Sample Return Propulsion Technology Development Under NASA's ISPT Project

NASA Technical Reports Server (NTRS)

Anderson, David J.; Dankanich, John; Hahne, David; Pencil, Eric; Peterson, Todd; Munk, Michelle M.

2011-01-01

Abstract In 2009, the In-Space Propulsion Technology (ISPT) program was tasked to start development of propulsion technologies that would enable future sample return missions. Sample return missions can be quite varied, from collecting and bringing back samples of comets or asteroids, to soil, rocks, or atmosphere from planets or moons. As a result, ISPT s propulsion technology development needs are also broad, and include: 1) Sample Return Propulsion (SRP), 2) Planetary Ascent Vehicles (PAV), 3) Multi-mission technologies for Earth Entry Vehicles (MMEEV), and 4) Systems/mission analysis and tools that focuses on sample return propulsion. The SRP area includes electric propulsion for sample return and low cost Discovery-class missions, and propulsion systems for Earth Return Vehicles (ERV) including transfer stages to the destination. Initially the SRP effort will transition ongoing work on a High-Voltage Hall Accelerator (HIVHAC) thruster into developing a full HIVHAC system. SRP will also leverage recent lightweight propellant-tanks advancements and develop flight-qualified propellant tanks with direct applicability to the Mars Sample Return (MSR) mission and with general applicability to all future planetary spacecraft. ISPT s previous aerocapture efforts will merge with earlier Earth Entry Vehicles developments to form the starting point for the MMEEV effort. The first task under the Planetary Ascent Vehicles (PAV) effort is the development of a Mars Ascent Vehicle (MAV). The new MAV effort will leverage past MAV analysis and technology developments from the Mars Technology Program (MTP) and previous MSR studies. This paper will describe the state of ISPT project s propulsion technology development for future sample return missions.12

Managing patients with dengue fever during an epidemic: the importance of a hydration tent and of a multidisciplinary approach

PubMed Central

2011-01-01

Background Dengue fever is one of the most common tropical diseases worldwide. Early detection of the disease, followed by intravenous fluid therapy in patients with dengue hemorrhagic fever (DHF) or with warning signs of dengue has a major impact on the prognosis. The purpose of this study is to describe the care provided in a hydration tent, including early detection, treatment, and serial follow-up of patients with dengue fever. Findings The analysis included all patients treated in the hydration tent from April 8 to May 9, 2008. The tent was set up inside the premises of the 2nd Military Firemen Group, located in Meier, a neighborhood in Rio de Janeiro, Brazil. The case form data were stored in a computerized database for subsequent assessment. Patients were referred to the tent from primary care units and from secondary city and state hospitals. The routine procedure consisted of an initial screening including vital signs (temperature, blood pressure, heart rate, and respiratory rate), tourniquet test and blood sampling for complete blood count. Over a 31-day period, 3,393 case recordings were seen at the hydration tent. The mean was 109 patients per day. A total of 2,102 initial visits and 1,291 return visits were conducted. Of the patients who returned to the hydration tent for reevaluation, 850 returned once, 230 returned twice, 114 returned three times, and 97 returned four times or more. Overall, 93 (5.3%) patients with DHF seen at the tent were transferred to a tertiary hospital. There were no deaths among these patients. Discussion As the epidemics were already widespread and there were no technical conditions for routine serology, all cases of suspected dengue fever were treated as such. Implementing hydration tents decrease the number of dengue fever hospitalizations. PMID:21902823

Return to Rugby After Brain Concussion: A Prospective Study in 35 High Level Rugby Players

PubMed Central

Chermann, Jean Francois; Klouche, Shahnaz; Savigny, Alexis; Lefevre, Nicolas; Herman, Serge; Bohu, Yoann

2014-01-01

Background: Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. Objectives: Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. Patients and Methods: A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 ± 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. Results: Thirty-three patients returned to rugby after a mean 22.1 ± 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. Conclusions: This prospective study validated the study protocol for the management of concussion in rugby players. PMID:25741414

Characteristics of the most intense lightning storm ever recorded at the CN Tower

NASA Astrophysics Data System (ADS)

Hussein, A. M.; Kazazi, S.; Anwar, M.; Yusouf, M.; Liatos, P.

2017-02-01

Lightning strikes to the CN Tower have been optically observed since 1978. In 1990, five independent systems started to operate to simultaneously record parameters of lightning strikes to the tower, including the time derivative of the current, the associated electric and magnetic fields, and the channel optical characteristics. On August 24, 2011, during an unusually severe lightning storm, video records showed that the CN Tower was struck with 52 lightning flashes within 84 min and 6.9 s. Thus, this storm produced, on average, a flash to the tower every 99 s. However, the CN Tower lightning current derivative measurement system only recorded 32 flashes, which were perfectly time-matched with 32 of the 52 video-recorded flashes. It is found that the current derivative measurement system recorded every video-recorded flash that contained at least one return stroke. Based on the analysis of video records, it is noted that each of the storm's 52 flashes contains an initial-stage current, proving that all flashes were upward initiated. This unique CN Tower storm - the most intense ever recorded at the tower - is here thoroughly analyzed, based on video and current records. The inter-flash time within the storm is found to vary between 10.6 s and 274 s, with an overall average of 98 s. It is also found that the inter-flash time between successive non-return-stroke flashes is on average 64% longer than that for successive flashes containing return strokes. Statistical analysis of video and current data clearly reveals that the time duration of flashes containing initial-stage currents and return strokes is on average 27% longer than that of flashes that only have initial-stage currents. Furthermore, it is important to note that the time duration of the initial-stage current in flashes containing no return strokes is on average 76% longer than that in flashes containing return strokes. Therefore, it is possible to conclude that if the time duration of the initial-stage current in a flash is long enough, resulting in large charge transfer, then there is less probability of having return strokes following it. The 32 current-recorded flashes contain a total of 156 return strokes, with an average multiplicity of 4.875. It is worth mentioning that during one decade, 1992-2001, the CN Tower current derivative measurement system only recorded 478 return strokes, demonstrating that the number of return strokes recorded at the tower within about 84 min is close to one third of those recorded at the tower during one decade. This finding clearly shows the great value and rarity of the presented extensive lightning current derivative data. Only one of the 32 current-recorded flashes is proved to be positive with a single return stroke. Based on current records, out of a total of 124 inter-stroke time intervals, 94% are found to be within 200 ms, with an overall inter-stroke time average of 68.1 ms. The maximum inter-stroke time recorded during this storm is 726.3 ms, the longest ever recorded at the CN Tower.

[Return to sport after surgical treatment of a posterior cruciate ligament injury : A retrospective study of 60 patients].

PubMed

Ahrend, M; Ateschrang, A; Döbele, S; Stöckle, U; Grünwald, L; Schröter, S; Ihle, C

2016-12-01

Injuries of the posterior cruciate ligament (PCL) lead to an initial reduction of sporting activity. However, in previous studies, return to sport after operative treatment of PCL injuries has been analysed insufficiently. The aim of this study was (1) to determine the rate of return to sport in physically active patients, (2) to analyse possible changes in sporting activities and (3) to examine the influence of the severity of the initial injury. Within a retrospective clinical and radiological follow-up at least 24 months after surgery (80.3 ± 28.2 months), 60 patients (44.8 ± 12.1 years) with surgically treated isolated or combined PCL injuries were included in the study. Pre-accidental and post-operative sporting activities were queried and compared in a standardised questionnaire. Possible differences with respect to the initial injury severity (Cooper classification) were examined. The return-to-sport rate of the physically active patients was 87.0 %. 17.6 % of patients with a combined PCL injury and 4.8 % of patients with isolated PCL injury were not able to return to sport. Significant reductions in the frequency of exercise (p = 0.0087), the duration of exercise (p = 0.0003) and the amount of regularly performed sports (p < 0.0001) were found. A change from high-impact sports to low-impact sports was noted. Patients with operatively treated PCL injuries can return to sport. However, for competitive athletes an injury to the PCL can lead to the end of their career. A reduction of sporting activities and a change from high-impact sports to low-impact sports can be expected. A persisting inability to return to sporting activities in patients with isolated PCL injuries cannot be assumed.

Why does negative CG lightning have subsequent return strokes?

NASA Astrophysics Data System (ADS)

Wilkes, R. A.; Kotovsky, D. A.; Uman, M. A.; Carvalho, F. L.; Jordan, D.

2017-12-01

It is not understood why cloud-to-ground (CG) lightning flashes lowering negative charge often produce discrete dart-leader/return-stroke sequences rather than having the first stroke drain the available cloud charge, as is almost always the case for CG lightning lowering positive charge. Triggered lightning data obtained at the International Center for Lightning Research and Testing (ICLRT) in north-central Florida have been analyzed to clarify the subsequent return-stroke process. In summers 2013 through 2016 at the ICLRT, 53% of the rocket launches did not initiate any part of a lightning flash, 13% of the rocket launches created an initial stage only (ISO) and failed to produce a following dart-leader/return-stroke sequences, and 34% of rocket launches produced an initial stage (IS) followed by return strokes. The IS of the triggered lightning consists of the upward positive leader and a following initial continuing current, both being responsible for transporting negative charge from the cloud to ground. Our ISO events may well have some commonality with the roughly 20 percent of natural CG flashes that fail to produce a dart-leader/return-stroke. We have analyzed the IS of 41 triggered lightning flashes with (19 cases) and without (22 cases) following return strokes and compared areas and heights of the flash using data collected by a Lightning Mapping Array (LMA). In our preliminary analysis, we can find no geometrical feature of the lightning channel during the IS that will predict the occurrence or lack of occurrence of following return strokes. We also have compared the triggered-lightning electrical current and charge transfer observed at the ground. We found that the average current, duration, and charge transfer during the IS for ISO events is each about half that of ISs analyzed which are followed by dart-leader/return-stroke sequences, contrary to the results presented from the GCOELD in China. Summarizing, there appear to be no differences in the channel geometry between initial stages that do or do not yield dart-leader/return-stroke sequences. In contrast, we find that particular electrical characteristics of the initial stage may indicate whether or not a dart-leader/return-stroke sequence may follow, potentially shedding light on the physical processes necessary for dart-leader initiation.

Sheep laterality.

PubMed

Anderson, Dean M; Murray, Leigh W

2013-01-01

Turning preferences among 309 white-faced ewes were individually evaluated in an enclosed, artificially lit T-maze, followed by each ewe choosing either a right or left return alley to return to peers. Data recorded included time in the start box, time in the T-maze, exit arm chosen to leave the T-maze, and return alley. Right and left arms of the T-maze were chosen 65.7% and 34.3% of the time, respectively, while right and left return alleys were chosen 32.4% and 67.6%, respectively. Exit arm and return alley were not independently chosen (p <.0001), with observed counts being higher than expected under independence when ewes made the same choice for exit and alley (RR or LL turn patterns) and being lower than expected for alternating choices (RL or LR). Out of the 309 ewes, 28.2% and 30.1% chose RR and LL turn patterns, respectively, while 37.5% chose the RL turn pattern, but only 13 (4.2%) chose the LR turning pattern. Overall, ewes that initially turned right when presented a second turning opportunity had a slight preference to alternate their turning direction, while ewes that initially turned left tended to continue turning left when given another chance to turn. Exit arm and return alley laterality was not related (α =.05) to time of day the test was administered, ewe's age or genetics, most recent liveweight, or most recent shorn fleece weight. The mean time spent in the start box (21 s) was not related to exit arm (p =.947) or return alley (p =.779). Mean time (15 s) spent in the T-maze was not related to exit arm (p =.086) or return alley (p =.952). More research will be required to understand sheep turning laterality and how it can impact working facilities and research equipment.

Satellite services system analysis study. Volume 3: Service equipment requirements

NASA Technical Reports Server (NTRS)

1981-01-01

Service equipment mission requirements are discussed. On-orbit operations, satellite classes, and reference missions are included. Service equipment usage and requirements are considered. Equipment identification methodology is discussed. Service equipment usage is analyzed, including initial launch, revisit, Earth return, and orbital storage. A summary of service requirements and equipment is presented, including service equipment status, even interaction, satellite features, and observations.

X-Ray Computed Tomography: The First Step in Mars Sample Return Processing

NASA Technical Reports Server (NTRS)

Welzenbach, L. C.; Fries, M. D.; Grady, M. M.; Greenwood, R. C.; McCubbin, F. M.; Zeigler, R. A.; Smith, C. L.; Steele, A.

2017-01-01

The Mars 2020 rover mission will collect and cache samples from the martian surface for possible retrieval and subsequent return to Earth. If the samples are returned, that mission would likely present an opportunity to analyze returned Mars samples within a geologic context on Mars. In addition, it may provide definitive information about the existence of past or present life on Mars. Mars sample return presents unique challenges for the collection, containment, transport, curation and processing of samples [1] Foremost in the processing of returned samples are the closely paired considerations of life detection and Planetary Protection. In order to achieve Mars Sample Return (MSR) science goals, reliable analyses will depend on overcoming some challenging signal/noise-related issues where sparse martian organic compounds must be reliably analyzed against the contamination background. While reliable analyses will depend on initial clean acquisition and robust documentation of all aspects of developing and managing the cache [2], there needs to be a reliable sample handling and analysis procedure that accounts for a variety of materials which may or may not contain evidence of past or present martian life. A recent report [3] suggests that a defined set of measurements should be made to effectively inform both science and Planetary Protection, when applied in the context of the two competing null hypotheses: 1) that there is no detectable life in the samples; or 2) that there is martian life in the samples. The defined measurements would include a phased approach that would be accepted by the community to preserve the bulk of the material, but provide unambiguous science data that can be used and interpreted by various disciplines. Fore-most is the concern that the initial steps would ensure the pristine nature of the samples. Preliminary, non-invasive techniques such as computed X-ray tomography (XCT) have been suggested as the first method to interrogate and characterize the cached samples without altering the materials [1,2]. A recent report [4] indicates that XCT may minimally alter samples for some techniques, and work is needed to quantify these effects, maximizing science return from XCT initial analysis while minimizing effects.

Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion.

PubMed

Stone, Sarah; Lee, Bobby; Garrison, J Craig; Blueitt, Damond; Creed, Kalyssa

2016-10-03

Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC. After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes. Retrospective cohort study. Level 3. A total of 579 participants (365 males [mean age, 15.0 ± 1.7 years], 214 females [mean age, 15.2 ± 1.5 years]), including middle school, high school, and collegiate athletes who participated in various sports and experienced an initial SRC were included and underwent retrospective chart review. The following information was collected: sex, age at injury, sport, history of prior concussion, date of injury, and date of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non-sport-related activity were excluded. Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002). On average, female athletes took approximately 6 days longer to begin an RTP progression compared with age-matched male athletes. This suggests that sex differences exist between athletes, ages 11 to 20 years, with regard to initiation of an RTP progression after SRC. Female athletes may take longer to recover after an SRC, and therefore, may take longer to return to sport. Sex should be considered as part of the clinical decision-making process when determining plan of care for this population. © 2016 The Author(s).

Returning individual research results for genome sequences of pancreatic cancer

PubMed Central

2014-01-01

Background Disclosure of individual results to participants in genomic research is a complex and contentious issue. There are many existing commentaries and opinion pieces on the topic, but little empirical data concerning actual cases describing how individual results have been returned. Thus, the real life risks and benefits of disclosing individual research results to participants are rarely if ever presented as part of this debate. Methods The Australian Pancreatic Cancer Genome Initiative (APGI) is an Australian contribution to the International Cancer Genome Consortium (ICGC), that involves prospective sequencing of tumor and normal genomes of study participants with pancreatic cancer in Australia. We present three examples that illustrate different facets of how research results may arise, and how they may be returned to individuals within an ethically defensible and clinically practical framework. This framework includes the necessary elements identified by others including consent, determination of the significance of results and which to return, delineation of the responsibility for communication and the clinical pathway for managing the consequences of returning results. Results Of 285 recruited patients, we returned results to a total of 25 with no adverse events to date. These included four that were classified as medically actionable, nine as clinically significant and eight that were returned at the request of the treating clinician. Case studies presented depict instances where research results impacted on cancer susceptibility, current treatment and diagnosis, and illustrate key practical challenges of developing an effective framework. Conclusions We suggest that return of individual results is both feasible and ethically defensible but only within the context of a robust framework that involves a close relationship between researchers and clinicians. PMID:24963353

Left behind in the return-to-work journey: consumer insights for policy change and practice strategies.

PubMed

Korzycki, Monica; Korzycki, Martha; Shaw, Lynn

2008-01-01

This study examined system barriers that precluded injured workers from accessing services and supports in the return-to-work (RTW) process. A grounded theory approach was used to investigate injured worker experiences. Methods included in-depth telephone interviews and the constant comparative method to analyze the data. Findings revealed that consumers experienced tensions or a tug-of-war between the RTW system, the health care system, and in accessing and using knowledge. Over time consumers reflected upon these tensions and initiated strategies to enhance return to function and RTW. Insights from consumer-driven strategies that might inform future policy change and promote positive service delivery for injured workers are examined.

Return on Investment in College Education. The Guardians Initiative: Reclaiming the Public Trust

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 2017

2017-01-01

"Return on Investment in College Education" is the second publication in a series of informational briefings developed as part of The Guardians Initiative: Reclaiming the Public Trust, an effort to educate and engage trustees as advocates on key issues in higher education. What is the return on investment (ROI) in college education?…

A leader-return-stroke consistent macroscopic model for calculations of return stroke current and its optical and electromagnetic emissions

NASA Astrophysics Data System (ADS)

Cai, Shuyao; Chen, Mingli; Du, Yaping; Qin, Zilong

2017-08-01

A downward lightning flash usually starts with a downward leader and an upward connecting leader followed by an upward return stroke. It is the preceding leader that governs the following return stroke property. Besides, the return stroke property evolves with height and time. These two aspects, however, are not well addressed in most existing return stroke models. In this paper, we present a leader-return stroke consistent model based on the time domain electric field integral equation, which is a growth and modification of Kumar's macroscopic model. The model is further extended to simulate the optical and electromagnetic emissions of a return stroke by introducing a set of equations relating the return stroke current and conductance to the optical and electromagnetic emissions. With a presumed leader initiation potential, the model can then simulate the temporal and spatial evolution of the current, charge transfer, channel size, and conductance of the return stroke, furthermore the optical and electromagnetic emissions. The model is tested with different leader initiation potentials ranging from -10 to -140 MV, resulting in different return stroke current peaks ranging from 2.6 to 209 kA with different return stroke speed peaks ranging from 0.2 to 0.8 speed of light and different optical power peaks ranging from 4.76 to 248 MW/m. The larger of the leader initiation potential, the larger of the return stroke current and speed. Both the return stroke current and speed attenuate exponentially as it propagates upward. All these results are qualitatively consistent with those reported in the literature.

United States Air Force Diversity Strategic Roadmap: A Journey to Excellence

DTIC Science & Technology

2010-10-19

engagement to include return on investment with SecAF/CSAF’s guidance Identify gaps in communications, marketing and advertising to improve society’s...21st century Actions: Identify and synchronize recruiting strategies, messaging, marketing and advertising , engagements, initiatives, and

The risks and returns of stock investment in a financial market

NASA Astrophysics Data System (ADS)

Li, Jiang-Cheng; Mei, Dong-Cheng

2013-03-01

The risks and returns of stock investment are discussed via numerically simulating the mean escape time and the probability density function of stock price returns in the modified Heston model with time delay. Through analyzing the effects of delay time and initial position on the risks and returns of stock investment, the results indicate that: (i) There is an optimal delay time matching minimal risks of stock investment, maximal average stock price returns and strongest stability of stock price returns for strong elasticity of demand of stocks (EDS), but the opposite results for weak EDS; (ii) The increment of initial position recedes the risks of stock investment, strengthens the average stock price returns and enhances stability of stock price returns. Finally, the probability density function of stock price returns and the probability density function of volatility and the correlation function of stock price returns are compared with other literatures. In addition, good agreements are found between them.

Return to Play and Future ACL Injury Risk Following ACL Reconstruction In Soccer Athletes From the MOON Group

PubMed Central

Brophy, Robert H.; Schmitz, Leah; Wright, Rick W.; Dunn, Warren R.; Parker, Richard D.; Andrish, Jack T.; McCarty, Eric C.; Spindler, Kurt P.

2013-01-01

Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (p<0.0001). Based on multivariate analysis, older athletes (p=0.006) and females (p=0.037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time. PMID:23002201

The influence of tortuosity on the spectrum of radiation from lightning return strokes

NASA Technical Reports Server (NTRS)

Levine, D. M.

1978-01-01

An investigation was made of the influence of tortuosity on the spectrum of radiation from lightning return strokes. The shape of the spectrum obtained by including effects of tortuosity was in keeping with data: The spectrum had a peak in the correct frequency regime followed by an initial decrease as the inverse of frequency. This spectrum was in better agreement with data than the spectrum predicted by the same model without tortuosity (i.e. the long straight channel), which decays at a rate proportional to 1/v squared.

Mars double-aeroflyby free returns

NASA Astrophysics Data System (ADS)

Jesick, Mark

2017-09-01

Mars double-flyby free-return trajectories that pass twice through the Martian atmosphere are documented. This class of trajectories is advantageous for potential Mars atmospheric sample return missions because of its low geocentric energy at departure and arrival, because it would enable two sample collections at unique locations during different Martian seasons, and because of its lack of deterministic maneuvers. Free return opportunities are documented over Earth departure dates ranging from 2015 through 2100, with viable missions available every Earth-Mars synodic period. After constraining the maximum lift-to-drag ratio to be less than one, the minimum observed Earth departure hyperbolic excess speed is 3.23 km/s, the minimum Earth atmospheric entry speed is 11.42 km/s, and the minimum round-trip flight time is 805 days. An algorithm using simplified dynamics is developed along with a method to derive an initial estimate for trajectories in a more realistic dynamic model. Multiple examples are presented, including free returns that pass outside and inside of Mars's appreciable atmosphere.

Early return to baseline range of motion and strength after anterior shoulder instability surgery: a Multicenter Orthopaedic Outcomes Network (MOON) shoulder group cohort study.

PubMed

Buckwalter V, Joseph A; Wolf, Brian R; Glass, Natalie; Bollier, Matt; Kuhn, John E; Hettrich, Carolyn M

2018-03-23

Patients often return to higher-level activities and sports at 4 to 8 months after anterior shoulder stabilization procedures. It is unknown what percentage of patients have regained normal function at this time frame and what factors predict residual deficits, range of motion (ROM), and strength after anterior shoulder instability surgery. Ten participating sites throughout the United States enrolled patients in a prospective cohort study including primary, revision, arthroscopic, and open anterior stabilization procedures. Baseline demographic data and patient outcomes questionnaires were collected with initial physical examination, treatment, surgical findings, and surgical repair details. At the 6-month follow-up visit, ROM and strength measurements were collected and compared with preoperative measurements. There were 348 patients identified who underwent surgical treatment for anterior shoulder instability. Of these, 259 patients (74.0%) returned to baseline, and 89 (26.0%) did not return to baseline shoulder ROM (≥20° loss of ROM) or strength. A higher Beighton score (P = .01) and number of dislocations (P < .01) were associated with failure to regain baseline ROM and strength at early follow-up. No surgical variables were found to influence return to baseline function, including open vs. arthroscopic surgery, primary vs. revision surgery, and number of suture anchors. By 4 to 8 months postoperatively, 76% of patients return to baseline ROM, 98% return to baseline strength, and 74% return to both baseline ROM and strength. An increased number of dislocations and generalized joint laxity were associated with failure to return to baseline ROM and strength at early follow-up after anterior shoulder instability surgery. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

28 CFR 542.14 - Initial filing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... place a single complaint or a reasonable number of closely related issues on the form. If the inmate includes on a single form multiple unrelated issues, the submission shall be rejected and returned without... of informal resolution and submission of a formal written Administrative Remedy Request, on the...

10 CFR 26.187 - Substance abuse expert.

Code of Federal Regulations, 2014 CFR

2014-01-01

... physician; (2) A licensed or certified social worker; (3) A licensed or certified psychologist; (4) A... and the return-to-duty process, including the initial evaluation, referrals for education and/or... providers; (7) Reporting and recordkeeping requirements of this part; and (8) Issues that SAEs confront in...

10 CFR 26.187 - Substance abuse expert.

Code of Federal Regulations, 2012 CFR

2012-01-01

... physician; (2) A licensed or certified social worker; (3) A licensed or certified psychologist; (4) A... and the return-to-duty process, including the initial evaluation, referrals for education and/or... providers; (7) Reporting and recordkeeping requirements of this part; and (8) Issues that SAEs confront in...

10 CFR 26.187 - Substance abuse expert.

Code of Federal Regulations, 2013 CFR

2013-01-01

... physician; (2) A licensed or certified social worker; (3) A licensed or certified psychologist; (4) A... and the return-to-duty process, including the initial evaluation, referrals for education and/or... providers; (7) Reporting and recordkeeping requirements of this part; and (8) Issues that SAEs confront in...

TEAM - Titan Exploration Atmospheric Microprobes

NASA Astrophysics Data System (ADS)

Nixon, Conor; Esper, Jaime; Aslam, Shahid; Quilligan, Gerald

2016-10-01

The astrobiological potential of Titan's surface hydrocarbon liquids and probable interior water ocean has led to its inclusion as a destination in NASA's "Ocean Worlds" initiative, and near-term investigation of these regions is a high-level scientific goal. TEAM is a novel initiative to investigate the lake and sea environs using multiple dropsondes -scientific probes derived from an existing cubesat bus architecture (CAPE - the Cubesat Application for Planetary Exploration) developed at NASA GSFC. Each 3U probe will parachute to the surface, making atmospheric structure and composition measurements during the descent, and photographing the surface - land, shoreline and seas - in detail. TEAM probes offer a low-cost, high-return means to explore multiple areas on Titan, yielding crucial data about the condensing chemicals, haze and cloud layers, winds, and surface features of the lakes and seas. These microprobes may be included on a near-term New Frontiers class mission to the Saturn system as additional payload, bringing increased scientific return and conducting reconnaissance for future landing zones. In this presentation we describe the probe architecture, baseline payload, flight profile and the unique engineering and science data that can be returned.

Brownfields opportunity -- A product of a probusiness USEPA

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

Anderson, K.E.

Brownfields are former industrial facilities, office buildings or other properties that have been abandoned or are no longer in use. They may be returned as a beneficial asset of a company with prudent planning and by completing selected activities. The tangible economic impacts of a Brownfield property often result in lost taxes and lost jobs. In order to return a Brownfield property to beneficial use various activities are involved, which may include the services provided by many or all of the following: attorneys, financiers, insurance firms, business planners and operators, and environmental consultants. The melding of these diverse resources formore » a specific project must be determined on a case-by-case basis in a flexible manner. Consistent with the desire of much of the populace to return Brownfields to meaningful assets, the US Environmental Protection Agency (USEPA) has now adopted a practical, profitable and reasonably low-risk program termed the Brownfields Incentive. Included in the Brownfields Incentive program are more reasonable, yet safe, cleanup levels. Additionally, this program provides specific protection for Brownfields participants from fines, sanctions and legal actions. Consistent with the USEPA`s program, approximately 40 states have also initiated or are planning to initiate Brownfields programs. It is obvious that programs exist at the Federal and State levels to enable the reasonable redevelopment of existing abandoned or vacant properties. The ability to form a team of professionals to redevelop a Brownfield property is required. A proper team of professionals, each performing activities required to return the property to a functioning status, will assure the success of a Brownfield project.« less

When Investment in Basic Skills Gives Negative Returns

ERIC Educational Resources Information Center

Billington, Mary Genevieve; Nissinen, Kari; Gabrielsen, Egil

2017-01-01

In recent years, the Norwegian government has invested heavily in improving basic skills in the adult population. Initiatives have included legislation, the introduction of work-based adult education programs, and reforms in schooling. In light of this investment, we explore trends in adult literacy and numeracy, by comparing data from two…

OAST Space Theme Workshop. Volume 2: Theme summary. 4: Solar system exploration (no. 10). A: Statement of theme: B. 26 April 1976 Presentation. C. Summary. D. Initiative actions (form 5)

NASA Technical Reports Server (NTRS)

1976-01-01

Major strategies for exploring the solar system focus on the return of information and the return of matter. Both the planetary exploration facility, and an orbiting automated space station, and the sample return and exploration facility have similar requirements. The single most essential need to enable intensive study of the outer solar system is nuclear propulsion and power capability. New initiatives in 1978 related to the reactor, data and sample acquisition and return, navigation, and environmental protection are examined.

The Competitive, Crowd sourced Investment (CCI) Initiative

DTIC Science & Technology

2016-03-01

any other organization of the Department of Defense. * * * Within the private sector, investment capital flows to the businesses that can best...The Competitive, Crowdsourced Investment (CCI) Initiative Col. Scott T. Wallace, USAF This article proposes an initiative for consideration by the...generate returns for investors. A result of this incentive structure is a business culture that relentlessly turns capital into future returns.Within the

Return to play after nonoperative management for a severe type III acromioclavicular separation in the throwing shoulder of a collegiate pitcher.

PubMed

Watson, Scott T; Wyland, Douglas J

2015-02-01

Treatment of type III acromioclavicular (AC) separations is controversial, especially in the dominant shoulder of a high-level throwing athlete. This case report describes the return to play after nonoperative management of a collegiate baseball pitcher with a severe type III AC separation in his throwing shoulder. Case report of return to play with nonoperative management of a type III AC separation in the throwing shoulder of a collegiate pitcher. A case report of a single patient. Prospective data were recorded in the case of a collegiate pitcher who suffered an acute injury to the dominant shoulder, resulting in a severe type III AC separation. He was initially treated with a figure-of-8 brace and a sling. Postinjury, strengthening of the wrist, hand, and elbow began at 3½ weeks, and shoulder range of motion (ROM) and a periscapular strengthening program began at 6 weeks. At 2 months postinjury, a deformity was still present, but the athlete was pain free, with full shoulder ROM and strength without tenderness at the AC joint. Formal physical therapy was initiated to include an accelerated interval throwing program. At 12 weeks postinjury, the athlete was pitching asymptomatically, and gradually returned to regular play. At 6 months and now through 24 months postinjury, the athlete reported full strength, full ROM, and return to his previous level of throwing and velocity without complication. He volunteered that he was 100% satisfied with the result, and feels he is the same pitcher as, if not stronger than, prior to this injury. This case demonstrates a collegiate baseball pitcher who returned to his preinjury level of pitching with nonoperative treatment of a severe type III AC separation.

Evaluation of economic and performance outcomes associated with the number of treatments after an initial diagnosis of bovine respiratory disease in commercial feeder cattle.

PubMed

Cernicchiaro, Natalia; White, Brad J; Renter, David G; Babcock, Abram H

2013-02-01

To evaluate associations between economic and performance outcomes with the number of treatments after an initial diagnosis of bovine respiratory disease (BRD) in commercial feedlot cattle. 212,867 cattle arriving in a Midwestern feedlot between 2001 and 2006. An economic model was created to estimate net returns. Generalized linear mixed models were used to determine associations between the frequency of BRD treatments and other demographic variables with economic and performance outcomes. Net returns decreased with increasing number of treatments for BRD. However, the magnitude depended on the season during which cattle arrived at the feedlot, with significantly higher returns for cattle arriving during fall and summer than for cattle arriving during winter and spring. For fall arrivals, there were higher mean net returns for cattle that were never treated ($39.41) than for cattle treated once ($29.49), twice ($16.56), or ≥ 3 times (-$33.00). For summer arrivals, there were higher least squares mean net returns for cattle that were never treated ($31.83) than for cattle treated once ($20.22), twice ($6.37), or ≥ 3 times ($-42.56). Carcass traits pertaining to weight and quality grade were deemed responsible for differences in net returns among cattle receiving different numbers of treatments after an initial diagnosis of BRD. Differences in economic net returns and performance outcomes for feedlot cattle were determined on the basis of number of treatments after an initial diagnosis of BRD; the analysis accounted for the season of arrival, sex, and weight class.

The Opera Instrument: An Advanced Curation Development for Mars Sample Return Organic Contamination Monitoring

NASA Technical Reports Server (NTRS)

Fries, M. D.; Fries, W. D.; McCubbin, F. M.; Zeigler, R. A.

2018-01-01

Mars Sample Return (MSR) requires strict organic contamination control (CC) and contamination knowledge (CK) as outlined by the Mars 2020 Organic Contamination Panel (OCP). This includes a need to monitor surficial organic contamination to a ng/sq. cm sensitivity level. Archiving and maintaining this degree of surface cleanliness may be difficult but has been achieved. MSR's CK effort will be very important because all returned samples will be studied thoroughly and in minute detail. Consequently, accurate CK must be collected and characterized to best interpret scientific results from the returned samples. The CK data are not only required to make accurate measurements and interpretations for carbon-depleted martian samples, but also to strengthen the validity of science investigations performed on the samples. The Opera instrument prototype is intended to fulfill a CC/CK role in the assembly, cleaning, and overall contamination history of hardware used in the MSR effort, from initial hardware assembly through post-flight sample curation. Opera is intended to monitor particulate and organic contamination using quartz crystal microbalances (QCMs), in a self-contained portable package that is cleanroom-compliant. The Opera prototype is in initial development capable of approximately 100 ng/sq. cm organic contamination sensitivity, with additional development planned to achieve 1 ng/sq. cm. The Opera prototype was funded by the 2017 NASA Johnson Space Center Innovation Charge Account (ICA), which provides funding for small, short-term projects.

Cultural practices in Appalachian hardwood sapling stands--are they worthwhile?

Treesearch

Gary W. Miller

1986-01-01

Forest managers often question the economic feasibility of cultural practices in hardwood sapling stands. Investment factors, including initial treatment cost, required rate of return, investment period, and stand response to treatment are discussed in terms of how they affect the outcome of early investments in even-aged hardwood stands. Attention is focused on...

25 CFR 20.100 - What definitions clarify the meaning of the provisions of this part?

Code of Federal Regulations, 2011 CFR

2011-04-01

... progress, advocacy, tracking and evaluating services provided, such as evaluation of child's treatment.... All plans for children in foster care or residential care must include a permanency plan which contains a time specific goal of the return of the child to the natural parents or initiation of a...

25 CFR 20.100 - What definitions clarify the meaning of the provisions of this part?

Code of Federal Regulations, 2013 CFR

2013-04-01

... progress, advocacy, tracking and evaluating services provided, such as evaluation of child's treatment.... All plans for children in foster care or residential care must include a permanency plan which contains a time specific goal of the return of the child to the natural parents or initiation of a...

25 CFR 20.100 - What definitions clarify the meaning of the provisions of this part?

Code of Federal Regulations, 2012 CFR

2012-04-01

... progress, advocacy, tracking and evaluating services provided, such as evaluation of child's treatment.... All plans for children in foster care or residential care must include a permanency plan which contains a time specific goal of the return of the child to the natural parents or initiation of a...

25 CFR 20.100 - What definitions clarify the meaning of the provisions of this part?

Code of Federal Regulations, 2014 CFR

2014-04-01

... progress, advocacy, tracking and evaluating services provided, such as evaluation of child's treatment.... All plans for children in foster care or residential care must include a permanency plan which contains a time specific goal of the return of the child to the natural parents or initiation of a...

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

PubMed Central

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes.

