstetrics and gynaecology training in Europe needs a next step.

PubMed

Scheele, Fedde; Novak, Ziva; Vetter, Klaus; Caccia, Nicolette; Goverde, Angelique

2014-09-01

Changing societal demands on doctors necessitate changes in the training of gynaecologists. Adapting this training will need well-thought-out and comprehensive planning that addresses the needs of the major stakeholders: society, patients, and doctors themselves. Doctors need to be cognizant of societal issues such as rapidly rising healthcare costs and budgetary crises, and be able to participate in the solutions. This demands effective medical leadership, which has been a neglected area in postgraduate training. It has become increasingly evident that a holistic view of the patient rooted in proper teamwork and systems-based practice is essential to provide patient-centered care. Specialists need to expand their skill set to participate in this kind of care. Furthermore, the feminisation of the medical profession and a new generation of doctors rejecting the constraints of the traditional model of medical care introduce new professional perspectives. This manuscript briefly reviews the challenges faced in the training of European gynaecologists in an effort to provoke discussion about how to best train the gynaecologists of the future. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Visiting Holocaust-Related Sites with Medical Students as an Aid in Teaching Medical Ethics.

PubMed

González-López, Esteban; Ríos-Cortés, Rosa

2016-05-01

During the Nazi period numerous doctors and nurses played a nefarious role. In Germany they were responsible for the sterilization and killing of disabled persons. Furthermore, the Nazi doctors used concentration camp inmates as guinea pigs in medical experiments for military or racial purposes. A study of the collaboration of doctors with National Socialism exemplifies behavior that must be avoided. Combining medical teaching with lessons from the Holocaust could be a way to transmit Medical Ethics to doctors, nurses and students. The authors describe a study tour with medical students to Poland, to the largest Nazi extermination camp, Auschwitz, and to the city of Krakow. The tour is the final component of a formal course entitled: "The Holocaust, a Reflection from Medicine" at the Autónoma University of Madrid, Spain. Visiting sites related to the Holocaust, the killing centers and the sites where medical experiments were conducted has a singular meaning for medical students. Tolerance, non-discrimination, and the value of human life can be both learnt and taught at the very place where such values were utterly absent.

[Present status of Japanese neurologists from the questionnaire survey - to support women doctor's career advancement].

PubMed

Fukaura, Hikoaki

2013-01-01

Childcare issue and family care issue are critical factors for women doctors to make a career as a neurologist in Japan. To know the actual business conditions of Japanese neurologists an online questioner survey was conducted. Answers were obtained from 737 members of Japanese Society of Neurology and 21 neurological medical facilities. Most of the answers were form members at three major metropolitan areas such as Tokyo, Osaka and Nagoya. Nobody from some prefectures was replied any answer. Almost sixty percent woman doctors had to change their working style from full time to part time at their child raising period and had difficulty with returning to full time job. Some neurologists have answered they used paid vacation to care their families and they felt they could not keep it for a longer period. At 70 percent of medical facilities sick child day care center were not operated. Opinions form members extremely varied from "In the first place woman doctors are unnecessary"to "With the help of the partner I have survived my child raising period".

Medical practice: defendants and prisoners.

PubMed Central

Bowden, P

1976-01-01

It is argued in this paper that a doctor cannot serve two masters. The work of the prison medical officer is examined and it is shown that his dual allegiance to the state and to those individuals who are under his care results in activities which largely favour the former. The World Health Organisation prescribes a system of health ethics which indicates, in qualitative terms, the responsibility of each state for health provisions. In contrast, the World Medical Association acts as both promulgator and guardian of a code of medical ethics which determines the responsibilities of the doctor to his patient. In the historical sense medical practitioners have always emphasized the sanctity of the relationship with their patients and the doctor's role as an expert witness is shown to have centered around this bond. The development of medical services in prisons has focused more on the partnership between doctor and institution. Imprisonment in itself could be seen as prejudicial to health as are disciplinary methods which are more obviously detrimental. The involvement of medical practitioners in such procedures is discussed in the light of their role as the prisoner's personal physician. PMID:1003433

A multiple linear regression analysis of hot corrosion attack on a series of nickel base turbine alloys

NASA Technical Reports Server (NTRS)

Barrett, C. A.

1985-01-01

Multiple linear regression analysis was used to determine an equation for estimating hot corrosion attack for a series of Ni base cast turbine alloys. The U transform (i.e., 1/sin (% A/100) to the 1/2) was shown to give the best estimate of the dependent variable, y. A complete second degree equation is described for the centered" weight chemistries for the elements Cr, Al, Ti, Mo, W, Cb, Ta, and Co. In addition linear terms for the minor elements C, B, and Zr were added for a basic 47 term equation. The best reduced equation was determined by the stepwise selection method with essentially 13 terms. The Cr term was found to be the most important accounting for 60 percent of the explained variability hot corrosion attack.

Memories of the terrorist attacks of September 11, 2001: a study of the consistency and phenomenal characteristics of flashbulb memories.

PubMed

Ferré Romeu, Pilar

2006-05-01

In this study, I investigated students' memories of the terrorist attacks of September 11, 2001, carried out by Al Qaeda terrorists against the World Trade Center in New York and the Pentagon in Washington. Participants completed on two occasions (2 weeks and 8 months after the events took place) a memory questionnaire that included an assessment of the phenomenal richness of their memories. The results showed that the participants remembered very well the circumstances in which they first heard about the terrorist attacks, that they were very confident about this information, and that these memories were characterized by a high phenomenal richness. Over time, there was a decrease in all of these variables, but people's ratings of phenomenology and confidence were still very high.

Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience

PubMed Central

Özdemir, Nihal; Tüysüz, Gülen; Çelik, Nigar; Yantri, Leman; Erginöz, Ethem; Apak, Hilmi; Özkan, Alp; Yıldız, İnci; Celkan, Tiraje

2016-01-01

Aim: An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. Material and Methods: Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients’ files. Results: A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. Conclusions: In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving survival. Evaluation of febrile neutropenia results by hematology-oncology units in years will be directive in early and successful treatment. PMID:27489464

Arbitrary Symmetric Running Gait Generation for an Underactuated Biped Model.

PubMed

Dadashzadeh, Behnam; Esmaeili, Mohammad; Macnab, Chris

2017-01-01

This paper investigates generating symmetric trajectories for an underactuated biped during the stance phase of running. We use a point mass biped (PMB) model for gait analysis that consists of a prismatic force actuator on a massless leg. The significance of this model is its ability to generate more general and versatile running gaits than the spring-loaded inverted pendulum (SLIP) model, making it more suitable as a template for real robots. The algorithm plans the necessary leg actuator force to cause the robot center of mass to undergo arbitrary trajectories in stance with any arbitrary attack angle and velocity angle. The necessary actuator forces follow from the inverse kinematics and dynamics. Then these calculated forces become the control input to the dynamic model. We compare various center-of-mass trajectories, including a circular arc and polynomials of the degrees 2, 4 and 6. The cost of transport and maximum leg force are calculated for various attack angles and velocity angles. The results show that choosing the velocity angle as small as possible is beneficial, but the angle of attack has an optimum value. We also find a new result: there exist biped running gaits with double-hump ground reaction force profiles which result in less maximum leg force than single-hump profiles.

Arbitrary Symmetric Running Gait Generation for an Underactuated Biped Model

PubMed Central

Esmaeili, Mohammad; Macnab, Chris

2017-01-01

This paper investigates generating symmetric trajectories for an underactuated biped during the stance phase of running. We use a point mass biped (PMB) model for gait analysis that consists of a prismatic force actuator on a massless leg. The significance of this model is its ability to generate more general and versatile running gaits than the spring-loaded inverted pendulum (SLIP) model, making it more suitable as a template for real robots. The algorithm plans the necessary leg actuator force to cause the robot center of mass to undergo arbitrary trajectories in stance with any arbitrary attack angle and velocity angle. The necessary actuator forces follow from the inverse kinematics and dynamics. Then these calculated forces become the control input to the dynamic model. We compare various center-of-mass trajectories, including a circular arc and polynomials of the degrees 2, 4 and 6. The cost of transport and maximum leg force are calculated for various attack angles and velocity angles. The results show that choosing the velocity angle as small as possible is beneficial, but the angle of attack has an optimum value. We also find a new result: there exist biped running gaits with double-hump ground reaction force profiles which result in less maximum leg force than single-hump profiles. PMID:28118401

Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial.

PubMed

Schneier, Franklin R; Neria, Yuval; Pavlicova, Martina; Hembree, Elizabeth; Suh, Eun Jung; Amsel, Lawrence; Marshall, Randall D

2012-01-01

Selective serotonin reuptake inhibitors (SSRIs) are often recommended in combination with established cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either SSRIs or CBT in treating PTSD related to terrorism. The authors compared prolonged exposure therapy (a CBT) plus paroxetine (an SSRI) with prolonged exposure plus placebo in the treatment of terrorism-related PTSD. Adult survivors of the World Trade Center attack of September 11, 2001, with PTSD were randomly assigned to 10 weeks of treatment with prolonged exposure (10 sessions) plus paroxetine (N=19) or prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment. Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50, 95% CI=0.30-0.85) and remission status (odds ratio=12.6, 95% CI=1.23-129) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life were also significantly more improved with combined treatment. The subset of patients who continued randomized treatment for 12 additional weeks showed no group differences. Initial treatment with paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attack. Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods.

Adolescent behavior and PTSD 6-7 years after the World Trade Center terrorist attacks of September 11, 2001.

PubMed

Mann, Mana; Li, Jiehui; Farfel, Mark R; Maslow, Carey B; Osahan, Sukhminder; Stellman, Steven D

2014-01-01

Behavioral problems and psychopathologies were reported in children exposed to the World Trade Center (WTC) attacks in New York City within 2-3 y post-disaster. Little is known of subsequent 9/11 related behavioral and emotional problems. We assessed risk factors for behavioral difficulties and probable posttraumatic stress disorder (PTSD) in 489 adolescent enrollees ages 11-18 y of age in the World Trade Center Health Registry cohort using the Strengths and Difficulties Questionnaire (SDQ) and DISC Predictive Scales (DPS), respectively, as reported by the adolescents. Associations between parental PTSD and adolescent PTSD and behavioral problems were studied in a subset of 166 adolescent-parent pairs in which the parent was also a Registry enrollee. Nearly one-fifth (17.4%) of the adolescents, all of whom were 5-12 y old at the time of the attacks, scored in the abnormal (5.7%) or borderline (11.7%) range of total SDQ. Problems were more frequent in minority, low-income, and single-parent adolescents. Abnormal and borderline SDQ scores were significantly associated with direct WTC exposures and with WTC-related injury or death of a family member. Adolescent PTSD was significantly associated with WTC exposure and with fear of one's own injury or death, and with PTSD in the parent (OR = 5.6; 95% CI 1.1-28.4). This adolescent population should be monitored for persistence or worsening of these problems. Co-occurrence of parent and child mental health symptoms following a disaster may have implications for healthcare practitioners and for disaster response planners.