PubMed

Kaminski, Thomas W; Hertel, Jay; Amendola, Ned; Docherty, Carrie L; Dolan, Michael G; Hopkins, J Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

Gaussian Decomposition of Laser Altimeter Waveforms

NASA Technical Reports Server (NTRS)

Hofton, Michelle A.; Minster, J. Bernard; Blair, J. Bryan

1999-01-01

We develop a method to decompose a laser altimeter return waveform into its Gaussian components assuming that the position of each Gaussian within the waveform can be used to calculate the mean elevation of a specific reflecting surface within the laser footprint. We estimate the number of Gaussian components from the number of inflection points of a smoothed copy of the laser waveform, and obtain initial estimates of the Gaussian half-widths and positions from the positions of its consecutive inflection points. Initial amplitude estimates are obtained using a non-negative least-squares method. To reduce the likelihood of fitting the background noise within the waveform and to minimize the number of Gaussians needed in the approximation, we rank the "importance" of each Gaussian in the decomposition using its initial half-width and amplitude estimates. The initial parameter estimates of all Gaussians ranked "important" are optimized using the Levenburg-Marquardt method. If the sum of the Gaussians does not approximate the return waveform to a prescribed accuracy, then additional Gaussians are included in the optimization procedure. The Gaussian decomposition method is demonstrated on data collected by the airborne Laser Vegetation Imaging Sensor (LVIS) in October 1997 over the Sequoia National Forest, California.

Bayesian analysis of a mastitis control plan to investigate the influence of veterinary prior beliefs on clinical interpretation.

PubMed

Green, M J; Browne, W J; Green, L E; Bradley, A J; Leach, K A; Breen, J E; Medley, G F

2009-10-01

The fundamental objective for health research is to determine whether changes should be made to clinical decisions. Decisions made by veterinary surgeons in the light of new research evidence are known to be influenced by their prior beliefs, especially their initial opinions about the plausibility of possible results. In this paper, clinical trial results for a bovine mastitis control plan were evaluated within a Bayesian context, to incorporate a community of prior distributions that represented a spectrum of clinical prior beliefs. The aim was to quantify the effect of veterinary surgeons' initial viewpoints on the interpretation of the trial results. A Bayesian analysis was conducted using Markov chain Monte Carlo procedures. Stochastic models included a financial cost attributed to a change in clinical mastitis following implementation of the control plan. Prior distributions were incorporated that covered a realistic range of possible clinical viewpoints, including scepticism, enthusiasm and uncertainty. Posterior distributions revealed important differences in the financial gain that clinicians with different starting viewpoints would anticipate from the mastitis control plan, given the actual research results. For example, a severe skeptic would ascribe a probability of 0.50 for a return of < 5 UK pounds per cow in an average herd that implemented the plan, whereas an enthusiast would ascribe this probability for a return of > 20 UK pounds per cow. Simulations using increased trial sizes indicated that if the original study was four times as large, an initial skeptic would be more convinced about the efficacy of the control plan but would still anticipate less financial return than an initial enthusiast would anticipate after the original study. In conclusion, it is possible to estimate how clinicians' prior beliefs influence their interpretation of research evidence. Further research on the extent to which different interpretations of evidence result in changes to clinical practice would be worthwhile.

Dose Regimens, Variability, and Complications Associated with Using Repeat-Bolus Dosing to Extend a Surgical Plane of Anesthesia in Laboratory Mice

PubMed Central

Jaber, Samer M; Hankenson, F Claire; Heng, Kathleen; McKinstry-Wu, Andrew; Kelz, Max B; Marx, James O

2014-01-01

Extending a surgical plane of anesthesia in mice by using injectable anesthetics typically is accomplished by repeat-bolus dosing. We compared the safety and efficacy of redosing protocols administered either during an anesthetic surgical plane (maintaining a continuous surgical plane, CSP), or immediately after leaving this plane (interrupted surgical plane, ISP) in C57BL/6J mice. Anesthesia was induced with ketamine, xylazine, and acepromazine (80, 8, and 1 mg/kg IP, respectively), and redosing protocols included 25% (0.25K), 50% (0.5K), or 100% (1.0K) of the initial ketamine dose or 25% (0.25KX) or 50% (0.5KX) of the initial ketamine–xylazine dose. In the ISP group, the surgical plane was extended by 13.8 ± 2.1 min (mean ± SEM) after redosing for the 0.25K redose with 50% returning to a surgical plane, 42.7 ± 4.5 min for the 0.5K redose with 88% returning to a surgical plane, and 44.3 ± 15.4 min for the 1.0K redose, 52.8 ± 7.2 min for the 0.25KX redose, and 45.9 ± 2.9 min for the 0.5KX redose, with 100% of mice returning to a surgical plane of anesthesia in these 3 groups. Mortality rates for ISP groups were 0%, 12%, 33%, 12%, and 18%, respectively. Mice in CSP groups had 50% mortality, independent of the repeat-dosing protocol. We recommend redosing mice with either 50% of the initial ketamine dose or 25% of the initial ketamine–xylazine dose immediately upon return of the pedal withdrawal reflex to extend the surgical plane of anesthesia in mice, optimize the extension of the surgical plane, and minimize mortality. PMID:25650976

Rates and Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction in National Collegiate Athletic Association Division I Soccer Athletes: A Study of the Southeastern Conference.

PubMed

Howard, Jennifer S; Lembach, Mark L; Metzler, Adam V; Johnson, Darren L

2016-02-01

Factors and details regarding return to play in elite, collegiate female soccer athletes after an anterior cruciate ligament (ACL) injury and reconstruction have not been well studied. To evaluate return to play among collegiate female soccer players, specifically examining the effect of surgical and individual athlete characteristics on the return-to-play rate. Descriptive epidemiology study. Sports medicine and athletic training staff at institutions from the National Collegiate Athletic Association Southeastern Conference (SEC) were contacted to request participation in the study. All institutions were sent a standardized spreadsheet with response choices and instructions regarding athlete inclusion criteria. Athlete, injury, surgical technique, and return-to-play data were requested for ACL reconstructions performed on female soccer athletes at the participating institutions over the previous 8 years. χ(2) analyses were used to compare the return-to-play rate by year in school, scholarship status, position, depth chart status, procedure, graft type, graft fixation, concomitant procedures, and previous ACL injuries. All 14 of the SEC institutions chose to participate and provided data. A total of 80 ACL injuries were reported, with 79 surgical reconstructions and return-to-play data for 78 collegiate soccer athletes. The overall return-to-play rate was 85%. There was a statistical significance in return-to-play rates favoring athletes in earlier years of eligibility versus later years (P < .001). Athletes in eligibility years 4 and 5 combined had a return-to-play rate of only 40%. Scholarship status likewise showed significance (P < .001), demonstrating a higher return-to-play rate for scholarship athletes (91%) versus nonscholarship athletes (46%). No significant differences in return-to-play rates were observed based on surgical factors, including concomitant knee procedures, graft type, and graft fixation method. Collegiate female soccer athletes have a high initial return-to-play rate. Undergoing ACL reconstruction earlier in the college career as well as the presence of a scholarship had a positive effect on return to play. Surgical factors including graft type, fixation method, tunnel placement technique, concomitant knee surgeries, and revision status demonstrated no significant effect on the return-to-play rate. © 2015 The Author(s).

Adverse Event Reporting for Herbal Medicines: A Result of Market Forces

PubMed Central

Walji, Rishma; Boon, Heather; Barnes, Joanne; Austin, Zubin; Baker, G. Ross; Welsh, Sandy

2009-01-01

Herbal products are readily available over the counter in health food stores and are often perceived to be without risk. The current Canadian adverse event reporting system suffers from severe underreporting, resulting in a scarcity of safety data on herbal products. Twelve health food store personnel in the Greater Toronto Area were interviewed about their responses to herbal product–related adverse reactions. They generally fostered customer loyalty by offering generous return policies, which included collecting contact information to be sent to the manufacturers with the returned product. Thus, despite the public's lack of knowledge about the formal reporting system, adverse reaction information was directed to manufacturers whenever it resulted in a product return. The relationship between health food stores, industry and Health Canada provides a new opportunity to facilitate adverse event reporting. Additional information could be collected during the return process, and educational initiatives could be implemented to augment current post-market surveillance procedures for herbal products. PMID:20436811

Clinical Commentary: On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction

PubMed Central

Capin, Jacob J.; Behrns, William; Thatcher, Karen; Arundale, Amelia; Smith, Angela Hutchinson; Snyder-Mackler, Lynn

2017-01-01

SYNOPSIS Limited literature exists pertaining to rehabilitation of ice hockey players seeking to return-to-sport after anterior cruciate ligament reconstruction (ACLR). The purpose of this clinical commentary is to present a criterion-based, return-to-ice hockey progression for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a four-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, non-contact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR. PMID:28355976

Latent Presentation of Decompression Sickness After Altitude Chamber Training in an Active Duty Flier.

PubMed

Gentry, James; Rango, Juan; Zhang, Jianzhong; Biedermann, Shane

2017-04-01

Decompression sickness (DCS) is a potential danger and risk for both divers and aircrew alike. DCS is also a potential side effect of altitude (hypobaric) chamber training as well and can present long after training occurs. Literature review shows that altitude chamber induced DCS has approximately a 0.25% incidence. A 32-yr-old, active duty military member developed symptoms of DCS 3 h after his hypobaric chamber training. Unfortunately, he did not seek treatment for DCS until 48 h after the exposure. His initial treatment included ground level oxygen therapy for 30 min at 12 L of oxygen per minute using a nonrebreathing mask. He achieved complete symptom resolution and was returned to duty. However, 12 d after his initial Flight Medicine evaluation, the patient returned complaining of a right temporal headache, multijoint pains, and fatigue. He was treated in the hyperbaric chamber and had complete resolution of symptoms. He was returned to flying status and 5 mo later denied any return of symptoms. Hypobaric chamber familiarity training is a requirement for all military aircrew personnel to allow them assess their ability to identify symptoms of hypoxia. This training method is not only costly to maintain, but it also places aircrew and chamber technicians at risk for potential long-term side effects from failed recompression treatment of DCS. We are presenting a case of recurrent DCS symptoms 12 d after initial ground level oxygen therapy.Gentry J, Rango J, Zhang J, Biedermann S. Latent presentation of decompression sickness after altitude chamber training in an active duty flier. Aerosp Med Hum Perform. 2017; 88(4):427-430.

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.

PubMed

Pommerening, Matthew J; DuBose, Joseph J; Zielinski, Martin D; Phelan, Herb A; Scalea, Thomas M; Inaba, Kenji; Velmahos, George C; Whelan, James F; Wade, Charles E; Holcomb, John B; Cotton, Bryan A

2014-08-01

Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P = .045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P = .05). Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours). Copyright © 2014 Mosby, Inc. All rights reserved.

Maternal employment and breast-feeding initiation: findings from the Millennium Cohort Study.

PubMed

Hawkins, Summer S; Griffiths, Lucy J; Dezateux, Carol; Law, Catherine

2007-05-01

Maternal employment rates have increased rapidly in recent years and little is known about how this influences whether women start breast feeding. We examined data from the Millennium Cohort Study to determine whether a mother's employment status (full-time, part-time, self-employed, on leave, not employed/student) and employment characteristics are related to breast-feeding initiation. This analysis comprised 14 830 white mothers from Britain and Ireland (6917 employed) with singleton babies, born from 2000 to 2002. Information was obtained on infant feeding history and mother's employment when the cohort child was 9 months old. We found that women employed full-time were less likely to initiate breast feeding than mothers who were not employed/students, after adjustment for confounding factors [adjusted rate ratio (aRR) = 0.92; 95% confidence interval (CI) 0.89, 0.96]; however, there were no differences in breast-feeding initiation between mothers employed part-time, self-employed, or on leave and mothers who were not employed/students. Among employed mothers, those who returned to work within 4 months postpartum were less likely to start breast feeding than women who returned at 5 or 6 months [aRR = 0.95; 95% CI 0.92, 0.99], and women who returned within the first 6 weeks were much less likely to start breast feeding [aRR = 0.85; 95% CI 0.77, 0.94]. Mothers returning for financial reasons were also less likely to initiate breast feeding [aRR = 0.96; 95% CI 0.93, 0.99] than those who returned for other reasons. Policies to increase breast feeding should address how both the time and circumstances of a mother's return to employment postpartum influence whether she decides to start breast feeding.

Restrictions into Opportunities: How Boundaries in the Life Course Can Shape Educational Pathways

ERIC Educational Resources Information Center

ahmed Shafi, Adeela; Rose, Jo

2014-01-01

This study explores relationships between experiences in initial education, subsequent life experiences/opportunities and the decision to return to education later in life. Semi-structured interviews with seven female returners to education, focused initially upon the women's perceptions of their aspirations and motivations at various ages, how…

Return to Play in Elite Contact Athletes After Anterior Cervical Discectomy and Fusion: A Meta-Analysis

PubMed Central

McAnany, Steven J.; Overley, Samuel; Andelman, Steven; Patterson, Diana C.; Cho, Samuel K.; Qureshi, Sheeraz; Hsu, Wellington K.

2017-01-01

Study Design: Systematic literature review and meta-analysis of studies published in English language. Objective: Return to play after anterior cervical discectomy and fusion (ACDF) in contact athletes remains a controversial topic with no consensus opinion in the literature. Additional information is needed to properly advise and treat this population of patients. This study is a meta-analysis assessing return to competitive contact sports after undergoing an ACDF. Methods: A literature search of Medline, Embase, and Cochrane Reviews was performed to identify investigations reporting return to play following ACDF in professional contact athletes. The pooled results were performed by calculating the effect size based on the logic event rate. Studies were weighted by the inverse of the variance, which included both within and between-study error. Confidence intervals (CIs) were reported at 95%. Heterogeneity was assessed using the Q statistic and I 2. Sensitivity analysis and publication bias calculations were performed. Results: The initial literature search resulted in 166 articles, of which 5 were determined relevant. Overall, return to play data was provided for 48 patients. The pooled clinical success rate for return to play was 73.5% (CI = 56.7%, 85.8%). The logit event rate was calculated to be 1.036 (CI = 0.270, 1.802), which was statistically significant (P = .008). The studies included in this meta-analysis demonstrated minimal heterogeneity with Q value of 4.038 and I 2 value of 0.956. Conclusions: Elite contact athletes return to competition 73.5% of the time after undergoing ACDF. As this is the first study to pool results from existing studies, it provides strong evidence to guide decision making and expectations in this patient population. PMID:28894685

Return to work and its relation to financial distress among Iranian cancer survivors.

PubMed

Ghasempour, Mostafa; Rahmani, Azad; Davoodi, Arefeh; Sheikhalipour, Zahra; Ziaeei, Jamal Evazie; Abri, Fariba

2015-01-01

Return to work after treatment completion is important for both cancer survivors and society. Financial distress is one of the factors that may influence the return to work in cancer survivors. However, this relationship has not been well investigated. This study aimed to determine the rate of return to work and its relation to financial distress among Iranian cancer survivors. This descriptive-correlational study was undertaken among 165 cancer survivors who completed their initial treatments and had no signs of active cancer. The Return to Work questionnaire and Financial Distress/Financial Well-Being Scale were used for data collection. Data were analyzed using SPSS statistical software. After initial treatments, 120 cancer survivors (72%) had returned to work, of which 50 patients (42%) had returned to full-time work and 70 (58%) reduced their work hours and returned to part-time work. Cancer survivors also reported high levels of financial distress. In addition, the financial distress was lower among patients who had returned completely to work, in comparison to patients who had quit working for cancer-related reasons (p=0.001) or returned to work as part-time workers (p=0.001). The findings showed that a high percent of Iranian cancer survivors had not returned to their jobs or considerably reduced working hours after treatment completion. Accordingly, due to high levels of financial distress experienced by participants and its relation to return to work, designing rehabilitation programs to facilitate cancer survivor return to work should be considered.

Reserve Component Soldiers as Peacekeepers.

DTIC Science & Technology

1996-10-01

follow - up surveys for 3 years after the soldiers’ return (end of...34 Personnel Needs § 3 Pinch (1994) also notes some factors that can inhibit the effectiveness of such screening. These include a "lack of routinization of...34 The responses received to this question have implications for both initial recruiting and follow - up retention activities. A high proportion

Work-Related Factors Considered by Sickness-Absent Employees When Estimating Timeframes for Returning to Work

PubMed Central

Choi, YoonSun

2016-01-01

Introduction Work-related factors have been found to be influential in shaping a number of return-to-work outcomes including return-to-work expectations. Based on the idea that work-related factors have the potential for modification through workplace-based initiatives, this study involved a detailed examination of work-related factors referenced by workers as being taken into consideration when estimating timeframes for returning to work. Methods Focus groups were conducted with 30 employees, currently off work (≤ 3 months) due to a musculoskeletal condition. During the focus groups, participants wrote and spoke about the factors that they considered when forming their expectations for returning to work. Data were subjected to thematic content analysis. Results Discussions revealed that participants’ considerations tended to differ depending on whether or not they had a job to return to. Those with jobs (n = 23) referenced specific influences such as working relationships, accommodations, physical and practical limitations, as well as concerns about their ability to do their job. Those without a job to return to (n = 7) talked about the ways they would go about finding work, and how long they thought this would take. Both groups mentioned the influence of wanting to find the “right” job, retraining and being limited due to the need for income. Conclusion Findings indicate that employees reference numerous work-related factors when estimating their timeframes for returning to work, and that many of these have been previously identified as relating to other return-to-work outcomes. Findings suggest the potential to improve return-to-work expectation through addressing work-related influences, and helping people work through the tasks they need to complete in order to move forward in the return-to-work process. PMID:27706194

Work-Related Factors Considered by Sickness-Absent Employees When Estimating Timeframes for Returning to Work.

PubMed

Young, Amanda E; Choi, YoonSun

2016-01-01

Work-related factors have been found to be influential in shaping a number of return-to-work outcomes including return-to-work expectations. Based on the idea that work-related factors have the potential for modification through workplace-based initiatives, this study involved a detailed examination of work-related factors referenced by workers as being taken into consideration when estimating timeframes for returning to work. Focus groups were conducted with 30 employees, currently off work (≤ 3 months) due to a musculoskeletal condition. During the focus groups, participants wrote and spoke about the factors that they considered when forming their expectations for returning to work. Data were subjected to thematic content analysis. Discussions revealed that participants' considerations tended to differ depending on whether or not they had a job to return to. Those with jobs (n = 23) referenced specific influences such as working relationships, accommodations, physical and practical limitations, as well as concerns about their ability to do their job. Those without a job to return to (n = 7) talked about the ways they would go about finding work, and how long they thought this would take. Both groups mentioned the influence of wanting to find the "right" job, retraining and being limited due to the need for income. Findings indicate that employees reference numerous work-related factors when estimating their timeframes for returning to work, and that many of these have been previously identified as relating to other return-to-work outcomes. Findings suggest the potential to improve return-to-work expectation through addressing work-related influences, and helping people work through the tasks they need to complete in order to move forward in the return-to-work process.

Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study.

PubMed

Dagher, Rada K; McGovern, Patricia M; Schold, Jesse D; Randall, Xian J

2016-07-29

The U.S. continues to have one of the lowest breastfeeding rates in the industrialized world. Studies have shown that full-time employment and early return to work decreased breastfeeding duration, but little is known about the relationship between leave policies and breastfeeding initiation and cessation. This study aimed to identify workplace-related barriers and facilitators associated with breastfeeding initiation and cessation in the first 6 months postpartum. A prospective cohort study design was utilized to recruit 817 Minnesota women aged 18 and older while hospitalized for childbirth. Selection criteria included English-speaking, employed mothers with a healthy, singleton birth. These women were followed up using telephone interviews at 6 weeks, 12 weeks, and 6 months after childbirth. The main study outcomes were breastfeeding initiation, measured during hospital enrollment, and breastfeeding cessation by 6 months postpartum. Women were 30 years old; 86 % were White, and 73 % were married. Breastfeeding rates were 81 % at childbirth, 67 % at 6 weeks, 49 % at 12 weeks, and 33 % at 6 months postpartum. Logistic regression revealed the odds of breastfeeding initiation were higher for women who: held professional jobs, were primiparae, had graduate degree, did not smoke prenatally, had no breastfeeding problems, and had family or friends who breastfeed. Survival analyses showed the hazard for breastfeeding cessation by 6 months was: higher for women who returned to work at any time during the 6 months postpartum versus those who did not return, lower for professional workers, higher among single than married women, higher for every educational category compared to graduate school, and higher for those with no family or friends who breastfeed. While employer paid leave policy did not affect breastfeeding initiation or cessation, women who took shorter leaves were more likely to stop breastfeeding in the first 6 months postpartum. Future research should examine women's awareness of employer policies regarding paid and unpaid leave.

Application of a Protocol Based on Trap-Neuter-Return (TNR) to Manage Unowned Urban Cats on an Australian University Campus.

PubMed

Swarbrick, Helen; Rand, Jacquie

2018-05-17

In August 2008, the University of New South Wales (UNSW) in Sydney, Australia, commenced a trap-neuter-return (TNR) program to manage the population of approximately 69 free-roaming unowned urban cats on its Kensington campus. The goals of the program included an ongoing audit of cats on campus, stabilization of cat numbers through TNR, and a subsequent reduction in cat numbers over time while maintaining the health of remaining campus cats. Continuation of the TNR program over nine years resulted in a current population, as of September 2017, of 15 cats, all desexed (78% reduction). Regular monitoring of the cats through a daily feeding program identified a further 34 cats that immigrated on to campus since initiation of the program; these comprised 28 adult cats (16 unsocialized, 12 socialized) and six solitary kittens. In addition, 19 kittens were born on campus, 14 of which were born to immigrant pregnant females. Unsocialized adult immigrants were absorbed into the resident campus population. Where possible, socialized adult immigrants, solitary kittens, and campus-born kittens were removed from campus through rehoming. Overall, reasons for reductions in the cat population (original residents, immigrants, campus-born kittens; n = 122) included rehoming or return to owner (30%), death/euthanasia (30%) and disappearance (29%). This successful animal management program received some initial funding from the university to support desexing, but was subsequently funded through donations, and continues with the university's approval and support.

Observation of incomplete drainage of a branched negative stepped leader system during the initial return stroke, and its implications

NASA Astrophysics Data System (ADS)

Petersen, D.; Beasley, W. H.

2012-12-01

We present high-speed video, taken at 75,000 frames per second, of an anomalous lightning flash that involved two distinct return strokes from different branches of the same branched negative stepped leader system. During the initial return stroke the leader system was incompletely drained, resulting in the continued development of a large side branch. The upper portions of this side branch exhibited a pulse of luminosity during the initial return stroke, but the luminosity did not extend down the branch. The lower portion of the branch continued to develop downward as a negative stepped leader, but at a much slower velocity. Continued stepping activity was observed in this branch as it continued downward at a significantly reduced velocity, finally attaching to the earth 1.8 milliseconds after the main return stroke. The ensuing return stroke was characterized by a slower vertical velocity and weaker luminous pulse. Based on this observation, we coin the term "orphaned branch" to describe a branch of a leader system that is not drained during a return stroke. While our case involves a branch that eventually connected to the ground and produced a return stroke, we also consider the possibility that such branches may also simply cease to progress and effectively deposit large amounts of space charge near their extremities. Such space charge would have a strong influence on subsequent breakdown activity in their vicinity, such as shielding subsequent descending negative stepped leaders or triggering upward positive leaders from earth's surface.

The optical and radiation field signatures produced by lightning return strokes

NASA Technical Reports Server (NTRS)

Guo, C.; Krider, E. P.

1982-01-01

Typical examples of the signals that are produced by first and subsequent return strokes in cloud-to-ground lightning on a microsecond time scale are presented. Statistics on the structure of the waveforms and the radiance of the channels are given. The relationship between the light signals and the associated electric field signatures is discussed. It is shown that the initial light signal from a return stroke tends to be linear for about 15 microsec and then rises more slowly to a peak that is delayed by approximately 60 microsec from the electric field peak. It is thought that the transition between the fast linear portion and the slower rise may be due to the return stroke entering the cloud base. A small percentage of the records suggest that two different branches of the same stepped leader can initiate separate return strokes. The light pulses from cloud discharges tend to be smaller and to vary more slowly than those from return strokes.

Return to activity among athletes with a symptomatic bipartite patella: a systematic review.

PubMed

Matic, George T; Flanigan, David C

2015-09-01

A bipartite patella is typically rare, but can become symptomatic during overuse activities such as those performed during athletic events. Therefore, this anomaly typically presents in the young, athletic population, often inhibiting athletic activities. Multiple treatment options exist, with nonsurgical management frequently adopted as the initial treatment of choice. To determine the most effective intervention in returning athletes with symptomatic bipartite patella to their prior activity levels. A systematic review of the literature was performed using PRISMA guidelines to identify studies reporting outcomes of athletes' ability to return to activity following treatment for a symptomatic bipartite patella. The type of intervention, type of bipartite classification, outcomes, and complications were recorded. Twenty articles with a total of 125 patients and 130 knees were identified and included in this review. A total of 105 athletes made a full return to athletic activity following treatment for their painful bipartite patella. One hundred athletes (85.5%) that underwent surgical treatment were able to make a full return to their sport without symptoms, although this varied by surgical procedure performed. Excision of the painful fragment produced the best results in returning athletes to sport, with 91% returning without symptoms and nine percent returning but with residual symptoms. Surgical treatments for symptomatic bipartite patellae are successful at returning athletes to their same level of play, and best outcomes are with excision of the fragment. These results are limited, however, due to the poor quality of original data given the rarity of the anomaly and the underrepresented conservative treatment group. Copyright © 2015 Elsevier B.V. All rights reserved.

On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction.

PubMed

Capin, Jacob J; Behrns, William; Thatcher, Karen; Arundale, Amelia; Smith, Angela Hutchinson; Snyder-Mackler, Lynn

2017-05-01

Synopsis The literature pertaining to the rehabilitation of ice hockey players seeking to return to sport after anterior cruciate ligament reconstruction (ACLR) is currently limited. The purpose of this clinical commentary was to present a criterion-based progression for return to ice hockey for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a 4-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, noncontact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR. J Orthop Sports Phys Ther 2017;47(5):324-333. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7245.

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion.

PubMed

Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Czarnota, Michael; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Driediger, Molly; Skopelja, Elaine N

2010-11-01

The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16-21-year-old) ice hockey players during a regular season. The authors conducted a prospective cohort study during 1 junior regular season (2009-2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7-29 days); the mean number of physician office visits by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

Influence of channel base current and varying return stroke speed on the calculated fields of three important return stroke models

NASA Technical Reports Server (NTRS)

Thottappillil, Rajeev; Uman, Martin A.; Diendorfer, Gerhard

1991-01-01

Compared here are the calculated fields of the Traveling Current Source (TCS), Modified Transmission Line (MTL), and the Diendorfer-Uman (DU) models with a channel base current assumed in Nucci et al. on the one hand and with the channel base current assumed in Diendorfer and Uman on the other hand. The characteristics of the field wave shapes are shown to be very sensitive to the channel base current, especially the field zero crossing at 100 km for the TCS and DU models, and the magnetic hump after the initial peak at close range for the TCS models. Also, the DU model is theoretically extended to include any arbitrarily varying return stroke speed with height. A brief discussion is presented on the effects of an exponentially decreasing speed with height on the calculated fields for the TCS, MTL, and DU models.

The TPS Advanced Development Project for CEV

NASA Technical Reports Server (NTRS)

Reuther, James; Wercinski, Paul; Venkatapathy, Ethiraj; Ellerby, Don; Raiche, George; Bowman, Lynn; Jones, Craig; Kowal, John

2006-01-01

The CEV TPS Advanced Development Project (ADP) is a NASA in-house activity for providing two heatshield preliminary designs (a Lunar direct return as well as a LEO only return) for the CEV, including the TPS, the carrier structure, the interfaces and the attachments. The project s primary objective is the development of a single heatshield preliminary design that meets both Lunar direct return and LEO return requirements. The effort to develop the Lunar direct return capable heatshield is considered a high risk item for the NASA CEV development effort due to the low TRL (approx. 4) of the candidate TPS materials. By initiating the TPS ADP early in the development cycle, the intent is to use materials analysis and testing in combination with manufacturing demonstrations to reduce the programmatic risk of using advanced TPS technologies in the critical path for CEV. Due to the technical and schedule risks associated a Lunar return heatshield, the ADP will pursue a parallel path design approach, whereby a back-up TPS/heatshield design that only meets LEO return requirements is also developed. The TPS materials and carrier structure design concept selections will be based on testing, analysis, design and evaluation of scalability and manufacturing performed under the ADP. At the TPS PDR, the preferred programmatic strategy is to transfer the continued (detailed) design, development, testing and evaluation (DDT&E) of both the Lunar direct and LEO return designs to a government/prime contractor coordinated sub-system design team. The CEV prime contractor would have responsibility for the continued heatshield sub-system development. Continued government participation would include analysis, testing and evaluation as well as decision authority at TPS Final System Decision (FSD) (choosing between the primary and back-up heatshields) occurring between TPS PDR and TPS Critical Design Review (CDR). After TPS FSD the prime CEV contractor will complete the detailed design, certification testing, procurement, and integration of the CEV TPS.

Factors associated with non-return to work in the severely injured victims 3 years after a road accident: A prospective study.

PubMed

Pélissier, C; Fort, E; Fontana, L; Charbotel, B; Hours, M

2017-09-01

Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess modifiable medical and socio-occupational factors of non-return to work in the severely injured 3 years after a road accident. Among1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 of the 222 severely injured (Maximal Abbreviated Injury Scale ≥ 3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n=113) and had not returned to work (n=28) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head and lower-limb injury, intense persistent pain at 3 years and post-traumatic stress disorder were significantly associated with non-return to work 3 years following severe road-accident injury. Post-traumatic stress disorder and chronic pain were essential modifiable medical determinants of non-return to work in the severely injured after a road accident: early adapted management could promote return to work in the severely injured. Improve early adapted treatment of pain and PTSD in the rehabilitation team should help the severely injured return to work following a road accident. Copyright © 2017 Elsevier Ltd. All rights reserved.

Vacuum-assisted venous return reduces blood usage.

PubMed

Banbury, Michael K; White, Jennifer A; Blackstone, Eugene H; Cosgrove, Delos M

2003-09-01

To determine whether vacuum-assisted venous return has clinical advantages over conventional gravity drainage apart from allowing the use of smaller cannulas and shorter tubing. A total of 150 valve operations were performed at our institution between February and July 1999 using vacuum-assisted venous return with small venous cannulas connected to short tubing. These were compared with (1) 83 valve operations performed between April 1997 and January 1998 using the initial version of vacuum-assisted venous return, and (2) 124 valve operations performed between January and April of 1997 using conventional gravity drainage. Priming volume, hematocrit value, red blood cell usage, and total blood product usage were compared multivariably. These comparisons were covariate and propensity adjusted for dissimilarities between the groups and confirmed by propensity-matched pairs analysis. Priming volume was 1.4 +/- 0.4 L for small-cannula vacuum-assisted venous return, 1.7 +/- 0.4 L for initial vacuum-assisted venous return, and 2.0 +/- 0.4 L for gravity drainage (P <.0001). Smaller priming resulted in higher hematocrit values both at the beginning of cardiopulmonary bypass (27% +/- 5% compared with 26% +/- 4% and 25% +/- 4%, respectively, P <.0001) and at the end (30% +/- 4% compared with 28% +/- 4% and 27% +/- 4%, respectively, P <.0001). Red cell transfusions were used in 17% of the patients having small-cannula vacuum-assisted venous return, 27% of the initial patients having vacuum-assisted venous return, and 37% of the patients having gravity drainage (P =.001); total blood product usage was 19%, 27%, and 39%, respectively (P =.002). Although ministernotomy also was associated with reduced blood product usage (P <.004), propensity matching on type of sternotomy confirmed the association of vacuum-assisted venous return with lowered blood product usage. Vacuum-assisted venous return results in (1) higher hematocrit values during cardiopulmonary bypass and (2) decreased red cell and total blood product usage.

Lunar Ascent and Rendezvous Trajectory Design

NASA Technical Reports Server (NTRS)

Sostaric, Ronald R.; Merriam, Robert S.

2008-01-01

The Lunar Lander Ascent Module (LLAM) will leave the lunar surface and actively rendezvous in lunar orbit with the Crew Exploration Vehicle (CEV). For initial LLAM vehicle sizing efforts, a nominal trajectory, along with required delta-V and a few key sensitivities, is very useful. A nominal lunar ascent and rendezvous trajectory is shown, along with rationale and discussion of the trajectory shaping. Also included are ascent delta-V sensitivities to changes in target orbit and design thrust-to-weight of the vehicle. A sample launch window for a particular launch site has been completed and is included. The launch window shows that budgeting enough delta-V for two missed launch opportunities may be reasonable. A comparison between yaw steering and on-orbit plane change maneuvers is included. The comparison shows that for large plane changes, which are potentially necessary for an anytime return from mid-latitude locations, an on-orbit maneuver is much more efficient than ascent yaw steering. For a planned return, small amounts of yaw steering may be necessary during ascent and must be accounted for in the ascent delta-V budget. The delta-V cost of ascent yaw steering is shown, along with sensitivity to launch site latitude. Some discussion of off-nominal scenarios is also included. In particular, in the case of a failed Powered Descent Initiation burn, the requirements for subsequent rendezvous with the Orion vehicle are outlined.

War zone veterans returning to treatment: effects of social functioning and psychopathology.

PubMed

Fontana, Alan; Rosenheck, Robert

2010-10-01

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

The Impact of an Integrated Program of Return-to-Field and Targeted Trap-Neuter-Return on Feline Intake and Euthanasia at a Municipal Animal Shelter

PubMed Central

Spehar, Daniel D.; Wolf, Peter J.

2018-01-01

Simple Summary Dramatic declines in the number of cats admitted to and euthanized at U.S. shelters have taken place in recent decades. Still, millions of cats, many of them free-roaming, enter shelters each year. At some facilities, as many as 70% of feline admissions are euthanized, and it is estimated that, nationally, up to one million or more cats are euthanized each year. New approaches, including return-to-field (RTF) and targeted trap-neuter-return (TNR) appear to have transformative potential. The present study examines changes in feline intake and euthanasia, as well as impacts on associated metrics, at a municipal animal shelter in Albuquerque, New Mexico, after formal RTF and targeted TNR protocols, collectively referred to as a community cat program (CCP), were added to ongoing community-based TNR efforts and a pilot RTF initiative. As part of the three-year CCP, 11,746 cats were trapped, sterilized, vaccinated and returned or adopted. Feline euthanasia at the Albuquerque Animal Welfare Department (AAWD) declined by 84.1% and feline intake dropped by 37.6%; the live release rate (LRR) increased by 47.7% due primarily to these reductions in both intake and euthanasia. Modest increases in the percentage of cats returned to owner (RTO) and the adoption rate were also observed, although both metrics decreased on an absolute basis, while the number of calls to the city about dead cats declined. Abstract Available evidence indicates that overall levels of feline intake and euthanasia at U.S. shelters have significantly declined in recent decades. Nevertheless, millions of cats, many of them free-roaming, continue to be admitted to shelters each year. In some locations, as many as 70% of cats, perhaps up to one million or more per year nationally, are euthanized. New approaches, including return-to-field (RTF) and targeted trap-neuter-return (TNR) appear to have transformative potential. The purpose of the present study was to examine changes in feline intake and euthanasia, as well as additional associated metrics, at a municipal animal shelter in Albuquerque, New Mexico, after institutionalized RTF and targeted TNR protocols, together referred to as a community cat program (CCP), were added to ongoing community-based TNR efforts and a pilot RTF initiative. Over the course of the CCP, which ran from April 2012 to March 2015, 11,746 cats were trapped, sterilized, vaccinated, and returned or adopted. Feline euthanasia at the Albuquerque Animal Welfare Department (AAWD) declined by 84.1% and feline intake dropped by 37.6% over three years; the live release rate (LRR) increased by 47.7% due primarily to these reductions in both intake and euthanasia. Modest increases in the percentage of cats returned to owner (RTO) and the adoption rate were also observed, although both metrics decreased on an absolute basis, while the number of calls to the city about dead cats declined. PMID:29652808

Introduction to Mars Sampling Handling Workshop Series. Workshop on Life Detection: Issues and Topics

NASA Technical Reports Server (NTRS)

Rummel, John D.

2001-01-01

Before martian soil and rock samples can be distributed to the research community, the returned materials will initially be quarantined and examined in a proposed BSL-4 containment facility to assure that no putative martian microorganisms or attendant potential biohazards exist. During the initial quarantine, state-of-the-art life detection and biohazard testing of the returned martian samples will be conducted. Life detection, as defined here in regard to Mars sample return missions, is the detection of living organisms and/or materials that have been derived from living organisms that may be present in the sample.

The resolution of inflammation: Principles and challenges.

PubMed

Headland, Sarah E; Norling, Lucy V

2015-05-01

The concept that chemokines, cytokines and pro-inflammatory mediators act in a co-ordinated fashion to drive the initiation of the inflammatory reaction is well understood. The significance of such networks acting during the resolution of inflammation however is poorly appreciated. In recent years, specific pro-resolving mediators were discovered which activate resolution pathways to return tissues to homeostasis. These mediators are diverse in nature, and include specialized lipid mediators (lipoxins, resolvins, protectins and maresins) proteins (annexin A1, galectins) and peptides, gaseous mediators including hydrogen sulphide, a purine (adenosine), as well as neuromodulator release under the control of the vagus nerve. Functionally, they can act to limit further leukocyte recruitment, induce neutrophil apoptosis and enhance efferocytosis by macrophages. They can also switch macrophages from classical to alternatively activated cells, promote the return of non-apoptotic cells to the lymphatics and help initiate tissue repair mechanisms and healing. Within this review we highlight the essential cellular aspects required for successful tissue resolution, briefly discuss the pro-resolution mediators that drive these processes and consider potential challenges faced by researchers in the quest to discover how inflammation resolves and why chronic inflammation persists. Copyright © 2015 Elsevier Ltd. All rights reserved.

Phase transition phenomenon: A compound measure analysis

NASA Astrophysics Data System (ADS)

Kang, Bo Soo; Park, Chanhi; Ryu, Doojin; Song, Wonho

2015-06-01

This study investigates the well-documented phenomenon of phase transition in financial markets using combined information from both return and volume changes within short time intervals. We suggest a new measure for the phase transition behaviour of markets, calculated as a return distribution conditional on local variance in volume imbalance, and show that this measure successfully captures phase transition behaviour under various conditions. We analyse the intraday trade and quote dataset from the KOSPI 200 index futures, which includes detailed information on the original order size and the type of each initiating investor. We find that among these two competing factors, the submitted order size yields more explanatory power on the phenomenon of market phase transition than the investor type.

Comparison of Propulsion Options for Human Exploration of Mars

NASA Technical Reports Server (NTRS)

Drake, Bret G.; McGuire, Melissa L.; McCarty, Steven L.

2018-01-01

NASA continues to advance plans to extend human presence beyond low-Earth orbit leading to human exploration of Mars. The plans being laid out follow an incremental path, beginning with initial flight tests followed by deployment of a Deep Space Gateway (DSG) in cislunar space. This Gateway, will serve as the initial transportation node for departing and returning Mars spacecraft. Human exploration of Mars represents the next leap for humankind because it will require leaving Earth on a long mission with very limited return, rescue, or resupply capabilities. Although Mars missions are long, approaches and technologies are desired which can reduce the time that the crew is away from Earth. This paper builds off past analyses of NASA's exploration strategy by providing more detail on the performance of alternative in-space transportation options with an emphasis on reducing total mission duration. Key options discussed include advanced chemical, nuclear thermal, nuclear electric, solar electric, as well as an emerging hybrid propulsion system which utilizes a combination of both solar electric and chemical propulsion.

Veggie: Space Vegetables for the International Space Station and Beyond

NASA Technical Reports Server (NTRS)

Massa, Gioia D.

2016-01-01

The Veggie vegetable production system was launched to the International Space Station (ISS) in 2014. Veggie was designed by ORBITEC to be a compact, low mass, low power vegetable production system for astronaut crews. Veggie consists of a light cap containing red, blue, and green LEDs, an extensible transparent bellows, and a baseplate with a root mat reservoir. Seeds are planted in plant pillows, small growing bags that interface with the reservoir. The Veggie technology validation test, VEG-01, was initiated with the first test crop of 'Outredgeous' red romaine lettuce. Prior to flight, lettuce seeds were sanitized and planted in a substrate of arcillite (baked ceramic) mixed with controlled release fertilizer. Upon initiation, astronauts open the packaged plant pillows, install them in the Veggie hardware, and prime the system with water. Operations include plant thinning, watering, and photography. Plants were grown on the ISS for 33 days, harvested, and returned frozen to Earth for analysis. Ground controls were conducted at Kennedy Space Center in controlled environment chambers reproducing ISS conditions of temperature, relative humidity, and CO2. Returned plant samples were analyzed for microbial food safety and chemistry including elements, antioxidants, anthocyanins and phenolics. In addition the entire plant microbiome was sequenced, and returned plant pillows were analyzed via x-ray tomography. Food safety analyses allowed us to gain approvals for future consumption of lettuce by the flight surgeons and the payload safety office. A second crop of lettuce was grown in 2015, and the crew consumed half the produce, with the remainder frozen for later analysis. This growth test was followed by testing of a new crop in Veggie, zinnias. Zinnias were grown to test a longer duration flowering crop in preparation for tests of tomatoes and other fruiting crops in the future. Zinnias were harvested in February. Samples from the second harvest of lettuce and the zinnia harvest are frozen on the ISS and will return with the next cargo return flight. Some challenges occurred in all tests, especially in the area of watering, with plants receiving insufficient or excess water leading to stressed growth. Zinnia plants were also challenged with fungal growth. Initial tests with Veggie have given us great insight into future crop production scenarios as we work to develop regular supplemental salad crop production on ISS and larger food production systems for our journey to Mars. Funding for this research comes from NASA's Space Biology Program.

A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders.

PubMed

Durand, Marie-José; Corbière, Marc; Coutu, Marie-France; Reinharz, Daniel; Albert, Valérie

2014-01-01

Workplace absenteeism is still a curse for developed countries, and more systematic practices need to be adopted to address this issue. To review the literature on best practices for managing work absences related to musculoskeletal or common mental disorders. A review was conducted by performing a search in bibliographic databases and on work-disability research institute websites. Recommendations regarding work-absence management and return-to-work practices were extracted from all the retained documents and organized within a chronological framework. In total, 17 documents were analyzed, leading to identification of common work-absence management and return-to-work practices, the importance of a worker support approach, and recommended roles and responsibilities for stakeholders. These practices were then integrated into a six-step process: (1) time off and recovery period; (2) initial contact with the worker; (3) evaluation of the worker and his job tasks; (4) development of a return-to-work plan with accommodations; (5) work resumption, and (6) follow-up of the return-to-work process. Based on this review, we constructed a comprehensive work-absence management and return-to-work process designed to assist organizations. Our results indicate that such a process must be included within a broader policy of health promotion and job retention. Adaptations will be required for implementation in the workplace.

Rotational joint assembly for the prosthetic leg

NASA Technical Reports Server (NTRS)

Owens, L. J.; Jones, W. C. (Inventor)

1977-01-01

A rotational joint assembly for a prosthetic leg has been devised, which enables an artificial foot to rotate slightly when a person is walking, running or turning. The prosthetic leg includes upper and lower tubular members with the rotational joint assembly interposed between them. The assembly includes a restrainer mechanism which consists of a pivotably mounted paddle element. This device applies limiting force to control the rotation of the foot and also restores torque to return the foot back to its initial position.

Electrification in winter storms and the analysis of thunderstorm overflight data

NASA Technical Reports Server (NTRS)

Brook, Marx

1993-01-01

We have been focusing our study of electrification in winter storms on the lightning initiation process, making inferences about the magnitude of the electric fields from the initial pulses associated with breakdown, i.e., with the formation of the initial streamers. The essence of the most significant finding is as follows: (1) initial breakdown radiation pulses from stepped leaders prior to the first return stroke are very large, reaching values of 20-30 Volts/meter, comparable to return stroke radiation; and (2) the duration of the stepped leader, from the initial detectable radiation pulse to the return stroke onset, is very-short-ranging from a minimum 1.5 ms to a maximum of 4.5 ms. This past summer (June-August of 1991) we participated in the CAPE program at the Kennedy Space Center in order to acquire data on stepped leaders in summer storms with the same equipment used to get the winter storm data. We discovered that the vigorous leaders seen in winter so frequently were present in summer storms, although not as large in amplitude and certainly not as frequent.

Initial analysis and curation plans for MUSES-C asteroidal samples

NASA Astrophysics Data System (ADS)

Yano, H.; Kushiro, I.; Fujiwara, A.

In the MUSES-C mission, sample return of several hundred mg to several g in to- tal is expected from the surface of the S-type near Earth asteroid 1998SF36 in 2007. The MUSES-C samples are expected to be more similar to micrometeorites than large pieces of rocks. Also the initial analysis to characterize general aspects of returned samples can consume only 15 % of its total mass and must complete the whole anal- yses including the database building before international AO for detailed analyses opens in less than a year. Confident exercise of non-destructive, micro-analyses when- ever possible are thus vital for the SMUSES-C Asteroidal Sample Preliminary Exam- ination Team (MASPET)T, which will be formed by the ISAS MUSES-C team, the international partners from NASA and Australia and Sall-JapanT meteoritic scientists to be selected as outsourcing parts of the initial analyses. In 2000-2001, in the pur- pose to survey what kinds and levels of micro-analysis techniques in respective fields, from major elements and mineralogy to trace and isotopic elements and organics, are available in Japan at present, ISAS welcomed a total of 11 applications to the first round open competition for the MASPET candidates. The initial evaluation was made by multiple domestic peer reviews. Nine out of 11 were then provided two kinds of Sasteroid sample analogsT that no applicant knew what they were in advance by the Selection Committee (chair: I. Kushiro) in order to conduct proposed analysis with self-claimed amount of samples (100 mg max) in self-claimed duration (6 months max). The proponents must demonstrate how much their technical capabilities, ana- lytical precision, and usefulness of the derived results for subsequent detailed analyses are worth being included in the MASPET studies. After the completion of multiple, international peer reviews, the Selection Committee compiled evaluations and recom- mended the finalists of this round competition. However, it is also recognized that there are a few more areas of expertise still lacked within the recommended members. Thus, the competition shall be repeated one or two more times (in early 2003 after the launch, and possibly in 2005 after in-situ data is obtained) in order to collect the best Japanese experts in the whole range of different types of analyses at the time of the sample return. The final members of the MASPET will be appointed about 2 years prior to the Earth return. Then they will conduct a Stest runT of the whole initial analysis procedures at the ISAS asteromaterial curation facility, to be newly created in next a few years, and their respective analysis facilities. This talk also covers the current concepts of the facility and plans of analysis procedure flow.

Influence of partner support on an employed mother's intention to breastfeed after returning to work.

PubMed

Tsai, Su-Ying

2014-05-01

Despite the increasing number of large companies complying with the demands for a breastfeeding-friendly workplace, providing on-site lactation support, some mothers still find continuing to breastfeed a challenge. We postulated that greater support and encouragement from the partner would be independently predictive of whether the mother would take advantage of workplace milk expression breaks and lactation rooms and continue to breastfeed after returning to work. To evaluate this hypothesis, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan. Six hundred eight working mothers in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan who had access to dedicated lactation rooms at the workplace were interviewed. Questionnaire content included female employee demographics, employment characteristics, partner-related characteristics, and breastfeeding behavior after returning to work following the birth of their most recently born child. The partner's initial support of the choice to breastfeed and encouragement to use the lactation room and milk expression breaks and the mother's perception of the partner's support for baby care were significant predictors of the intention to continue to breastfeed after returning to work, after adjusting for the employed mother's demographics and employment characteristics, supporting our hypothesis. These findings suggest that antenatal education or activities provided by the workplace should include the partner, which may improve workplace breastfeeding rates.

Influence of Partner Support on an Employed Mother's Intention to Breastfeed After Returning to Work

PubMed Central

2014-01-01

Abstract Background: Despite the increasing number of large companies complying with the demands for a breastfeeding-friendly workplace, providing on-site lactation support, some mothers still find continuing to breastfeed a challenge. We postulated that greater support and encouragement from the partner would be independently predictive of whether the mother would take advantage of workplace milk expression breaks and lactation rooms and continue to breastfeed after returning to work. To evaluate this hypothesis, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan. Subjects and Methods: Six hundred eight working mothers in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan who had access to dedicated lactation rooms at the workplace were interviewed. Questionnaire content included female employee demographics, employment characteristics, partner-related characteristics, and breastfeeding behavior after returning to work following the birth of their most recently born child. Results: The partner's initial support of the choice to breastfeed and encouragement to use the lactation room and milk expression breaks and the mother's perception of the partner's support for baby care were significant predictors of the intention to continue to breastfeed after returning to work, after adjusting for the employed mother's demographics and employment characteristics, supporting our hypothesis. Conclusions: These findings suggest that antenatal education or activities provided by the workplace should include the partner, which may improve workplace breastfeeding rates. PMID:24650363

The Recovery of TOMS-EP

NASA Technical Reports Server (NTRS)

Robertson, Brent; Sabelhaus, Phil; Mendenhall, Todd; Fesq, Lorraine

1998-01-01

On December 13th 1998, the Total Ozone Mapping Spectrometer - Earth Probe (TOMS-EP) spacecraft experienced a Single Event Upset which caused the system to reconfigure and enter a Safe Mode. This incident occurred two and a half years after the launch of the spacecraft which was designed for a two year life. A combination of factors, including changes in component behavior due to age and extended use, very unfortunate initial conditions and the safe mode processing logic prevented the spacecraft from entering its nominal long term storage mode. The spacecraft remained in a high fuel consumption mode designed for temporary use. By the time the onboard fuel was exhausted, the spacecraft was Sun pointing in a high rate flat spin. Although the uncontrolled spacecraft was initially in a power and thermal safe orientation, it would not stay in this state indefinitely due to a slow precession of its momentum vector. A recovery team was immediately assembled to determine if there was time to develop a method of despinning the vehicle and return it to normal science data collection. A three stage plan was developed that used the onboard magnetic torque rods as actuators. The first stage was designed to reduce the high spin rate to within the linear range of the gyros. The second stage transitioned the spacecraft from sun pointing to orbit reference pointing. The final stage returned the spacecraft to normal science operation. The entire recovery scenario was simulated with a wide range of initial conditions to establish the expected behavior. The recovery sequence was started on December 28th 1998 and completed by December 31st. TOMS-EP was successfully returned to science operations by the beginning of 1999. This paper describes the TOMS-EP Safe Mode design and the factors which led to the spacecraft anomaly and loss of fuel. The recovery and simulation efforts are described. Flight data are presented which show the performance of the spacecraft during its return to science. Finally, lessons learned are presented.

Medical outcomes a new approach called "return on risk".

PubMed

Morris, Gregory R; Yunker, Daniel T

2005-06-01

Managing risk to generate a measurable return provides these benefits: Risk can be leveraged into a competitive advantage. Quality of care initiatives can be justified. A "portfolio of risks" can be managed.

RETURN TO DIVISION IA FOOTBALL FOLLOWING A 1ST METATARSOPHALANGEAL JOINT DORSAL DISLOCATION

PubMed Central

Cook, Chad; Zarzour, Hap; Moorman, Claude T.

2010-01-01

Background. Although rare in occurrence, a dorsal dislocation of the 1st metatarsophalangeal (MTP) joint has been successfully treated using surgical and/or non-operative treatment. No descriptions of conservative intervention following a dorsal dislocation of the MTP joint in an athlete participating in a high contact sport are present in the literature. Objectives. The purpose of this case report is to describe the intervention and clinical reasoning during the rehabilitative process of a collegiate football player diagnosed with a 1st MTP joint dorsal dislocation. The plan of care and return to play criteria used for this athlete are presented. Case Description. The case involved a 19-year-old male Division IA football player, who suffered a traumatic dorsal dislocation of the 1st MTP joint during practice. The dislocation was initially treated on-site by closed reduction. Non-operative management included immobilization, therapeutic exercises, non-steroidal anti-inflammatories, manual treatment, modalities, prophylactic athletic taping, gait training, and a sport specific progression program for full return to Division IA football. Outcomes. Discharge from physical therapy occurred after six weeks of treatment. At discharge, no significant deviations existed during running, burst, and agility related drills. At a six-month follow-up, the patient reported full return to all football activities including contact drills without restrictions. Discussion. This case describes an effective six-week rehabilitation intervention for a collegiate football player who sustained a traumatic great toe dorsal dislocation. Further study is suggested to evaluate the intervention strategies and timeframe for return to contact sports. PMID:21589669

Return to sports participation after articular cartilage repair in the knee: scientific evidence.

PubMed

Mithoefer, Kai; Hambly, Karen; Della Villa, Stefano; Silvers, Holly; Mandelbaum, Bert R

2009-11-01

Articular cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee. Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee. Systematic review. A comprehensive literature review of original studies was performed to provide information about athletic participation after articular cartilage repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology. Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations.

Effect of initial conditions and of intra-event rainfall intensity variability on shallow landslide triggering return period

NASA Astrophysics Data System (ADS)

Peres, David Johnny; Cancelliere, Antonino

2016-04-01

Assessment of shallow landslide hazard is important for appropriate planning of mitigation measures. Generally, return period of slope instability is assumed as a quantitative metric to map landslide triggering hazard on a catchment. The most commonly applied approach to estimate such return period consists in coupling a physically-based landslide triggering model (hydrological and slope stability) with rainfall intensity-duration-frequency (IDF) curves. Among the drawbacks of such an approach, the following assumptions may be mentioned: (1) prefixed initial conditions, with no regard to their probability of occurrence, and (2) constant intensity-hyetographs. In our work we propose the use of a Monte Carlo simulation approach in order to investigate the effects of the two above mentioned assumptions. The approach is based on coupling a physically based hydrological and slope stability model with a stochastic rainfall time series generator. By this methodology a long series of synthetic rainfall data can be generated and given as input to a landslide triggering physically based model, in order to compute the return period of landslide triggering as the mean inter-arrival time of a factor of safety less than one. In particular, we couple the Neyman-Scott rectangular pulses model for hourly rainfall generation and the TRIGRS v.2 unsaturated model for the computation of transient response to individual rainfall events. Initial conditions are computed by a water table recession model that links initial conditions at a given event to the final response at the preceding event, thus taking into account variable inter-arrival time between storms. One-thousand years of synthetic hourly rainfall are generated to estimate return periods up to 100 years. Applications are first carried out to map landslide triggering hazard in the Loco catchment, located in highly landslide-prone area of the Peloritani Mountains, Sicily, Italy. Then a set of additional simulations are performed in order to compare the results obtained by the traditional IDF-based method with the Monte Carlo ones. Results indicate that both variability of initial conditions and of intra-event rainfall intensity significantly affect return period estimation. In particular, the common assumption of an initial water table depth at the base of the pervious strata may lead in practice to an overestimation of return period up to one order of magnitude, while the assumption of constant-intensity hyetographs may yield an overestimation by a factor of two or three. Hence, it may be concluded that the analysed simplifications involved in the traditional IDF-based approach generally imply a non-conservative assessment of landslide triggering hazard.

The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.

PubMed

Abualenain, Jameel; Frohna, William J; Smith, Mark; Pipkin, Michael; Webb, Cynthia; Milzman, David; Pines, Jesse M

2013-08-01

Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues. We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome. Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed. Any substandard quality on the first visit or change in outcome on the return admission was considered "low quality." Multivariate logistic regression was used to assess the relationship between cases judged as low quality vs. not low quality. Of 741,132 ED visits across 5 years, 3682 (0.5%) were 72-h return admissions. Of those, 192 (5%) were low quality. In 158 (4%) and 8 (0.2%) there were moderate and severe deviations from care standards, respectively. Similarly, in 53 (1%) and 14 (0.4%) there were moderate and severe changes in outcome. In adjusted analysis, there were higher rates of low-quality 72-h return admissions in ambulance arrivals (odds ratio [OR] 1.5, 95% confidence interval (CI) 1.1-2.1); and lower rates in Medicaid patients (OR 0.3, 95% CI 0.2-0.7). There were higher rates in low-quality 72-h return admissions in hospital 1 (OR 3.6, 95% CI 2.2-6.1) and hospital 3 (OR 3.2, 95% CI 2.0-4.7) compared to hospital 2. Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality. Copyright © 2013 Elsevier Inc. All rights reserved.

PCR negative cerebral malaria in a traveller returning from Mumbai.

PubMed

Bhome, Rohan; Bhome, Rahul

2011-08-11

The incidence of imported malaria to the UK is significant. The authors report a case of a healthy young man diagnosed with PCR negative cerebral malaria, a week after returning from Mumbai. The patient presented with acute confusion and vomiting. His condition deteriorated quickly warranting intubation, ventilation and transfer to intensive therapy unit. Extensive investigation did not find an underlying cause. Antimalarial treatment was initiated based on clinical suspicion despite a negative malarial screen. A rapid response to treatment followed such that the patient was extubated within 24 h. This case highlights the need for the UK Health Protection Agency to review its risk classification of malaria for travellers to Mumbai. Additionally, clinicians should promptly initiate antimalarial treatment in an unwell traveller returning from an endemic area when there is a high clinical suspicion even in the absence of a positive initial malaria screen.

Parents Returning to Work: Evaluation of Grant Recipient Outcomes 2004-05, 2005-06

ERIC Educational Resources Information Center

Ferrier, Fran; Kellock, Peter; Burke, Gerald

2007-01-01

The Parents Returning to Work Program (PRTW) is a Victorian government initiative which commenced in 2003. It provides grants to assist eligible parents who wish to return to paid employment after a period of caring for children to participate in training that will increase their work skills and job prospects. This evaluation aimed to review the…

DEVELOPMENT OF A PHYSICAL PERFORMANCE ASSESSMENT CHECKLIST FOR ATHLETES WHO SUSTAINED A LOWER EXTREMITY INJURY IN PREPARATION FOR RETURN TO SPORT: A DELPHI STUDY

PubMed Central

Haines, Sara; Baker, Tricia

2013-01-01

Purpose/Background: To develop a consensus on the critical constructs necessary to be included in a physical performance assessment checklist (PPAC) to assess an athlete's ability for return to sport following a lower extremity injury. Methods: The study used a 3‐round Delphi method to finalize the PPAI originally developed by a panel of experts. Fourteen Delphi representative sample participants were randomly derived from the authors of peer‐reviewed publications of lower extremity injuries. Nine participants completed all 3 rounds. Results: Throughout the 3 rounds, the 10 initial constructs were modified and revised to produce the finalized PPAC consisting of 12 constructs necessary to consider for an athlete's return to sport after a lower extremity injury. Conclusions: This instrument can be used as a checklist to advocate for prospective batteries of physical performance tests to incorporate the elements identified by this study. Level of Evidence: 5 PMID:23439809

Factors associated with comprehensive dental care following an initial emergency dental visit.

PubMed

Johnson, Jeffrey T; Turner, Erwin G; Novak, Karen F; Kaplan, Alan L

2005-01-01

The purpose of this study was to characterize the patient population utilization of a dental home as grouped by: (1) age; (2) sex; and (3) payment method. A retrospective chart review of 1,020 patients, who initially presented for an emergency visit, was performed. From the original data pool, 2 groups were delineated: (1) those patients who returned for comprehensive dental care; and (2) those who did not return for comprehensive dental care. Patients with private dental insurance or Medicaid dental benefits were statistically more likely to return for comprehensive oral health care than those with no form of dental insurance. Younger patients (< or =3 years of age) were least likely to return for comprehensive dental care. Socioeconomic factors play a crucial role in care-seeking behaviors. These obstacles are often a barrier to preventive and comprehensive oral health care.

A Review of New and Developing Technology to Significantly Improve Mars Sample-Return Missions

NASA Technical Reports Server (NTRS)

Carsey, F.; Brophy, J.; Gilmore, M.; Rodgers, D.; Wilcox, B.

2000-01-01

A JPL development activity was initiated in FY 1999 for the purpose of examining and evaluating technologies that could materially improve future (i.e., beyond the 2005 launch) Mars sample return missions. The scope of the technology review was comprehensive and end-to-end; the goal was to improve mass, cost, risk, and scientific return. A specific objective was to assess approaches to sample return with only one Earth launch. While the objective of the study was specifically for sample-return, in-situ missions can also benefit from using many of the technologies examined.

A Review of New and Developing Technology to Significantly Improve Mars Sample-Return Missions

NASA Astrophysics Data System (ADS)

Carsey, F.; Brophy, J.; Gilmore, M.; Rodgers, D.; Wilcox, B.

2000-07-01

A JPL development activity was initiated in FY 1999 for the purpose of examining and evaluating technologies that could materially improve future (i.e., beyond the 2005 launch) Mars sample return missions. The scope of the technology review was comprehensive and end-to-end; the goal was to improve mass, cost, risk, and scientific return. A specific objective was to assess approaches to sample return with only one Earth launch. While the objective of the study was specifically for sample-return, in-situ missions can also benefit from using many of the technologies examined.

Naval Arms Control: The Backdrop of History

DTIC Science & Technology

1990-08-01

with the Allies would be destroyed. On May 7, a German submarine sank the passenger liner Lusitania with a loss of 1,100 civilians, including 128...ADEQUATE NAVY IN THE WORLD" Spurred by the Lusitania sinking, the United States returned to building its own naval ships, but with considerably enlarged...war. 36Germany abandoned its initial submarine campaign in September 1915, partly because of negative international reaction to the Lusitania sinking

A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

PubMed

Currie, Dustin W; Comstock, R Dawn; Fields, Sarah K; Cantu, Robert C

To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. Retrospective analysis of longitudinal surveillance data. Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P < .0001); 26.6% of recurrent concussions were season ending. We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

"Still Rather Hazy at Present": Citizens' and Physicians' Views on Returning Results from Biobank Research Using Broad Consent.

PubMed

Barazzetti, Gaia; Cavalli, Samuele; Benaroyo, Lazare; Kaufmann, Alain

2017-03-01

Informed consent and return of research results are among the most debated topics in the biobank literature. We discuss ethical, social, and policy issues associated with returning results in the context of biobanks using a broad consent approach, in the light of data from a qualitative survey of citizens' and physicians' views. Data were collected through interviews and focus groups to investigate stakeholders' perspectives about a large-scale hospital-based biobank designed to foster biomedical research, including prospective genomics research, and "personalized" medicine. Both physicians and citizens considered psychosocial impacts as crucial in the assessment of benefits expected from a return of results to biobank participants. In particular, physicians highlighted the possible consequences on the patient-doctor relationship and discussed implications for the concept of "personalized" medicine. Citizens held ambivalent attitudes toward returning individual research results: they defended the "right not to know," while they also considered a sort of "responsibility to know" because of potential implications of results for family members. Moreover, physicians and citizens raised questions about the broad consent model used for inhospital biobank recruitment and expressed their needs for more training in genomics and more information on the biobank initiative. Stakeholders such as citizens and physicians, who may be concerned as potential biobank participants or as healthcare professionals involved in the management of clinically relevant research results, provide useful insights into several aspects of broad consent and return of results, related in particular to the interface between research and the clinic.

Statistical analysis of electric field parameters for negative lightning in Malaysia

NASA Astrophysics Data System (ADS)

Wooi, Chin-Leong; Abdul-Malek, Zulkurnain; Ahmad, Noor-Azlinda; El Gayar, Ali I.

2016-08-01

This paper presents a comparative study on the electric field and its derivative parameters of negative lightning in Malaysia and other regions. This study is the first in Malaysia where the parameters of negative electric field and its derivative are thoroughly analyzed. 104 negative lightning flashes containing 277 negative return strokes occurring within 10-100 km from the measuring station and recorded during monsoon period in the state of Johor, Malaysia had been analyzed. It was found that 73% of the recorded flashes are multiple strokes with an average multiplicity of 2.6 strokes per flash. For first return strokes, the arithmetic mean (AM) of initial peak electric field and the AM of initial peak electric field derivative are 21.8 V/m and 11.3 V/m/μs, respectively. The initial peaks of electric field and its derivative for first return strokes are larger than those for the subsequent return strokes. Comparison of overall results with those obtained earlier in Sri Lanka, Germany, Sweden, Japan, Florida indicates that several electric field and its derivative parameters are affected by propagation media and geographical region. Similarity of results with other countries having the same climatic condition is also observed.

Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury.

PubMed

Silverberg, Noah D; Panenka, William; Iverson, Grant L

2018-04-18

Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (M=2.7, SD=1.5 weeks post-injury) and again 4-5 months later. Of 273 patients screened, 102 completed the initial assessment and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multidimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B= 1.22-6.33) and disability (95% CI for B=2.16-5.48), but not return to work (95% CI for B=-0.68-0.24). The avoidance composite was also associated with an increased risk for depression (OR=1.76, 95% CI=1.02-3.02) and anxiety disorders (OR=1.89, 95% CI=1.16-3.19). Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets.

Third tarsal bone fractures in the greyhound.

PubMed

Guilliard, M J

2010-12-01

To describe the signalment, morphology, response to treatment and prognosis of third tarsal bone fractures in the racing greyhound. All third tarsal bone fractures seen by the author over a ten year period were included in the study. Diagnosis was by radiography. Treatments were reconstruction with a lag screw, fragment removal, centrodistal joint arthrodesis or conservative management. Twenty-three cases were included in the study of which 16 cases were recent and seven cases chronic fractures. The chronic cases had been rested from between three and six months before an examination for recurrent lameness. There were five concomitant second tarsal bone fractures. Partial dorsal collapse was present in four cases. Thirteen dogs had lag screw fixation; three were lost to follow-up, seven returned to racing and three, all with partial tarsal collapse, failed to return to racing. Two dogs that had a centrodistal joint arthrodesis and one dog treated by rest alone raced again. Two dogs that had fragment removal failed to return to racing. Veterinary examination of greyhounds with third tarsal bone fractures is often not sought at the time of the initial injury due to the benign presenting signs. Recurrence of lameness after rest is common. The prognosis for a successful return to racing would appear to be good following fragment fixation in both acute and chronic cases without dorsal tarsal collapse. Centrodistal joint arthrodesis may encourage bone union. The prognosis for conconservatively treated cases is guarded. Fragment removal is not recommended as a treatment. © 2010 British Small Animal Veterinary Association.

Acute clinical care and care coordination for traumatic brain injury within Department of Defense.

PubMed

Jaffee, Michael S; Helmick, Kathy M; Girard, Philip D; Meyer, Kim S; Dinegar, Kathy; George, Karyn

2009-01-01

The nature of current combat situations that U.S. military forces encounter and the use of unconventional weaponry have dramatically increased service personnel's risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of concussion between 10% and 20%. The Department of Defense has recently released statistics on TBI dating back to before the wars in Iraq and Afghanistan to better elucidate the impact and burden of TBI on America's warriors and veterans. Patients with severe TBI move through a well-established trauma system of care, beginning with triage of initial injury by first-responders in the war zone to acute care to rehabilitation and then returning home and to the community. Mild and moderate TBIs may pose different clinical challenges, especially when initially undetected or if treatment is delayed because more serious injuries are present. To ensure identification and prompt treatment of mild and moderate TBI, the U.S. Congress has mandated that military and Department of Veterans Affairs hospitals screen all service personnel returning from combat. Military health professionals must evaluate them for concussion and then treat the physical, emotional, and cognitive problems that may surface. A new approach to health management and care coordination is needed that will allow medical transitions between networks of care to become more centralized and allow for optimal recovery at all severity levels. This article summarizes the care systems available for the acute management of TBI from point of injury to stateside military treatment facilities. We describe TBI assessment, treatment, and overall coordination of care, including innovative clinical initiatives now used.

Workplace wellness programming in low-and middle-income countries: a qualitative study of corporate key informants in Mexico and India.

PubMed

Wipfli, Heather; Zacharias, Kristin Dessie; Nivvy Hundal, Nuvjote; Shigematsu, Luz Myriam Reynales; Bahl, Deepika; Arora, Monika; Bassi, Shalini; Kumar, Shubha

2018-05-09

A qualitative study of key informant semi-structured interviews were conducted between March and July 2016 in Mexico and India to achieve the following aims: to explore corporations' and stakeholders' views, attitudes and expectations in relation to health, wellness and cancer prevention in two middle-income countries, and to determine options for health professions to advance their approach to workplace wellness programming globally, including identifying return-on-investment incentives for corporations to implement wellness programming. There is an unmet demand for workplace wellness resources that can be used by corporations in an international context. Corporations in India and Mexico are already implementing a range of health-related wellness programs, most often focused on disease prevention and management. A number of companies indicated interest is collecting return on investment data but lacked the knowledge and tools to carry out return-on-investment analyses. There was widespread interest in partnership with international non-governmental organizations (public health organizations) and a strong desire for follow-up among corporations interviewed, particularly in Mexico. As low-and middle-income countries continue to undergo economic transitions, the workforce and disease burden continue to evolve as well. Evidence suggests a there is a growing need for workplace wellness initiatives in low-and middle-income countries. Results from this study suggest that while corporations in India and Mexico are implementing wellness programming in some capacity, there are three areas where corporations could greatly benefit from assistance in improving wellness programming in the workplace: 1) innovative toolkits for workplace wellness initiatives and technical support for adaptation, 2) assistance with building partnerships to help implement wellness initiatives and build capacity, and 3) tools and training to collect data for surveillance as well as monitoring and evaluation of wellness programs.

Return Stroke Current Reflections in Rocket-Triggered Lightning

NASA Astrophysics Data System (ADS)

Caicedo, J.; Uman, M. A.; Jordan, D.; Biagi, C. J.; Hare, B.

2015-12-01

In the six years from 2009 to 2014, there have been eight triggered flashes at the ICLRT, from a total of 125, in which a total of ten return stroke channel-base currents exhibited a dip 3.0 to 16.6 μs after the initial current peak. Close range electric field measurements show a related dip following the initial electric field peak, and electric field derivative measurements show an associated bipolar pulse, confirming that this phenomenon is not an instrumentation effect in the current measurement. For six of the eight flashes, high-speed video frames show what appears to be suspended sections of unexploded triggering wire at heights of about 150 to 300 m that are illuminated when the upward current wave reaches them. The suspended wire can act as an impedance discontinuity, perhaps as it explodes, and cause a downward reflection of some portion of the upward-propagating current wave. This reflected wave travels down the channel and causes the dip in the measured channel-base current when it reaches ground and reflects upward. The modified transmission line model with exponential decay (MTLE) is used to model the close electric field and electric field derivatives of the postulated initial and reflected current waves, starting with the measured channel base current, and the results are compared favorably with measurements made at distances ranging from 92 to 444 m. From the measured time between current impulse initiation and the time the current reflection reaches the channel base and the current dip initiates, along with the reflection height from the video records, we find the average return stroke current speed for each of the ten strokes to be from 0.28 to 1.9×108 ms-1, with an error of ±0.01×108 ms-1 due to a ±0.1 μs uncertainty in the measurement. This represents the first direct measurement of return stroke current speed, all previous return stroke speed measurements being derived from the luminosity of the process.