Development of village doctors in China: financial compensation and health system support.

PubMed

Hu, Dan; Zhu, Weiming; Fu, Yaqun; Zhang, Minmin; Zhao, Yang; Hanson, Kara; Martinez-Alvarez, Melisa; Liu, Xiaoyun

2017-07-01

Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages' collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors' income. The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.

[A position paper on end of life shared between those who believe and those who don't believe: a dialogue is possible].

PubMed

Gristina, Giuseppe R

2015-11-01

In the modern medicine a sound evidence is available today supporting the four fundamental principles representing the best scientific and ethical approach to end of life issues: shared decision making process in a doctor-patient relationship centered care; rejection of dying process marked by the suffering and disproportionate treatments; withholding/withdrawing these treatments and palliative sedation as main contributions to suppress the patients' suffering and pain at the end of life; clear-cut difference between these clinical and ethical options and euthanasia. In some European countries, such as Germany, France, UK, and Spain, these principles are included in a well set legislation regarding the end of life issue, but this is not the case of our country. Despite this failure, in Italy, doctors, patients, and their families, need a law aimed to deal with the complex issues of end of life care as a whole. Therefore, the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) together with Italian Society of Palliative Care (SICP), shared with the Foundation "Courtyard of the Gentiles" - Department of the Pontifical Council for the Culture - the project to appoint a panel of religious and non-religious experts (physicians, philosophers, legal experts, and politicians) in order to draw up and offer to the political consideration a shared position paper, containing all the ethical and legal principles aimed to outline a more complete regulation of end of life in our country. The "Courtyard of the Gentiles" - whose aim is to promote the dialogue in regard to the issues of contemporary society between those who believe and those who don't believe, with a view to connect political and cultural institutions - appointed the panel in April 2014 and the shared position paper was formally presented on 17 September 2015, in a public conference in the Senate. The physicians who have been part of the panel, affirmed that all the problems related to the legal approach to the decision making process at the end of life may be solved only through a regulation of the doctor-patient relationship centered care. The aim of this regulation will be to set goals, rules, and limits of therapies, patients and doctors rights, procedures able to support and safeguard the good clinical practice, giving to patients and doctors an ethic reference point in the context of a law's guarantee. The fundamental principles of the regulation of the doctor-patient relationship centered care will rest on the contents of code of medical ethics, the safeguard of dignity, autonomy, and health of human beings. In conclusion, we hope to have supplied a useful contribution to draw up in the next future a law able to guarantee the autonomy of doctor-patient relationship, respecting different cultures and religious or non-religious approaches to life and death, as well as the different biography and biology of everyone. Our first goal was to comprehensively address the issue of end of life, understanding the concerns of patients and their families in a very problematic stage of their life, and offering to the doctors a valuable tool for dealing with the increasing complex connection between disease, death and modern medical practice on one hand, and related human fortunes on the other hand.

Security in maritime transport : risk factors and economic impact

DOT National Transportation Integrated Search

2003-07-01

Immediately after the devastating September 11th World Trade Center attacks in New York, governments around the world scrambled to assess their vulnerability to highly organised terrorist groups. World trade is dependent on maritime transport and gre...

Terrorist Attacks Put Academic Freedom to the Test.

ERIC Educational Resources Information Center

Wilson, Robin; Cox, Ana Marie

2001-01-01

Explores how, in the aftermath of the airplane hijackings and deaths at New York's World Trade Center and the Pentagon, academic freedom may be under threat. Provides examples of student or administrative action against professors offering different viewpoints. (EV)

Finding Effective Responses Against Cyber Attacks for Divided Nations

DTIC Science & Technology

2015-12-01

Coordination Center LTE Long Term Evolution MAC Media Access Control MCRC Master Control and Reporting Center MEI Ministry of Electronics...satellites that aid Internet connections. Individual users can access the Internet via not only a wired connection up to 1 Gbps, but also by 4G LTE ...operate air-gapped intranets with security measures such as cryptographic modules that correspond to security levels. The MND does maintain the public

Finding the Right Care | Center for Cancer Research

Cancer.gov

Trained as a registered nurse and with a doctoral degree in public health, Jane D. is no stranger to the U.S. health care system. But, when she found herself facing a diagnosis of anal cancer in 2013, she felt adrift.

EMPLOYMENT OPPORTUNITIES IN NCEA

EPA Science Inventory

Research Post-Doctoral Program Opportunities

Career Appointments:

Polysomnography

MedlinePlus

... Test Whether the test is at a sleep study center or at home, you prepare the same way. Unless directed to do so by your doctor, do not take any sleep medicine and do not drink alcohol or caffeinated beverages before the test. They can interfere with your ...

Heart House: Where Doctors Learn

ERIC Educational Resources Information Center

American School and University, 1978

1978-01-01

The new learning center and administrative headquarters of the American College of Cardiology in Bethesda, Maryland, contain a unique classroom equipped with the highly sophisticated audiovisual aids developed to teach the latest techniques in the diagnosis and treatment of heart disease. (Author/MLF)

Expedition 19 Crew Training

NASA Image and Video Library

2009-03-20

Spaceflight Participant Charles Simonyi, left, Expedition 19 Commander Gennady I. Padalka, center, and Flight Engineer Michael R. Barratt along with the backup crew and flight doctors walk the grounds of the Cosmonaut Hotel, Saturday, March 21, 2009 in Baikonur, Kazakhstan. (Photo Credit: NASA/Bill Ingalls)

78 FR 2258 - Board of Regents of the Uniformed Services University of the Health Sciences; Quarterly Meeting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-10

... Graduate School of Nursing; and recommendations regarding the awarding of master's and doctoral degrees in... and the Executive Director of the Center for Deployment Psychology. All of these actions are necessary...

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

PubMed

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level.

PubMed

Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

2015-10-01

Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

Transforming trauma healthcare delivery in rural areas by use of an integrated call center.

PubMed

Agrawal, Deepak

2012-01-01

There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients' overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner.

Transforming trauma healthcare delivery in rural areas by use of an integrated call center

PubMed Central

Agrawal, Deepak

2012-01-01

Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients’ overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner. PMID:22416147

Lateral-directional stability characteristics of a wing-fuselage configuration at angles of attack up to 44 deg

NASA Technical Reports Server (NTRS)

Henderson, W. P.; Huffman, J. K.

1974-01-01

An investigation has been conducted to determine the effects of configuration variables on the lateral-directional stability characteristics of a wing-fuselage configuration. The variables under study included variations in the location of a single center-line vertical tail and twin vertical tails, wing height, fuselage strakes, and horizontal tails. The study was conducted in the Langley high-speed 7-by 10-foot tunnel at a Mach number of 0.30, at angles of attack up to 44 deg and at sideslip angles of 0 deg and plus or minus 5 deg.

Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China.

PubMed

Sun, Qiang; Dyar, Oliver J; Zhao, Lingbo; Tomson, Göran; Nilsson, Lennart E; Grape, Malin; Song, Yanyan; Yan, Ling; Lundborg, Cecilia Stålsby

2015-03-31

Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors' attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold. A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors. A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p < 0.001). A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001). Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

Liftoff and Transition Aerodynamics of the Ares I (A106) Launch Vehicle

NASA Technical Reports Server (NTRS)

Capone, Francis J.; Paulson, John W., Jr.; Erickson, Gary E.

2011-01-01

An investigation has been conducted in the NASA Langley Research Center 14- by 22- Foot Subsonic Wind Tunnel to obtain the liftoff and transition aerodynamics of the Ares I (A106) Crew Launch Vehicle. Data were obtained in free-air at angles of attack from 10 to 90 at various roll angles and at roll angles of 0 to 360 at various angles of attack. In addition, tower effects were assessed by testing with and without a mobile launcher/tower at all wind azimuth angles and at various model heights to simulate the rise of the vehicle as it clears the tower on launch. The free-air data will be used for low speed high angle of attack flight simulation and as a bridge to the low angle of attack ascent database (0.5 < Mach < 5.0) being developed with data from the Langley Unitary Plan Wind Tunnel and Boeing Polysonic Wind Tunnel. The Ares I Database Development Team will add incremental tower effects data to the free-air data to develop the database for tower clearance.

The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling

PubMed Central

Hijazi, Heba H.; Harvey, Heather L.; Alyahya, Mohammad S.; Alshraideh, Hussam A.; Al abdi, Rabah M.; Parahoo, Sanjai K.

2018-01-01

Targeting the patient’s needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital’s engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses’ perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital’s agenda as a strategy for continuous quality improvement. PMID:29482410

The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling.

PubMed

Hijazi, Heba H; Harvey, Heather L; Alyahya, Mohammad S; Alshraideh, Hussam A; Al Abdi, Rabah M; Parahoo, Sanjai K

2018-01-01

Targeting the patient's needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital's engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses' perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital's agenda as a strategy for continuous quality improvement.

Hypersonic Boundary-Layer Stability Experiments on a Flared-Cone Model at Angle of Attack in a Quiet Wind Tunnel

NASA Technical Reports Server (NTRS)

Doggett, Glen P.; Chokani, Ndaona

1996-01-01

An experimental investigation of the effects of angle of attack on hypersonic boundary-layer stability on a flared-cone model was conducted in the low-disturbance Mach-6 Nozzle-Test Chamber Facility at NASA Langley Research Center. This unique facility provided a 'quiet' flow test environment which is well suited for stability experiments because the low levels of freestream 'noise' minimize artificial stimulation of flow-disturbance growth. Surface pressure and temperature measurements documented the adverse-pressure gradient and transition-onset location. Hot-wire anemometry diagnostics were applied to identify the instability mechanisms which lead to transition. In addition, the mean flow over the flared-cone geometry was modeled by laminar Navier-Stokes computations. Results show that the boundary layer becomes more stable on the windward ray and less stable on the leeward ray relative to the zero-degree angle-of-attack case. The second-mode instability dominates the transition process at a zero-degree angle of attack, however, on the windward ray at an angle of attack this mode was completely stabilized. The less-dominant first-mode instability was slightly destabilized on the windward ray. Non-linear mechanisms such as saturation and harmonic generation are identified from the flow-disturbance bispectra.