Marshall Space Flight Center Propulsion Systems Department (PSD) KM Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnadoe, Tom; McCarter, Mike

2006-01-01

NASA Marshall Space Flight Center s Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities with in the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center Of Excellence (AISCE), Intergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KM implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to support the planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have been performed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural/KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level systems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

2006-01-01

NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level svstems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, - evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Clinical providers' experiences with returning results from genomic sequencing: an interview study.

PubMed

Wynn, Julia; Lewis, Katie; Amendola, Laura M; Bernhardt, Barbara A; Biswas, Sawona; Joshi, Manasi; McMullen, Carmit; Scollon, Sarah

2018-05-08

Current medical practice includes the application of genomic sequencing (GS) in clinical and research settings. Despite expanded use of this technology, the process of disclosure of genomic results to patients and research participants has not been thoroughly examined and there are no established best practices. We conducted semi-structured interviews with 21 genetic and non-genetic clinicians returning results of GS as part of the NIH funded Clinical Sequencing Exploratory Research (CSER) Consortium projects. Interviews focused on the logistics of sessions, participant/patient reactions and factors influencing them, how the sessions changed with experience, and resources and training recommended to return genomic results. The length of preparation and disclosure sessions varied depending on the type and number of results and their implications. Internal and external databases, online resources and result review meetings were used to prepare. Respondents reported that participants' reactions were variable and ranged from enthusiasm and relief to confusion and disappointment. Factors influencing reactions were types of results, expectations and health status. A recurrent challenge was managing inflated expectations about GS. Other challenges included returning multiple, unanticipated and/or uncertain results and navigating a rare diagnosis. Methods to address these challenges included traditional genetic counseling techniques and modifying practice over time in order to provide anticipatory guidance and modulate expectations. Respondents made recommendations to improve access to genomic resources and genetic referrals to prepare future providers as the uptake of GS increases in both genetic and non-genetic settings. These findings indicate that returning genomic results is similar to return of results in traditional genetic testing but is magnified by the additional complexity and potential uncertainty of the results. Managing patient expectations, initially identified in studies of informed consent, remains an ongoing challenge and highlights the need to address this issue throughout the testing process. The results of this study will help to guide future providers in the disclosure of genomic results and highlight educational needs and resources necessary to prepare providers. Future research on the patient experience, understanding and follow-up of recommendations is needed to more fully understand the disclosure process.

Failure to Return for Posttest Counseling and HIV Test Results at the Prevention and Voluntary Testing and Counseling Centers of Douala, Cameroon: An Evaluation of a Routine Five-Year Program.

PubMed

Ngangue, Patrice; Bedard, Emmanuelle; Ngueta, Gerard; Adiogo, Dieudonné; Gagnon, Marie-Pierre

2016-01-01

This study examined the magnitude and time trends in failure to return (FTR) rates and the relation between FTR and individual characteristics, tests procedures, waiting period for the results, and HIV test results among people who were screened for HIV in the prevention and voluntary testing and counseling centers (PVTCCs) of six district hospitals of the city of Douala in Cameroon, between January 2009 and December 2013. It was a retrospective analysis of medical records. Among the 32,020 analyzed records, the failure to return (FTR) rate was 14.3%. Overall, people aged 50 years and over, those tested between 2011 and 2012, and those tested in the PVTCC of Bonassama were less likely to return for their results. Significant factors associated with FTR included being a housewife, having a positive/undetermined/requiring confirmation result, and provider-initiated testing and counseling (PITC). There was an increasing trend for FTR in the PVTCCs of Bonassama, New-Bell, Nylon, and Cité des Palmiers. HIV testing and counseling services in Douala district hospitals must be reorganized such that individuals tested for HIV receive their results on the same day of the test. Also counselors need to better alert clients concerning the importance of returning for their test results.

Failure to Return for Posttest Counseling and HIV Test Results at the Prevention and Voluntary Testing and Counseling Centers of Douala, Cameroon: An Evaluation of a Routine Five-Year Program

PubMed Central

Ngangue, Patrice; Bedard, Emmanuelle; Ngueta, Gerard; Adiogo, Dieudonné; Gagnon, Marie-Pierre

2016-01-01

This study examined the magnitude and time trends in failure to return (FTR) rates and the relation between FTR and individual characteristics, tests procedures, waiting period for the results, and HIV test results among people who were screened for HIV in the prevention and voluntary testing and counseling centers (PVTCCs) of six district hospitals of the city of Douala in Cameroon, between January 2009 and December 2013. It was a retrospective analysis of medical records. Among the 32,020 analyzed records, the failure to return (FTR) rate was 14.3%. Overall, people aged 50 years and over, those tested between 2011 and 2012, and those tested in the PVTCC of Bonassama were less likely to return for their results. Significant factors associated with FTR included being a housewife, having a positive/undetermined/requiring confirmation result, and provider-initiated testing and counseling (PITC). There was an increasing trend for FTR in the PVTCCs of Bonassama, New-Bell, Nylon, and Cité des Palmiers. HIV testing and counseling services in Douala district hospitals must be reorganized such that individuals tested for HIV receive their results on the same day of the test. Also counselors need to better alert clients concerning the importance of returning for their test results. PMID:26925261

Prescription Opioid Initiation, Correlates, and Consequences Among a Sample of OEF/OIF Military Personnel

PubMed Central

Golub, Andrew; Bennett, Alex S.

2013-01-01

Prescription opioid (PO) misuse represents a major health risk for many service members and veterans. This paper examines the pathways to misuse among a sample of US veterans who recently returned from Iraq and Afghanistan to low-income, predominately minority sections of New York City. Recreational PO misuse was not common on deployment. Most PO misusers initiated use subsequent to PO use for pain management, an iatrogenic pathway. However, most PO users did not misuse them. Veterans that misused POs were more likely to have other reintegration problems including drug and alcohol use disorders, traumatic brain injury (TBI), unemployment, and homelessness. PMID:23869455

Prescription opioid initiation, correlates, and consequences among a sample of OEF/OIF military personnel.

PubMed

Golub, Andrew; Bennett, Alex S

2013-07-01

Prescription opioid (PO) misuse represents a major health risk for many service members and veterans. This paper examines the pathways to misuse among a sample of U.S. veterans who recently returned from Iraq and Afghanistan to low-income, predominately minority sections of New York City. Recreational PO misuse was not common on deployment. Most PO misusers initiated use subsequent to PO use for pain management, an iatrogenic pathway. However, most PO users did not misuse them. Veterans that misused POs were more likely to have other reintegration problems including drug and alcohol use disorders, traumatic brain injury (TBI), unemployment, and homelessness.

[A project for the occupational reintegration of impaired subjects].

PubMed

Capodaglio, E M; Giorgi, I; Capodaglio, P; Morelli, L; Mattazzi, G M; Nervi, O

2000-01-01

In this paper we have explained the criteria for an integrated socio-medical intervention (Local Health Care Institution, Cooperation, Scientific Institute of Care and Research) within the frame of a Communitary Initiative titled "Local network for return to work of persons with social disadvantage". The goal of the Initiative is to "create and experiment new facilities to support intervention strategies for return-to-work, and to start a virtuous circle matching the demands of both the disadvantaged persons and the local labour market". In the paper we describe the functional evaluations, performed in the Medical Center of Pavia by specialists in the field of Rehabilitation, Psychology and Ergonomy, and the following return-to-work phase, performed by operators of the Cooperation.

Return on investment. What is ROI and how to use it.

PubMed

Cotter, Steve

2014-08-01

Formulated and interpreted correctly, ROI tools and techniques can be very useful for EMS managers when evaluating various competing projects and initiatives within the organization. More so, decision makers and elected bodies responsible for approving the financial support of these initiatives are demanding that they be presented with a more complete picture of the return for any dollars allocated under ever-tightening financial considerations that all organizations face today. ROI can be a powerful tool in supporting your organization when competing for limited dollars.

Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

PubMed Central

Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

2016-01-01

Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

Early Initial Antibiotics and Debridement Independently Reduce Infection in an Open Fracture Model

DTIC Science & Technology

2012-01-01

infection in those Gustilo-Anderson grade III fractures whose surgery was delayed until return to the US, compared with those who underwent early...LEAP) included a prospective observational study of 315 patients with Gustilo-Anderson grade III open fractures of the tibia, foot and ankle and, in...6. Ashford RU, Mehta JA, Cripps R. Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures . Injury

Developing Federated Services within Seismology: IRIS' involvement in the CoopEUS Project

NASA Astrophysics Data System (ADS)

Ahern, T. K.; Trabant, C. M.; Stults, M.

2014-12-01

As a founding member of the CoopEUS initiative, IRIS Data Services has partnered with five data centers in Europe and the UC Berkeley (NCEDC) in the US to implement internationally standardized web services to access seismological data using identical methodologies. The International Federation of Digital Seismograph Networks (FDSN) holds commission status within IASPEI/IUGG and as such is the international body that governs data exchange formats and access protocols within seismology. The CoopEUS project involves IRIS and UNAVCO as part of the EarthScope project and the European collaborators are all members of the European Plate Observing System (EPOS). CoopEUS includes one work package that attempts to coordinate data access between EarthScope and EPOS facilities. IRIS has worked with its partners in the FDSN to develop and adopt three key international service standards within seismology. These include 1) fdsn-dataselect, a service that returns time series data in a variety of standard formats, 2) fdsn-station, a service that returns related metadata about a seismic station in stationXML format, and 3) fdsn-event, a service that returns information about earthquakes and other seismic events in QuakeML format. Currently the 5 European data centers supporting these services include the ORFEUS Data Centre in the Netherlands, the GFZ German Research Centre for Geosciences in Potsdam, Germany, ETH Zurich in Switzerland, INGV in Rome, Italy, and the RESIF Data Centre in Grenoble France. Presently these seven centres can all be accessed using standardized web services with identical service calls and returns results in standardized ways. IRIS is developing an IRIS federator that will allow a client to seamlessly access information across the federated centers. Details and current status of the IRIS Federator will be presented.

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

PubMed Central

McLeod, Tamara C. Valovich; Lewis, Joy H.; Whelihan, Kate; Bacon, Cailee E. Welch

2017-01-01

Objective: To systematically review the literature regarding rest and return to activity after sport-related concussion. Data Sources: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Study Selection: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. Data Extraction: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Data Synthesis: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. Conclusions: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers. PMID:28387547

Understanding the Impact of Return-Current Losses on the X-Ray Emission from Solar Flares

NASA Technical Reports Server (NTRS)

Holman, Gordon D.

2012-01-01

I obtain and examine the implications of one-dimensional analytic solutions for return-current losses on an initially power-law distribution of energetic electrons with a sharp low-energy cutoff in flare plasma with classical (collisional) resistivity. These solutions show, for example, that return-current losses are not sensitive to plasma density, but are sensitive to plasma temperature and the low energy cutoff of the injected nonthermal electron distribution. A characteristic distance from the electron injection site, x(sub rc), is derived. At distances less than x(sub rc) the electron flux density is not reduced by return-current losses, but plasma heating can be substantial in this region, in the upper, coronal part of the flare loop. Before the electrons reach the collisional thick-target region of the flare loop, an injected power-law electron distribution with a low-energy cutoff maintains that structure, but with a flat energy distribution below the cutoff energy, which is now determined by the total potential drop experienced by the electrons. Modifications due to the presence of collisional losses are discussed. I compare these results with earlier analytical results and with more recent numerical simulations. Emslie's 1980 conjecture that there is a maximum integrated X-ray source brightness on the order of 10(exp -15) photons per square centimeter per second per square centimeter is examined. I find that this is not actually a maximum brightness and its value is parameter dependent, but it is nevertheless a valuable benchmark for identifying return-current losses in hard X-ray spectra. I discuss an observational approach to identifying return-current losses in flare data, including identification of a return-current "bump" in X-ray light curves at low photon energies.

Return on investment in healthcare leadership development programs.

PubMed

Jeyaraman, Maya M; Qadar, Sheikh Muhammad Zeeshan; Wierzbowski, Aleksandra; Farshidfar, Farnaz; Lys, Justin; Dickson, Graham; Grimes, Kelly; Phillips, Leah A; Mitchell, Jonathan I; Van Aerde, John; Johnson, Dave; Krupka, Frank; Zarychanski, Ryan; Abou-Setta, Ahmed M

2018-02-05

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.

Ball Machine Usage in Tennis: Movement Initiation and Swing Timing While Returning Balls from a Ball Machine and from a Real Server

PubMed Central

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-01-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers’ movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key points Players have shorter initial move time when they are facing the ball machine. Using the ball machine results in different swing timing and movement coordination. The use of the ball machine should be limited. PMID:24790483

Ball machine usage in tennis: movement initiation and swing timing while returning balls from a ball machine and from a real server.

PubMed

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-05-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers' movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key pointsPlayers have shorter initial move time when they are facing the ball machine.Using the ball machine results in different swing timing and movement coordination.The use of the ball machine should be limited.

Automatic inoculating apparatus. [includes movable carraige, drive motor, and swabbing motor

NASA Technical Reports Server (NTRS)

Wilkins, J. R.; Mills, S. M. (Inventor)

1974-01-01

An automatic inoculating apparatus for agar trays is described and using a simple inoculating element, such as a cotton swab or inoculating loop. The apparatus includes a movable carriage for supporting the tray to be inoculated, a drive motor for moving the tray along a trackway, and a swabbing motor for automatically swabbing the tray during the movement. An actuator motor controls lowering of the inoculating element onto the tray and lifting of the inoculating element. An electrical control system, including limit microswitches, enables automatic control of the actuator motor and return of the carriage to the initial position after inoculating is completed.

The Impact of an Integrated Program of Return-to-Field and Targeted Trap-Neuter-Return on Feline Intake and Euthanasia at a Municipal Animal Shelter.

PubMed

Spehar, Daniel D; Wolf, Peter J

2018-04-13

Available evidence indicates that overall levels of feline intake and euthanasia at U.S. shelters have significantly declined in recent decades. Nevertheless, millions of cats, many of them free-roaming, continue to be admitted to shelters each year. In some locations, as many as 70% of cats, perhaps up to one million or more per year nationally, are euthanized. New approaches, including return-to-field (RTF) and targeted trap-neuter-return (TNR) appear to have transformative potential. The purpose of the present study was to examine changes in feline intake and euthanasia, as well as additional associated metrics, at a municipal animal shelter in Albuquerque, New Mexico, after institutionalized RTF and targeted TNR protocols, together referred to as a community cat program (CCP), were added to ongoing community-based TNR efforts and a pilot RTF initiative. Over the course of the CCP, which ran from April 2012 to March 2015, 11,746 cats were trapped, sterilized, vaccinated, and returned or adopted. Feline euthanasia at the Albuquerque Animal Welfare Department (AAWD) declined by 84.1% and feline intake dropped by 37.6% over three years; the live release rate (LRR) increased by 47.7% due primarily to these reductions in both intake and euthanasia. Modest increases in the percentage of cats returned to owner (RTO) and the adoption rate were also observed, although both metrics decreased on an absolute basis, while the number of calls to the city about dead cats declined.

Dynamic Modeling of Ascent Abort Scenarios for Crewed Launches

NASA Technical Reports Server (NTRS)

Bigler, Mark; Boyer, Roger L.

2015-01-01

For the last 30 years, the United States' human space program has been focused on low Earth orbit exploration and operations with the Space Shuttle and International Space Station programs. After over 40 years, the U.S. is again working to return humans beyond Earth orbit. To do so, NASA is developing a new launch vehicle and spacecraft to provide this capability. The launch vehicle is referred to as the Space Launch System (SLS) and the spacecraft is called Orion. The new launch system is being developed with an abort system that will enable the crew to escape launch failures that would otherwise be catastrophic as well as probabilistic design requirements set for probability of loss of crew (LOC) and loss of mission (LOM). In order to optimize the risk associated with designing this new launch system, as well as verifying the associated requirements, NASA has developed a comprehensive Probabilistic Risk Assessment (PRA) of the integrated ascent phase of the mission that includes the launch vehicle, spacecraft and ground launch facilities. Given the dynamic nature of rocket launches and the potential for things to go wrong, developing a PRA to assess the risk can be a very challenging effort. Prior to launch and after the crew has boarded the spacecraft, the risk exposure time can be on the order of three hours. During this time, events may initiate from either the spacecraft, the launch vehicle, or the ground systems, thus requiring an emergency egress from the spacecraft to a safe ground location or a pad abort via the spacecraft's launch abort system. Following launch, again either the spacecraft or the launch vehicle can initiate the need for the crew to abort the mission and return home. Obviously, there are thousands of scenarios whose outcome depends on when the abort is initiated during ascent and how the abort is performed. This includes modeling the risk associated with explosions and benign system failures that require aborting a spacecraft under very dynamic conditions, particularly in the lower atmosphere, and returning the crew home safely. This paper will provide an overview of the PRA model that has been developed of this new launch system, including some of the challenges that are associated with this effort.

Dynamic Modeling of Ascent Abort Scenarios for Crewed Launches

NASA Technical Reports Server (NTRS)

Bigler, Mark; Boyer, Roger L.

2015-01-01

For the last 30 years, the United States's human space program has been focused on low Earth orbit exploration and operations with the Space Shuttle and International Space Station programs. After nearly 50 years, the U.S. is again working to return humans beyond Earth orbit. To do so, NASA is developing a new launch vehicle and spacecraft to provide this capability. The launch vehicle is referred to as the Space Launch System (SLS) and the spacecraft is called Orion. The new launch system is being developed with an abort system that will enable the crew to escape launch failures that would otherwise be catastrophic as well as probabilistic design requirements set for probability of loss of crew (LOC) and loss of mission (LOM). In order to optimize the risk associated with designing this new launch system, as well as verifying the associated requirements, NASA has developed a comprehensive Probabilistic Risk Assessment (PRA) of the integrated ascent phase of the mission that includes the launch vehicle, spacecraft and ground launch facilities. Given the dynamic nature of rocket launches and the potential for things to go wrong, developing a PRA to assess the risk can be a very challenging effort. Prior to launch and after the crew has boarded the spacecraft, the risk exposure time can be on the order of three hours. During this time, events may initiate from either of the spacecraft, the launch vehicle, or the ground systems, thus requiring an emergency egress from the spacecraft to a safe ground location or a pad abort via the spacecraft's launch abort system. Following launch, again either the spacecraft or the launch vehicle can initiate the need for the crew to abort the mission and return to the home. Obviously, there are thousands of scenarios whose outcome depends on when the abort is initiated during ascent as to how the abort is performed. This includes modeling the risk associated with explosions and benign system failures that require aborting a spacecraft under very dynamic conditions, particularly in the lower atmosphere, and returning the crew home safely. This paper will provide an overview of the PRA model that has been developed of this new launch system, including some of the challenges that are associated with this effort. Key Words: PRA, space launches, human space program, ascent abort, spacecraft, launch vehicles

Subsequent-year recaptures at winter sites in three species of shrubland sparrows (Emberizidae)

USGS Publications Warehouse

Knick, Steven T.; Leu, Matthias; Hanser, Steven E.

2017-01-01

The tendency by individual birds to return to winter sites in subsequent years can be important in assessing the potential influence of habitat changes during the nonbreeding period. We recaptured five Brewer's (Spizella breweri), seven sagebrush (Artemisiospiza nevadensis), and three black-throated (Amphispiza bilineata) sparrows from 1–3 subsequent years at the same winter location following their initial capture. Two Brewer's and one sagebrush sparrow returned to the same winter location at least 4 years after their initial capture. Levels of feather deuterium indicated that birds captured together on winter sites had different breeding ranges. Although individuals of these species returned to specific sites used in previous years, the low recapture rate suggests that wintering individuals may use an itinerant strategy adapted to seasonal food resources.

Noise Suppression Addition to the 8- by 6-Foot Supersonic Wind Tunnel

NASA Image and Video Library

1950-08-21

The 8- by 6-Foot Supersonic Wind Tunnel at the National Advisory Committee for Aeronautics (NACA) Lewis Flight Propulsion Laboratory was the largest supersonic wind tunnel in the nation at the time and the only one able to test full-scale engines at supersonic speeds. The 8- by 6 was designed as a non-return and open-throat tunnel. A large compressor created the air flow at one end of the tunnel, squeezed the flow to increase its velocity just before the test section, then reduced the velocity, and expelled it into the atmosphere at the other end of the tunnel. This design worked well for initial aerodynamic testing, but the local community was literally rattled by the noise and vibrations when researchers began running engines in the test section in January 1950. The NACA’s most modern wind tunnel was referred to as “an 87,000-horsepower bugle aimed at the heart of Cleveland.” NACA Lewis responded to the complaints by adding an acoustic housing at the end of the tunnel to dampen the noise. The structure included resonator chambers and a reinforced concrete muffler structure. Modifications continued over the years. A return leg was added, and a second test section, 9 -by 15-foot, was incorporated in the return leg in the 1960s. Since its initial operation in 1948, the 8- by 6-foot tunnel has been aggressively used to support the nation's aeronautics and space programs for the military, industry, and academia.

Protracted exposure to fallout: the Rongelap and Utirik experience.

PubMed

Lessard, E T; Miltenberger, R P; Cohn, S H; Musolino, S V; Conard, R A

1984-03-01

From June 1946 to August 1958, the U.S. Department of Defense and the U.S. Atomic Energy Commission (AEC) conducted nuclear weapons tests in the Northern Marshall Islands. On 1 March 1954, BRAVO, an above-ground test in the Castle series, produced high levels of radioactive material, some of which subsequently fell on Rongelap and Utirik Atolls due to an unexpected wind shift. On 3 March 1954, the inhabitants of these atolls were moved out of the affected area. They later returned to Utirik in June 1954 and to Rongelap in June 1957. Comprehensive environmental and personnel radiological monitoring programs were initiated in the mid 1950s by Brookhaven National Laboratory to ensure that body burdens of the exposed Marshallese subjects remained within AEC guidelines. Their body-burden histories and calculated activity ingestion rate patterns post-return are presented along with estimates of internal committed effective dose equivalents. External exposure data are also included. In addition, relationships between body burden or urine-activity concentration and declining continuous intake were developed. The implications of these studies are: (1) the dietary intake of 137Cs was a major component contributing to the committed effective dose equivalent for the years after the initial contamination of the atolls; (2) for persons whose diet included fish, 65Zn was a major component of committed effective dose equivalent during the first years post-return; (3) a decline in the daily activity ingestion rate greater than that resulting from radioactive decay of the source was estimated for 137Cs, 65Zn, 90Sr and 60Co; (4) the relative impact of each nuclide on the estimate of committed effective dose equivalent was dependent upon the time interval between initial contamination and rehabilitation; and (5) the internal committed effective dose equivalent exceeded the external dose equivalent by a factor of 1.1 at Utirik and 1.5 at Rongelap during the rehabitation period. Few reliable 239Pu measurements on human excreta were made. An analysis of the tentative data leads to the conclusion that a reliable estimate of committed effective dose equivalent requires further research.

Design study for a two-color beta measurement system

NASA Technical Reports Server (NTRS)

1982-01-01

Design analysis of the beam splitter combined two color beta system is presented. Conventional and dichroic beam splitters are discussed. Design analysis of the beta system employing two beams with focusing at separate points is presented. Alterations and basic parameters of the two beam system are discussed. Alterations in the focus of the initial laser and the returning beams are also discussed. Heterodyne efficiencies for the on axis and off axis reflected radiation are included.

Laser Transmitter Aims At Laser Beacon

NASA Technical Reports Server (NTRS)

Hemmati, Hamid; Lesh, James R.

1993-01-01

Transmitter part of developmental optical communication system. Compact, lightweight, partially-self-aiming laser transmitter built to verify some capabilities of developmental free-space optical communication system. Design capable of providing 0.5 Mbps data return over range equal to Moon-Earth distance. Breadboard of transmitting terminal constructed and tested in laboratory. Prototype transmitter includes receiving circuitry that keeps it aimed at beacon, once brought into initial alignment within about 1.7 degrees of line of sight to beacon.

Returning to work while breastfeeding.

PubMed

Biagioli, Frances

2003-12-01

Mothers who work outside the home initiate breastfeeding at the same rate as mothers who stay at home. However, the breastfeeding continuance rate declines sharply in mothers who return to work. While the work environment may be less than ideal for the breastfeeding mother, obstacles can be overcome. Available breast pump types include manual pumps, battery-powered pumps, electric diaphragm pumps, electric piston pumps, and hospital-grade electric piston pumps. Electric piston pumps may be the most suitable type for mothers who work outside the home for more than 20 hours per week; however, when a mother is highly motivated, any pump type can be successful in any situation. Conservative estimates suggest that breast milk can be stored at room temperature for eight hours, refrigerated for up to eight days, and frozen for many months. A breastfeeding plan can help the working mother anticipate logistic problems and devise a practical pumping schedule. A mother's milk production usually is well established by the time her infant is four weeks old; it is best to delay a return to work until at least that time, and longer if possible.

Abort Options for Potential Mars Missions

NASA Technical Reports Server (NTRS)

Tartabini, P. V.; Striepe, S. A.; Powell, R. W.

1994-01-01

Mars trajectory design options were examined that would accommodate a premature termination of a nominal manned opposition class mission for opportunities between 2010 and 2025. A successful abort must provide a safe return to Earth in the shortest possible time consistent with mission constraints. In this study, aborts that provided a minimum increase in the initial vehicle mass in low Earth orbit (IMLEO) were identified by locating direct transfer nominal missions and nominal missions including an outbound or inbound Venus swing-by that minimized IMLEO. The ease with which these missions could be aborted while meeting propulsion and time constraints was investigated by examining free return (unpowered) and powered aborts. Further reductions in trip time were made to some aborts by the addition or removal of an inbound Venus swing-by. The results show that, although few free return aborts met the specified constraints, 85% of each nominal mission could be aborted as a powered abort without an increase in propellant. Also, in many cases, the addition or removal of a Venus swing-by increased the number of abort opportunities or decreased the total trip time during an abort.

76 FR 55256 - Section 6707A and the Failure To Include on Any Return or Statement Any Information Required To...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

... Section 6707A and the Failure To Include on Any Return or Statement Any Information Required To Be... respect to the penalties applicable to the failure to include on any return or statement any information... (TD 9425) relating to the penalty under section 6707A for the failure to include on any return or...

Technology initiatives with government/business overlap

NASA Astrophysics Data System (ADS)

Knapp, Robert H., Jr.

2015-03-01

Three important present-day technology development settings involve significant overlap between government and private sectors. The Advanced Research Project Agency for Energy (ARPA-E) supports a wide range of "high risk, high return" projects carried out in academic, non-profit or private business settings. The Materials Genome Initiative (MGI), based in the White House, aims at radical acceleration of the development process for advanced materials. California public utilities such as Pacific Gas & Electric operate under a structure of financial returns and political program mandates that make them arms of public policy as much as independent businesses.

Effectiveness of a Hospital-Based Work Support Intervention for Female Cancer Patients – A Multi-Centre Randomised Controlled Trial

PubMed Central

Tamminga, Sietske J.; Verbeek, Jos H. A. M.; Bos, Monique M. E. M.; Fons, Guus; Kitzen, Jos J. E. M.; Plaisier, Peter W.; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.

2013-01-01

Objective One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial. Methods Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14–435) versus 192 days (range 82–465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64–1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement. Trial Registration Nederlands Trial Register (NTR) 1658 PMID:23717406

Outcome of conservative treatment for Little League shoulder in young baseball players: factors related to incomplete return to baseball and recurrence of pain.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Kondo, Mikiro; Uno, Tomohiro; Takagi, Michiaki; Mura, Nariyuki

2018-01-01

The purpose of this study was to investigate the factors associated with poor results and pain recurrence in young baseball players with Little League shoulder (LLS). Eighty-seven young baseball players with LLS (mean age, 12.1 years) underwent conservative treatment. Of the players, 68 (78%) underwent conservative treatment involving the prohibition of throwing for an average of 1.2 months whereas the remaining 19 (22%) continued throwing with limitations. We analyzed the factors associated with poor results at 2 months and pain recurrence. At 2 months, 18% of participants reported the presence of pain, and the results regarding the return to baseball were as follows: complete return in 43%, incomplete return in 33%, and no return in 24%. A total of 83 subjects (95%) had completely returned at an average of 2.8 months. Pain recurrence was present in 20 subjects (25%) at an average of 6.2 months. Statistical analysis showed that the following factors were significantly associated with poor results at 2 months: longer period from initial presentation to throwing prohibition and worse shoulder flexibility (P = .04 and P = .01, respectively). It also revealed that the following factors were significantly associated with pain recurrence: higher frequency of pain at 2 months and longer duration until complete return (P = .0003 and P = .04, respectively). It is important for subjects with LLS to be prohibited from throwing immediately after initial presentation. Good shoulder flexibility was associated with a return to baseball without pain. A complete return in subjects who had pain at 2 months was significantly delayed, and these subjects exhibited more rapidly recurring pain after their return. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Exploring Literate Lives: Returning to the Field

ERIC Educational Resources Information Center

Henderson, Robyn; Woods, Annette

2016-01-01

The challenges of conducting lengthy fieldwork in today's busy academic world have impacted the types of research that are able to be carried out. In particular, traditional educational ethnography has become problematic for research beyond initial doctoral research programs. This article analyzes data collected during a return to the field of a…

Accepting transitions: African Americans discuss end of life.

PubMed

Yancu, Cecile N; Farmer, Deborah F; Graves, Mara J; Rhinehardt, April; Leahman, Dee

2015-06-01

African Americans typically underuse hospice care; this study explores their end of life attitudes. An iterative focus group strategy generated qualitative data using 4 baseline groups and 1 confirmatory focus group recruited from predominantly African American churches. Each group consisted of 8 to 14 adults. Investigators analyzed data for dominant themes, representatives from baseline groups returned to discuss the results. A total of 43 African Americans (male: 8 [18.6]; female: 35 [81.4]) participated in initial discussions, with 10 returning for follow-up. The prevailing theme was transitions; with life to death dominating discourse; other themes included curative to palliative care and acceptance of death as inevitable. Among African Americans, outreach efforts may be strengthened by reframing the dying process as the product of many transitions and reaching out to faith-based communities. © The Author(s) 2014.

Comet Odyssey: Comet Surface Sample Return

NASA Astrophysics Data System (ADS)

Weissman, Paul R.; Bradley, J.; Smythe, W. D.; Brophy, J. R.; Lisano, M. E.; Syvertson, M. L.; Cangahuala, L. A.; Liu, J.; Carlisle, G. L.

2010-10-01

Comet Odyssey is a proposed New Frontiers mission that would return the first samples from the surface of a cometary nucleus. Stardust demonstrated the tremendous power of analysis of returned samples in terrestrial laboratories versus what can be accomplished in situ with robotic missions. But Stardust collected only 1 milligram of coma dust, and the 6.1 km/s flyby speed heated samples up to 2000 K. Comet Odyssey would collect two independent 800 cc samples directly from the surface in a far more benign manner, preserving the primitive composition. Given a minimum surface density of 0.2 g/cm3, this would return two 160 g surface samples to Earth. Comet Odyssey employs solar-electric propulsion to rendezvous with the target comet. After 180 days of reconnaissance and site selection, the spacecraft performs a "touch-and-go” maneuver with surface contact lasting 3 seconds. A brush-wheel sampler on a remote arm collects up to 800 cc of sample. A duplicate second arm and sampler collects the second sample. The samples are placed in a return capsule and maintained at colder than -70 C during the return flight and at colder than -30 C during re-entry and for up to six hours after landing. The entire capsule is then refrigerated and transported to the Astromaterials Curatorial Facility at NASA/JSC for initial inspection and sample analysis by the Comet Odyssey team. Comet Odyssey's planned target was comet 9P/Tempel 1, with launch in December 2017 and comet arrival in June 2022. After a stay of 300 days at the comet, the spacecraft departs and arrives at Earth in May 2027. Comet Odyssey is a forerunner to a flagship Cryogenic Comet Sample Return mission that would return samples from deep below the nucleus surface, including volatile ices. This work was supported by internal funds from the Jet Propulsion Laboratory.

[Impact of headache among studied military population in Afghanistan deployed in the Kabul military field hospital].

PubMed

Guilloton, L; Bruneau, O; Trousselard, M; Zagnoli, F; Blanc, P A; De Greslan, T; Drouet, A

2015-11-01

Headaches are a common reason for consultation with a prevalence of 30%. Few data exist for military personnel, including in situations of war operations. The main objective of this work was to measure the evolution of the impact of headache in such a context. Two hundred and one personnel deployed in the Kaïa military field hospital in Afghanistan were recruited. A questionnaire designed to recognize headaches, supported by two quality of life scales (MIDAS and HIT-6) and a stress questionnaire were filled out before departure and upon return from missions. Sixty-three patients with headache were initially identified, of whom 52 remained symptomatic during the mission. The average total score of MIDAS before departure was 4 days and fell to 1.4 days upon return, with a mean measured change of 3.3 days. For HIT-6, the mean total score was 51.2 points initially and 51.9 points at the end of the mission with a mean change of-0.3 points. Nine patients without headache initially became symptomatic: MIDAS and HIT-6 were not affected. Thus, the impact of headache in the particular context of presence in a theater of operations was low: improved MIDAS score and the lack of influence on the HIT-6 score are underlined. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women.

PubMed

Kimbro, Rachel Tolbert

2006-01-01

As both employed and breastfeeding mothers increase, more women are facing the decision of whether and how to combine the behaviors. This paper examines three hypotheses for a sample of low-income women: 1) Mothers who expect to return to work after the birth of their baby will be less likely to initiate breastfeeding; 2) The timing of the return to work and quitting breastfeeding will coincide; 3) Mothers in professional jobs and Stay-at-Home (SAH) Moms will breastfeed for longer durations than mothers with other types of jobs. The Fragile Families and Child Wellbeing Study, a sample of mostly low-income, unmarried U.S. mothers, offers a unique opportunity to study this issue, as there is reason to believe that employment may impact breastfeeding differently for low-income women. Logistic regression determines the relationship between the expectation of work and breastfeeding initiation, and discrete-time logit models examine breastfeeding duration, the timing of the return to work, and occupation type. Expecting to work in the year after the baby's birth does not impact breastfeeding initiation. The timing of quitting breastfeeding and the return to work are closely and powerfully linked, and mothers in administrative and manual positions quit earlier than other women. Interestingly, women in service occupations do not differ in breastfeeding duration from SAH mothers or professionals. This research demonstrates that low-income women are having difficulty combining work and breastfeeding, which has important health implications for their infants, and that women working in administrative and manual occupations may face special constraints.

Present experience of NRI REZ with preparation of spent nuclear fuel shipment to Russian Federation

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

Svitak, F.; Broz, V.; Hrehor, M.

2008-07-15

The Nuclear Research Institute Rez plc (NRI) jointed the Russian Research Reactor Fuel Return (RRRFR) programme under the US-Russian Global Threat Reduction Initiative (GTRI) initiative and started the preparation of the spent nuclear fuel (SNF) shipment from the LVR-15 research reactor back to the Russian Federation (RF). The transport of 16 SKODA VPVR/M casks with EK-10, IRT-2M 80 %, and IRT-2M 36% fuel types is planned for the autumn of 2007. The paper describes the experience gained so far during the preparatory works for the SNF shipment (facility equipment modification, cask licenses) and the actual preparation of the SNF formore » transport, in particular its checking, repacking in a hot cell, loading into the VPVR/M casks, drying, manipulation, completion of the transport documentation, etc., including its transport to the SNF storage facility at the NRI before it is shipped to the RF. The paper also briefly describes a regulatory framework for these activities with a focus on legislative and methodological aspects of the return of vitrified waste back to the Czech Republic. (author)« less

Embryo banking among women diagnosed with cancer: a pilot population-based study in New York, Texas, and Illinois.

PubMed

Luke, Barbara; Brown, Morton B; Spector, Logan G; Stern, Judy E; Smith, Yolanda R; Williams, Melanie; Koch, Lori; Schymura, Maria J

2016-05-01

The purpose of the present study is to estimate the proportion of women with cancer who return to use the embryos that they have banked and to compare this proportion to that of women without cancer who bank embryos. This is a cohort study of three groups of women from New York, Texas, and Illinois who used embryo banking in their first assisted reproductive technology (ART) treatment cycle: two groups with cancer (222 women without an infertility diagnosis and 48 women with an infertility diagnosis) and a control group without cancer (68 women with the infertility diagnosis of male factor only). Women were included only if their first ART cycle reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) occurred between 2004 and 2009. Cancer cases were identified from each State Cancer Registry from 5 years prior to initiation of ART treatment to 6 months post-initiation; mean follow-up after the first ART cycle was 2.0 years. Women with cancer without an infertility diagnosis returned for a subsequent ART cycle at a lower rate (10.8 %) than those with an infertility diagnosis (31.3 %, p = 0.0010) or the control group (85.3 %, p < 0.0001). Among those who returned for a subsequent cycle, women with cancer waited a longer time to return (14.3 months without an infertility diagnosis and 8.3 months with an infertility diagnosis, p = 0.13) compared to the control group (2.8 months, p = 0.0007). The live birth rate among women who did not utilize embryo banking in their second cycle did not differ significantly across the three study groups, ranging from 25.0 and 42.9 % for women with cancer with and without an infertility diagnosis, respectively, to 36.2 % for women in the control group. Women with cancer without an infertility diagnosis are either less likely to return for subsequent treatment or will wait a longer time to return than women with an infertility diagnosis or those that do not have cancer. A longer-term study is necessary to assess whether these women return to use their frozen embryos after cancer treatment or are able to spontaneously conceive and if those subsequent pregnancies are adversely affected by the cancer diagnosis or therapy.

Factors contributing to initial weight loss among adolescents with polycystic ovary syndrome.

PubMed

Geier, L M; Bekx, M T; Connor, E L

2012-12-01

To evaluate the impact of a multidisciplinary clinic on weight management among adolescents with PCOS. 140 adolescent females were evaluated in a multidisciplinary PCOS clinic from March 2005 to December 2008. The team included a pediatric endocrinologist, health psychologist, dietitian, and pediatric gynecologist. 110 were diagnosed with PCOS based on the Rotterdam Criteria. Height, weight, BMI, number of subspecialists seen, use of metformin, and compliance with return visits were obtained from medical records. American Family Children's Hospital in Madison, Wisconsin. 110 adolescent females with polycystic ovary syndrome. Consultation with a dietitian and health psychologist. Change in weight. The average age at first visit was 15.9 years. The average BMI was 34.7 kg/m(2) (range 18.1-55.5). Seventy-six percent had an initial BMI above the 95(th) percentile. Interactions with providers at the initial visit included a pediatric endocrinologist (100%), health psychologist (60.9%), dietitian (75.5%) and gynecologist (70.9%). Seventy one percent returned for a follow-up visit, (average time of 4.5 months between visits) with 57% achieving weight loss (average 3.5 kg) and an additional 12.6% demonstrating no significant weight gain (< 1.5 kg). Thus, 69.6% demonstrated weight loss/stabilization. In this multidisciplinary clinic for adolescents with PCOS, nearly 70% of patients succeeded in short-term weight stabilization, with 57% demonstrating weight loss. Interactions with the health psychologist and dietitian appeared to play a key role in successful weight control, supporting the importance of psychology and nutrition expertise in the management of this disorder. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Investment appraisal of technology innovations on dairy farm electricity consumption.

PubMed

Upton, J; Murphy, M; De Boer, I J M; Groot Koerkamp, P W G; Berentsen, P B M; Shalloo, L

2015-02-01

The aim of this study was to conduct an investment appraisal for milk-cooling, water-heating, and milk-harvesting technologies on a range of farm sizes in 2 different electricity-pricing environments. This was achieved by using a model for electricity consumption on dairy farms. The model simulated the effect of 6 technology investment scenarios on the electricity consumption and electricity costs of the 3 largest electricity-consuming systems within the dairy farm (i.e., milk-cooling, water-heating, and milking machine systems). The technology investment scenarios were direct expansion milk-cooling, ice bank milk-cooling, milk precooling, solar water-heating, and variable speed drive vacuum pump-milking systems. A dairy farm profitability calculator was combined with the electricity consumption model to assess the effect of each investment scenario on the total discounted net income over a 10-yr period subsequent to the investment taking place. Included in the calculation were the initial investments, which were depreciated to zero over the 10-yr period. The return on additional investment for 5 investment scenarios compared with a base scenario was computed as the investment appraisal metric. The results of this study showed that the highest return on investment figures were realized by using a direct expansion milk-cooling system with precooling of milk to 15°C with water before milk entry to the storage tank, heating water with an electrical water-heating system, and using standard vacuum pump control on the milking system. Return on investment figures did not exceed the suggested hurdle rate of 10% for any of the ice bank scenarios, making the ice bank system reliant on a grant aid framework to reduce the initial capital investment and improve the return on investment. The solar water-heating and variable speed drive vacuum pump scenarios failed to produce positive return on investment figures on any of the 3 farm sizes considered on either the day and night tariff or the flat tariff, even when the technology costs were reduced by 40% in a sensitivity analysis of technology costs. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Small Numbers, Large Returns: College Students Helping Community Members Prepare Income Tax Returns

ERIC Educational Resources Information Center

Hulsart, Robyn W.

2007-01-01

This article examines the Volunteer Income Tax Assistance program, an IRS-sponsored initiative designed to help those who cannot afford professional tax assistance, people with disabilities, people uncomfortable speaking and understanding English, the elderly, and others with special needs. The author discusses its implementation at a small…

Contamination Knowledge Strategy for the Mars 2020 Sample-Collecting Rover

NASA Technical Reports Server (NTRS)

Farley, K. A.; Williford, K.; Beaty, D W.; McSween, H. Y.; Czaja, A. D.; Goreva, Y. S.; Hausrath, E.; Herd, C. D. K.; Humayun, M.; McCubbin, F. M.;

The impact of patient education and psychosocial supports on return to normalcy 36 months post-kidney transplant.

PubMed

Wilkins, Freda; Bozik, Karen; Bennett, Katherine

2003-01-01

Improvements in immunosuppression, and expansion of immunosuppression coverage by Medicare now necessitate beginning to define success in transplantation from a holistic or whole person approach rather than the historical emphasis on patient and graft survival alone. In a new transplant environment, efforts will have to be made to redefine practice so that kidney transplant recipients are prepared for 10 or more years of life with a transplanted graft. Currently, 83% of transplanted patients will never return to work. The purpose of this study is to determine how targeted education and specific psychosocial supports affect the transplant patient's return to normalcy 36 months after kidney transplant. Normalcy is defined as age and socially appropriate activities for that patient. This is a synopsis of a 1-year cross-sectional study of 51 patients who received kidney transplants in 1999 at or near their 36-month anniversary date. Thirty-six months was chosen because this is the date when most patients will lose their Medicare coverage for immunosuppression. In 1999, a multidisciplinary plan was initiated to restructure the transplant recipient evaluation process, such that education about kidney transplantation and expectations for return to normalcy were addressed at the initial 'introduction to transplant session'. These measures were then consistently reinforced with each subsequent contact. At the second contact, written verbal plans for medication purchase and return to normalcy were identified. The team made a conscious effort to develop relationships with the recipients and their significant others, with the intention to better empower them to return to normalcy post-transplant. These measures (education and psychosocial support) were this study's independent variables. At 36 months, all patients were contacted by telephone and a 12-item questionnaire was administered. The questionnaire sought information about the study's dependent variables - employment and insurance status, pre- and post-transplant. In this study, 44% of pre-transplant patients were non-disabled compared with 62% of transplanted patients at 36 months post-transplant (P = 0.06, Chi square). Non-disabled includes persons who are employed, homemakers, students, retired or otherwise involved in age and socio-economically appropriate activities. Pre-transplant, 23% of recipients utilized Medicare and Medicaid for health insurance coverage. At 36 months post-transplant, only 11 or 20% of patients were dependent on Medicare and Medicaid. Pre-transplant, 17 recipients had private insurance coverage vs. 23 patients 36 months later (P < 0.02, Chi square). Fifty-six per cent of the patients received a living donor transplant. A targeted multidisciplinary programme of education and psychosocial support that emphasizes return to normalcy and non-disability, beginning with the first exposure to transplant and continuing throughout the first 6 months post-transplant, yielded high rates of return to normalcy for kidney transplant recipients.

Venture funding for science-based African health innovation.

PubMed

Masum, Hassan; Chakma, Justin; Simiyu, Ken; Ronoh, Wesley; Daar, Abdallah S; Singer, Peter A

2010-12-13

While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital's potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns. Such funds should be structured to overcome the challenges identified, be sustainable in the long run, attract for-profit private sector funds, and have measurable and significant health impact. If this is done, the proposed venture approach may have complementary benefits to existing initiatives and encourage local scientific and economic development while tapping new sources of funding.

Venture funding for science-based African health innovation

PubMed Central

2010-01-01

Background While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital’s potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. Discussion The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Summary Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns. Such funds should be structured to overcome the challenges identified, be sustainable in the long run, attract for-profit private sector funds, and have measurable and significant health impact. If this is done, the proposed venture approach may have complementary benefits to existing initiatives and encourage local scientific and economic development while tapping new sources of funding. PMID:21144072

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study.

PubMed

Gundersen, Kenneth; Kvaløy, Jan Terje; Kramer-Johansen, Jo; Steen, Petter Andreas; Eftestøl, Trygve

2009-02-06

One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions. From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation) of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels. From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24-0.29), 0.077 (0.070-0.085) and 0.040(0.036-0.045), respectively, 27 seconds into the interval (95% confidence intervals in parenthesis). During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.

Ultrasonography versus computed tomography for suspected nephrolithiasis.

PubMed

Smith-Bindman, Rebecca; Aubin, Chandra; Bailitz, John; Bengiamin, Rimon N; Camargo, Carlos A; Corbo, Jill; Dean, Anthony J; Goldstein, Ruth B; Griffey, Richard T; Jay, Gregory D; Kang, Tarina L; Kriesel, Dana R; Ma, O John; Mallin, Michael; Manson, William; Melnikow, Joy; Miglioretti, Diana L; Miller, Sara K; Mills, Lisa D; Miner, James R; Moghadassi, Michelle; Noble, Vicki E; Press, Gregory M; Stoller, Marshall L; Valencia, Victoria E; Wang, Jessica; Wang, Ralph C; Cummings, Steven R

2014-09-18

There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography. In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy. A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to CT (P=0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P=0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups. Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations. (Funded by the Agency for Healthcare Research and Quality.).

Remote observations of reentering spacecraft including the space shuttle orbiter

NASA Astrophysics Data System (ADS)

Horvath, Thomas J.; Cagle, Melinda F.; Grinstead, Jay H.; Gibson, David M.

Flight measurement is a critical phase in development, validation and certification processes of technologies destined for future civilian and military operational capabilities. This paper focuses on several recent NASA-sponsored remote observations that have provided unique engineering and scientific insights of reentry vehicle flight phenomenology and performance that could not necessarily be obtained with more traditional instrumentation methods such as onboard discrete surface sensors. The missions highlighted include multiple spatially-resolved infrared observations of the NASA Space Shuttle Orbiter during hypersonic reentry from 2009 to 2011, and emission spectroscopy of comparatively small-sized sample return capsules returning from exploration missions. Emphasis has been placed upon identifying the challenges associated with these remote sensing missions with focus on end-to-end aspects that include the initial science objective, selection of the appropriate imaging platform and instrumentation suite, target flight path analysis and acquisition strategy, pre-mission simulations to optimize sensor configuration, logistics and communications during the actual observation. Explored are collaborative opportunities and technology investments required to develop a next-generation quantitative imaging system (i.e., an intelligent sensor and platform) with greater capability, which could more affordably support cross cutting civilian and military flight test needs.

Remote Observations of Reentering Spacecraft Including the Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Horvath, Thomas J.; Cagle, Melinda F.; Grinstead, jay H.; Gibson, David

2013-01-01

Flight measurement is a critical phase in development, validation and certification processes of technologies destined for future civilian and military operational capabilities. This paper focuses on several recent NASA-sponsored remote observations that have provided unique engineering and scientific insights of reentry vehicle flight phenomenology and performance that could not necessarily be obtained with more traditional instrumentation methods such as onboard discrete surface sensors. The missions highlighted include multiple spatially-resolved infrared observations of the NASA Space Shuttle Orbiter during hypersonic reentry from 2009 to 2011, and emission spectroscopy of comparatively small-sized sample return capsules returning from exploration missions. Emphasis has been placed upon identifying the challenges associated with these remote sensing missions with focus on end-to-end aspects that include the initial science objective, selection of the appropriate imaging platform and instrumentation suite, target flight path analysis and acquisition strategy, pre-mission simulations to optimize sensor configuration, logistics and communications during the actual observation. Explored are collaborative opportunities and technology investments required to develop a next-generation quantitative imaging system (i.e., an intelligent sensor and platform) with greater capability, which could more affordably support cross cutting civilian and military flight test needs.

Outcomes at 12 months after early magnetic resonance imaging in acute trauma patients with persistent midline cervical tenderness and negative computed tomography.

PubMed

Ackland, Helen M; Cameron, Peter A; Wolfe, Rory; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Cooper, D James; Rosenfeld, Jeffrey V; Liew, Susan M

2013-06-01

A prospective observational cohort study of alert, neurologically intact trauma patients presenting to the emergency department with midline cervical tenderness. Screening cervical magnetic resonance imaging (MRI) had been conducted after negative computed tomography (CT) when tenderness was persistent. To determine the association of acute findings and demographic characteristics with any long-term neck disability, and with time to return to work in such patients. The relationship between acute findings and outcomes in these patients is unknown, and we hypothesized that outcomes at 12 months would correlate with acute clinical signs and symptoms, MRI findings, and mechanisms of injury. Patients at a Level 1 trauma center with persistent midline cervical tenderness in the absence of evidence of intoxication, painful distracting injury, persistently abnormal neurology, or acute CT findings, who underwent early cervical MRI under the institutional protocol, were reviewed in the outpatient spine clinic after discharge. In addition, the factors associated with neck disability and time to return to work were examined at follow-up at 12 months after presentation. There were 162 of 178 patients available for follow-up at 12 months (91%). Of these, 46% had MRI-identified cervical spine injury at their initial examination, and 22% had required clinical management, including 2.5% with operative stabilization. Neck disability was present in 43% of patients and was associated with depressive symptoms, workers' compensation, and low annual income. Delay in return to work was associated with the presence of minor limb/other fractures and depressive symptoms, whereas patients on high annual incomes were found to return to work more quickly. Surprisingly in these acute trauma patients, MRI-detected injury, clinical factors, and injury mechanism were not found to be associated with long-term patient outcomes. As a result, a trial of a more targeted, individual return to work plan, including strategies aimed at improving physical and psychological function, may now be justified to optimize long-term recovery, reduce health resource costs, and maximize economic productivity through early return to work.

Military milk: breastfeeding rates among Australian Defence Force women who return to military service following maternity leave.

PubMed

Stewart, Kelley

2015-02-01

The breastfeeding behaviors among Australian Defence Force women have not previously been examined. Studies have shown that breastfeeding prevalence and duration are affected by maternity leave entitlements and returning to work. This study aimed to benchmark breastfeeding initiation, prevalence, and duration among a cohort of Australian Defence Force women and to compare these findings against Australian population norms. A cross-sectional survey was conducted via email in 2008 for Australian Defence Force women who had taken maternity leave in the Australian financial year of 2006/2007. Analysis of breastfeeding indicators was undertaken. Ninety-eight percent of Australian Defence Force women in this cohort initiated breastfeeding and breastfed for a median duration of 8 months, returning to work when the mean age of the child was 8.4 months. Breastfeeding prevalence did not meet 2003 Australian National Health and Medical Research Council targets by 6 months postpartum but compared favorably to the Australian population norms. Sixty-six percent of the respondents returned to work full-time, with a median breastfeeding duration of 7 months. Women who returned to work part-time had a longer median duration of 10 months. Breastfeeding rates among this cohort of Australian Defence Force women compare favorably with the general Australian population until 9 months, coinciding with returning to work after a period of maternity leave. The results support recent Australian population studies on breastfeeding and employment. © The Author(s) 2014.

Advances in Small Particle Handling of Astromaterials in Preparation for OSIRIS-REx and Hayabusa2: Initial Developments

NASA Technical Reports Server (NTRS)

Snead, C. J.; McCubbin, F. M.; Nakamura-Messenger, K.; Righter, K.

2018-01-01

The Astromaterials Acquisition and Curation office at NASA Johnson Space Center has established an Advanced Curation program that is tasked with developing procedures, technologies, and data sets necessary for the curation of future astromaterials collections as envisioned by NASA exploration goals. One particular objective of the Advanced Curation program is the development of new methods for the collection, storage, handling and characterization of small (less than 100 micrometer) particles. Astromaterials Curation currently maintains four small particle collections: Cosmic Dust that has been collected in Earth's stratosphere by ER2 and WB-57 aircraft, Comet 81P/Wild 2 dust returned by NASA's Stardust spacecraft, interstellar dust that was returned by Stardust, and asteroid Itokawa particles that were returned by the JAXA's Hayabusa spacecraft. NASA Curation is currently preparing for the anticipated return of two new astromaterials collections - asteroid Ryugu regolith to be collected by Hayabusa2 spacecraft in 2021 (samples will be provided by JAXA as part of an international agreement), and asteroid Bennu regolith to be collected by the OSIRIS-REx spacecraft and returned in 2023. A substantial portion of these returned samples are expected to consist of small particle components, and mission requirements necessitate the development of new processing tools and methods in order to maximize the scientific yield from these valuable acquisitions. Here we describe initial progress towards the development of applicable sample handling methods for the successful curation of future small particle collections.

The impact of a community mental health initiative on outcomes for offenders with a serious mental disorder.

PubMed

Stewart, Lynn A; Farrell-MacDonald, Shanna; Feeley, Stacey

2017-10-01

The Community Mental Health Initiative (CMHI) is mandated to assist offenders with serious mental disorders in their transition from institutions to the community, but this incorporates different styles of service. An important unanswered question is whether these are equivalent. Our aim was to compare outcomes for different intervention styles within the CMHI, a programme for serious offenders in prison who also have at least one major mental disorder. Our specific research questions were as follows: do outcomes differ according to whether offenders with mental health difficulties receive (1) clinical discharge planning only; (2) community mental health services only; (3) the combined services or (4) none, although meeting criteria for any CMHI service? Survival analyses, controlling for variables with a significant effect on recidivism or return to prison, were used to test for differences in recidivism or return to prison rates between the intervention and no-intervention groups during a fixed follow-up period. Men receiving only community mental health services had a significantly lower risk of returning to custody and of recidivism than men receiving discharge planning alone or no community mental health service at all, even after controlling for potential confounders including age, number of previous imprisonments and number of previous community failures. The advantages were apparent within 3-6 months and sustained for up to 4 years. Provision of specialised community mental health services for higher-risk male offenders with a mental disorder may reduce recidivism in the short and longer term - within 3 months and up to 4 years respectively. Statistical modelling also pointed to the need to include treatment for substance abuse and assistance in identifying stable accommodation and brokerage of community services among the interventions and services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

2016-01-01

Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport. PMID:20702858

INTEGRATION OF STRENGTH AND CONDITIONING PRINCIPLES INTO A REHABILITATION PROGRAM

PubMed Central

Lorenz, Daniel S.

2011-01-01

Background and Purpose: Rehabilitation and strength and conditioning are often seen as two separate entities in athletic injury recovery. Traditionally an athlete progresses from the rehabilitation environment under the care of a physical therapist and/or athletic trainer to the strength and conditioning coach for specific return to sport training. These two facets of return to sport are often considered to have separate goals. Initial goals of each are often different due to the timing of their implementation encompassing different stages of post-injury recovery. The initial focus of post injury rehabilitation includes alleviation of dysfunction, enhancement of tissue healing, and provision of a systematic progression of range-of-motion and strength. During the return to function phases, specific return to play goals are paramount. Understanding of specific principles and program parameters is necessary when designing and implementing an athlete's rehabilitation program. Communication and collaboration amongst all individuals caring for the athlete is a must. The purpose of this review is to outline the current evidence supporting utilization of training principles in athletic rehabilitation, as well as provide suggested implementation of such principles throughout different phases of a proposed rehabilitation program. Evidence Acquisition: The following electronic databases were used to identify research relevant to this clinical commentary: MEDLINE (from 1950–June 2011) and CINAHL (1982–June 2011), for all relevant journal articles written in English. Additional references were accrued by independent searching of references from relevant articles. Results: Currently evidence is lacking in the integration of strength and conditioning principles into the rehabilitation program for the injured athlete. Numerous methods are suggested for possible utilization by the clinician in practice to improve strength, power, speed, endurance, and metabolic capacity. Conclusion: Despite abundance of information on the implementation of training principles in the strength and conditioning field, investigation regarding the use of these principles in a properly designed rehabilitation program is lacking. PMID:21904701

High carriage rate of ESBL-producing Enterobacteriaceae at presentation and follow-up among travellers with gastrointestinal complaints returning from India and Southeast Asia.

PubMed

Barreto Miranda, Isabel; Ignatius, Ralf; Pfüller, Roland; Friedrich-Jänicke, Barbara; Steiner, Florian; Paland, Matthias; Dieckmann, Sebastian; Schaufler, Katharina; Wieler, Lothar H; Guenther, Sebastian; Mockenhaupt, Frank P

2016-02-01

International travel contributes to the spread of multidrug-resistant microorganisms including extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We assessed the proportion of faecal carriers of ESBL-PE among 211 patients with gastrointestinal symptoms who returned to Berlin, Germany, after international travel. ESBL-PE were screened for on chromogenic agar, antimicrobial susceptibility testing was performed, and ESBL-genes were genotyped. Travel-related data were assessed by questionnaire. Diarrhoea, abdominal pain and nausea were the main symptoms. Half of the travellers carried ESBL-PE (97% Escherichia coli); the proportion was highest for returnees from India (72%) and mainland Southeast Asia (59%), and comparatively lower for Africa (33%) and Central America (20%). Co-resistance to fluoroquinolones (particularly in isolates from India), gentamicin and cotrimoxazole was frequent but all isolates were carbapenem-susceptible. ESBL-PE carriage decreased with increasing timespan from return to presentation, and with age. At revisit of initially ESBL-PE positive patients half a year later, 28% (17/61) of the individuals were still carriers, CTX-M groups being congruent with the initial isolates. CTX-M groups 9 and 1/9, vegetarian diet and cat ownership tended to be associated with ESBL-PE carriage upon revisit. Travellers, particularly those returning from India and Southeast Asia, constitute a relevant source of potential spread of ESBL-PE. Carriage declines over time but ESBL-PE persist for at least 6 months in a substantial proportion of individuals. Both genetic characteristics of the bacteria and lifestyle factors seem to contribute to persistent carriage of ESBL-PE. A recent, extra-European travel history argues for ESBL-PE screening and contact precautions for patients admitted to hospital. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

The CRAF/Cassini power subsystem - Preliminary design update

NASA Technical Reports Server (NTRS)

Atkins, Kenneth L.; Brisendine, Philip; Clark, Karla; Klein, John; Smith, Richard

1991-01-01

A chronology is provided of the rationale leading from the early Mariner spacecraft to the CRAF/Cassini Mariner Mark II power subsystem architecture. The display pathway began with a hybrid including a solar photovoltaic array, a radioisotope thermoelectric generator (RTG), and a battery supplying a power profile with a peak loading of about 300 W. The initial concept was to distribute power through a new solid-state, programmable switch controlled by an embedded microprocessor. As the overall mission, science, and project design matured, the power requirements increased. The design evolved from the hybrid to two RTG plus batteries to meet peak loadings of near 500 W in 1989. Later that year, circumstances led to abandonment of the distributed computer concept and a return to centralized control. Finally, as power requirements continued to grow, a third RTG was added to the design and the battery removed, with the return to the discharge-controller for transients during fault recovery procedures.

Return on Investment of a Work-Family Intervention: Evidence From the Work, Family, and Health Network.

PubMed

Barbosa, Carolina; Bray, Jeremy W; Dowd, William N; Mills, Michael J; Moen, Phyllis; Wipfli, Brad; Olson, Ryan; Kelly, Erin L

2015-09-01

To estimate the return on investment (ROI) of a workplace initiative to reduce work-family conflict in a group-randomized 18-month field experiment in an information technology firm in the United States. Intervention resources were micro-costed; benefits included medical costs, productivity (presenteeism), and turnover. Regression models were used to estimate the ROI, and cluster-robust bootstrap was used to calculate its confidence interval. For each participant, model-adjusted costs of the intervention were $690 and company savings were $1850 (2011 prices). The ROI was 1.68 (95% confidence interval, -8.85 to 9.47) and was robust in sensitivity analyses. The positive ROI indicates that employers' investment in an intervention to reduce work-family conflict can enhance their business. Although this was the first study to present a confidence interval for the ROI, results are comparable with the literature.

Results of the JIMO Follow-on Destinations Parametric Studies

NASA Technical Reports Server (NTRS)

Noca, Muriel A.; Hack, Kurt J.

2005-01-01

NASA's proposed Jupiter Icy Moon Orbiter (JIMO) mission currently in conceptual development is to be the first one of a series of highly capable Nuclear Electric Propulsion (NEP) science driven missions. To understand the implications of a multi-mission capability requirement on the JIMO vehicle and mission, the NASA Prometheus Program initiated a set of parametric high-level studies to be followed by a series of more in-depth studies. The JIMO potential follow-on destinations identified include a Saturn system tour, a Neptune system tour, a Kuiper Belt Objects rendezvous, an Interstellar Precursor mission, a Multiple Asteroid Sample Return and a Comet Sample Return. This paper shows that the baseline JIMO reactor and design envelop can satisfy five out of six of the follow-on destinations. Flight time to these destinations can significantly be reduced by increasing the launch energy or/and by inserting gravity assists to the heliocentric phase.

Rural to urban migration is an unforeseen impact of development intervention in Ethiopia.

PubMed

Gibson, Mhairi A; Gurmu, Eshetu

2012-01-01

Rural development initiatives across the developing world are designed to improve community well-being and livelihoods. However they may also have unforeseen consequences, in some cases placing further demands on stretched public services. In this paper we use data from a longitudinal study of five Ethiopian villages to investigate the impact of a recent rural development initiative, installing village-level water taps, on rural to urban migration of young adults. Our previous research has identified that tap stands dramatically reduced child mortality, but were also associated with increased fertility. We demonstrate that the installation of taps is associated with increased rural-urban migration of young adults (15-30 years) over a 15 year period (15.5% migrate out, n = 1912 from 1280 rural households). Young adults with access to this rural development intervention had three times the relative risk of migrating to urban centres compared to those without the development. We also identify that family dynamics, specifically sibling competition for limited household resources (e.g. food, heritable land and marriage opportunities), are key to understanding the timing of out-migration. Birth of a younger sibling doubled the odds of out-migration and starting married life reduced it. Rural out-migration appears to be a response to increasing rural resource scarcity, principally competition for agricultural land. Strategies for livelihood diversification include education and off-farm casual wage-labour. However, jobs and services are limited in urban centres, few migrants send large cash remittances back to their families, and most return to their villages within one year without advanced qualifications. One benefit for returning migrants may be through enhanced social prestige and mate-acquisition on return to rural areas. These findings have wide implications for current understanding of the processes which initiate rural-to-urban migration and transitions to low fertility, as well as for the design and implementation of development intervention across the rural and urban developing world.

Rural to Urban Migration Is an Unforeseen Impact of Development Intervention in Ethiopia

PubMed Central

Gibson, Mhairi A.; Gurmu, Eshetu

2012-01-01

Rural development initiatives across the developing world are designed to improve community well-being and livelihoods. However they may also have unforeseen consequences, in some cases placing further demands on stretched public services. In this paper we use data from a longitudinal study of five Ethiopian villages to investigate the impact of a recent rural development initiative, installing village-level water taps, on rural to urban migration of young adults. Our previous research has identified that tap stands dramatically reduced child mortality, but were also associated with increased fertility. We demonstrate that the installation of taps is associated with increased rural-urban migration of young adults (15–30 years) over a 15 year period (15.5% migrate out, n = 1912 from 1280 rural households). Young adults with access to this rural development intervention had three times the relative risk of migrating to urban centres compared to those without the development. We also identify that family dynamics, specifically sibling competition for limited household resources (e.g. food, heritable land and marriage opportunities), are key to understanding the timing of out-migration. Birth of a younger sibling doubled the odds of out-migration and starting married life reduced it. Rural out-migration appears to be a response to increasing rural resource scarcity, principally competition for agricultural land. Strategies for livelihood diversification include education and off-farm casual wage-labour. However, jobs and services are limited in urban centres, few migrants send large cash remittances back to their families, and most return to their villages within one year without advanced qualifications. One benefit for returning migrants may be through enhanced social prestige and mate-acquisition on return to rural areas. These findings have wide implications for current understanding of the processes which initiate rural-to-urban migration and transitions to low fertility, as well as for the design and implementation of development intervention across the rural and urban developing world. PMID:23155400

Mathematical Formulation of the Remote Electric and Magnetic Emissions of the Lightning Dart Leader and Return Stroke

NASA Astrophysics Data System (ADS)

Thiemann, Edward M. B.

Lightning detection and geolocation networks have found widespread use by the utility, air traffic control and forestry industries as a means of locating strikes and predicting imminent recurrence. Accurate lightning geolocation requires detecting VLF radio emissions at multiple sites using a distributed sensor network with typical baselines exceeding 150 km, along with precision time of arrival estimation to triangulate the origin of a strike. The trend has been towards increasing network accuracy without increasing sensor density by incorporating precision GPS synchronized clocks and faster front-end signal processing. Because lightning radio waveforms evolve as they propagate over a finitely conducting earth, and that measurements for a given strike may have disparate propagation path lengths, accurate models are required to determine waveform fiducials for precise strike location. The transition between the leader phase and return stroke phase may offer such a fiducial and warrants quantitative modeling to improve strike location accuracy. The VLF spectrum of the ubiquitous downward negative lightning strike is able to be modeled by the transfer of several Coulombs of negative charge from cloud to ground in a two-step process. The lightning stepped leader ionizes a plasma channel downward from the cloud at a velocity of approximately 0.05c, leaving a column of charge in its path. Upon connection with a streamer, the subsequent return stroke initiates at or near ground level and travels upward at an average but variable velocity of 0.3c. The return stroke neutralizes any negative charge along its path. Subsequent dart leader and return strokes often travel smoothly down the heated channel left by a preceding stroke, lacking the halting motion of the preceding initial stepped leader and initial return stroke. Existing lightning models often neglect the leader current and rely on approximations when solving for the return stroke. In this thesis, I present an analytic solution to Maxwell's Equations for the lightning leader followed by a novel return stroke model. I model the leader as a downward propagating boxcar function of uniform charge density and constant velocity, and the subsequent return stroke is modeled as an upward propagating boxcar with a time dependent velocity. Charge conservation is applied to ensure self-consistency of the driving current and charge sources, and physical observations are used to support model development. The resulting transient electric and magnetic fields are presented at various distances and delay times and compared with measured waveforms and previously published models.

Building the Partners HealthCare Biobank at Partners Personalized Medicine: Informed Consent, Return of Research Results, Recruitment Lessons and Operational Considerations

PubMed Central

Karlson, Elizabeth W.; Boutin, Natalie T.; Hoffnagle, Alison G.; Allen, Nicole L.

2016-01-01

The Partners HealthCare Biobank is a Partners HealthCare enterprise-wide initiative whose goal is to provide a foundation for the next generation of translational research studies of genotype, environment, gene-environment interaction, biomarker and family history associations with disease phenotypes. The Biobank has leveraged in-person and electronic recruitment methods to enroll >30,000 subjects as of October 2015 at two academic medical centers in Partners HealthCare since launching in 2010. Through a close collaboration with the Partners Human Research Committee, the Biobank has developed a comprehensive informed consent process that addresses key patient concerns, including privacy and the return of research results. Lessons learned include the need for careful consideration of ethical issues, attention to the educational content of electronic media, the importance of patient authentication in electronic informed consent, the need for highly secure IT infrastructure and management of communications and the importance of flexible recruitment modalities and processes dependent on the clinical setting for recruitment. PMID:26784234

Improving Primary Care Provider Practices in Youth Concussion Management.

PubMed

Arbogast, Kristy B; Curry, Allison E; Metzger, Kristina B; Kessler, Ronni S; Bell, Jeneita M; Haarbauer-Krupa, Juliet; Zonfrillo, Mark R; Breiding, Matthew J; Master, Christina L

2017-08-01

Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

Harmonic engine

DOEpatents

Bennett, Charles L.; Sewall, Noel; Boroa, Carl

2014-08-19

An engine based on a reciprocating piston engine that extracts work from pressurized working fluid. The engine includes a harmonic oscillator inlet valve capable of oscillating at a resonant frequency for controlling the flow of working fluid into of the engine. In particular, the inlet valve includes an inlet valve head and a spring arranged together as a harmonic oscillator so that the inlet valve head is moveable from an unbiased equilibrium position to a biased closed position occluding an inlet. Upon releasing the inlet valve the inlet valve head undergoes a single oscillation past the equilibrium positio to a maximum open position and returns to a biased return position close to the closed position to choke the flow and produce a pressure drop across the inlet valve causing the inlet valve to close. Protrusions carried either by the inlet valve head or piston head are used to bump open the inlet valve from the closed position and initiate the single oscillation of the inlet valve head, and protrusions carried either by the outlet valve head or piston head are used to close the outlet valve ahead of the bump opening of the inlet valve.

Employee experience of workplace supervisor contact and support during long-term sickness absence.