Beliefs About Control in the Physician-patient Relationship

PubMed Central

Street, Richard L; Krupat, Edward; Bell, Robert A; Kravitz, Richard L; Haidet, Paul

2003-01-01

OBJECTIVES Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant). DESIGN Stratified case-controlled study. PATIENTS/PARTICIPANTS Twenty family medicine and internal medicine physicians and 135 patients. MEASUREMENTS Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation. MAIN RESULTS Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation. CONCLUSIONS Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other. PMID:12911642

Simplistic and complex thought in medicine: the rationale for a person-centered care model as a medical revolution

PubMed Central

Reach, Gérard

2016-01-01

According to the concept developed by Thomas Kuhn, a scientific revolution occurs when scientists encounter a crisis due to the observation of anomalies that cannot be explained by the generally accepted paradigm within which scientific progress has thereto been made: a scientific revolution can therefore be described as a change in paradigm aimed at solving a crisis. Described herein is an application of this concept to the medical realm, starting from the reflection that during the past decades, the medical community has encountered two anomalies that, by their frequency and consequences, represent a crisis in the system, as they deeply jeopardize the efficiency of care: nonadherence of patients who do not follow the prescriptions of their doctors, and clinical inertia of doctors who do not comply with good practice guidelines. It is proposed that these phenomena are caused by a contrast between, on the one hand, the complex thought of patients and doctors that sometimes escapes rationalization, and on the other hand, the simplification imposed by the current paradigm of medicine dominated by the technical rationality of evidence-based medicine. It is suggested therefore that this crisis must provoke a change in paradigm, inventing a new model of care defined by an ability to take again into account, on an individual basis, the complex thought of patients and doctors. If this overall analysis is correct, such a person-centered care model should represent a solution to the two problems of patients’ nonadherence and doctors’ clinical inertia, as it tackles their cause. These considerations may have important implications for the teaching and the practice of medicine. PMID:27103790

[Prevalence and factors associated with frequent attendence in family medicine clinic].

PubMed

Parejo Maestre, N; Lendínez-de la Cruz, J M; Bermúdez-Torres, F M; Gónzalez-Contero, L; Gutierrez-Espinosa de Los Monteros, M P; Espejo-Almazán María, T

2016-01-01

The use of health services has seen a steep rise. The frequent users are responsible for significant economic, human and social impact. The objective is to analyze the characteristics of frequent attenders in our Health Center, in order to evaluate the possibility of taking corrective measures to improve the quality of care and efficiency in the use of resources. Descriptive observational study of a sample of 379 patients over 18 years old. The dependent variables were attendance (number of visits to their family doctor during the previous year), frequent attendance (10 or more visits to the family doctor in the last year), and persistent frequent attenders (10 or more visits to the family doctor in each of the last two years). Data were collected from medical records and by telephone interview. The mean attendance was 6.83 (95%CI: 6.13-7.53), frequent attendance reached 25.4% (95%CI: 21.4-29.6), and persistent frequent attenders, 1.6% (95%CI: 0.5-2.9). Frequent attendance was associated with sex, age, marital status, educational level, family structure, existence of chronic disease, use of anxiolytic and antidepressants, request for additional tests, and referrals to other specialists, proximity to the health center, and level of satisfaction with their family doctor. The low persistent frequent attenders found suggests that frequent attendance could be largely due to factors related to professional and organization. Studies are required to address the high level of consumption of psychotropic drugs, and improving professional skills in dealing with mental problems. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Predictors of hospitalised patients' preferences for physician-directed medical decision-making.

PubMed

Chung, Grace S; Lawrence, Ryan E; Curlin, Farr A; Arora, Vineet; Meltzer, David O

2012-02-01

Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Data were collected from 8308 of 11,620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.

LABORATORY GUIDELINES FOR ANALYSIS OF BIOTERRORISM SAMPLES

EPA Science Inventory

After the attack on the World Trade Center on September 11, 2002, and the subsequent deaths associated with Bacillus anthracis spore contaminated mail, a worldwide need was apparent for increased laboratory capacity to safely analyze bioterrorism samples. The U.S. Department o...

Annual Research Briefs - 1996

NASA Technical Reports Server (NTRS)

1996-01-01

This report contains the 1996 annual progress reports of the research fellows and students supported by the Center for Turbulence Research. Last year, CTR hosted twelve resident Postdoctoral Fellows, three Research Associates, four Senior Research Fellows, and supported one doctoral student and ten short term visitors.

The Origin of Variation in Primary Care Process and Outcome Indicators

PubMed Central

Orueta, Juan F.; García-Alvarez, Arturo; Grandes, Gonzalo; Nuño-Solinís, Roberto

2015-01-01

Abstract Healthcare providers are often evaluated by studying variability in their indicators. However, the usefulness of this analysis may be limited if we do not distinguish the variability attributable to health professionals and organizations from that associated with their patients. Our objectives are to describe the main process and outcome indicators of primary healthcare services, analyzing the contribution to variability in these indicators from different levels: individual, health professional, health center, and health district. This is a cross-sectional study that includes all. All the individuals covered by the public Basque Health Service (children [age 0–13], n = 247,493; adults [≥14 years old], n = 1,959,682) over a 12-month period. We calculated the number of visits to primary care doctors, number of referrals, prescription costs, and potentially avoidable hospitalizations for ambulatory care sensitive conditions (ACSCs). Using multilevel analysis, we determined the percentage of variance attributable to each level. After adjusting for the characteristics of patients (demographic, socioeconomic, and morbidity), doctors (panel size), health center (size, staff satisfaction, demographic structure of the community), and health district, the variance in the indicators was mainly attributable to differences between patients, independently of the attending health professional, the center, or the healthcare organization, both in children (94.21% for visits to the doctor; 96.66% for referrals; 98.57% for prescription costs; 90.02% for potentially avoidable hospitalizations for ACSCs) and in adults (88.10%; 96.26%; 97.92%; and 93.77%, respectively). The limited contribution of health professionals and organizations to variability in indicators should be taken into account when performing evaluations and planning quality improvement strategies. PMID:26252315

A Study on Secure Medical-Contents Strategies with DRM Based on Cloud Computing

PubMed Central

Měsíček, Libor; Choi, Jongsun

2018-01-01

Many hospitals and medical clinics have been using a wearable sensor in its health care system because the wearable sensor, which is able to measure the patients' biometric information, has been developed to analyze their patients remotely. The measured information is saved to a server in a medical center, and the server keeps the medical information, which also involves personal information, on a cloud system. The server and network devices are used by connecting each other, and sensitive medical records are dealt with remotely. However, these days, the attackers, who try to attack the server or the network systems, are increasing. In addition, the server and the network system have a weak protection and security policy against the attackers. In this paper, it is suggested that security compliance of medical contents should be followed to improve the level of security. As a result, the medical contents are kept safely. PMID:29796233

Toward more environmentally resistant gas turbines: Progress in NASA-Lewis programs

NASA Technical Reports Server (NTRS)

Lowell, C. E.; Grisaffe, S. J.; Levine, S. R.

1976-01-01

A wide range of programs are being conducted for improving the environmental resistance to oxidation and hot corrosion of gas turbine and power system materials. They range from fundamental efforts to delineate attack mechanisms, allow attack modeling and permit life prediction, to more applied efforts to develop potentially more resistant alloys and coatings. Oxidation life prediction efforts have resulted in a computer program which provides an initial method for predicting long time metal loss using short time oxidation data by means of a paralinear attack model. Efforts in alloy development have centered on oxide-dispersion strengthened alloys based on the Ni-Cr-Al system. Compositions have been identified which are compromises between oxidation and thermal fatigue resistance. Fundamental studies of hot corrosion mechanisms include thermodynamic studies of sodium sulfate formation during turbine combustion. Information concerning species formed during the vaporization of Na2SO4 has been developed using high temperature mass spectrometry.

Collaboration Between Public Health and Law Enforcement: New Paradigms and Partnerships for Bioterrorism Planning and Response

PubMed Central

Cohen, Mitchell L.; Friedman, Cindy R.; Scripp, Robert M.; Watz, Craig G.

2002-01-01

The biological attacks with powders containing Bacillus anthracis sent through the mail during September and October 2001 led to unprecedented public health and law enforcement investigations, which involved thousands of investigators from federal, state, and local agencies. Following recognition of the first cases of anthrax in Florida in early October 2001, investigators from Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) were mobilized to assist investigators from state and local public health and law enforcement agencies. Although public health and criminal investigations have been conducted in concert in the past, the response to the anthrax attacks required close collaboration because of the immediate and ongoing threat to public safety. We describe the collaborations between CDC and FBI during the investigation of the 2001 anthrax attacks and highlight the challenges and successes of public health and law enforcement collaborations in general. PMID:12396931

A Study on Secure Medical-Contents Strategies with DRM Based on Cloud Computing.

PubMed

Ko, Hoon; Měsíček, Libor; Choi, Jongsun; Hwang, Seogchan

2018-01-01

Many hospitals and medical clinics have been using a wearable sensor in its health care system because the wearable sensor, which is able to measure the patients' biometric information, has been developed to analyze their patients remotely. The measured information is saved to a server in a medical center, and the server keeps the medical information, which also involves personal information, on a cloud system. The server and network devices are used by connecting each other, and sensitive medical records are dealt with remotely. However, these days, the attackers, who try to attack the server or the network systems, are increasing. In addition, the server and the network system have a weak protection and security policy against the attackers. In this paper, it is suggested that security compliance of medical contents should be followed to improve the level of security. As a result, the medical contents are kept safely.

Effect of vertical-tail location on the aerodynamic characteristics at subsonic speeds of a close-coupled canard configuration

NASA Technical Reports Server (NTRS)

Huffman, J. K.

1975-01-01

The effects were studied of various vertical-tail configurations on the longitudinal and lateral directional-stability characteristics of a general research fighter model utilizing wing-body-canard. The study indicates that the addition of the high canard resulted in an increase in total lift at angles of attack above 4 deg with a maximum lift coefficient about twice as large as that for the wing-body configuration. For the wing-body (canard off) configuration, the center-line vertical tail indicates positive vertical-tail effectiveness throughout the test angle-of-attack range; however, for this configuration none of the wing-mounted vertical-tail locations tested resulted in a positive directional-stability increment at the higher angles of attack. For the wing-body-canard configuration several outboard locations of the wing-mounted vertical tails were found.