PubMed

Buys, Nicholas J; Selander, John; Sun, Jing

2017-12-07

Workplace support is an important factor in promoting successful return to work. The purpose of this article is to examine relationships between supervisor contact, perceived workplace support and demographic variables among employees on long-term sickness absence. Data were collected from 204 public employees at a municipality in Sweden who had been on long term sickness absence (60 days or more) using a 23 question survey instrument that collected information on demographic variables, supervisor contact and perceived workplace support. Most injured employees (97%) reported having contact with their supervisors during their sickness absence, with a majority (56%) reporting high levels of support, including early (58.6%) and multiple (70.7%) contacts. Most were pleased with amount of contact (68.9%) and the majority had discussed workplace accommodations (68.1%). Employees who self-initiated contact, felt the amount of contact was appropriate, had a personal meeting with their supervisors and discussed workplace adjustments reported experiencing higher levels of support from supervisors. Employees on long-term sickness absence appreciate contact from their supervisors and this is associated with perceived workplace support. However, the amount and employee experience of this contact is important. It needs to be perceived by employees as supportive, which includes a focus on strategies (e.g., work adjustment) to facilitate a return to work. Supervisor training is required in this area to support the return to work process. Implications for Rehabilitation Contact and support from workplace supervisors is important to workers on long-term sickness absence. Employees appreciate frequent contact from supervisors during long-terms sickness absence. Employees appreciate a personal meeting with supervisors and the opportunity to discuss issues related to return to work such as work adjustment. Employers should provide training to supervisors on how to communicate and assist employees on long-term sickness absence.

Public Libraries--A Wise Investment: A Return on Investment Study of Colorado Public Libraries

ERIC Educational Resources Information Center

Steffen, Nicolle; Lietzau, Zeth; Lance, Keith Curry; Rybin, Amanda; Molliconi, Carla

2009-01-01

Public libraries deliver many benefits to their patrons, but understanding these benefits in terms of dollars-and-cents is difficult. In an effort to quantify the return on investment to taxpayers for monies invested in public libraries, the Library Research Service (LRS) initiated the study, "Public Libraries -- A Wise Investment: A Return…

Traumatic Brain Injury in K-12 Students II: Response to Instruction--When Will They Ever Learn?

ERIC Educational Resources Information Center

Schutz, Larry E.; McNamara, Elizabeth A.

2011-01-01

Most students who have sustained severe traumatic brain injury (TBI) appear normal when they return to school. Hopeful parents, encouraged by deceptively positive medical feedback, expect a return to regular education. In the classroom, the students initially seem almost ready to resume learning, but instead they fall farther behind grade level…

Exploring Career Agency during Self-Initiated Repatriation: A Study of Chinese Sea Turtles

ERIC Educational Resources Information Center

Guo, Chun; Porschitz, Emily T.; Alves, Jose

2013-01-01

Purpose: Drawing on career and self-initiated expatriation/repatriation literatures, this paper aims to examine the career experiences of Chinese self-initiated repatriates after their return to China. Design/methodology/approach: The authors conducted an exploratory, qualitative study involving in-depth interviews with 20 Chinese individuals who…

Recent Worldwide Developments in eHealth and mHealth to more Effectively Manage Cancer and other Chronic Diseases – A Systematic Review

PubMed Central

Ray, P.; Liaw, S.-T.

2016-01-01

Summary Objectives This paper is a systematic literature review intended to gain an understanding of the most original, excellent, state-of-the-art research in the application of eHealth (including mHealth) in the management of chronic diseases with a focus on cancer over the past two years. Method This review looks at peer-reviewed papers published between 2013 and 2015 and examines the background and trends in this area. It systematically searched peer-reviewed journals in databases PubMed, Proquest, Cochrane Library, Elsevier, Sage and the Institute of Electrical and Electronic Engineers (IEEE Digital Library) using a set of pre-defined keywords. It then employed an iterative process to filter out less relevant publications. Results From an initial search return of 1,519,682 results returned, twenty nine of the most relevant peer reviewed articles were identified as most relevant. Conclusions Based on the results we conclude that innovative eHealth and its subset mHealth initiatives are rapidly emerging as an important means of managing cancer and other chronic diseases. The adoption is following different paths in the developed and developing worlds. Besides governance and regulatory issues, barriers still exist around information management, interoperability and integration. These include medical records available online information for clinicians and consumers on cancer and other chronic diseases, mobile app bundles that can help manage co-morbidities and the capacity of supporting communication technologies. PMID:27830236

Stroke patients' experiences of return to work.

PubMed

Medin, Jennie; Barajas, Josefin; Ekberg, Kerstin

2006-09-15

Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

Family migration and employment: the importance of migration history and gender.

PubMed

Bailey, A J; Cooke, T J

1998-01-01

"This article uses event history data to specify a model of employment returns to initial migration, onward migration, and return migration among newly married persons in the U.S. Husbands are more likely to be full-time employed than wives, and being a parent reduces the employment odds among married women. Employment returns to repeated migration differ by gender, with more husbands full-time employed after onward migration and more wives full-time employed after return migration events. We interpret these empirical findings in the context of family migration theory, segmented labor market theory, and gender-based responsibilities." Data are from the National Longitudinal Survey of Youth from 1979 to 1991. excerpt

Unscheduled return visits by patients to the accident and emergency department.

PubMed Central

O'Dwyer, F; Bodiwala, G G

1991-01-01

To determine why patients reattend an A&E department we surveyed 235 patients who returned unscheduled in a one-month period. Sixty-two per cent returned because of persistent symptoms. Sixty-three per cent presented within a week of their initial visit. Only 32% had attempted to see their GP. Thirty-five per cent of all patients claimed that A&E staff had advised them to return if they had problems. Half of the patients did not require treatment and 61% were discharged home. Twenty-one patients had pathology that had been missed on their first visit. Better patient education may minimize misuse of the service allowing better care for those who need it. PMID:1930505

Rehabilitation and return to play after foot and ankle injuries in athletes.

PubMed

Hudson, Zoe

2009-09-01

Rehabilitation after acute ankle injury can be categorized in to early, middle, and late phases. This paper aims to cover some of the key concepts from initial management to end stage rehabilitation that could be applied to many musculoskeletal injuries around the foot and ankle. Pathology specific rehabilitation, functional performance tests, and sports specific and return to play issues are also addressed, as the aim of any rehabilitation programme is to return the athlete to the field of play as quickly as it is safe to do so.

Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study.

PubMed

Visser, Maartje; van Aar, Fleur; Koedijk, Femke D H; Kampman, Carolina J G; Heijne, Janneke C M

2017-12-20

Chlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous. Longitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test. In total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3-5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test. Repeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.

Maintenance of lateral stability during standing and walking in the cat.

PubMed

Karayannidou, A; Zelenin, P V; Orlovsky, G N; Sirota, M G; Beloozerova, I N; Deliagina, T G

2009-01-01

During free behaviors animals often experience lateral forces, such as collisions with obstacles or interactions with other animals. We studied postural reactions to lateral pulses of force (pushes) in the cat during standing and walking. During standing, a push applied to the hip region caused a lateral deviation of the caudal trunk, followed by a return to the initial position. The corrective hindlimb electromyographic (EMG) pattern included an initial wave of excitation in most extensors of the hindlimb contralateral to push and inhibition of those in the ipsilateral limb. In cats walking on a treadmill with only hindlimbs, application of force also caused lateral deviation of the caudal trunk, with subsequent return to the initial position. The type of corrective movement depended on the pulse timing relative to the step cycle. If the force was applied at the end of the stance phase of one of the limbs or during its swing phase, a lateral component appeared in the swing trajectory of this limb. The corrective step was directed either inward (when the corrective limb was ipsilateral to force application) or outward (when it was contralateral). The EMG pattern in the corrective limb was characterized by considerable modification of the hip abductor and adductor activity in the perturbed step. Thus the basic mechanisms for balance control in these two forms of behavior are different. They perform a redistribution of muscle activity between symmetrical limbs (in standing) and a reconfiguration of the base of support during a corrective lateral step (in walking).

A preliminary study of Mars rover/sample return missions

NASA Technical Reports Server (NTRS)

1987-01-01

The Solar System Exploration Committee (SSEC) of the NASA Advisory Council recommends that a Mars Sample Return mission be undertaken before the year 2000. Comprehensive studies of a Mars Sample Return mission have been ongoing since 1984. The initial focus of these studies was an integrated mission concept with the surface rover and sample return vehicle elements delivered to Mars on a single launch and landed together. This approach, to be carried out as a unilateral U.S. initiative, is still a high priority goal in an Augmented Program of exploration, as the SSEC recommendation clearly states. With this background of a well-understood mission concept, NASA decided to focus its 1986 study effort on a potential opportunity not previously examined; namely, a Mars Rover/Sample Return (MRSR) mission which would involve a significant aspect of international cooperation. As envisioned, responsibility for the various mission operations and hardware elements would be divided in a logical manner with clearly defined and acceptable interfaces. The U.S. and its international partner would carry out separately launched but coordinated missions with the overall goal of accomplishing in situ science and returning several kilograms of surface samples from Mars. Important considerations for implementation of such a plan are minimum technology transfer, maximum sharing of scientific results, and independent credibility of each mission role. Under the guidance and oversight of a Mars Exploration Strategy Advisory Group organized by NASA, a study team was formed in the fall of 1986 to develop a preliminary definition of a flight-separable, cooperative mission. The selected concept assumes that the U.S. would undertake the rover mission with its sample collection operations and our international partner would return the samples to Earth. Although the inverse of these roles is also possible, this study report focuses on the rover functions of MRSR because rover operations have not been studied in as much detail as the sample return functions of the mission.

Physicians' assessment of pediatric returns to the Emergency Department.

PubMed

Easter, Joshua S; Bachur, Richard

2013-03-01

Return visits to the Emergency Department (ED) requiring admission are frequently reviewed for the purpose of quality improvement. Treating physicians typically perform this review, but it is unclear if they accurately identify the reasons for the returns. To assess the characteristics of pediatric return visits to the ED, and the ability of treating physicians to identify the root causes for these return visits. This retrospective cohort study reviewed all returns within 96 h of an initial visit over a 2-year period at a tertiary care pediatric ED. Baseline characteristics were determined from review of patients' charts. The treating physicians, the primary author, and independent reviewers identified the root cause for the returns. There were 97,374 patients that presented to the ED during the study, and 1091 (1.1%) of these children returned to the ED and were admitted. Returns were most common among children aged<5 years, arriving between 3:00 p.m. and 11:00 p .m. via private transportation, with infectious diseases. The physician involved in the care of the patient attributed 3.1% of returns to potential deficiencies in medical management, whereas the independent reviewers attributed 13% to potential deficiencies. Both returns and the subset of returns due to potential deficiencies in management are more common than previously estimated, rendering review of returns a valuable quality improvement tool. However, EDs should not rely exclusively on the treating physicians to identify the reason for returns, as they seem to underestimate the frequency of returns due to potential deficiencies in medical management. Copyright © 2013 Elsevier Inc. All rights reserved.

A new look at red pine financial returns in the Lake States.

Treesearch

David C. Lothner; Dennis P. Bradley

1984-01-01

Describes the financial performance of red pine on site index 60, 70, and 80 lands by using new yield evidence and up-to-date cost and revenue assumptions. Best combinations of initial stocking, residual basal area after thinning, an rotation age are identified for two different financial criteria: soil expectation value and internal rate of return.

Improvement in South African Students' Outlook Due to Music Involvement

ERIC Educational Resources Information Center

Roy, Michael M.; Devroop, Karendra; Getz, Laura

2015-01-01

In the spring of 2009, we started a concert band programme at a high school in KwaZulu-Natal, South Africa. In the fall of 2011, we returned to the school to measure the impact of participating in a concert band on the students' attitude and outlook. During our initial and return visits, we measured feelings of self-esteem, optimism, positive…

German Trainees' Reflections on Two Approaches to Initial Teacher Training

ERIC Educational Resources Information Center

Chambers, Gary N.

2007-01-01

Two German native speakers come to England to undertake a course of initial teacher training. They complete the course successfully. Instead of seeking and finding jobs as teachers, however, they return to Germany to undertake a second course of initial teacher training. This is unusual. This article reviews their reasons for taking two routes in…

Initial assessment of the ground-water resources in the Monterey Bay region, California

USGS Publications Warehouse

Muir, K.S.

1977-01-01

Because urban growth has placed an increasing demand on the ground-water resources of the Monterey Bay region, Calif., an assessment of the ground-water conditions was made to aid the development of local and regional plans. Ground water provides 80 percent of the water used in the region, which includes six ground-water subbasins. In several of the subbasins, pumpage exceeds safe yield. Existing water-quality degradation results from seawater intrusion, septic-tank effluent, and irrigation-return water. Potential sources of degradation include municipal sewage disposal, leachates from solid-waste disposal sites, and poor-quality connate water. High-priority items for future study include location of recharge areas, detection of seawater intrusion, and well-monitoring of landfill sites. (Woodard-USGS)

Quality circles in a department of dietetics.

PubMed

Treadwell, D D; Klein, J A

1984-06-01

Quality circles can be an excellent approach to managerial effectiveness in the 1980s. For the Department of Dietetics at Miami Valley Hospital, Dayton , Ohio, quality circles have demonstrated excellent return on investment. Their many benefits include increased productivity, improved employee satisfaction and morale, and cost savings. In order to ensure success, the team needs to be selected carefully and trained thoroughly in problem-solving techniques. Initial meetings should be directed to defining the objectives and code of conduct as well as establishing a trusting environment in which to grow and develop.

Low cost manned Mars mission based on indigenous propellant production

NASA Technical Reports Server (NTRS)

Bruckner, A. P.; Cinnamon, M.; Hamling, S.; Mahn, K.; Phillips, J.; Westmark, V.

1993-01-01

The paper describes a low-cost approach to the manned exploration of Mars (which involves an unmanned mission followed two years later by a manned mission) based on near-term technologies and in situ propellant production. Particular attention is given to the basic mission architecture and its major components, including the orbital analysis, the unmanned segment, the Earth Return Vehicle, the aerobrake design, life sciences, guidance, communications, power, propellant production, the surface rovers, and Mars science. Also discussed are the cost per mission over an assumed 8-yr initiative.

The Virtual Solar Observatory: Progress and Diversions

NASA Astrophysics Data System (ADS)

Gurman, Joseph B.; Bogart, R. S.; Amezcua, A.; Hill, Frank; Oien, Niles; Davey, Alisdair R.; Hourcle, Joseph; Mansky, E.; Spencer, Jennifer L.

2017-08-01

The Virtual Solar Observatory (VSO) is a known and useful method for identifying and accessing solar physics data online. We review current "behind the scenes" work on the VSO, including the addition of new data providers and the return of access to data sets to which service was temporarily interrupted. We also report on the effect on software development efforts when government IT “security” initiatives impinge on finite resoruces. As always, we invite SPD members to identify data sets, services, and interfaces they would like to see implemented in the VSO.

The Petal Project: An innovation in sexual healthcare and education for Kenyan schoolgirl.

PubMed

Parker, Karen M

2018-01-01

In the western province of Nyanza in Kenya, girls and women face an issue all too common in the developing world-little or no access to affordable means to effectively managing their menstrual flow. As a result, many stay at home or drop out of school because they are teased and embarrassed. Some approach men for money to buy pads and are forced, in return, to engage in transactional sex. The girls may not be able to return to school at all due to pregnancy. The story literally and figuratively continues to cycle, keeping girls in positions of dependency and poverty. In May 2011, two visiting nursing faculty conducting health clinics with students, were approached by a young male school volunteer who shared his observations and unease with what he saw happening. Concerns shared that day spawned an initiative known as the Petal Project, which has yielded thousands of starter kits hand-sewn and delivered to girls in Kenya. The Petal Project has grown in popularity and participation on their college campus and in neighboring communities. Since its inception, this initiative has expanded to include over six countries and has positively impacted the lives of hundreds of givers and receivers. © 2018 Wiley Periodicals, Inc.

Asteroid Redirect Robotic Mission: Robotic Boulder Capture Option Overview

NASA Technical Reports Server (NTRS)

Mazanek, Daniel D.; Merrill, Raymond G.; Belbin, Scott P.; Reeves, David M.; Earle, Kevin D.; Naasz, Bo J.; Abell, Paul A.

2014-01-01

The National Aeronautics and Space Administration (NASA) is currently studying an option for the Asteroid Redirect Robotic Mission (ARRM) that would capture a multi-ton boulder (typically 2-4 meters in size) from the surface of a large (is approximately 100+ meter) Near-Earth Asteroid (NEA) and return it to cislunar space for subsequent human and robotic exploration. This alternative mission approach, designated the Robotic Boulder Capture Option (Option B), has been investigated to determine the mission feasibility and identify potential differences from the initial ARRM concept of capturing an entire small NEA (4-10 meters in size), which has been designated the Small Asteroid Capture Option (Option A). Compared to the initial ARRM concept, Option B allows for centimeter-level characterization over an entire large NEA, the certainty of target NEA composition type, the ability to select the boulder that is captured, numerous opportunities for mission enhancements to support science objectives, additional experience operating at a low-gravity planetary body including extended surface contact, and the ability to demonstrate future planetary defense strategies on a hazardous-size NEA. Option B can leverage precursor missions and existing Agency capabilities to help ensure mission success by targeting wellcharacterized asteroids and can accommodate uncertain programmatic schedules by tailoring the return mass.

System technology analysis of aeroassisted orbital transfer vehicles: Moderate lift/drag (0.75-1.5),volume 1B, part 1, study results

NASA Technical Reports Server (NTRS)

1985-01-01

Significant performance benefits can be realized via aerodynamic breaking and/or aerodynamic maneuvering on return from higher altitude orbits to low Earth orbit. This approach substantially reduces the mission propellant requirements by using the aerodynamic drag, D, to brake the vehicle to near circular velocity and the aerodynamic lift, L, to null out accumulated errors as well as change the orbital inclination to that required for rendezous with the Space Shuttle Orbiter. A study was completed where broad concept evaluations were performed and the technology requirements and sensitivities for aeroassisted Orbital Transfer Vehicles (AOTVs) over a range of vehicle hypersonic L/D from 0.75 to 1.5 were systematically identified and assessed. The AOTV is capable of evolving from an initial delivery only system to one eventually capable of supporting manned roundtrip missions to geosynchronous orbit. Concept screenings were conducted on numerous configurations spanning the L/D = 0.75 to 1.5 range, and several with attractive features were identified. Initial payload capability was evaluated for a baseline of delivery to GEO, six hour polar, and Molniya orbits with return and recovery of the AOTV at LEO. Evolutionary payload requirements that were assessed include a GEO servicing mission and a manned GEO mission.

Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study.

PubMed

Ozegovic, Dejan; Carroll, Linda J; David Cassidy, J

2009-06-01

To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportional hazard analysis we assessed the association between return to work expectations and self-perceived recovery during the first year following the event. After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26-1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery.

Customers' perspectives on the impact of the Pathways to Work condition management programme on their health, well-being and vocational activity.

PubMed

Secker, Jenny; Pittam, Gail; Ford, Fiona

2012-11-01

Pathways to Work is a UK initiative aimed at supporting customers on incapacity benefits to return to work. This qualitative study complements previous evaluations of Pathways to Work by exploring customers' perceptions of the impact of the Condition Management Programme (CMP) offered to claimants with long-term health conditions. 39 customers took part in focus groups held at the seven sites where Pathways was originally piloted. The main focus of the discussions was on perceptions of the ways in which participation had impacted on health, well-being and return to work. The discussions were audio-recorded and fully transcribed for analysis using a text analysis framework to enable the development and refinement of categories and overarching patterns in the data. Perceived impacts on health and well-being included a more positive outlook, social contact, changed perceptions of conditions and improvements in health. Some customers also reported an increase in their vocational activity and others felt ready to embark on new activities. Factors associated with positive outcomes included the extent and quality of contact with CMP staff and practical advice about condition management. Factors impeding positive employment outcomes related mainly to obstacles to returning to work. The results indicated that CMP can assist customers to learn about and manage their health conditions and increase their vocational activity, and that CMP therefore provides a promising means of enabling people with long-term health conditions to regain a fulfilling, productive life.

Radiation from lightning return strokes over a finitely conducting earth

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Gesell, L.; Kao, Michael

1986-01-01

The effects of the conductivity of the earth on radiation from lightning return strokes are examined theoretically using a piecewise linear transmission line model for the return stroke. First, calculations are made of the electric field radiated during the return stroke, and then this electric field is used to compute the response of conventional AM radio receivers and electric field change systems during the return stroke. The calculations apply to the entire transient waveform (they are not restricted to the initial portions of the return stroke) and yield fast field changes and RF radiation in agreement with measurements made during real lightning. This research was motivated by measurements indicating that a time delay exists between the time of arrival of the fast electric field change and the RF radiation from first return strokes. The time delay is on the order of 20 microsec for frequencies in the HF-UHF range for lightning in Florida. The time delay is obtained theoretically in this paper. It occurs when both the effects of attenuation due to conductivity of the earth, and the finite velocity of propagation of the current pulse up the return stroke channel, are taken into account in the model.

Influence of environmental statistics on inhibition of saccadic return

PubMed Central

Farrell, Simon; Ludwig, Casimir J. H.; Ellis, Lucy A.; Gilchrist, Iain D.

2009-01-01

Initiating an eye movement is slowed if the saccade is directed to a location that has been fixated in the recent past. We show that this inhibitory effect is modulated by the temporal statistics of the environment: If a return location is likely to become behaviorally relevant, inhibition of return is absent. By fitting an accumulator model of saccadic decision-making, we show that the inhibitory effect and the sensitivity to local statistics can be dissociated in their effects on the rate of accumulation of evidence, and the threshold controlling the amount of evidence needed to generate a saccade. PMID:20080778

Calculations of lightning return stroke electric and magnetic fields above ground

NASA Technical Reports Server (NTRS)

Master, M. J.; Uman, M. A.; Ling, Y. T.; Standler, R. B.

1981-01-01

Lin et al., (1980) presented a lightning return stroke model with which return stroke electric and magnetic fields measured at ground level could be reproduced. This model and a modified version of it, in which the initial current peak decays with height above ground, are used to compute waveforms for altitudes from 0-10 km and at ranges of 20 m to 10 km. Both the original and modified models gave accurate predictions of measured ground-based fields. The use of the calculated fields in calibrating airborne field measurements from simultaneous ground and airborne data is discussed.

The tropics and the crime they did not commit.

PubMed

Goorhuis, A; van Thiel, P P A M; Middeldorp, S; van Eck, B L F; Grobusch, M P

2013-02-01

Travellers to tropical destinations who seek medical attention after returning to their home country often present with fever, frequently as a result of an imported infectious disease. For this reason, clinicians initially focus on an infectious cause when a clear relationship in time exists between travel and disease onset. We present a case of a patient, who developed fever 2 weeks after his return from Ghana and who was finally diagnosed with an auto-immune disease: arteritis of the large arteries. This case illustrates that broad differential diagnostic thinking is paramount in the assessment of returned travellers.

Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

PubMed

Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

2013-05-01

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Impact micro-positioning actuator

NASA Technical Reports Server (NTRS)

Cuerden, Brian (Inventor); Angel, J. Roger P. (Inventor); Burge, James H. (Inventor); DeRigne, Scott T. (Inventor)

2006-01-01

An impact micro-positioning actuator. In one aspect of the invention, a threaded shaft is threadably received in a nut and the nut is impacted by an impacting device, causing the nut first to rotate relative to the shaft by slipping as a result of shaft inertia and subsequently to stick to the shaft as a result of the frictional force therebetween. The nut is returned to its initial position by a return force provided by a return mechanism after impact. The micro-positioning actuator is further improved by controlling at least one and preferably all of the following: the friction, the impact provided by the impacting device, the return force provided by the return mechanism, and the inertia of the shaft. In another aspect of the invention, a threaded shaft is threadably received in a nut and the shaft is impacted by an impacting device, causing the shaft to rotate relative to the nut.

IPV6 Network Infrastructure and Stability Inference

DTIC Science & Technology

2014-09-01

study focused on determining restart behavior for addresses with incremental fragmen- tation identification numbers. However, the initial evaluation ...the Too Big Trick (TBT) to induce the remote targets to return fragmented responses. By evaluating the responses, the uptime for approximately 35% of...to return fragmented responses. By evaluating the responses, the uptime for approximately 35% of the IPv6 addresses can be inferred. v THIS PAGE

Performance Indexing: Assessing the Nonmonetized Returns on Investment in Military Equipment

DTIC Science & Technology

2016-05-17

investment’s value (return) because it cannot be objectively quanti - fied. To support resource allocation decisions, our mission was to provide accurate and...timely analyses with readily available information. In fiscal year 2014, the Marine Corps evaluated its strategic equipment investment initiatives...battle outcomes (Department of the Air Force, 1996). Elaborate opera- tional testing and evaluation events are created to evaluate these measures

Army Net Zero Installation Initiative and Cost Benefit Analysis Activity

DTIC Science & Technology

2011-10-31

freshwater resources and returns water back to the same watershed so not to deplete the groundwater and surface water resources of that... freshwater resources & returns water back to the same watershed so not to deplete the groundwater & surface water resources of that region in quantity...Goals: Reduce freshwater demand through water efficiency & conservation Access/develop alternate water sources to offset freshwater demand Develop

76 FR 21946 - Proposed Collection; Comment Request for Form 990-BL; Schedule A (Form 990-BL), Form 6069

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-19

... required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently... Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons, and Form 6069, Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Under Section 4953 and Computation...

Measuring the Effect of In-Country Recruitment Activities on Future International Enrollment at a Large Canadian University

ERIC Educational Resources Information Center

Soltice, John G.

2016-01-01

There are many recruitment methods and tactics an institution can choose to pursue diversification of international student enrollment goals. Return on investment in a choice of tactic can take up to three or more years to determine thus initial choice is vital. Just as important though is in our ability to measure the return. If we can not…

[Preservation of ability to work and securing vocational participation : non-pharmaceutical support options for rheumatologists].

PubMed

Drambyan, Y; Parthier, K

2014-02-01

For patients of working age with chronic rheumatic diseases preservation of the ability to work and therefore for equal participation in professional life is of particular importance. Significant supporting actions by rheumatologists include non-pharmaceutical and non-medical interventions in addition to drug therapy. Measures aiming at sustained working capacity such as physiotherapy, occupational therapy, medical rehabilitation and stepwise return to work have to be utilized. This support can include referral to a counseling service and assistance with the application for medical or vocational rehabilitation programs. In order to ensure sustainable success of the initiated measures it is essential that follow-up care and function-related interventions are supervised by a rheumatologist.

Groundbreaking Mars Sample Return for Science and Human Exploration

NASA Technical Reports Server (NTRS)

Cohen, Barbara; Draper, David; Eppler, Dean; Treiman, Allan

2012-01-01

Partnerships between science and human exploration have recent heritage for the Moon (Lunar Precursor Robotics Program, LPRP) and nearearth objects (Exploration Precursor Robotics Program, xPRP). Both programs spent appreciable time and effort determining measurements needed or desired before human missions to these destinations. These measurements may be crucial to human health or spacecraft design, or may be desired to better optimize systems designs such as spacesuits or operations. Both LPRP and xPRP recommended measurements from orbit, by landed missions and by sample return. LPRP conducted the Lunar Reconnaissance Orbiter (LRO) and Lunar Crater Observation and Sensing Satellite (LCROSS) missions, providing high-resolution visible imagery, surface and subsurface temperatures, global topography, mapping of possible water ice deposits, and the biological effects of radiation [1]. LPRP also initiated a landed mission to provide dust and regolith properties, local lighting conditions, assessment of resources, and demonstration of precision landing [2]. This mission was canceled in 2006 due to funding shortfalls. For the Moon, adequate samples of rocks and regolith were returned by the Apollo and Luna programs to conduct needed investigations. Many near-earth asteroids (NEAs) have been observed from the Earth and several have been more extensively characterized by close-flying missions and landings (NEAR, Hayabusa, Rosetta). The current Joint Robotic Precursor Activity program is considering activities such as partnering with the New Frontiers mission OSIRIS-Rex to visit a NEA and return a sample to the Earth. However, a strong consensus of the NEO User Team within xPRP was that a dedicated mission to the asteroid targeted by humans is required [3], ideally including regolith sample return for more extensive characterization and testing on the Earth.

Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series.

PubMed

McAleer, Stephen S; Lippie, Ed; Norman, Darcy; Riepenhof, Helge

2017-09-01

Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.

What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.

PubMed

vanVonno, Catherine J; Ozminkowski, Ronald J; Smith, Mark W; Thomas, Eileen G; Kelley, Doniece; Goetzel, Ron; Berg, Gregory D; Jain, Susheel K; Walker, David R

2005-12-01

In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered. Each cohort was followed for 12 months before the program began and 12 months afterward. The outcome measures of primary interest were the differences over time in medical care expenditures paid by FEP and by all payers. Independent variables included indicators of program participation, type of heart disease, comorbidity measures, and demographics. From the perspective of the funding organization (FEP), the estimated return on investment for the pilot CHF disease management program was a savings of $1.08 in medical expenditure for every dollar spent on the program. Adding savings to other payers as well, the return on investment was a savings of $1.15 in medical expenditures per dollar spent on the program. The amount of savings depended upon CHF risk levels. The value of a pilot initiative and evaluation is that lessons for larger-scale efforts can be learned prior to full-scale rollout.

Military personnel sustaining Lisfranc injuries have high rates of disability separation.

PubMed

Balazs, George C; Hanley, M G; Pavey, G J; Rue, J-Ph

2017-06-01

Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries. Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation. Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain. Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures. 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/.

Treatment of Unicameral Bone Cysts of the Proximal Femur With Internal Fixation Lessens the Risk of Additional Surgery.

PubMed

Wilke, Benjamin; Houdek, Matthew; Rao, Rameshwar R; Caird, Michelle S; Larson, A Noelle; Milbrandt, Todd

2017-09-01

Little data exist to guide the treatment of unicameral bone cysts in the proximal femur. Methods of treatment include corticosteroid injections, curettage and bone grafting, and internal fixation. The authors completed a multi-institutional, retrospective review to evaluate their experience with proximal femoral unicameral bone cysts. They posed the following questions: (1) Does internal fixation reduce the risk of further procedures for the treatment of a unicameral bone cyst? (2) Is radiographic healing faster with internal fixation? Following institutional review board approval, the authors conducted a retrospective review of 36 patients treated for a unicameral bone cyst of the proximal femur at their institutions between 1974 and 2014. Medical records and radiographs were reviewed to identify patient demographics and treatment outcomes. Tumor locations included femoral neck (n=13), intertrochanteric (n=16), and subtrochanteric (n=7). Initial treatment included steroid injection (n=2), curettage and bone grafting (n=9), and internal fixation with curettage and bone grafting (n=25). Mean time was 9 months to radiographic healing and 15 months to return to full activity. The number of patients requiring additional surgeries was increased among those who did not undergo internal fixation. There was no difference in time to radiographic healing. However, time to return to normal activities was reduced if patients had received internal fixation. A significant reduction in additional procedures was observed when patients had been treated with internal fixation. Although this did not influence time to radiographic healing, patients did return to normal activities sooner. Internal fixation should be considered in the treatment of proximal femoral unicameral bone cysts. [Orthopedics. 2017; 40(5):e862-e867.]. Copyright 2017, SLACK Incorporated.

Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

PubMed Central

Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

2016-01-01

Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

Syringe Pump Performance Maintained with IV Filter Use During Low Flow Rate Delivery for Pediatric Patients.

PubMed

Chau, Destiny F; Vasilopoulos, Terrie; Schoepf, Miriam; Zhang, Christina; Fahy, Brenda G

2016-09-01

Complex surgical and critically ill pediatric patients rely on syringe infusion pumps for precise delivery of IV medications. Low flow rates and in-line IV filter use may affect drug delivery. To determine the effects of an in-line filter to remove air and/or contaminants on syringe pump performance at low flow rates, we compared the measured rates with the programmed flow rates with and without in-line IV filters. Standardized IV infusion assemblies with and without IV filters (filter and control groups) attached to a 10-mL syringe were primed and then loaded onto a syringe pump and connected to a 16-gauge, 16-cm single-lumen catheter. The catheter was suspended in a normal saline fluid column to simulate the back pressure from central venous circulation. The delivered infusate was measured by gravimetric methods at predetermined time intervals, and flow rate was calculated. Experimental trials for initial programmed rates of 1.0, 0.8, 0.6, and 0.4 mL/h were performed in control and filter groups. For each trial, the flow rate was changed to double the initial flow rate and was then returned to the initial flow rate to analyze pump performance for titration of rates often required during medication administration. These conditions (initial rate, doubling of initial rate, and return to initial rate) were analyzed separately for steady-state flow rate and time to steady state, whereas their average was used for percent deviation analysis. Differences between control and filter groups were assessed using Student t tests with adjustment for multiplicity (using n = 3 replications per group). Mean time from 0 to initial flow (startup delay) was <1 minute in both groups with no statistical difference between groups (P = 1.0). The average time to reach steady-state flow after infusion startup or rate changes was not statistically different between the groups (range, 0.8-5.5 minutes), for any flow rate or part of the trial (initial rate, doubling of initial rate, and return to initial rate), although the study was underpowered to detect small time differences. Overall, the mean steady-state flow rate for each trial was below the programmed flow rate with negative mean percent deviations for each trial. In the 1.0-mL/h initial rate trial, the steady-state flow rate attained was lower in the filter than the control group for the initial rate (P = 0.04) and doubling of initial rate (P = 0.04) with a trend during the return to initial rate (P = 0.06), although this same effect was not observed when doubling the initial rate trials of 0.8 or 0.6 mL/h or any other rate trials compared with the control group. With low flow rates used in complex surgical and pediatric critically ill patients, the addition of IV filters did not confer statistically significant changes in startup delay, flow variability, or time to reach steady-state flow of medications administered by syringe infusion pumps. The overall flow rate was lower than programmed flow rate with or without a filter.

26 CFR 301.6103(l)-1 - Disclosure of returns and return information for purposes other than tax administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for purposes other than tax administration. 301.6103(l)-1 Section 301.6103(l)-1 Internal Revenue... ADMINISTRATION Information and Returns Returns and Records § 301.6103(l)-1 Disclosure of returns and return... provisions of section 6103(l) of the Internal Revenue Code, the term agent includes a contractor. (b...

26 CFR 301.6103(p)(2)(B)-1 - Disclosure of returns and return information by other agencies.

Code of Federal Regulations, 2013 CFR

2013-04-01

... other agencies. 301.6103(p)(2)(B)-1 Section 301.6103(p)(2)(B)-1 Internal Revenue INTERNAL REVENUE... Information and Returns Returns and Records § 301.6103(p)(2)(B)-1 Disclosure of returns and return information... regulations thereunder, including, if applicable, safeguards imposed by section 6103(p)(4). (d) Records and...

26 CFR 301.6103(p)(2)(B)-1 - Disclosure of returns and return information by other agencies.

Code of Federal Regulations, 2014 CFR

2014-04-01

... other agencies. 301.6103(p)(2)(B)-1 Section 301.6103(p)(2)(B)-1 Internal Revenue INTERNAL REVENUE... Information and Returns Returns and Records § 301.6103(p)(2)(B)-1 Disclosure of returns and return information... regulations thereunder, including, if applicable, safeguards imposed by section 6103(p)(4). (d) Records and...

26 CFR 301.6103(p)(2)(B)-1 - Disclosure of returns and return information by other agencies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... other agencies. 301.6103(p)(2)(B)-1 Section 301.6103(p)(2)(B)-1 Internal Revenue INTERNAL REVENUE... Information and Returns Returns and Records § 301.6103(p)(2)(B)-1 Disclosure of returns and return information... regulations thereunder, including, if applicable, safeguards imposed by section 6103(p)(4). (d) Records and...

26 CFR 301.6103(p)(2)(B)-1 - Disclosure of returns and return information by other agencies.

Code of Federal Regulations, 2012 CFR

2012-04-01

... other agencies. 301.6103(p)(2)(B)-1 Section 301.6103(p)(2)(B)-1 Internal Revenue INTERNAL REVENUE... Information and Returns Returns and Records § 301.6103(p)(2)(B)-1 Disclosure of returns and return information... regulations thereunder, including, if applicable, safeguards imposed by section 6103(p)(4). (d) Records and...

26 CFR 301.6103(p)(2)(B)-1 - Disclosure of returns and return information by other agencies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... other agencies. 301.6103(p)(2)(B)-1 Section 301.6103(p)(2)(B)-1 Internal Revenue INTERNAL REVENUE... Information and Returns Returns and Records § 301.6103(p)(2)(B)-1 Disclosure of returns and return information... regulations thereunder, including, if applicable, safeguards imposed by section 6103(p)(4). (d) Records and...

Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review.

PubMed

Nwachukwu, Benedict U; Anthony, Shawn G; Lin, Kenneth M; Wang, Tim; Altchek, David W; Allen, Answorth A

2017-09-01

To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball. NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics. A systematic review of the literature was performed using the MEDLINE database. Inclusion criteria were: English language, ACL surgery outcome, professional basketball and RTP outcome. We reviewed studies for RTP rates and RTP performance. Our study included 12 professional basketball players with NBA level experience. Eleven of the 12 players returned to their prior level of play. Eight of the 9 (88.9%) players actively playing in the NBA returned to play in the NBA at a mean 9.8 months. Among players returning to NBA play, during RTP season 1, mean per game statistics decreased for the following: minutes, points, rebounds, assists, steals, blocks, turnovers and personal fouls - none of these changes reached statistical significance. Player efficiency ratings significantly declined from pre-injury (12.5) to the first RTP season (7.6) (p = 0.05). By RTP season 2, player performance metrics approximated pre-injury levels and were not significantly different. Six studies met inclusion criteria; reported RTP rates ranged from 78-86%. Identified studies similarly found a decline in functional performance after RTP. There is a high rate (89%) of return to NBA play for NBA players undergoing ACLR. After RTP, however, there is a quantitative decline in initial season 1 RTP statistics with a significant decrease in player efficiency rating. By RTP season 2, performance metrics demonstrated an improvement compared to RTP season 1 but did not reach pre-injury functional performance, though performance metrics are not significantly different between pre-injury and RTP season 2.

Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study.

PubMed

Roth, Joshua A; Etzioni, Ruth; Waters, Teresa M; Pettinger, Mary; Rossouw, Jacques E; Anderson, Garnet L; Chlebowski, Rowan T; Manson, Joann E; Hlatky, Mark; Johnson, Karen C; Ramsey, Scott D

2014-05-06

The findings of the Women's Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial's $260 million cost (2012 U.S. dollars). To estimate the economic return from the WHI E+P trial. Decision model to simulate health outcomes for a "WHI scenario" with observed cHT use and a "no-WHI scenario" with cHT use extrapolated from the pretrial period. Primary analyses of WHI outcomes, peer-reviewed literature, and government sources. Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy. 2003 to 2012. Payer. Combined hormone therapy. Disease incidence, expenditure, quality-adjusted life-years, and net economic return. The WHI scenario resulted in 4.3 million fewer cHT users, 126,000 fewer breast cancer cases, 76,000 fewer cardiovascular disease cases, 263,000 more fractures, 145,000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100,000 per quality-adjusted life-year. The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion. No evaluation of indirect costs or outcomes beyond 2012. The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects. National Heart, Lung, and Blood Institute.

Returning to ourselves: Palestinian complementary healers in Israel.

PubMed

Popper-Giveon, Ariela; Weiner-Levy, Naomi

2014-01-01

Studies of traditional healers in various cultures describe their initiation into the healing profession as a climax that constructs their professional and personal identity. Literature emphasizes the healers' intense association with the culture in which they work, as reflected in the initiation narratives that healers in various cultures recount. In this article we reveal unique initiation stories and identity formation from Palestinian nonconventional healers in Israel who described a cross-cultural journey: After studying healing traditions of foreign cultures and on returning to their own cultural environment, they developed a unique and complex combination of healing values and traditions. We examine the stories of these healers, whose personal and professional identities are affected by cultural, political, and social contexts. We note the blending of healing traditions and practices, and the changes in identity, assessing them against cultural processes that many Palestinians in Israel have been undergoing over the past few decades.

Exact closed-form solution of the hyperbolic equation of string vibrations with material relaxation properties taken into account

NASA Astrophysics Data System (ADS)

Kudinov, I. V.; Kudinov, V. A.

2014-09-01

The differential equation of damped string vibrations was obtained with the finite speed of extension and strain propagation in the Hooke's law formula taken into account. In contrast to the well-known equations, the obtained equation contains the first and third time derivatives of the displacement and the mixed derivative with respect to the space and time variables. Separation of variables was used to obtain its exact closed-form solution, whose analysis showed that, for large values of the relaxation coefficient, the string return to the initial state after its escape from equilibrium is accompanied by high-frequency low-amplitude damped vibrations, which occur on the initial time interval only in the region of positive displacements. And in the limit, for some large values of the relaxation coefficient, the string return to the initial state occurs practically without any oscillatory process.

[WHO Healthy City Initiative in Japan].

PubMed

Yoshizawa, Kazuko

2013-01-01

City environmental conditions are associated with health outcomes in people living there. World Health Organization (WHO) initiated Healthy City in 1986. To promote the networking, Alliance for Healthy Cities (AFHC) was launched in 2003 with local offices including AFHC Japan. As of 2010, 26 cities are members of AFHC Japan. A questionnaire was sent to those member cities. It includes questions on why they became an AFHC member, which section is in charge of the initiatives, what factors are important for promotion, and others. Out of the 26 cities, 13 cities returned the completed questionnaire. As for factors important for promoting the initiatives, 10 (77%) out of the 13 cities answered "consciousness of residents", while five (38%) chose "budget". This result suggests that community participation is a more important factor than budget for promoting and succeeding in the initiatives. Aging is a problem in any of the member cities, and six cities out the 13 falls under the category of superaged society, which is defined as a society with the proportion of aged people < 65 years being greater than 21% of the whole population. Eleven cities (85%) agreed that bicycles are an alternative means of transportation to cars; however, infrastructure for ensuring safety needs further improvement. In the promotion of Healthy City, networking among the member cities in Japan and worldwide should be promoted. Community participation with empowerment from the planning stage should lead to sustainable initiatives. The function of AFHC in collaboration among the members should be strengthened to cope with the rapidly changing city environment.

Reliability in the parameterization of the functional reach test in elderly stroke patients: a pilot study.

PubMed

Merchán-Baeza, Jose Antonio; González-Sánchez, Manuel; Cuesta-Vargas, Antonio Ignacio

2014-01-01

Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). Five subjects over 65 who suffer from a stroke. FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

Role of Vestibular Evoked Myogenic Potentials as an Indicator of Recovery in Patients with Benign Paroxysmal Positional Vertigo.

PubMed

Mendeš, Tihana; Maslovara, Siniša; Včeva, Andrijana; Butković Soldo, Silva

2017-12-01

Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.

Variables Associated With Return to Sport Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

PubMed Central

Czuppon, Sylvia; Racette, Brad A.; Klein, Sandra E.; Harris-Hayes, Marcie

2014-01-01

Background As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their pre-injury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. Purpose The purpose of this review is to summarize the literature reporting on variables proposed to be associated with return to sport following anterior cruciate ligament reconstruction. Study Design Systematic Review Methods Medline, Embase, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: 1) included patients with primary ACLR, 2) reported at least one knee impairment, function or psychological measure, 3) reported a return to sport measure and 4) analyzed the relationship between the measure and return to sport. Results Weak evidence existed in sixteen articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher pre-operative knee self-efficacy, lower kinesiophobia and higher pre-operative self-motivation. Conclusion Weak evidence supports an association between knee impairment, functional, and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilizing evidence-based return to sport guidelines following ACLR may ensure athletes are physically and psychologically capable of sports participation, which may reduce re-injury rates and the need for subsequent surgery. PMID:24124040

Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair.

PubMed

Cvetanovich, Gregory L; Lizzio, Vincent; Meta, Fabien; Chan, Derek; Zaltz, Ira; Nho, Shane J; Makhni, Eric C

2017-11-01

To assess comprehensiveness and variability of postoperative physical therapy protocols published online following hip arthroscopy for femoroacetabular impingement (FAI) and/or labral repair. Surgeons were identified by the International Society for Hip Arthroscopy "Find a Surgeon" feature in North America (http://www.isha.net/members/, search August 10, 2016). Exclusion criteria included nonsurgeons and protocols for conditions other than hip arthroscopy for FAI and/or labral tear. Protocols were identified by review of surgeons' personal and departmental websites and evaluated for postoperative restrictions, rehabilitation components, and the time points for ending restrictions and initiating activities. Of 111 surgeons available online, 31 (27.9%) had postoperative hip arthroscopy physical therapy protocols available online. Bracing was used in 54.8% (17/31) of protocols for median 2-week duration (range, 1-6 weeks). Most protocols specified the initial postoperative weight-bearing status (29/31, 93.5%), most frequently partial weight-bearing with 20 pounds foot flat (20/29, 69.0%). The duration of weight-bearing restriction was median 3 weeks (range, 2-6) for FAI and median 6 weeks (range, 3-8) for microfracture. The majority of protocols specified initial range of motion limitations (26/31, 83.9%) for median 3 weeks (range, 1.5-12). There was substantial variation in the rehabilitation activities and time points for initiating activities. Time to return to running was specified by 20/31 (64.5%) protocols at median 12 weeks (range, 6-19), and return to sport timing was specified by 13/31 (41.9%) protocols at median 15.5 weeks (range, 9-23). There is considerable variability in postoperative physical therapy protocols available online following hip arthroscopy for FAI, including postoperative restrictions, rehabilitation activities, and time points for activities. This information offers residents, fellows, and established hip arthroscopists a centralized comparison of publicly available physical therapy protocols following hip arthroscopy. Practicing arthroscopists might find this analysis useful to compare various therapy strategies to their own recommendations. The variability we report can also provide inspiration for future efficacy research toward a more standard rehabilitation. Copyright © 2017. Published by Elsevier Inc.

Perceptions of Writing by Exceptional Cases of Adult Returning Women in a Rural Community College: Differences between Persisters and Leavers.

ERIC Educational Resources Information Center

Starks, Gretchen

A study was conducted at a rural community college to explore the process by which adult women who had returned to college decided whether to persist or drop out. In-depth interviews were conducted with 17 women who had been identified as exceptional in that they either persisted and graduated even though they had been initially identified as…

Secondary ventricular fibrillation or pulseless ventricular tachycardia during cardiac arrest and epinephrine dosing.

PubMed

Straznitskas, Andrew D; Wong, Sylvia; Kupchik, Nicole; Carlbom, David

2015-05-01

Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not. Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls. Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001). More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia. ©2015 American Association of Critical-Care Nurses.

Effectiveness of Workplace Lactation Interventions on Breastfeeding Outcomes in the United States: An Updated Systematic Review.

PubMed

Kim, Julia H; Shin, Jong C; Donovan, Sharon M

2018-06-01

Background Returning to work is one of the main barriers to breastfeeding duration among working mothers in the United States. However, the impact of workplace lactation programs is unclear. Research Aim The aim of this study was to evaluate the effectiveness of workplace lactation programs in the United States on breastfeeding practices. Methods A systematic search was conducted of seven databases through September 2017. Articles ( N = 10) meeting the inclusion criteria of describing a workplace lactation intervention and evaluation in the United States and measuring initiation, exclusivity, or duration using an experimental or observational study design were critically evaluated. Two reviewers conducted quality assessments and reviewed the full-text articles during the analysis. Results Common services provided were breast pumps, social support, lactation rooms, and breastfeeding classes. Breastfeeding initiation was very high, ranging from 87% to 98%. Several factors were significantly associated with duration of exclusive breastfeeding: (a) receiving a breast pump for one year (8.3 versus 4.7 months), (b) return-to-work consultations (40% versus 17% at 6 months), and (c) telephone support (42% versus 15% at 6 months). Each additional service (except prenatal education) dose-dependently increased exclusively breastfeeding at 6 months. Sociodemographic information including older maternal age, working part-time, longer maternity leave, and white ethnicity were associated with longer breastfeeding duration. Conclusion Workplace lactation interventions increased breastfeeding initiation, duration, and exclusive breastfeeding, with greater changes observed with more available services. More evidence is needed on the impact of workplace support in low-income populations, and the cost-effectiveness of these programs in reducing health care costs.

Outcomes in Thoracolumbar Burst Fractures With a Thoracolumbar Injury Classification Score (TLICS) of 4 Treated With Surgery Versus Initial Conservative Management.

PubMed

Nataraj, Andrew; Jack, Andrew S; Ihsanullah, Ihsan; Nomani, Shawn; Kortbeek, Frank; Fox, Richard

2018-05-25

This is a single-center, retrospective, observational cohort study. To determine whether surgery or nonoperative treatment has better clinical outcomes in neurologically intact patients with an intermediate severity thoracolumbar burst fracture. Optimal management, whether initial operative or nonoperative treatment, for thoracolumbar injury classification score (TLICS) 4 burst fractures remains controversial. Better insight into the treatment which affords patients a better clinical outcome could significantly affect patient care. This retrospective study included consecutive cases of TLICS 4 burst fracture patients from 2007 to 2013 and minimum 6-month follow-up. Potential confounders examined included age, sex, injury severity score, initial kyphotic angle, injured facets, and interspinous widening. Outcomes were determined by standardized questionnaires [Oswestry Disability Index (ODI), 12-item Short Form Physical Component Score (SF-12 PCS), and back pain Visual Analog Scale (VAS)] and analyzed using regression analysis. A total of 230 patients with burst fractures were identified, of which 67/230 (29%) were TLICS 4 and 47/67 (70%) had completed follow-up. No difference on univariate analysis was found between nonsurgical and surgical groups in mean ODI scores (P=0.27, t test), nor mean time to return to work (P=0.10, t test).Regarding outcomes, linear regression analysis revealed no association between having surgery and ODI (P=0.29), SF-12 PCS (P=0.59), or VAS (P=0.33). Furthermore, no difference was found between groups for employed patients working versus not working (P=0.09, the Fisher test), nor in mean time to return to work (P=0.30, Cox regression). This is one of the largest studies examining TLICS 4 burst fracture patients, adjusting for both clinical and radiologic confounders and reporting patient outcomes with minimum 6-month follow-up. No differences were found in outcomes between patients treated either surgically or nonsurgically. Studies focusing on early postoperative differences or cost-effectiveness might help in decision making. Level III.

Optimal design of near-Earth asteroid sample-return trajectories in the Sun-Earth-Moon system

NASA Astrophysics Data System (ADS)

He, Shengmao; Zhu, Zhengfan; Peng, Chao; Ma, Jian; Zhu, Xiaolong; Gao, Yang

2016-08-01

In the 6th edition of the Chinese Space Trajectory Design Competition held in 2014, a near-Earth asteroid sample-return trajectory design problem was released, in which the motion of the spacecraft is modeled in multi-body dynamics, considering the gravitational forces of the Sun, Earth, and Moon. It is proposed that an electric-propulsion spacecraft initially parking in a circular 200-km-altitude low Earth orbit is expected to rendezvous with an asteroid and carry as much sample as possible back to the Earth in a 10-year time frame. The team from the Technology and Engineering Center for Space Utilization, Chinese Academy of Sciences has reported a solution with an asteroid sample mass of 328 tons, which is ranked first in the competition. In this article, we will present our design and optimization methods, primarily including overall analysis, target selection, escape from and capture by the Earth-Moon system, and optimization of impulsive and low-thrust trajectories that are modeled in multi-body dynamics. The orbital resonance concept and lunar gravity assists are considered key techniques employed for trajectory design. The reported solution, preliminarily revealing the feasibility of returning a hundreds-of-tons asteroid or asteroid sample, envisions future space missions relating to near-Earth asteroid exploration.

Estimating tobacco consumption in remote Aboriginal communities using retail sales data: some challenges and opportunities.

PubMed

MacLaren, David; Redman-MacLaren, Michelle; Clough, Alan

2010-07-01

To describe and discuss challenges and opportunities encountered when estimating tobacco consumption in six remote Aboriginal communities using tobacco sales data from retail outlets. We consider tobacco sales data collected from retail outlets selling tobacco to six Aboriginal communities in two similar but separate studies. Despite challenges--including: not all outlets provided data; data not uniform across outlets (sales and invoice data); change in format of data; personnel change or management restructures; and anomalies in data and changes in community populations--tobacco consumption was estimated and returned through project newsletters and community feedback sessions. Amounts of tobacco sold were returned using graphs in newsletters and pictures of items common to the community in community feedback sessions. Despite inherent limitations of estimating tobacco consumption using tobacco sales data, returning the amount of tobacco sold to communities provided an opportunity to discuss tobacco consumption and provide a focal point for individual and community action. Using this method, however, may require large and sustained changes be observed over time to evaluate whether initiatives to reduce tobacco consumption have been effective. Estimating tobacco consumption in remote Aboriginal communities using tobacco sales data from retail outlets requires careful consideration of many logistical, social, cultural and geographic challenges.

Ultrasonic hydrometer. [Specific gravity of electrolyte

DOEpatents

Swoboda, C.A.

1982-03-09

The disclosed ultrasonic hydrometer determines the specific gravity (density) of the electrolyte of a wet battery, such as a lead-acid battery. The hydrometer utilizes a transducer that when excited emits an ultrasonic impulse that traverses through the electrolyte back and forth between spaced sonic surfaces. The transducer detects the returning impulse, and means measures the time t between the initial and returning impulses. Considering the distance d between the spaced sonic surfaces and the measured time t, the sonic velocity V is calculated with the equation V = 2d/t. The hydrometer also utilizes a thermocouple to measure the electrolyte temperature. A hydrometer database correlates three variable parameters including sonic velocity in and temperature and specific gravity of the electrolyte, for temperature values between 0 and 40/sup 0/C and for specific gravity values between 1.05 and 1.30. Upon knowing two parameters (the calculated sonic velocity and the measured temperature), the third parameter (specific gravity) can be uniquely found in the database. The hydrometer utilizes a microprocessor for data storage and manipulation.

Mars Ascent Vehicle Gross Lift-off Mass Sensitivities for Robotic Mars Sample Return

NASA Technical Reports Server (NTRS)

Dux, Ian J.; Huwaldt, Joseph A.; McKamey, R. Steve; Dankanich, John W.

2011-01-01

The Mars ascent vehicle is a critical element of the robotic Mars Sample Return (MSR) mission. The Mars ascent vehicle must be developed to survive a variety of conditions including the trans-Mars journey, descent through the Martian atmosphere and the harsh Martian surface environments while maintaining the ability to deliver its payload to a low Mars orbit. The primary technology challenge of developing the Mars ascent vehicle system is designing for all conditions while ensuring the mass limitations of the entry descent and landing system are not exceeded. The NASA In-Space Propulsion technology project has initiated the development of Mars ascent vehicle technologies with propulsion system performance and launch environments yet to be defined. To support the project s evaluation and development of various technology options the sensitivity of the Mars ascent vehicle gross lift-off mass to engine performance, inert mass, target orbits, and launch conditions has been completed with the results presented herein.

Stress reactions involving the pars interarticularis in young athletes

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

Jackson, D.W.; Wiltse, L.L.; Dingeman, R.D.

A stress reaction involving the pars interarticularis of the lumbar spine was confirmed in seven young athletes with a positive technetium pyrophosphate bone scan. No pars defects were detectable on their lumbosacral roentgenograms, which included oblique views. The return to normal levels of radioactive uptake on repeat bone scans correlated closely with their clinical course. If the bony reaction is recognized early, it may heal at a subroentgenographic level and prevent the development of lumbar spondylolysis. These early lesions usually show unilateral increased uptake at one lumbar level on the bone scan and, initially, the athlete localizes the pain tomore » the corresponding unilateral lumbar paraspinous area. The ''one-legged hyperextension test'' is positive on the ipsilateral side and aggravates the pain. Treatment consists of avoiding the aggravating activities and resting. The average time for return to pain-free competition was 7.3 months. These developing defects may be the source of considerable prolonged disability in the young athlete, particularly if undiagnosed and untreated.« less

Semiconducting double-dot exchange-only qubit dynamics in the presence of magnetic and charge noises

NASA Astrophysics Data System (ADS)

Ferraro, E.; Fanciulli, M.; De Michielis, M.

2018-06-01

The effects of magnetic and charge noises on the dynamical evolution of the double-dot exchange-only qubit (DEOQ) is theoretically investigated. The DEOQ consisting of three electrons arranged in an electrostatically defined double quantum dot deserves special interest in quantum computation applications. Its advantages are in terms of fabrication, control and manipulation in view of implementation of fast single and two-qubit operations through only electrical tuning. The presence of the environmental noise due to nuclear spins and charge traps, in addition to fluctuations in the applied magnetic field and charge fluctuations on the electrostatic gates adopted to confine the electrons, is taken into account including random magnetic field and random coupling terms in the Hamiltonian. The behavior of the return probability as a function of time for initial conditions of interest is presented. Moreover, through an envelope-fitting procedure on the return probabilities, coherence times are extracted when model parameters take values achievable experimentally in semiconducting devices.

Posttraumatic proximal migration of the first metatarsophalangeal joint sesamoids: a report of four cases.

PubMed

Graves, S C; Prieskorn, D; Mann, R A

1991-10-01

Four cases are presented with plantar plate injury to the first metatarsophalangeal (MTP) joint and proximal retraction of the sesamoids by the flexor hallucis brevis. No history of dislocation occurred in any patient, although two had associated fractures of a sesamoid bone. Clinical and radiographic aids to the diagnosis are discussed. Clinical findings included diffuse pain beneath the first MTP joint and pain with extremes of joint motion in all patients. The anterior-posterior (AP) radiographic technique was the most helpful in determining the proximal migration of the sesamoids. By taking the AP view with both feet on the cassette and by centering the beam perpendicular to it, the diagnosis of plantar plate disruption can easily be made. Initial treatment of this disorder was nonoperative using a stiff soled shoe. With conservative treatment, two of the patients returned to preinjury activities. One patient required sesamoidectomy for resistant pain, and the final patient is still unable to return to his preinjury job requiring standing and heavy lifting.

Early Ambulation After Microsurgical Reconstruction of the Lower Extremity.

PubMed

Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel

2018-06-01

Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

Amebic Liver Abscess Diagnosed by Polymerase Chain Reaction in 14 Returning Travelers

PubMed Central

Vallois, Dorothée; Epelboin, Loïc; Touafek, Feriel; Magne, Denis; Thellier, Marc; Bricaire, François; Caumes, Eric

2012-01-01

Amebic liver abscesses (ALA) are not commonly described in travelers. The ALA diagnosis is usually based on serology and Entamoeba histolytica polymerase chain reaction (PCR) is a new tool. We retrospectively reviewed all ALA cases diagnosed by PCR on the liver abscess pus aspirate of patients admitted in French hospitals between 2007 and 2011. Fourteen cases (10 male, median age 48 years) were included. The median lag time between return and onset of symptoms was 23 days (interquartile range [IQ] 18–24). All patients had an elevated cardiopulmonary resuscitation level, and 11 had leukocytosis. The ALA was multiple in five patients, localized in the right lobe in 12, and higher than 5 cm in 11. Serology was initially negative in one patient, whereas PCR was positive. There was bacterial co-infection in one patient. The outcome was good. Liver puncture allows a rapid diagnosis of ALA with PCR and helps identify the association with a bacterial dual infection. PMID:23033402

Cannabis Withdrawal, Posttreatment Abstinence, and Days to First Cannabis Use Among Emerging Adults in Substance Use Treatment: A Prospective Study

PubMed Central

Davis, Jordan P.; Smith, Douglas C.; Morphew, Jason W.; Lei, Xinrong; Zhang, Saijun

2015-01-01

Very little prospective research investigates how cannabis withdrawal is associated with treatment outcomes, and this work has not used the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) thresholds for cannabis withdrawal. The sample included 110 emerging adults entering outpatient substance use treatment who were heavy cannabis users with no other drug use and limited alcohol use. We used survival analyses to predict days to first use of cannabis and logistic regression to predict whether participants were abstinent and living in the community at 3 months. Those meeting criteria for cannabis withdrawal were more likely to return to use sooner than those not meeting criteria for cannabis withdrawal. However, the presence of cannabis withdrawal was not a significant predictor of 3-month abstinence. Emerging adults with DSM-5 cannabis withdrawal may have difficulty initiating abstinence in the days following their intake assessment, implying the need for strategies to mitigate their more rapid return to cannabis use. PMID:26877548

Demographic, psychometric, and case progression information as predictors of return-to-work in teachers undergoing occupational rehabilitation.

PubMed

Young, A E; Russell, J

1995-12-01

Occupational stress is a significant problem and is of particular concern for educational organizations. It was the aim of the current project to identify variables that could predict return-to-work outcomes in a group of teachers who had taken leave for a work-related stress condition. Demographic, psychometric, and case progression data were collected for 119 teachers who had taken Workers' Compensation Leave and were participating in a rehabilitation program. The participants' return to work outcomes were followed-up at least 12 months after they initially left their workplace. Hierarchical discriminant function analysis indicated that 84.62% of the cases could be correctly classified as either "returning to work" or "not returning to work due to illness." The main predictor variables were: if the individual had attempted to return to work within 505 days of injury, the individual's health behaviors, the sex of the individual, and the type of school in which he or she was employed (primary or secondary). It is suggested that the derived model could be further developed and used to predict return to work from stress-related illnesses.

Launch and Landing of Russian Soyuz - Medical Support for US and Partner Astronauts

NASA Technical Reports Server (NTRS)

Menon, Anil

2017-01-01

Launching, landing, flight route, expeditions, Soyuz, near Kazakhstan USOS Crew Surgeon -Quarantine and direct care to crew before launch, then present in close proximity to launch for abort. IP Crew Surgeon -same Deputy Crew Surgeon -Back up for crew surgeon, care for immediate family, stationed at airport for helicopter abort response Russian based US doctor -Coordinate with SOS staff USOS Crew Surgeon -Nominal helicopter response and initial medical care and support during return on gulfstreamIPcenter dotP Crew Surgeon -same Deputy Crew Surgeon -Ballistic helicopter support Russian based US doctor -Coordinate with SOS staff Direct return doctor -Direct medical care on return flight

An Application for Normal and Critical Operations in a Tactical MLS System

DTIC Science & Technology

2010-12-01

Initialization........................................................................................27 2. FatFs ...CONCLUSION ............................................................................................121 APPENDIX A. DESIGN OVERVIEW OF FATFS ...123 A. FATFS RETURN CODES ..........................................................................123

When is a search not a search? A comparison of searching the AMED complementary health database via EBSCOhost, OVID and DIALOG.

PubMed

Younger, Paula; Boddy, Kate

2009-06-01

The researchers involved in this study work at Exeter Health library and at the Complementary Medicine Unit, Peninsula School of Medicine and Dentistry (PCMD). Within this collaborative environment it is possible to access the electronic resources of three institutions. This includes access to AMED and other databases using different interfaces. The aim of this study was to investigate whether searching different interfaces to the AMED allied health and complementary medicine database produced the same results when using identical search terms. The following Internet-based AMED interfaces were searched: DIALOG DataStar; EBSCOhost and OVID SP_UI01.00.02. Search results from all three databases were saved in an endnote database to facilitate analysis. A checklist was also compiled comparing interface features. In our initial search, DIALOG returned 29 hits, OVID 14 and Ebsco 8. If we assume that DIALOG returned 100% of potential hits, OVID initially returned only 48% of hits and EBSCOhost only 28%. In our search, a researcher using the Ebsco interface to carry out a simple search on AMED would miss over 70% of possible search hits. Subsequent EBSCOhost searches on different subjects failed to find between 21 and 86% of the hits retrieved using the same keywords via DIALOG DataStar. In two cases, the simple EBSCOhost search failed to find any of the results found via DIALOG DataStar. Depending on the interface, the number of hits retrieved from the same database with the same simple search can vary dramatically. Some simple searches fail to retrieve a substantial percentage of citations. This may result in an uninformed literature review, research funding application or treatment intervention. In addition to ensuring that keywords, spelling and medical subject headings (MeSH) accurately reflect the nature of the search, database users should include wildcards and truncation and adapt their search strategy substantially to retrieve the maximum number of appropriate citations possible. Librarians should be aware of these differences when making purchasing decisions, carrying out literature searches and planning user education.

Why do some apheresis donors donate blood just once?

PubMed

Ringwald, J; Lange, N; Rabe, C; Zimmermann, R; Strasser, E; Hendelmeier, M; Strobel, J; Eckstein, R

2007-11-01

More knowledge about the reasons for non-return of blood donors (BD) would enable blood donation services (BDS) to improve the efficacy of recruitment and retention programmes. We interviewed returning (RBD) and non-returning apheresis BDs (NRBD) of our university hospital-based BDS. A questionnaire was sent to 1218 individuals who passed the initial health check with no more than one subsequent blood donation. A similar questionnaire was answered by 235 randomly incoming RBDs. We asked for age, sex, profession, education level, motives to donate blood and, if applicable, reasons for non-return. These data were compared between NRBDs and RBDs and were analysed in relationship to the reasons for non-return. We received 267 answered questionnaires (21.9%). As 32 individuals indicated that they had been permanently deferred and 47 BDs had donated blood elsewhere, 188 NRBDs remained for further analysis. We found more women than men among NRBDs. Medical professions were less likely to return than students and trainees. Individuals motivated by personal experience, remuneration or a free health check were more likely to return than others. Whereas logistic reasons were of highest relevance for non-return in general, women indicated anxiety of blood donation as reason for non-return more often than men. Reducing women's anxiety of blood donation, reminding medical professions more intensively on blood donation and appealing to personal experience or a free health check may be the most promising approaches to increase BDs' return rates.

NASA/ESMD Analogue Mission Plans

NASA Technical Reports Server (NTRS)

Hoffman, Stephen J.

2007-01-01

A viewgraph presentation exploring Earth and its analogues is shown. The topics include: 1) ESMD Goals for the Use of Earth Analogues; 2) Stakeholders Summary; 3) Issues with Current Analogue Situation; 4) Current state of Analogues; 5) External Implementation Plan (Second Step); 6) Recent Progress in Utilizing Analogues; 7) Website Layout Example-Home Page; 8) Website Layout Example-Analogue Site; 9) Website Layout Example-Analogue Mission; 10) Objectives of ARDIG Analog Initiatives; 11) Future Plans; 12) Example: Cold-Trap Sample Return; 13) Example: Site Characterization Matrix; 14) Integrated Analogue Studies-Prerequisites for Human Exploration; and 15) Rating Scale Definitions.

Psychiatry in the Korean War: perils, PIES, and prisoners of war.

PubMed

Ritchie, Elspeth Cameron

2002-11-01

In the initial months of the Korean War, very high numbers of psychological casualties occurred among American troops, 250 per 1,000 per annum. Initially, these men were evacuated to Japan or the United States, and very few of them were returned to duty. Then the principles of early and far-forward treatment, learned in the previous world wars, were reinstituted. Up to 80% of neuropsychiatric casualties were returned to duty. During and after the war, the prisoners of war were believed to have been "brainwashed," have "give-it-upitis," and exhibit apathy and depression. Mistakenly believed to be signs of moral decay, the psychiatric symptoms during and after release were probably a result of extended inhumane treatment and vitamin deficiencies.

Flight service evaluation of composite helicopter components

NASA Technical Reports Server (NTRS)

Rich, M. J.; Lowry, D. W.

1983-01-01

This first interim report presents the technical background for including environmental effects in the design of helicopter composite structures, and test results after approximately two year field exposure of components and panels. Composite structural components were removed from Sikorsky S-76 helicopters commercially operated in the Gulf Coast region of Louisiana. Fatigue tests were conducted for a graphite/epoxy tail rotor spar and static test for a graphite/epoxy and Kevlar/epoxy stabilizer. Graphite/epoxy and Kevlar/epoxy panels are being exposed to the outdoor environment in Stratford, Connecticut and West Palm Beach, Florida. For this reporting period the two year panels were returned, moisture measurements taken, and strength tests conducted. Results are compared with initial type certificate strengths for components and with initial laboratory coupon tests for the exposed panels. Comparisons are also presented with predicted and measured moisture contents.

Flight service evaluation of composite helicopter components

NASA Technical Reports Server (NTRS)

Rich, M. J.; Lowry, D. W.

1982-01-01

This first interim report presents the technical background for including environmental effects in the design of helicopter composite structures, and test results after approximately two year field exposure of components and panels. Composite structural components were removed from Sikorsky S-76 helicopters commercially operated in the Gulf Coast region of Louisiana. Fatigue tests were conducted for a graphite/epoxy tail rotor spar and static test for a graphite/epoxy and Kevlar/epoxy stabilizer. Graphite/epoxy and Kevlar/epoxy panels are being exposed to the outdoor environment in Stratford, Connecticut and West Palm Beach, Florida. For this reporting period the two year panels were returned, moisture measurements taken, and strength tests conducted. Results are compared with initial type certificate strengths for components and with initial laboratory coupon tests for the exposed panels. Comparisons are also presented with predicted and measured moisture contents.

A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis

PubMed Central

Temple, Larissa K.F.; Litwin, Demetrius E.; McLeod, Robin S.

Objective To determine if any significant differences exist between laparoscopic appendectomy (LA) and open appendectomy (OA). Design A meta-analysis of randomized controlled trials (RCTs) comparing LA to OA. Data sources An extensive literature search was conducted for appropriate articles published between January 1990 and March 1997. Articles were initially retrieved through MEDLINE with MeSH terms “appendicitis” or “appendectomy” and “laparoscopy.” Additional methods included cross-referencing bibliographies of retrieved articles, hand searching abstracts from relevant meetings and consultation with a content expert. Study selection Only RCTs published in English in which patients had a preoperative diagnosis of acute appendicitis were included. Data extraction The outcomes of interest included operating time, hospital stay, readmission rates, return to normal activity and complications. The Cochrane Collaboration Review Manager 3.0 was used to calculate odds ratios (OR), weighted mean differences (WMD) and 95% confidence intervals (CI). The random-effects model was used for statistical analysis. Data synthesis Twelve trials met the inclusion criteria. Because there were insufficient data in some trials, operating time, hospitalization and return to work were assessed in only 8 trials. Mean operating time was significantly longer with LA (WMD 18.10 minutes, 95% CI 12.87 to 23.15 minutes). There were fewer wound infections in LA (OR 0.40, 95% CI 0.24 to 0.69), but no significant differences in intra-abdominal abscess rates (OR 1.94, 95% CI 0.68 to 5.58). There was no significant difference in the mean length of hospital stay (WMD −0.16 days, 95% CI −0.44 to 0.15 days) or readmission rates (OR 1.16, 95% CI 0.54 to 2.48). However, the return to normal activity was significantly earlier with LA (WMD −5.79 days, 95% CI −7.38 to −4.21 days). Sensitivity analyses did not affect the results. Conclusion This meta-analysis suggests that operating room time is significantly longer, hospital stay is unchanged but return to normal activities is significantly earlier with LA. PMID:10526524

Cutaneous Leishmaniasis in an American Adolescent Returning From Israel.