Results of an experimental investigation to determine separation characteristics for the Orbiter/747 using a 0.0125-scale model (48-0 AX1318I-1 747) in the Ames Research Center 14-foot wind tunnel (CA23B)

NASA Technical Reports Server (NTRS)

Esparza, V.

1976-01-01

Aerodynamic separation data obtained from a wind tunnel test of an 0.0125-scale SSV Orbiter model of a VC70-000002 Configuration and a 0.0125-scale 747 model was presented. Separation data was obtained at a Mach number of 0.6 and three incidence angles of 4, 6, and 8 degrees. The orbiter angle of attack was varied from 0 to 14 degrees. Longitudinal, lateral and normal separation increments were obtained for fixed 747 angles of attack of 0, 2, and 4 degrees while varying the orbiter angle of attack. Control surface settings on the 747 carrier included rudder deflections of 0 and 10 degrees and horizontal stabilizer deflections of -1 and +5 degrees.

Mutual Authentication Scheme in Secure Internet of Things Technology for Comfortable Lifestyle.

PubMed

Park, Namje; Kang, Namhi

2015-12-24

The Internet of Things (IoT), which can be regarded as an enhanced version of machine-to-machine communication technology, was proposed to realize intelligent thing-to-thing communications by utilizing the Internet connectivity. In the IoT, "things" are generally heterogeneous and resource constrained. In addition, such things are connected to each other over low-power and lossy networks. In this paper, we propose an inter-device authentication and session-key distribution system for devices with only encryption modules. In the proposed system, unlike existing sensor-network environments where the key distribution center distributes the key, each sensor node is involved with the generation of session keys. In addition, in the proposed scheme, the performance is improved so that the authenticated device can calculate the session key in advance. The proposed mutual authentication and session-key distribution system can withstand replay attacks, man-in-the-middle attacks, and wiretapped secret-key attacks.

Adjusting to Random Demands of Patient Care: A Predictive Model for Nursing Staff Scheduling at Naval Medical Center San Diego

DTIC Science & Technology

2008-09-01

rich mix of medical services that range from simple ambulatory visits to plastic surgery , neuro- surgery , general surgery , bariatric , ophthalmology...CENTER SAN DIEGO NMCSD is a 266-bed tertiary care facility providing patient services ranging from same day surgery to brain surgery . The hospital...orthopedics, cardiology, thoracic surgery , vascular surgery , transient ischemic attack/cerebro vascular accident (TIA/CVA), OB/GYN, urology, non

Blood and Treasure: The U.S. Debt and Its Implications for National Defense and Security

DTIC Science & Technology

2012-12-01

Reserve Board, “Major Foreign Holders of Treasury Securities ,” 15 May 2012. http://www.treasury.gov/resource-center/ data -chart- center/tic/Documents...Coupled with numerous cyber -attacks and theft of intelligence, China could be performing dry runs and gaining intelligence on every occasion for the...THE U.S. DEBT AND ITS IMPLICATIONS FOR NATIONAL DEFENSE AND SECURITY by Nicholas C. Malokofsky December 2012 Thesis Advisor: Carolyn

KSC-98pc772

NASA Image and Video Library

1998-06-22

KENNEDY SPACE CENTER, FLA. -- A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. The Merritt Island National Wildlife Refuge, which is operated by the U.S. Fish and Wildlife Service, is located on Kennedy Space Center property.

KSC-98pc769

NASA Image and Video Library

1998-06-22

KENNEDY SPACE CENTER, FLA. -- A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. The Merritt Island National Wildlife Refuge, which is operated by the U.S. Fish and Wildlife Service, is located on Kennedy Space Center property.

KSC-98pc773

NASA Image and Video Library

1998-06-22

KENNEDY SPACE CENTER, FLA. -- A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. The Merritt Island National Wildlife Refuge, which is operated by the U.S. Fish and Wildlife Service, is located on Kennedy Space Center property.

KSC-98pc771

NASA Image and Video Library

1998-06-22

KENNEDY SPACE CENTER, FLA. -- A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. The Merritt Island National Wildlife Refuge, which is operated by the U.S. Fish and Wildlife Service, is located on Kennedy Space Center property.

KSC-98pc770

NASA Image and Video Library

1998-06-22

KENNEDY SPACE CENTER, FLA. -- A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. The Merritt Island National Wildlife Refuge, which is operated by the U.S. Fish and Wildlife Service, is located on Kennedy Space Center property.

Understanding estimated worker absenteeism rates during an influenza pandemic.

PubMed

Thanner, Meridith H; Links, Jonathan M; Meltzer, Martin I; Scheulen, James J; Kelen, Gabor D

2011-01-01

Published employee absenteeism estimates during an influenza pandemic range from 10 to 40 percent. The purpose of this study was to estimate daily employee absenteeism through the duration of an influenza pandemic and to determine the relative impact of key variables used to derive the estimates. Using the Centers for Disease Control and Prevention's FluWorkLoss program, the authors estimated the number of absent employees on any given day over the course of a simulated 8-week pandemic wave by using varying attack rates. Employee data from a university with a large academic health system were used. Sensitivity of the program outputs to variation in predictor (inputs) values was assessed. Finally, the authors examined and documented the algorithmic sequence of the program. Using a 35 percent attack rate, a total of 47,270 workdays (or 3.4 percent of all available workdays) would be lost over the course of an 8-week pandemic among a population of 35,026 employees. The highest (peak) daily absenteeism estimate was 5.8 percent (minimum 4.8 percent; maximum 7.4 percent). Sensitivity analysis revealed that varying days missed for nonhospitalized illness had the greatest potential effect on peak absence rate (3.1 to 17.2 percent). Peak absence with 15 and 25 percent attack rates were 2.5 percent and 4.2 percent, respectively. The impact of an influenza pandemic on employee availability may be less than originally thought, even with a high attack rate. These data are generalizable and are not specific to institutions of higher education or medical centers. Thus, these findings provide realistic and useful estimates for influenza pandemic planning for most organizations.

The impact of the World Trade Center attack on FDNY firefighter retirement, disabilities, and pension benefits.

PubMed

Niles, J K; Webber, M P; Gustave, J; Zeig-Owens, R; Lee, R; Glass, L; Weiden, M D; Kelly, K J; Prezant, D J

2011-09-01

Our goal was to examine the effect of the World Trade Center (WTC) attack and subsequent New York City Fire Department (FDNY) rescue/recovery activities on firefighter retirements. We also analyzed the financial impact associated with the increased number and proportion of service-connected "accidental" disability retirements on the FDNY pension system. A total of 7,763 firefighters retired between 9/11/1994 and 9/10/2008. We compared the total number of retirements and the number and proportion of accidental disability retirements 7 years before and 7 years after the WTC attack. We categorized WTC-related accidental disability retirements by medical cause and worked with the New York City Office of the Actuary to approximate the financial impact by cause. In the 7 years before 9/11 there were 3,261 retirements, 48% (1,571) of which were accidental disability retirements. In the 7 years after 9/11, there were 4,502 retirements, 66% (2,970) were accidental disability retirements, of which 47% (1,402) were associated with WTC-related injuries or illnesses. After 9/11, the increase in accidental disability retirements was, for the most part, due to respiratory-related illnesses. Additional increases were attributed to psychological-related illnesses and musculoskeletal injuries incurred at the WTC site. Pension benefits associated with WTC-related accidental disability retirements have produced an increased financial burden of over $826 million on the FDNY pension system. The WTC attacks affected the health of the FDNY workforce resulting in more post-9/11 retirements than expected, and a larger proportion of these retirees with accidental disability pensions. Copyright © 2011 Wiley-Liss, Inc.

Patient-Centred Multidisciplinary Inpatient Care-Have Diagnosis-Related Groups an Effect on the Doctor-Patient Relationship and Patients' Motivation for Behavioural Change?

PubMed

Romeyke, Tobias; Noehammer, Elisabeth; Ch Scheuer, Hans; Stummer, Harald

2016-10-01

The aim of this, the largest survey of patients performed to date, is to analyse the effects of diagnosis related groups (DRGs) on the doctor-patient relationship in the context of interdisciplinary patient-centered care. In addition, it is intended to investigate the possibility of motivating patients to change their behavioural patterns and lifestyle in the context of holistic therapy. Over a period of five years, a continuous survey was performed of hospitalised patients who were exercising their entitlement to interdisciplinary therapy in an acute, inpatient setting. The therapy was evaluated as good to very good both with and without the conditions of the case tariff fee system. Effects of the diagnosis related groups on the quality of the doctor-patient relationship could not be demonstrated (Mann-Whitney U test, p>0,05). A clear trend was evident in the influence on motivation to change behavioural patterns and lifestyle (Fisher's exact test, p=0,000). Studies of the effects of reimbursement systems in the context of interdisciplinary care are still in their infancy, despite the widespread use of diagnosis related groups. The mandatory character implicit in the case tariff fee system, which requires minimum qualitative standards for structural and procedural parameters in the context of providing interdisciplinary patient-centered care, can influence patients' behavioural patterns and lifestyle.

An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

PubMed

Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

2009-09-01

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.

PubMed

Alberts, Mark J; Latchaw, Richard E; Jagoda, Andy; Wechsler, Lawrence R; Crocco, Todd; George, Mary G; Connolly, E S; Mancini, Barbara; Prudhomme, Stephen; Gress, Daryl; Jensen, Mary E; Bass, Robert; Ruff, Robert; Foell, Kathy; Armonda, Rocco A; Emr, Marian; Warren, Margo; Baranski, Jim; Walker, Michael D

2011-09-01

The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.

[Doctor Albéric Pont (1870-1960). Dental surgeon, doctor and creator of the center of maxillo-facial surgery of Lyon in 1914].

PubMed

Riaud, Xavier

2008-01-01

As Stomatologist and Dental Surgeon Albéric Pont founded with six other Dental Surgeons the School of Dentistry in Lyons which he ran for a long time. When he enlisted in the French Army in 1914 he soon became aware of the extent of facial damage that occurred among the injured soldiers. His subsequent decision was to create and run a Centre for maxillofacial surgery in Lyons. He died in 1960 and left a significant scientific work as well as technical elements of surgery, dental index and devices which still bear his name.

In Memoriam: Claude Klee, M.D. | Center for Cancer Research

Cancer.gov

Claude Klee, M.D., a true giant among the many great biochemists at the National Institutes of Health (NIH), died on Monday, April 3, after suffering a heart attack. She was 85 years old.  Learn more...     

College that Serves New York's Finest Faces Deaths in a "Wartime" Atmosphere.

ERIC Educational Resources Information Center

Farrell, Elizabeth F.

2001-01-01

Describes how John Jay College of Criminal Justice, which serves many New York City police officers, is helping students and alumni at Ground Zero, location of the September 11, 2001 terrorist attacks on the World Trade Center. (EV)

World Trade Center Health Program requirements for the addition of new WTC-related health conditions. Final rule.

PubMed

2012-04-25

Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) to establish the World Trade Center (WTC) Health Program. Sections 3311, 3312, and 3321 of Title XXXIII of the PHS Act require that the WTC Program Administrator develop regulations to implement portions of the WTC Health Program established within the Department of Health and Human Services (HHS). The WTC Health Program, which is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, Shanksville, PA, and at the Pentagon, and to eligible survivors of the New York City attacks. This final rule establishes the processes by which the WTC Program Administrator may add a new condition to the list of WTC-related health conditions through rulemaking, including a process for considering petitions by interested parties to add a new condition.

Buffet induced structural/flight-control system interaction of the X-29A aircraft

NASA Technical Reports Server (NTRS)

Voracek, David F.; Clarke, Robert

1991-01-01

High angle-of-attack flight regime research is currently being conducted for modern fighter aircraft at the NASA Ames Research Center's Dryden Flight Research Facility. This flight regime provides enhanced maneuverability to fighter pilots in combat situations. Flight research data are being acquired to compare and validate advanced computational fluid dynamic solutions and wind-tunnel models. High angle-of-attack flight creates unique aerodynamic phenomena including wing rock and buffet on the airframe. These phenomena increase the level of excitation of the structural modes, especially on the vertical and horizontal stabilizers. With high gain digital flight-control systems, this structural response may result in an aeroservoelastic interaction. A structural interaction on the X-29A aircraft was observed during high angle-of-attack flight testing. The roll and yaw rate gyros sensed the aircraft's structural modes at 11, 13, and 16 Hz. The rate gyro output signals were then amplified through the flight-control laws and sent as commands to the flaperons and rudder. The flight data indicated that as the angle of attack increased, the amplitude of the buffet on the vertical stabilizer increased, which resulted in more excitation to the structural modes. The flight-control system sensors and command signals showed this increase in modal power at the structural frequencies up to a 30 degree angle-of-attack. Beyond a 30 degree angle-of-attack, the vertical stabilizer response, the feedback sensor amplitude, and control surface command signal amplitude remained relatively constant. Data are presented that show the increased modal power in the aircraft structural accelerometers, the feedback sensors, and the command signals as a function of angle of attack. This structural interaction is traced from the aerodynamic buffet to the flight-control surfaces.

Pronominalization: A Device for Unifying Sentences in Memory

ERIC Educational Resources Information Center

Lesgold, Alan M.

1972-01-01

Based on the author's doctoral dissertation. Experiments supported by a National Science Foundation Predoctoral Fellowship and a National Institute of Mental Health grant; paper preparation supported by the Learning Research and Development Center, University of Pittsburgh, through the U.S. Office of Education. (VM)

Search Technologies | NCI Technology Transfer Center | TTC

Cancer.gov

Our team of technology transfer specialists has specialized training in invention reporting, patenting, patent strategy, executing technology transfer agreements and marketing. TTC is comprised of professionals with diverse legal, scientific, and business/marketing expertise. Most of our staff hold doctorate-level technical and/or legal training.

Partnering Events | NCI Technology Transfer Center | TTC

Cancer.gov

Our team of technology transfer specialists has specialized training in invention reporting, patenting, patent strategy, executing technology transfer agreements and marketing. TTC is comprised of professionals with diverse legal, scientific, and business/marketing expertise. Most of our staff hold doctorate-level technical and/or legal training.

Available Technologies | NCI Technology Transfer Center | TTC

Cancer.gov

Our team of technology transfer specialists has specialized training in invention reporting, patenting, patent strategy, executing technology transfer agreements and marketing. TTC is comprised of professionals with diverse legal, scientific, and business/marketing expertise. Most of our staff hold doctorate-level technical and/or legal training.

A Motivational Interviewing Course for Pharmacy Students

PubMed Central

Hawes, Starlyn M.; Duval, Elizabeth R.; Spresser, Carrie D.; Martínez, David A.; Lynam, Ian; Barnes, Amy; Hinton-Dampf, Amber M.; Murphy, Meghan E.; Marken, Patricia A.; Catley, Delwyn

2010-01-01

Objective To create, implement, and evaluate a pharmacy course on motivational interviewing. Design A 3-hour elective course was created to train doctor of pharmacy (PharmD) students in brief patient-centered motivational interviewing counseling strategies that have proven effective with the types of health issues most commonly addressed in pharmacy settings. Students were assisted in developing their skills through required readings, interactive lectures, in-class demonstrations and practice sessions, out of class skills practice, one-on-one supervision provided by doctoral level clinical health psychology students, and written reflections on each class session. Assessment Students demonstrated significant improvement in motivational interviewing skills and a high level of motivation for and confidence in using these skills in their future practice. Students overall assessment of the course and supervision process was highly positive. Conclusion This patient-centered counseling skills course was feasible and produced improvements in PharmD students' counseling skills and increased their motivation and confidence to use motivational interviewing skills in their future communications with patients. PMID:20585431

Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing.

PubMed

Harding, S R; D'Eon, M F

2001-01-01

Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

Patient reports of the quality of care in community health centers: the importance of having a regular provider.

PubMed

Beal, Anne; Hernandez, Susan

2010-05-01

To examine the importance of having a regular provider in community health centers (CHCs) for high quality care. Analyses of a national survey-the Commonwealth Fund 2006 Health care Quality Survey-among patients with a private doctor's (PMD) office (n=1,743) or CHC (n=275) as their regular source of care. Outcomes include prevention measures, and measures of patient experience. Patients at CHCs are less likely than patients who use a PMD to report having a regular doctor (53% vs. 95%, p

Microgravity

NASA Image and Video Library

1998-06-16

Eddie Snell (standing), Post-Doctoral Fellow the National Research Council (NRC),and Marc Pusey of Marshall Space Flight Center (MSFC) use a reciprocal space mapping diffractometer for marcromolecular crystal quality studies. The diffractometer is used in mapping the structure of marcromolecules such as proteins to determine their structure and thus understand how they function with other proteins in the body. This is one of several analytical tools used on proteins crystalized on Earth and in space experiments. Photo credit: NASA/Marshall Space Flight Center (MSFC)

Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

PubMed

Bonner, Carissa; McKinn, Shannon; Lau, Annie; Jansen, Jesse; Doust, Jenny; Trevena, Lyndal; McCaffery, Kirsten

2018-05-01

Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes. GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis. Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms. CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases. Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

Millennium development goals-knowledge and attainability as perceived by doctors: a case study.

PubMed

Adegboye, O A; Adeboye, M A; Erinle, S A; Nwachukwu, N D; Salawu, F K; Sajo, N J

2011-01-01

To audit the knowledge of doctors and evaluate their disposition toward the attainment of the Millennium Development Goals (MDGs). Semi-structured questionnaires requesting information about knowledge of the acronym "MDGs" were administered on willing doctors at three tertiary health centers: University of Ilorin Teaching Hospital, Federal Medical Centre, Bida, and Federal Medical Centre, Yola. Data were analyzed using frequency tables and simple statistical methods. One hundred and eighty-three doctors participated in the study, comprising 65 (35.5%) from Bida, 18 (9.8%) from Yola, and 100 (54.7%) from Ilorin, with a male to female ratio of 2:1 (P < 0.05). Thirty-nine respondents (21.3%) had no fore kowledge of MDG (P < 0.05). Only 77 (42.1%) of the respondents who had fore knowledge of "MDG" knew the number of goals to be eight (P < 0.05). Among those who had fore knowledge of MDG, only 34 comprising 15 (10.4%, Bida), 1 (0.7%, Yola), and 18 (12.5%, Ilorin) could correctly list a minimum of four of the MDGs (P < 0.05). Only 12 (8.3%) of the respondents believed that the MDGs are very achievable. There is an absolute need for more elaborate publicity on the MDGs among doctors as they are key players if attaining the MDGs is to be a reality.

[The treatment of anxiety and acute stress reaction (ASR) in civilian casualties in community stress centers (CSC) in the 2nd Lebanon War].

PubMed

Rubinstein, Zohar; Polakevitz, Yakov; Ben Gershon, Bella; Lubin, Gadi; Bar-Dayan, Yaron

2010-07-01

The treatment of anxiety and acute stress reaction (ASR) in civilian casualties exposed to continuous missile attacks during Lebanon War II is described in this study. Casualties were treated in community stress centers (CSC) erected ad-hoc, as a result of cooperation between the Mental Health Section of the Home Front Command of the Israel Defense Forces (IDF), the Mental Health Services of the Ministry of Health (MOH) and the Emergency and Disaster Management Division of the MOH. A total of 536 casualties were admitted to the centers. Eighteen were evacuated to the zone hospitals due to physical problems. The remaining casualties were released within 2-4 hours of intensive intervention according to the protocol. Symptoms of casualties ranged from anxiety (and ASR)--90%; fear (mainly agoraphobia)--7%; adaptation--2%; sleep disturbances--1%. Mental health intervention included counseling talk--80%; ventilation--9%; relaxation--3%; non-verbaL intervention--3%; fulfillment of basic needs--1% and evacuation to hospitals--3%. We discovered that anxiety and ASR were the most prevalent syndromes among those casualties as a result of the missile attacks on the civil population. The CSCs succeeded in providing adequate response and treatment for the majority of the casualties, thus putting off the need to evacuate those casualties to the ERs. Thereby, evacuation resources were saved and the ER load was reduced. The authors recommend that preparedness of the population under missile attacks, as well as other disaster scenarios, which resulted in a high rate of mental casualties, will be focused in the activation of CSCs in the format which has been described in this article.

Adolescent behavior and PTSD 6–7 years after the World Trade Center terrorist attacks of September 11, 2001

PubMed Central

Mann, Mana; Li, Jiehui; Farfel, Mark R; Maslow, Carey B; Osahan, Sukhminder; Stellman, Steven D

2014-01-01

Behavioral problems and psychopathologies were reported in children exposed to the World Trade Center (WTC) attacks in New York City within 2–3 y post-disaster. Little is known of subsequent 9/11 related behavioral and emotional problems. We assessed risk factors for behavioral difficulties and probable posttraumatic stress disorder (PTSD) in 489 adolescent enrollees ages 11–18 y of age in the World Trade Center Health Registry cohort using the Strengths and Difficulties Questionnaire (SDQ) and DISC Predictive Scales (DPS), respectively, as reported by the adolescents. Associations between parental PTSD and adolescent PTSD and behavioral problems were studied in a subset of 166 adolescent-parent pairs in which the parent was also a Registry enrollee. Nearly one-fifth (17.4%) of the adolescents, all of whom were 5–12 y old at the time of the attacks, scored in the abnormal (5.7%) or borderline (11.7%) range of total SDQ. Problems were more frequent in minority, low-income, and single-parent adolescents. Abnormal and borderline SDQ scores were significantly associated with direct WTC exposures and with WTC-related injury or death of a family member. Adolescent PTSD was significantly associated with WTC exposure and with fear of one's own injury or death, and with PTSD in the parent (OR = 5.6; 95% CI 1.1–28.4). This adolescent population should be monitored for persistence or worsening of these problems. Co-occurrence of parent and child mental health symptoms following a disaster may have implications for healthcare practitioners and for disaster response planners. PMID:28229007

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001.

PubMed

Alper, Howard E; Yu, Shengchao; Stellman, Steven D; Brackbill, Robert M

2017-12-01

The World Trade Center attack of September 11, 2001 in New York City (9/11) exposed thousands of people to intense concentrations of hazardous materials that have resulted in reports of increased levels of asthma, heart disease, diabetes, and other chronic diseases along with psychological illnesses such as post-traumatic stress disorder (PTSD). Few studies have discriminated between health consequences of immediate (short-term or acute) intense exposures versus chronic residential or workplace exposures. We used proportional hazards methods to determine adjusted hazard ratios (AHRs) for associations between several components of acute exposures (e.g., injury, immersion in the dust cloud) and four chronic disease outcomes: asthma, other non-neoplastic lung diseases, cardiovascular disease, and diabetes, in 8701 persons free of those conditions prior to exposure and who were physically present during or immediately after the World Trade Center attacks. Participants were followed prospectively up to 11 years post-9/11. Heart disease exhibited a dose-response association with sustaining injury (1 injury type: AHR =2.0, 95% CI (Confidence Interval) 1.1-3.6; 2 injury types: AHR = 3.1, 95% CI 1.2-7.9; 3 or more injury types: AHR = 6.8, 95% CI 2.0-22.6), while asthma and other lung diseases were both significantly associated with dust cloud exposure (AHR = 1.3, 95% CI 1.0-1.6). Diabetes was not associated with any of the predictors assessed in this study. In this study we demonstrated that the acute exposures of injury and dust cloud that were sustained on 9/11/2001 had significant associations with later heart and respiratory diseases. Continued monitoring of 9/11 exposed persons' health by medical providers is warranted for the foreseeable future.

Understanding security failures of two authentication and key agreement schemes for telecare medicine information systems.

PubMed

Mishra, Dheerendra

2015-03-01

Smart card based authentication and key agreement schemes for telecare medicine information systems (TMIS) enable doctors, nurses, patients and health visitors to use smart cards for secure login to medical information systems. In recent years, several authentication and key agreement schemes have been proposed to present secure and efficient solution for TMIS. Most of the existing authentication schemes for TMIS have either higher computation overhead or are vulnerable to attacks. To reduce the computational overhead and enhance the security, Lee recently proposed an authentication and key agreement scheme using chaotic maps for TMIS. Xu et al. also proposed a password based authentication and key agreement scheme for TMIS using elliptic curve cryptography. Both the schemes provide better efficiency from the conventional public key cryptography based schemes. These schemes are important as they present an efficient solution for TMIS. We analyze the security of both Lee's scheme and Xu et al.'s schemes. Unfortunately, we identify that both the schemes are vulnerable to denial of service attack. To understand the security failures of these cryptographic schemes which are the key of patching existing schemes and designing future schemes, we demonstrate the security loopholes of Lee's scheme and Xu et al.'s scheme in this paper.

Individualized Integrative Cancer Care in Anthroposophic Medicine: A Qualitative Study of the Concepts and Procedures of Expert Doctors.

PubMed

Kienle, Gunver S; Mussler, Milena; Fuchs, Dieter; Kiene, Helmut

2016-12-01

Background Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient's wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care-related specialists. Conclusion Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care. © The Author(s) 2016.

Emotional Learning and Identity Development in Medicine: A Cross-Cultural Qualitative Study Comparing Taiwanese and Dutch Medical Undergraduates.

PubMed

Helmich, Esther; Yeh, Huei-Ming; Yeh, Chi-Chuan; de Vries, Joy; Fu-Chang Tsai, Daniel; Dornan, Tim

2017-06-01

Current knowledge about the interplay between emotions and professional identity formation is limited and largely based on research in Western settings. This study aimed to broaden understandings of professional identity formation cross-culturally. In fall 2014, the authors purposively sampled 22 clinical students from Taiwan and the Netherlands and asked them to keep audio diaries, narrating emotional experiences during clerkships using three prompts: What happened? What did you feel/think/do? How does this interplay with your development as a doctor? Dutch audio diaries were supplemented with follow-up interviews. The authors analyzed participants' narratives using a critical discourse analysis informed by Figured Worlds theory and Bakhtin's concept of dialogism, according to which people's spoken words create identities in imagined future worlds. Participants talked vividly, but differently, about their experiences. Dutch participants' emotions related to individual achievement and competence. Taiwanese participants' rich, emotional language reflected on becoming both a good person and a good doctor. These discourses constructed doctors' and patients' autonomy in culturally specific ways. The Dutch construct centered on "hands-on" participation, which developed the identity of a technically skilled doctor, but did not address patients' self-determination. The Taiwanese construct located physicians' autonomy within moral values more than practical proficiency, and gave patients agency to influence doctor-patient relationships. Participants' cultural constructs of physician and patient autonomy led them to construct different professional identities within different imagined worlds. The contrasting discourses show how medical students learn about different meanings of becoming doctors in culturally specific contexts.

The Dual Role of NFL Team Doctors.

PubMed

Washington, Marvin

2016-11-01

Glenn Cohen, Holly Fernandez Lynch, and Christopher Deubert are right in their article "A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust" that the problem with the medical care rendered to National Football League players is not that the doctors are bad, but that the system in which they provide care is structured badly. We saw some of the problems this system causes last season in what happened to Case Kenum, a quarterback for the Los Angeles Rams who, despite having a possible concussion from a game injury, was allowed to continue to play, with a concussion spotter in the booth and coaches, teammates, seven game officials, and two full training staffs present. From my experience playing in the league from 1989 to 1999, I do not believe that you can eliminate the conflict of interest completely, but I think it can be limited to the point that it does not harm the player. As the structure is now, with the team paying the club doctor, it is impossible to put the players' health and well-being before the team's on-field priorities. © 2016 The Hastings Center.

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

PubMed

Streit, Sven; Baumann, Philippe; Barth, Jürgen; Mattle, Heinrich P; Arnold, Marcel; Bassetti, Claudio L; Meli, Damian N; Fischer, Urs

2015-01-01

Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

A practical approach to Events Medicine provision.

PubMed

Smith, Susan P; Cosgrove, Joseph F; Driscoll, Peter J; Smith, Andrew; Butler, John; Goode, Peter; Waldmann, Carl; Vallis, Christopher J; Topham, Fiona; Mythen, Michael Monty

2017-08-01

In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France ( Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest , medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Conduct of Occupational Health During Major Disasters: A Comparison of Literature on Occupational Health Issues in the World Trade Center Terrorist Attack and the Fukushima Nuclear Power Plant Accident.

PubMed

Toyoda, Hiroyuki; Mori, Koji

2017-01-01

Workers who respond to large-scale disasters can be exposed to health hazards that do not exist in routine work. It is assumed that learning from past cases is effective for preparing for and responding to such problems, but published information is still insufficient. Accordingly, we conducted a literature review about the health issues and occupational health activities at the World Trade Center (WTC) terrorist attack and at the Fukushima Nuclear Power Plant accident to investigate how occupational health activities during disasters should be conducted. Seven studies about the WTC attack were extracted and categorized into the following topics: "in relation to emergency systems including occupational health management"; "in relation to improvement and prevention of health effects and occupational hygiene"; and "in relation to care systems aimed at mitigating health effects." Studies about the Fukushima Nuclear Power Plant accident have been used in a previous review. We conclude that, to prevent health effects in workers who respond to large-scale disasters, it is necessary to incorporate occupational health regulations into the national response plan, and to develop practical support functions that enable support to continue for an extended period, training systems for workers with opportunities to report accidents, and care systems to mitigate the health effects.

[Consideration of national policies to support the development of medical services for dementia].

PubMed

Awata, Shuichi

2014-01-01

To consider national policies to support the development of medical services for dementia, we conducted three studies. Study 1: We evaluated the dementia management capacity of clinics using a questionnaire on medical services for dementia 1) Clinics that employed doctors who had attended a lecture on dementia management had a superior capacity to provide primary care services, make diagnoses, manage behavioral and psychological symptoms of dementia (BPSD), provide home healthcare for dementia, and promote community integration compared to clinics that did not employ such doctors. 2)Clinics that employed"dementia support doctors"had a superior capacity to provide such dementia management as mentioned above compared to clinics employing doctors who had attended a lecture on dementia management. However, 3) the questionnaire data suggested that only some clinics that employed "dementia support doctors" could provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in their regular clinical practice. Study 2: We evaluated the current activities of Medical Centers for Dementia (MCDs). 1) MCDs had more efficient activities in general compared to Dementia Centers for the Elderly (DCEs) established in 1989 and suspended in 2007. However, there was a large disparity among the facilities in terms of their activities. 2) Many MCDs thought that they could not provide adequate services due to the size of their catchment area. 3) Emergency services for dementia patients with concurrent medical conditions were supported by staff of many MCDs located in general hospitals without the designation of a special MCD for providing emergency services. 4) Inpatient stays tended to be longer in psychiatric hospitals where MCDs were located. Study 3: We conducted a preliminary investigation on activities in possible "dementia support clinics". These clinics had an inferior capacity to provide inpatient services but a similar capacity to make diagnoses, provide management of BPSD, and promote community integration compared to MCDs. From these findings, we made recommendations as follows: (1) It is necessary to not only increase the number of "dementia support doctors", but also to develop adequate numbers of "dementia support clinics" that provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in cooperation with community general support centers in regular clinical practice. (2) It is necessary to monitor the level of activities and develop adequate numbers of MCDs based on the size of the area and population. MCDs should take part in establishing community-based, integrated care systems in cooperation with the local government. Equipping "dementia support teams" might be indispensable in general hospitals that provide emergency medical services for dementia patients. (3) It would be significant to arrange "dementia support clinics" as a medical resource to make diagnoses, provide management of BPSD, and promote community integration for dementia in local dementia planning by a municipality.

Model Deformation and Optical Angle of Attack Measurement System in the NASA Ames Unitary Plan Wind Tunnel

NASA Technical Reports Server (NTRS)

Kushner, Laura K.; Drain, Bethany A.; Schairer, Edward T.; Heineck, James T.; Bell, James H.

2017-01-01

Both AoA and MDM measurements can be made using an optical system that relies on photogrammetry. Optical measurements are being requested by customers in wind tunnels with increasing frequency due to their non-intrusive nature and recent hardware and software advances that allow measurements to become near real time. The NASA Ames Research Center Unitary Plan Wind Tunnel is currently developing a system based on photogrammetry to measure model deformation and model angle of attack. This paper describes the new system, its development, its use on recent tests and plans to further develop the system.

Home and Clinical Cardiovascular Care Center (H4C): a Framework for Integrating Body Sensor Networks and QTRU Cryptography System.

PubMed

Zakerolhosseini, Ali; Sokouti, Massoud; Pezeshkian, Massoud

2013-01-01

Quick responds to heart attack patients before arriving to hospital is a very important factor. In this paper, a combined model of Body Sensor Network and Personal Digital Access using QTRU cipher algorithm in Wifi networks is presented to efficiently overcome these life threatening attacks. The algorithm for optimizing the routing paths between sensor nodes and an algorithm for reducing the power consumption are also applied for achieving the best performance by this model. This system is consumes low power and has encrypting and decrypting processes. It also has an efficient routing path in a fast manner.

Flowfield computations over the Space Shuttle Orbiter with a proposed canard at a Mach number of 5.8 and 50 degrees angle of attack

NASA Technical Reports Server (NTRS)

Reuter, William H.; Buning, Pieter G.; Hobson, Garth V.

1993-01-01

An effective control canard design to provide enhanced controllability throughout the flight regime is described which uses a 3D, Navier-Stokes computational solution. The use of canard by the Space Shuttle Orbiter in both hypersonic and subsonic flight regimes can enhance its usefullness by expanding its payload carrying capability and improving its static stability. The canard produces an additional nose-up pitching moment to relax center-of-gravity constraint and alleviates the need for large, lift-destroying elevon deflections required to maintain the high angles of attack for effective hypersonic flight.

The World Trade Center Attack: Similarities to the 1988 earthquake in Armenia: time to teach the public life-supporting first aid?

PubMed Central

Crippen, David

2001-01-01

On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation equipment. This article makes the case for teaching life-supporting first aid to the public in the hope that one day, should another such incident occur, they would be able to preserve injured victims until formal rescue occurs. PMID:11737915

Home and Clinical Cardiovascular Care Center (H4C): a Framework for Integrating Body Sensor Networks and QTRU Cryptography System

PubMed Central

Zakerolhosseini, Ali; Sokouti, Massoud; Pezeshkian, Massoud

2013-01-01

Quick responds to heart attack patients before arriving to hospital is a very important factor. In this paper, a combined model of Body Sensor Network and Personal Digital Access using QTRU cipher algorithm in Wifi networks is presented to efficiently overcome these life threatening attacks. The algorithm for optimizing the routing paths between sensor nodes and an algorithm for reducing the power consumption are also applied for achieving the best performance by this model. This system is consumes low power and has encrypting and decrypting processes. It also has an efficient routing path in a fast manner. PMID:24252988

Crisis Management Research Summaries

ERIC Educational Resources Information Center

Brock, Stephen E., Ed.; Zhe, Elizabeth; Torem, Chris; Comeaux, Natashia; Dempsey, Allison

2010-01-01

This article presents a summary of recent crisis management publications. The first research report summarized, "Predictors of PTSD," was a study of predictor variables for responses to the World Trade Center attack. The second paper, "Effective Mental Health Response to Catastrophic Events," looked at effective responses following Hurricane…

PHYSICAL CHARACTERISTICS AND HEALTH EFFECTS OF AEROSOLS FROM COLLAPSED BUILDINGS

EPA Science Inventory

Airborne pollutants can rise to extreme levels when large buildings fall down. The terrorist attack on New York's World Trade Center (WTC) towers caused the release of an enormous quantity of pulverized building materials and combustion products into the local environment. Partic...

THE ESTABLISHMENT OF LABORATORY GUIDELINES FOR ANALYSIS OF BIOTERRORISM SAMPLES

EPA Science Inventory

After the attack on the World Trade Center on September 11, 2002, and the subsequent deaths associated with Bacillus anthracis spore contaminated mail, a worldwide need was apparent for increased laboratory capacity to safely analyze bioterrorism samples. The U.S. Department of ...

Managing pedestrians during evacuations of metropolitan areas.

DOT National Transportation Integrated Search

2007-03-01

The September 11(or 9/11), 2001, attacks on the high-profile workplaces of the World Trade Center (WTC) in New York City and the Pentagon in : the Washington, D.C. area, made real the impact of an unexpected, or no-notice, event in a metropolit...

Memorial Image Taken on Mars on Sept. 11, 2011

NASA Image and Video Library

2011-09-12

This view from NASA rover Opportunity, of an American flag on metal recovered from the site of the World Trade Center towers shortly after their destruction, was taken on Mars on Sept. 11, 2011, the 10th anniversary of the attacks on the towers.

Ballistic Range Testing of the Mars Exploration Rover Entry Capsule

NASA Technical Reports Server (NTRS)

Schoenenberger, Mark; Hathaway, Wayne; Yates, Leslie; Desai, Prasun

2005-01-01

Results from a 25 shot ballistic range test of the Mars Exploration Rover (MER) aeroshell are presented. The supersonic pitch damping properties of the MER capsule were characterized between Mach = 1.5 and Mach = 3.5 and total angles-of-attack from 0 degrees to greater than 25 degrees. Three capsule center-of-gravity positions were tested across this range of conditions, 0.27, 0.30 and 0.33 body diameters aft of the nose. Parameter identification results show that the capsule is dynamically unstable at low angles-of-attack across the Mach numbers tested, with instability increasing with lower speeds. This dynamic instability was seen to increase with aft center-of-gravity movement. The MER outer mold line was very similar to the successful Mars Pathfinder capsule with only minor modifications. Pathfinder relied on Viking forced oscillation data for preflight predictions. The pitch damping data calculated from this test program are shown to more accurately reproduce the measured Path finder flight data.

Elements of resilience after the World Trade Center disaster: reconstituting New York City's Emergency Operations Centre.

PubMed

Kendra, James M; Wachtendorf, Tricia

2003-03-01

In this paper we examine the reconstitution of the Emergency Operations Centre (EOC) after its destruction in the World Trade Center attack, using that event to highlight several features of resilience. The paper summarises basic EOC functions, and then presents conceptions of resilience as understood from several disciplinary perspectives, noting that work in these fields has sought to understand how a natural or social system that experiences disturbance sustains its functional processes. We observe that, although the physical EOC facility was destroyed, the organisation that had been established to manage crises in New York City continued, enabling a response that drew on the resources of New York City and neighbouring communities, states and the federal government. Availability of resources--which substituted for redundancy of personnel, equipment and space--pre-existing relationships that eased communication challenges as the emergency developed and the continuation of organisational patterns of response integration and role assignments were among the factors that contributed to resilience following the attack.

Cancellation control law for lateral-directional dynamics of a supermaneuverable aircraft

NASA Technical Reports Server (NTRS)

Snell, Antony

1993-01-01

Cancellation control laws are designed which reduce the high levels of lateral acceleration encountered during aggressive rolling maneuvers executed at high angle of attack. Two independent problem are examined. One is to reduce lateral acceleration at the mass center, while the other focuses on lateral acceleration at the pilot's station, located 7.0 m forward of the mass center. Both of these problems are challenging and somewhat different in their limitations. In each case the design is based on a linearization of the lateral-directional dynamics about a high angle of attack condition. The controllers incorporate dynamic inversion inner loops to provide control of stability-axis roll- and yaw-rates and then employ cancellation filters in both feed-forward and feed-back signal paths. The relative simplicity of the control laws should allow nonlinear generalizations to be devised. Although it is shown that lateral acceleration can be reduced substantially by such control laws, this is at the cost of slowed roll response, poor dutch-roll damping or a combination of the two.

Flight investigation of the effect of tail configuration on stall, spin, and recovery characteristics of a low-wing general aviation research airplane

NASA Technical Reports Server (NTRS)

Stough, H. Paul, III; Patton, James M., Jr.; Sliwa, Steven M.

1987-01-01

Flight tests were performed to investigate the stall, spin, and recovery characteristics of a low-wing, single-engine, light airplane with four interchangeable tail configurations. The four tail configurations were evaluated for effects of varying mass distribution, center-of-gravity position, and control inputs. The airplane tended to roll-off at the stall. Variations in tail configuration produced spins ranging from 40 deg to 60 deg angle of attack and turn rates of about 145 to 208 deg/sec. Some unrecoverable flat spins were encountered which required use of the airplane spin chute for recovery. For recoverable spins, antispin rudder followed by forward wheel with ailerons centered provided the quickest spin recovery. The moderate spin modes agreed very well with those predicted from spin-tunnel model tests, however, the flat spin was at a lower angle of attack and a slower rotation rate than indicated by the model tests.

The design, fate and impact of a hospital-wide training program in evidence-based medicine for physicians - an observational study.

PubMed

Thor, Johan; Olsson, Daniel; Nordenström, Jörgen

2016-03-08

Many doctors fail to practice Evidence-Based Medicine (EBM) effectively, in part due to insufficient training. We report on the design, fate and impact of a short learner-centered EBM train-the-trainer program aimed at all 2400 doctors at the Karolinska University Hospital in Sweden on the heels of a tumultuous merger, focusing particularly on whether it affected the doctors' knowledge, attitudes and skills regarding EBM. We used a validated EBM instrument in a before-and-after design to assess the impact of the training. Changes in responses were analyzed at the individual level using the Wilcoxon matched pairs test. We also reviewed documentation from the program - including the modular EBM training schedule and the template for participants' Critically Appraised Topic reports - to describe the training's content, design, conduct, and fate. The training, designed to be delivered in modules of 45 min totaling 1.5 days, failed to reach most doctors at the hospital, due to cost cutting pressures and competing demands. Among study participants (n = 174), many reported suboptimal EBM knowledge and skills before the training. Respondents' strategies for solving clinical problems changed after the training: the proportion of respondents reporting to use (or intend to use) secondary sources "Often/very often" changed from 5 % before the training to 76 % after the training; in parallel, reliance on textbooks and on colleagues fell (48 to 23 % and 79 to 65 %, respectively). Participants' confidence in assessing scientific articles increased and their attitudes toward EBM became more positive. The proportion of correct answers in the EBM knowledge test increased from 52 to 71 %. All these changes were statistically significant at p < 0.05. Many study participants, despite working at a university hospital, lacked basic EBM knowledge and skills and used the scientific literature suboptimally. The kind of short learner-centered EBM training evaluated here brought significant improvements among the minority of hospital doctors who were able to participate and, if applied widely, could contribute to better, safer and more cost-effective care.

CCR scientists tease out mechanisms of immune cell communication | Center for Cancer Research

Cancer.gov

Researchers from the Cancer and Inflammation Program at the Center for Cancer Research and the Ben-Gurion University of the Negev in Israel have discovered that the simple processes of molecular diffusion and absorption control the spread of cytokines through dense body tissues. The simple control mechanisms enable the immune response to tailor itself to the nature and severity of a pathogenic attack and to prevent dangerous autoimmune reactions.  Read more...

The IDF: Tactical Success - Strategic Failure, SOD, the Second Intifada and Beyond

DTIC Science & Technology

2011-05-19

the time periods in between. Additionally, Robert St. John’s biography Ben Gurion presented an interesting and useful account of one of Israel’s...Schiff, A History of the Israeli Army, 2. 9 Ibid., 4. 10 Robert St. John, Ben Gurion: The Biography of an Extraordinary Man (New York: Doubleday...Jewish settlements and Jews in Palestine’s population centers. The 1929 Arab Revolt centered on Jerusalem and consisted of Arab attacks against

Letting the story unfold: a case study of client-centered therapy for childhood traumatic grief.

PubMed

Goodman, Robin F; Morgan, Alison V; Juriga, Sandra; Brown, Elissa J

2004-01-01

There has been increasing interest in the newly identified condition of childhood traumatic grief (CTG) since the 2001 attack on the World Trade Center. The case presented here is one of an adolescent girl who was diagnosed with CTG following the death of her father, a firefighter killed in the line of duty on September 11, 2001. Literature on CTG, its treatment, and adolescent development will be discussed. The application of client-centered treatment to CTG will be highlighted by the case description and diagnostic findings prior to, during, and following treatment.

A big alligator snacks on a smaller alligator

NASA Technical Reports Server (NTRS)

1998-01-01

A large alligator attacks and eats a smaller one in a natural display of cannibalism. Although this event has been observed infrequently by Kennedy Space Center's staff photographers, it is common feeding behavior among the wild alligator population on the space center. Alligators are carnivorous and will eat any living thing that crosses their paths and is small enough for them to kill. For this reason, it is dangerous to feed wild alligators, and in Florida, it is also illegal. Kennedy Space Center is located on the Merritt Island National Wildlife Refuge which is operated by the U.S. Fish and Wildlife Service.

In-flight leading-edge extension vortex flow-field survey measurements on a F-18 aircraft at high angle of attack

NASA Technical Reports Server (NTRS)

Richwine, David M.; Fisher, David F.

1992-01-01

Flow-field measurements on the leading-edge extension (LEX) of the F-18 High Alpha Research Vehicle (HARV) were obtained using a rotating rake with 16 hemispherical-tipped five-hole probes. Detailed pressure, velocity, and flow direction data were obtained through the LEX vortex core. Data were gathered during 1-g quasi-stabilized flight conditions at angles of attack alpha from 10 degrees to 52 degrees and at Reynolds numbers based on mean aerodynamic cord up to 16 x 10(exp 6). Normalized dynamic pressures and crossflow velocities clearly showed the primary vortex above the LEX and formation of a secondary vortex at higher angles of attack. The vortex was characterized by a ring of high dynamic pressure surrounding a region of low dynamic pressure at the vortex core center. The vortex core, subcore diameter, and vertical location of the core above the LEX increased with angle of attack. Minimum values for static pressure were obtained in the vortex subcore and decreased nearly linearly with increasing angle of attack until vortex breakdown. Rake-measured static pressures were consistent with previously documented surface pressures and showed good agreement with flow visualization flight test results. Comparison of the LEX vortex flight test data to computational solutions at alpha approximately equals 19 degrees and 30 degrees showed fair correlation.

On cognitive debiasing and the judgment of suicide-attackers.

PubMed

Bou Khalil, R; Richa, S

2018-03-23

Suicide-attacks are possibly increasing in frequency all over the world. To date, these attacks are not considered as a manifestation of a particular mental illness. However, the process of radicalization of suicide-attackers has to interest the field of mental health. One plausible explanation for the radicalization of individuals is the use of biased cognitive schemes by the indoctrinator. Among these cognitive schemes could figure the causal attribution bias in which the subject cannot distinguish in front of two factors that operate simultaneously, the share of each factor in achieving a certain goal. Another cognitive bias would be the confirmation bias during which the subject would tend to adhere to ideas from his/her own thinking or the thinking of subjects who share some cultural values with him/her and refute any other ideas. Finally, the bias of polarization or splitting could also be incriminated. Through this bias, the subject would either be proud of being a member of a cultural group or ashamed when he/she feels that this group is being attacked and that he/she is unable to rescue it. Approaches to increase the awareness of individuals to the adverse effects of these biased cognitive schemes may theoretically reduce the risk of committing suicide-attacks. However, despite numerous attempts of "deradicalization" involving technological means of communication as well as social "reintegration" centers, all approaches aiming at raising awareness of cognitive biases need to be studied in a scientific manner before they become widespread. Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Studies of the vicarious traumatization of college students by the September 11th attacks: effects of proximity, exposure and connectedness.

PubMed

Blanchard, Edward B; Kuhn, Eric; Rowell, Dianna L; Hickling, Edward J; Wittrock, David; Rogers, Rebecca L; Johnson, Michelle R; Steckler, Debra C

2004-02-01

From mid-October 2001 through the end of November 2001, we collected fairly large sets of questionnaires from undergraduates at three public universities (Albany, NY, n = 507, Augusta, GA, n = 336, Fargo, ND, n = 526 ) to assess rate of acute stress disorder (ASD) and level of ASD symptoms following the September 11th attacks, rate of current posttraumatic stress disorder (PTSD) and level of PTSD symptoms, and current level of depressive symptoms resulting from the September 11th attacks. We also gathered information on exposure to media coverage of the attacks, connectedness to the World Trade Center (WTC) and personnel there, and degree of engagement in reparative acts such as giving blood, attending vigils. We found higher levels of ASD, ASD symptoms, PTSD and PTSD symptoms as a function of geographical proximity to New York City (and within the Albany site, proximity of students' homes) and gender. Exposure (hours of TV watched) was a predictor in some instances as was connectedness to WTC victims. ASD symptoms were the strongest predictor of subsequent PTSD symptoms. Path models accounted for over 60% of the variance in PTSD symptoms.

Network traffic anomaly prediction using Artificial Neural Network

NASA Astrophysics Data System (ADS)

Ciptaningtyas, Hening Titi; Fatichah, Chastine; Sabila, Altea

2017-03-01

As the excessive increase of internet usage, the malicious software (malware) has also increase significantly. Malware is software developed by hacker for illegal purpose(s), such as stealing data and identity, causing computer damage, or denying service to other user[1]. Malware which attack computer or server often triggers network traffic anomaly phenomena. Based on Sophos's report[2], Indonesia is the riskiest country of malware attack and it also has high network traffic anomaly. This research uses Artificial Neural Network (ANN) to predict network traffic anomaly based on malware attack in Indonesia which is recorded by Id-SIRTII/CC (Indonesia Security Incident Response Team on Internet Infrastructure/Coordination Center). The case study is the highest malware attack (SQL injection) which has happened in three consecutive years: 2012, 2013, and 2014[4]. The data series is preprocessed first, then the network traffic anomaly is predicted using Artificial Neural Network and using two weight update algorithms: Gradient Descent and Momentum. Error of prediction is calculated using Mean Squared Error (MSE) [7]. The experimental result shows that MSE for SQL Injection is 0.03856. So, this approach can be used to predict network traffic anomaly.

Protein Crystal Quality Studies

NASA Technical Reports Server (NTRS)

1998-01-01

Eddie Snell (standing), Post-Doctoral Fellow the National Research Council (NRC),and Marc Pusey of Marshall Space Flight Center (MSFC) use a reciprocal space mapping diffractometer for marcromolecular crystal quality studies. The diffractometer is used in mapping the structure of marcromolecules such as proteins to determine their structure and thus understand how they function with other proteins in the body. This is one of several analytical tools used on proteins crystalized on Earth and in space experiments. Photo credit: NASA/Marshall Space Flight Center (MSFC)

LEACHING BOUNDARY MOVEMENT IN SOLIDIFIED/STABILIZED WASTE FORMS

EPA Science Inventory

Investigation of the leaching of cement-based waste forms in acetic acid solutions found that acids attacked the waste form from the surface toward the center. A sharp leaching boundary was identified in every leached sample, using pH color indica- tors. The movement of the leach...

Redefining Attack: Taking the Offensive Against Networks

DTIC Science & Technology

2003-03-01

for his insight, inspiration, and thought provoking discussion that stretched the limits of our imaginations. The thesis all began with owls, mice ......order of battle for these elusive networks is hidden from view. There are few tanks to count, barracks and command centers to reconnoiter or industrial