PubMed

Ganjaei, Kimia G; Lawton, Kira; Gaur, Sunanda

2018-06-06

We present here the case of a healthy 16-year-old American girl who returned from an organized trip to Israel with cutaneous leishmaniasis caused by Leishmania major; the infection was treated successfully with paromomycin-gentamicin ointment. She was initially misdiagnosed with staphylococcal and pseudomonal cellulitis. Although cutaneous leishmaniasis is seen only rarely in the United States, it should be considered when diagnosing new skin lesions after travel to affected countries.

Performance Characteristics of Lithium Ion Prototype Cells for 2003 Mars Sample Return Athena Rover

NASA Technical Reports Server (NTRS)

Ratnakumar, B. V.; Smart, M. C.; Ewell, R.; Surampudi, S.; Marsh, R. A.

2000-01-01

A viewgraph presentation outlines the mission objectives and power subsystem for the Mars Sample Return (MSR) Athena Rover. The NASA-DOD (depth of discharge) Interagency Li Ion program objectives are discussed. Evaluation tests performed at JPL are listed, and test results are shown for the Li-Ion cell initial capacity, charge/discharge capacity, voltage and ratio, specific energy, watt-hour efficiency, and cell voltage at various temperatures.

Parachute Testing for the NASA X-38 Crew Return Vehicle

NASA Technical Reports Server (NTRS)

Stein, Jenny M.

2005-01-01

NASA's X-38 program was an in-house technology demonstration program to develop a Crew Return Vehicle (CRV) for the International Space Station capable of returning seven crewmembers to Earth when the Space Shuttle was not present at the station. The program, managed out of NASA's Johnson Space Center, was started in 1995 and was cancelled in 2003. Eight flights with a prototype atmospheric vehicle were successfully flown at Edwards Air Force Base, demonstrating the feasibility of a parachute landing system for spacecraft. The intensive testing conducted by the program included testing of large ram-air parafoils. The flight test techniques, instrumentation, and simulation models developed during the parachute test program culminated in the successful demonstration of a guided parafoil system to land a 25,000 Ib spacecraft. The test program utilized parafoils of sizes ranging from 750 to 7500 p. The guidance, navigation, and control system (GN&C) consisted of winches, laser or radar altimeter, global positioning system (GPS), magnetic compass, barometric altimeter, flight computer, and modems for uplink commands and downlink data. The winches were used to steer the parafoil and to perform the dynamic flare maneuver for a soft landing. The laser or radar altimeter was used to initiate the flare. In the event of a GPS failure, the software navigated by dead reckoning using the compass and barometric altimeter data. The GN&C test beds included platforms dropped from cargo aircraft, atmospheric vehicles released from a 8-52, and a Buckeye powered parachute. This paper will describe the test program and significant results.

Influence of age and selected environmental factors on reproductive performance of canvasbacks

USGS Publications Warehouse

Serie, Jerome R.; Trauger, David L.; Austin, Jane E.

1992-01-01

Age, productivity, and other factors affecting breeding performance of canvasbacks (Aythya valisineria) are poorly understood. Consequently, we tested whether reproductive performance of female canvasbacks varied with age and selected environmental factors in southwestern Manitoba from 1974 to 1980. Neither clutch size, nest parasitism, nest success, nor the number of ducklings/brood varied with age. Return rates, nest initiation dates, renesting, and hen success were age-related. Return rates averaged 21% for second-year (SY) and 69% for after-second-year (ASY) females (58% for third-year and 79% for after-third-year females). Additionally, water conditions and spring temperatures influenced chronology of arrival, timing of nesting, and reproductive success. Nest initiation by birds of all ages was affected by minimum April temperatures. Clutch size was higher in nests initiated earlier. Interspecific nest parasitism did not affect clutch size, nest success, hen success, or hatching success. Nest success was lower in dry years (17%) than in moderately wet (54%) or wet (60%) years. Nests per female were highest during wet years. No nests of SY females were found in dry years. In years of moderate to good wetland conditions, females of all ages nested. Predation was the primary factor influencing nest success. Hen success averaged 58% over all years. The number of ducklings surviving 20 days averaged 4.7/brood. Because SY females have lower return rates and hen success than ASY females, especially during drier years, management to increase canvasback populations might best be directed to increasing first year recruitment (no. of females returning to breed) and to increasing overall breeding success by reducing predation and enhancing local habitat conditions during nesting.

HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities

PubMed Central

Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis

2014-01-01

HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection. PMID:24592330

HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities.

PubMed

Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis

2014-01-01

HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.

The Regular Education Initiative in the Anchorage Public Schools.

ERIC Educational Resources Information Center

Kennedy, Sylvia

The study examined the number of Anchorage (Alaska) public schools that are using the Regular Education Initiative (REI) concept in their special education programs and the attitudes of building principals concerning both REI and collaborative consultation. Surveys mailed to 65 principals yielded a return of 30 questionnaires (6 secondary and 24…

In-flight automated external defibrillator use and consultation patterns.

PubMed

Brown, Aaron Michael; Rittenberger, Jon C; Ammon, Charles M; Harrington, Scott; Guyette, Francis X

2010-01-01

Limited information exists about the in-flight use and outcomes associated with automated external defibrillators (AEDs) on commercial airlines. To describe the characteristics and outcomes of AED use during in-flight emergencies including in-flight cardiac arrest and the associated ground medical consultation patterns. We collected cases of AED use that were self-reported to an airline consultation service from three U.S. airlines between May 2004 and March 2009. We reviewed all available data files, related consultation forms, and recordings. For each case, demographics, initial rhythm, shock delivery/success, survival to admission, and ground medical consultation use were obtained. Success was defined as the return of a perfusing rhythm. Initial rhythms were classified as sinus, heart block, supraventricular tachycardia (SVT), atrial fibrillation/flutter, asystole, pulseless electrical activity (PEA), and ventricular fibrillation (VF)/ventricular tachycardia (VT). There were a total of 169 AED applications with 40 cardiac arrests. The mean patient ages were 58 years (standard deviation [SD] 15) and 63 years (SD 12), respectively; both populations were 64% male. AEDs were applied for monitoring in 129 (76%) cases with the following initial rhythms: sinus, 114 (88%); atrial fibrillation/flutter, seven (5%); complete heart block, four (3%); and SVT, four (3%). Presenting rhythms among the cardiac arrest population were as follows: asystole, 16 (40%); VF/VT, 10 (25%); and PEA, 14 (35%). Fourteen patients were defibrillated, including nine of the 10 patients with initial VF/VT and five for the presence of VF/VT after resuscitation for initial PEA/asystole. Defibrillation was advised but not performed in the remaining case of initial VF/VT, and no medical consultation was obtained. All five successful defibrillations occurred in patients with initial VF/VT. There were six (15%; 95% confidence interval [CI] 3-27%) survivors, with five survivals occurring after successful defibrillation for initial VF/VT and one with return of a perfusing rhythm after cardiopulmonary resuscitation (CPR) for a junctional rhythm. Survival in those with VF/VT was five of 10 (50%; 95% CI 14-86%). Medications were delivered in two cases. The median time to first shock was 19 seconds (interquartile range [IQR] 12-24 seconds) after AED application. Medical consultation was obtained in 42 (33%) of the 129 AED monitoring cases and 14 (35%) of the 40 cardiac arrest cases. Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest. Survival is poor among patients presenting with nonshockable rhythms. AEDs are used extensively for in-flight monitoring, with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests.

Hayabusa Asteroidal Sample Preliminary Examination Team (HASPET) and the Astromaterial Curation Facility at JAXA/ISAS

NASA Astrophysics Data System (ADS)

Yano, H.; Fujiwara, A.

After the successful launch in May 2003, the Hayabusa (MUSES-C) mission of JAXA/ISAS will collect surface materials (e.g., regolith) of several hundred mg to several g in total from the S-type near Earth asteroid (25143) Itokawa in late 2005 and bring them back to ground laboratories in the summer of 2007. The retrieved samples will be given initial analysis at the JAXA/ISAS astromaterial curation facility, which is currently in the preparation for its construction, by the Hayabusa Asteroidal Sample Preliminary Examination Team (HASPET). HASPET is consisted of the ISAS Hayabusa team, the international partners from NASA and Australia and all-Japan meteoritic scientists to be selected as outsourcing parts of the initial analyses. The initial analysis to characterize general aspects of returned samples can consume only 15 % of its total mass and must complete the whole analyses including the database building before international AO for detailed analyses within the maximum of 1 year. Confident exercise of non-destructive, micro-analyses whenever possible are thus vital for the HASPET analysis. In the purpose to survey what kinds and levels of micro-analysis techniques in respective fields, from major elements and mineralogy to trace and isotopic elements and organics, are available in Japan at present, ISAS has conducted the HASPET open competitions in 2000-01 and 2004. The initial evaluation was made by multiple domestic peer reviews. Applicants were then provided two kinds of unknown asteroid sample analogs in order to conduct proposed analysis with self-claimed amount of samples in self-claimed duration. After the completion of multiple, international peer reviews, the Selection Committee compiled evaluations and recommended the finalists of each round. The final members of the HASPET will be appointed about 2 years prior to the Earth return. Then they will conduct a test-run of the whole initial analysis procedures at the ISAS astromaterial curation facility and their respective analysis facilities. This talk also summarizes the curation facility design and plans of initial analysis procedure flow.

In-flight automated external defibrillator use and consultation patterns

PubMed Central

Brown, AM; Rittenberger, JC; Ammon, CM; Harrington, S; Guyette, FX

2010-01-01

Background Limited information exists about the in-flight use and outcomes associated with automatic external defibrillators (AED) on commercial airlines. Methods We collected self-reported cases of AED use to an airline consultation service from three US airlines between May 2004 and March 2009. We reviewed all available data files, related consult forms, and recordings. For each case, demographics, initial rhythm, shock delivery/success, survival to admission, and ground medical consultation use were obtained. Success was defined as the return of a perfusing rhythm. Initial rhythms were classified as: sinus, heart block, SVT, atrial fibrillation/flutter, asystole, PEA and VF/VT. Results There were a total of 169 AED applications with 40 cardiac arrests. The mean ages were 58 years (SD 15) and 63 years (SD 12) respectively; both populations were 64% male. AEDs were applied for monitoring in 129 (76%) cases with initial rhythms of: sinus 114 (88%); atrial fibrillation/flutter 7 (5%); complete heart block 4 (3%); and SVT 4 (3%). Presenting rhythms among the cardiac arrest population were: asystole 16 (40%); ventricular fibrillation/ventricular tachycardia 10 (25%); and PEA 14 (35%). Fourteen patients were defibrillated including nine of the 10 patients with initial VF/VT and five for the presence of VF/VT after resuscitation for initial PEA/asystole. Defibrillation was advised but not performed in the remaining case of initial VF/VT and no medical consult was obtained. All five successful defibrillations occurred in patients with initial VF/VT. There were 6 (15%; 95% CI 3–27%) survivors with 5 occurring after successful defibrillation for initial VF/VT and one with return of a perfusing rhythm after CPR for a junctional rhythm. Survival in those with VF/VT was 5/10 (50%; 95% CI 14–86%). Medications were delivered twice. The median time to first shock was 19 (IQR 12–24) seconds from AED application. Medical consultation was obtained in 56 (33%) of the 169 AED cases and 14 (35%) of the cardiac arrests. Conclusion AEDs resulted in 50% survival among those with VT/VF in-flight and 14% overall survival for cardiac arrest. Survival is poor among patients presenting with non-shockable rhythms. AEDs are used extensively for in-flight monitoring with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests. PMID:20128705

Mass-losing M supergiants in the solar neighborhood

NASA Technical Reports Server (NTRS)

Jura, M.; Kleinmann, S. G.

1990-01-01

A list of the 21 mass-losing red supergiants (20 M type, one G type; L greater than 100,000 solar luminosities) within 2.5 kpc of the sun is compiled. These supergiants are highly evolved descendants of main-sequence stars with initial masses larger than 20 solar masses. The surface density is between about 1 and 2/sq kpc. As found previously, these stars are much less concentrated toward the Galactic center than W-R stars, which are also highly evolved massive stars. Although with considerable uncertainty, it is estimated that the mass return by the M supergiants is somewhere between 0.00001 and 0.00003 solar mass/sq kpc yr. In the hemisphere facing the Galactic center there is much less mass loss from M supergiants than from W-R stars, but, in the anticenter direction, the M supergiants return more mass than do the W-R stars. The duration of the M supergiant phase appears to be between 200,000 and 400,000 yr. During this phase, a star of initially at least 20 solar masses returns perhaps 3-10 solar masses into the interstellar medium.

On the cutting edge technology enabling the challenging missions to asteroids and comets, our primitive neighbors

NASA Astrophysics Data System (ADS)

Kawaguchi, J.

2014-07-01

The world's first sample-and-return mission from an object orbiting outside the sphere of influence of the Earth was successfully performed through Hayabusa in 2010, an engineering demonstration mission of JAXA. And it was followed by another technology demonstrator, Ikaros, the world's first solar-sail mission launched in 2010, the same year of the Hayabusa return. These two demonstrations represent the significance of the technology development that shall precede the real science missions that will follow. The space-exploration community focuses its attention on the use of asteroids and comets as one of the most immediate destinations. Humans will perform voyages to those objects sooner or later. And we will initiate a kind of research as scientific activity for those objects. The missions may include even sample-and-return missions to those bodies for assessing the chance of possible resource utilization in future. The first step for it is, needless to say, science. Combining the sample-and-return technology using the ultra-high-speed reentry for sample recovery with the new propulsion system using both electric and photon force will be the direct conclusion from Hayabusa and Ikaros. And key elements such as autonomy are also among the essential factors in making the sophisticated operation possible around asteroids and comets avoiding the communication difficulty. This presentation will comprehensively touch on what those technology skills are, and how they are applicable to the subsequent new missions, from the mission leader's point of view. They are probably real requisites for planning brand-new innovative challenges in the ACM community.

Variation in light intensity with height and time from subsequent lightning return strokes

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

Jordan, D.M.; Uman, M.A.

1983-08-20

Relative light intensity has been measured photographically as a function of height and time for seven subsequent return strokes in two lightning flashes at ranges of 7.8 and 8.7 km. The film used was Kodak 5474 Shellburst, which has a roughly constant spectral response between 300 and 670 nm. The time resolution was about 1.0 ..mu..s, and the spatial resolution was about 4 m. The observed light signals consisted of a fast rise to peak, followed by a slower decrease to a relatively constant value. The amplitude of the initial light peak decreases exponentially with height with a decay constantmore » of about 0.6 to 0.8 km. The 20% to 80% rise time of the initial light signal is between 1 and 4 ..mu..s near ground and increases by an additional 1 to 2 ..mu..s by the time the return stroke reaches the cloud base, a height between 1 and 2 km. The light intensity 30 ..mu..s after the initial peak is relatively constant with height and has an amplitude that is 15% to 30% of the initial peak near the ground and 50% to 100% of the initial peak at cloud base. The logarithm of the peak light intensity near the ground is roughly proportional to the initial peak electric field intensity, and this in turn implies that the current decrease with height may be much slower than the light decrease. The absolute light intensity has been estimated by integrating the photographic signals from individual channel segments to simulate the calibrated all-sky photoelectric data of Guo and Krider (1982). Using this method, the authors find that the mean peak radiance near the ground is 8.3 x 10/sup 5/ W/m, with a total range from 1.4 x 10/sup 5/ to 3.8 x 10/sup 6/ W/m. 16 references, 11 figures.« less

Meteorological Aspects of Two Modes of Lightning Triggered Upward Lightning (LTUL) Events in Sprite-Producing MCSs

NASA Technical Reports Server (NTRS)

Lyons, W. A.; Nelson, T. E.; Warner, T. A.; Lang, T. J.; Cummins, K.; Quick, M.; Rison, W.; Krehbiel, P.; Cummer, S. A.; Meyers, J.;

The pathophysiology of heart failure.

PubMed

Kemp, Clinton D; Conte, John V

2012-01-01

Heart failure is a clinical syndrome that results when the heart is unable to provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return. This common condition affects over 5 million people in the United States at a cost of $10-38 billion per year. Heart failure results from injury to the myocardium from a variety of causes including ischemic heart disease, hypertension, and diabetes. Less common etiologies include cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs. As the heart fails, patients develop symptoms which include dyspnea from pulmonary congestion, and peripheral edema and ascites from impaired venous return. Constitutional symptoms such as nausea, lack of appetite, and fatigue are also common. There are several compensatory mechanisms that occur as the failing heart attempts to maintain adequate function. These include increasing cardiac output via the Frank-Starling mechanism, increasing ventricular volume and wall thickness through ventricular remodeling, and maintaining tissue perfusion with augmented mean arterial pressure through activation of neurohormonal systems. Although initially beneficial in the early stages of heart failure, all of these compensatory mechanisms eventually lead to a vicious cycle of worsening heart failure. Treatment strategies have been developed based upon the understanding of these compensatory mechanisms. Medical therapy includes diuresis, suppression of the overactive neurohormonal systems, and augmentation of contractility. Surgical options include ventricular resynchronization therapy, surgical ventricular remodeling, ventricular assist device implantation, and heart transplantation. Despite significant understanding of the underlying pathophysiological mechanisms in heart failure, this disease causes significant morbidity and carries a 50% 5-year mortality. Copyright © 2012 Elsevier Inc. All rights reserved.

26 CFR 1.338-10 - Filing of returns.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section 338. (ii) New target in purchasing corporation's consolidated return. If new target is includible... election or other action that must be specified in a timely filed return for new target's first taxable... section, any deemed sale tax consequences are reported on the final return of old target filed for old...

26 CFR 1.338-10 - Filing of returns.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 338. (ii) New target in purchasing corporation's consolidated return. If new target is includible... election or other action that must be specified in a timely filed return for new target's first taxable..., any deemed sale tax consequences are reported on the final return of old target filed for old target's...

26 CFR 1.338-10 - Filing of returns.

Code of Federal Regulations, 2012 CFR

2012-04-01

... section 338. (ii) New target in purchasing corporation's consolidated return. If new target is includible... election or other action that must be specified in a timely filed return for new target's first taxable... section, any deemed sale tax consequences are reported on the final return of old target filed for old...

26 CFR 1.338-10 - Filing of returns.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section 338. (ii) New target in purchasing corporation's consolidated return. If new target is includible... election or other action that must be specified in a timely filed return for new target's first taxable..., any deemed sale tax consequences are reported on the final return of old target filed for old target's...

26 CFR 1.338-10 - Filing of returns.

Code of Federal Regulations, 2013 CFR

2013-04-01

... section 338. (ii) New target in purchasing corporation's consolidated return. If new target is includible... election or other action that must be specified in a timely filed return for new target's first taxable... section, any deemed sale tax consequences are reported on the final return of old target filed for old...

A Sustainable Architecture for Lunar Resource Prospecting from an EML-based Exploration Platform

NASA Astrophysics Data System (ADS)

Klaus, K.; Post, K.; Lawrence, S. J.

2012-12-01

Introduction - We present a point of departure architecture for prospecting for Lunar Resources from an Exploration Platform at the Earth - Moon Lagrange points. Included in our study are launch vehicle, cis-lunar transportation architecture, habitat requirements and utilization, lander/rover concepts and sample return. Different transfer design techniques can be explored by mission designers, testing various propulsive systems, maneuvers, rendezvous, and other in-space and surface operations. Understanding the availability of high and low energy trajectory transfer options opens up the possibility of exploring the human and logistics support mission design space and deriving solutions never before contemplated. For sample return missions from the lunar surface, low-energy transfers could be utilized between EML platform and the surface as well as return of samples to EML-based spacecraft. Human Habitation at the Exploration Platform - Telerobotic and telepresence capabilities are considered by the agency to be "grand challenges" for space technology. While human visits to the lunar surface provide optimal opportunities for field geologic exploration, on-orbit telerobotics may provide attractive early opportunities for geologic exploration, resource prospecting, and other precursor activities in advance of human exploration campaigns and ISRU processing. The Exploration Platform provides a perfect port for a small lander which could be refueled and used for multiple missions including sample return. The EVA and robotic capabilities of the EML Exploration Platform allow the lander to be serviced both internally and externally, based on operational requirements. The placement of the platform at an EML point allows the lander to access any site on the lunar surface, thus providing the global lunar surface access that is commonly understood to be required in order to enable a robust lunar exploration program. Designing the sample return lander for low-energy trajectories would reduce the overall mass and potentially increase the sample return mass. The Initial Lunar Mission -Building upon Apollo sample investigations, the recent results of the LRO/LCROSS, international missions such as Chandrayaan-1, and legacy missions including Lunar Prospector, and Clementine, among the most important science and exploration goals is surface prospecting for lunar resources and to provide ground truth for orbital observations. Being able to constrain resource production potential will allow us to estimate the prospect for reducing the size of payloads launched from Earth required for Solar System exploration. Flight opportunities for something like the NASA RESOLVE instrument suite to areas of high science and exploration interest could be used to refine and improve future Exploration architectures, reducing the outlays required for cis-lunar operations. Summary - EML points are excellent for placement of a semi-permanent human-tended Exploration Platform both in the near term, while providing important infrastructure and deep-space experience that will be built upon to gradually increase long-term operational capabilities.

Outcomes After Arthroscopic Bankart Repair in Adolescent Athletes Participating in Collision and Contact Sports

PubMed Central

Saper, Michael G.; Milchteim, Charles; Zondervan, Robert L.; Andrews, James R.; Ostrander, Roger V.

2017-01-01

Background: Literature on arthroscopic stabilization in adolescent patients participating in collision and contact sports is limited, as most studies include adolescents within a larger sample group comprised primarily of adults. Purpose: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Study Design: Case series; Level of evidence, 4. Methods: This retrospective review included 39 shoulders in 37 adolescent (≤19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Recurrence of dislocation and return to sporting activity were also assessed. Results: The mean age at the time of surgery was 16.9 years (range, 15-19 years), and the mean follow-up was 6.3 years (range, 4.3-10.0 years); 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. The majority (78.1%) of patients returned to sports at the same level of competition. Mean VAS was 0.49 ± 1.0, and the mean ASES and Rowe scores were 92.8 ± 12.6 and 85.0 ± 24.2, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P = .005; Rowe, P = .001) and failure to return to sport (ASES, P = .016; Rowe, P = .004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent Hill-Sachs lesion, and repair of a superior labral anterior-posterior (SLAP) lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport. PMID:28451607

Coptis teeta-based agroforestry system and its conservation potential: a case study from northwest Yunnan.

PubMed

Huang, Ji; Long, Chunlin

2007-06-01

Coptis teeta (Ranunculaceae), is a nontimber forest product (NTFP) that only grows in northwest Yunnan and northeast India. Its tenuous rhizome, known as "Yunnan goldthread" in the traditional Chinese medicine system, has been used as an antibacterial and as an antiinflammatory medicine for a long time. The increasing demand has resulted in commercial harvesting pressure on wild populations that were already dwindling as a result of deforestation, and wild populations are at risk of extinction. Fortunately, there exists at least 2000 hectares of a C. teeta-based agroforestry system initiated by the Lisu people in Nujiang, northwest Yunnan. This cultivation supplies us with a valuable study case for the balance between conservation and sustainable use. This case study investigated the traditional management system and history of C. teeta in Nujiang through ethnobotanical methods and field investigation. We also contrasted initial costs, economic returns, and labor demands for C. teeta cultivation with other major land uses in the region. Compared with swidden agriculture, the major land-use type in the region, C. teeta cultivation offers high economic returns and low labor and initial costs; moreover, C. teeta cultivation does not interfere with subsistence agricultural duties. This agroforestry system reflected that the cultivation of NTFPs is a conservation strategy for maintaining forest diversity, while providing a stable economic return to local forest communities, and indicates how local people manage biodiversity effectively.

A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury.

PubMed

Street, Tamara D; Lacey, Sarah J

2015-06-05

Injuries occurring in the workplace can have serious implications for the health of the individual, the productivity of the employer and the overall economic community. The objective of this paper is to increase the current state of understanding of individual demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. Studies included in this systematic literature review tracked participants' return to work status over a minimum of three months, identified either demographic, psychosocial or general injury predictors of poor return to work outcomes and included a heterogeneous sample of workplace injuries. Identified predictors of poor return to work outcomes included older age, female gender, divorced marital status, two or more dependent family members, lower education levels, employment variables associated with reduced labour market desirability, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant. There is a need for clear and consistent definition and measurement of return to work outcomes and a holistic theoretical model integrating injury, psychosocial and demographic predictors of return to work. Through greater understanding of the nature of factors affecting return to work, improved outcomes could be achieved.

Effect of Academic Grade Level on Return to Athletic Competition After Anterior Cruciate Ligament Reconstruction.

PubMed

Bauer, Matthew; Feeley, Brian T; Gallo, Robert A

2016-11-07

After anterior cruciate ligament (ACL) reconstruction, 63% to 87% of high school athletes return to competition. Although physical and psychological factors are known contributors for failure to return to play, little attention has been paid to effect of academic grade level. Our purpose was to determine the influence of effect of academic grade level on return to competitive play. The primary hypothesis is that high school seniors who undergo ACL reconstruction or knee arthroscopy will be less likely to return to competitive play at 1 year than those in grades 9 to 11. We retrospectively reviewed high school athletes who injured their knee during competitive athletic activity and underwent arthroscopic knee surgery, including ACL reconstruction. We included those 14 to 18 years old at time of surgery and analyzed records for grade level, sporting activity, surgery details, and date of return to play. The definition of return to competitive play was return to same preinjury sport within 1 year of surgery and the sport had to be organized. Our study group included 225 patients that underwent an ACL reconstruction and 74 had knee arthroscopy. Athletes undergoing ACL reconstructions were less likely to return to preinjury sport within 1 year than those undergoing knee arthroscopy (P=0.0163). Seniors were significantly less likely to return to play at 1 year than athletes in grades 9 to 11 after both ACL reconstruction (P<0.0001) and knee arthroscopy (P=0.0335). Although return to competitive play rates remained fairly constant within grades 9 to 11, a precipitous decline by 28.9% and 29.4% in return to play rates occurred in the ACL reconstruction and knee arthroscopy groups, respectively, between the junior and senior years of high school. Although return to competition rates were lower for high school athletes undergoing ACL reconstruction than those undergoing knee arthroscopy, both had declines in return when the surgery occurs during their senior season. These data are useful when interpreting return to play rates. Future studies would benefit from further defining this relationship, or at least, noting the number of "senior" athletes studied. Therapeutic study-Level III.

Advanced Curation Preparation for Mars Sample Return and Cold Curation

NASA Technical Reports Server (NTRS)

Fries, M. D.; Harrington, A. D.; McCubbin, F. M.; Mitchell, J.; Regberg, A. B.; Snead, C.

2017-01-01

NASA Curation is tasked with the care and distribution of NASA's sample collections, such as the Apollo lunar samples and cometary material collected by the Stardust spacecraft. Curation is also mandated to perform Advanced Curation research and development, which includes improving the curation of existing collections as well as preparing for future sample return missions. Advanced Curation has identified a suite of technologies and techniques that will require attention ahead of Mars sample return (MSR) and missions with cold curation (CCur) requirements, perhaps including comet sample return missions.

Radiative return capabilities of a high-energy, high-luminosity e + e - collider

DOE PAGES

Karliner, Marek; Low, Matthew; Rosner, Jonathan L.; ...

2015-08-14

An electron-positron collider operating at a center-of-mass energy E CM can collect events at all lower energies through initial-state radiation (ISR or radiative return). We explore the capabilities for radiative return studies by a proposed high-luminosity collider at E CM = 250 or 90 GeV, to fill in gaps left by lower-energy colliders such as PEP, PETRA, TRISTAN, and LEP. These capabilities are compared with those of the lower-energy e +e - colliders as well as hadron colliders such as the Tevatron and the CERN Large Hadron Collider (LHC). Some examples of accessible questions in dark photon searches and heavymore » flavor spectroscopy are given.« less

Formation of the portfolio of high-rise construction projects on the basis of optimization of «risk-return» rate

NASA Astrophysics Data System (ADS)

Uvarova, Svetlana; Kutsygina, Olga; Smorodina, Elena; Gumba, Khuta

2018-03-01

The effectiveness and sustainability of an enterprise are based on the effectiveness and sustainability of its portfolio of projects. When creating a production program for a construction company based on a portfolio of projects and related to the planning and implementation of initiated organizational and economic changes, the problem of finding the optimal "risk-return" ratio of the program (portfolio of projects) is solved. The article proposes and approves the methodology of forming a portfolio of enterprise projects on the basis of the correspondence principle. Optimization of the portfolio of projects on the criterion of "risk-return" also contributes to the company's sustainability.

A systematic review of the psychological factors associated with returning to sport following injury.

PubMed

Ardern, Clare L; Taylor, Nicholas F; Feller, Julian A; Webster, Kate E

2013-11-01

Psychological factors have been shown to be associated with the recovery and rehabilitation period following sports injury, but less is known about the psychological response associated with returning to sport after injury. The aim of this review was to identify psychological factors associated with returning to sport following sports injury evaluated with the self-determination theory framework. Systematic review. Electronic databases were searched from the earliest possible entry to March 2012. Quantitative studies were reviewed that included athletes who had sustained an athletic injury, reported the return to sport rate and measured at least one psychological variable. The risk of bias in each study was appraised with a quality checklist. Eleven studies that evaluated 983 athletes and 15 psychological factors were included for review. The three central elements of self-determination theory-autonomy, competence and relatedness were found to be related to returning to sport following injury. Positive psychological responses including motivation, confidence and low fear were associated with a greater likelihood of returning to the preinjury level of participation and returning to sport more quickly. Fear was a prominent emotional response at the time of returning to sport despite the fact that overall emotions became more positive as recovery and rehabilitation progressed. There is preliminary evidence that positive psychological responses are associated with a higher rate of returning to sport following athletic injury, and should be taken into account by clinicians during rehabilitation.

Recovery of gravitropism after basipetal centrifugation in protonemata of the moss Ceratodon purpureus

NASA Technical Reports Server (NTRS)

Walker, L. M.; Sack, F. D.

1991-01-01

Apical cells of 5-day-old dark-grown protonemata of the moss Ceratodon purpureus (Hedw.) Brid. are negatively gravitropic and appear to utilize amyloplasts as statoliths. These cells exhibit a characteristic plastid zonation (five zones) with one zone (No. 3) specialized for the lateral sedimentation of amyloplasts. Basipetal centrifugation displaces all amyloplasts in the apical cell to the end wall. In basipetally centrifuged protonemata observed using infrared videomicroscopy, tip extension occurred with or without amyloplasts present in the apical dome. The initial return of upward curvature was always correlated with the return and sedimentation of amyloplasts in zone 3. Subsequent vigorous upward curvature was correlated with distinct amyloplast zonation and further sedimentation in zone 3. Initial downward ("wrong way") curvature, which often preceded upward curvature, correlated with the presence of amyloplasts in the apical dome (zone 1). These data support the hypotheses that nonsedimenting amyloplasts in zone 1 are necessary for initial downward curvature and that amyloplast sedimentation in zone 3 is necessary for upward curvature.

The channel radius and energy of cloud-to-ground lightning discharge plasma with multiple return strokes

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

Wang, Xuejuan; Yuan, Ping; Cen, Jianyong

2014-03-15

Using the spectra of a cloud-to-ground (CG) lightning flash with multiple return strokes and combining with the synchronous radiated electrical field information, the linear charge density, the channel radius, the energy per unit length, the thermal energy, and the energy of dissociation and ionization in discharge channel are calculated with the aid of an electrodynamic model of lightning. The conclusion that the initial radius of discharge channel is determined by the duration of the discharge current is confirmed. Moreover, the correlativity of several parameters has been analyzed first. The results indicate that the total intensity of spectra is positive correlatedmore » to the channel initial radius. The ionization and thermal energies have a linear relationship, and the dissociation energy is correlated positively to the ionization and thermal energies, the energy per unit length is in direct proportion to the square of initial radius in different strokes of one CG lightning.« less

A case of imported tungiasis in Scotland initially mimicking verrucae vulgaris.

PubMed

Wardhaugh, A D; Norris, J F

1994-10-01

A case is described of Tunga penetrans infection in the feet of a tourist returning from South America to Scotland. The condition had initially mimicked verrucae vulgaris, but microscopic examination of the lesions together with the travel history allowed the diagnosis of tungiasis to be made. This is the first case reported in Scotland.

Allocation model for air tanker initial attack in firefighting

Treesearch

Francis E. Greulich; William G. O' Regan

1975-01-01

Timely and appropriate use of air tankers in firefighting can bring high returns, but their misuse can be expensive when measured in operating and other costs. An allocation model has been developed for identifying superior strategies-for air tanker initial attack, and for choosing an optimum set of allocations among airbases. Data are presented for a representative...

Peace in the pipeline

NASA Astrophysics Data System (ADS)

Luhar, Mitul

2018-04-01

Turbulence in pipe flows causes substantial friction and economic losses. The solution to appease the flow through pipelines might be, counterintuitively, to initially enhance turbulent mixing and get laminar flow in return.

Implementation of an intraoperative blood transport and storage initiative and its effect on reducing red blood cell and plasma waste.

PubMed

Brown, Michael J; Button, Lisa M; Badjie, Karafa S; Guyer, Jean M; Dhanorker, Sarah R; Brach, Erin J; Johnson, Pamela M; Stubbs, James R

2014-03-01

The national waste rate for hospital-issued blood products ranges from 0% to 6%, with operating room-responsible waste representing up to 70% of total hospital waste. A common reason for blood product waste is inadequate intraoperative storage. Our transfusion service database was used to quantify and categorize red blood cell (RBC) and fresh-frozen plasma (FFP) units issued for intraoperative transfusion that were wasted over a 27-month period. Two cohorts were created: 1) before implementation of a blood transport and storage initiative (BTSI)-RBC and plasma waste January 1, 2011-May 31, 2012; 2) after implementation of BTSI-RBC and plasma waste June 1, 2012, to March 31, 2013. The BTSI replaced existing storage coolers (8-hr coolant life span with temperature range of 1-10°C) with a cooler that had a coolant life span of 18 hours and a temperature range of 1 to 6°C and included an improved educational cooler placard and an alert mechanism in the electronic health record. Monthly median RBC and plasma waste and its associated cost were the primary outcomes. An intraoperative BTSI significantly reduced median monthly RBC (1.3% vs. 0.07%) and FFP (0.4% vs. 0%) waste and its associated institutional cost. The majority of blood product waste was due to an unacceptable temperature of unused returned blood products. An intraoperative BTSI significantly reduced median monthly RBC and FFP waste. The cost to implement this initiative was small, resulting in a significant estimated return on investment that may be reproducible in institutions other than ours. © 2013 American Association of Blood Banks.

Getting a Valid Survey Response From 662 Plastic Surgeons in the 21st Century.

PubMed

Reinisch, John F; Yu, Daniel C; Li, Wai-Yee

2016-01-01

Web-based surveys save time and money. As electronic questionnaires have increased in popularity, telephone and mailed surveys have declined. With any survey, a response rate of 75% or greater is critical for the validity of any study. We wanted to determine which survey method achieved the highest response among academic plastic surgeons. All American Association of Plastic Surgeons members were surveyed regarding authorship issues. They were randomly assigned to receive the questionnaire through 1 of 4 methods: (A) emailed with a link to an online survey; (B) regular mail; (C) regular mail + $1 bill, and (D) regular mail + $5 bill. Two weeks after the initial mailing, the number of responses was collected, and nonresponders were contacted to remind them to participate. The study was closed after 10 weeks. Survey costs were calculated based on the actual cost of sending the initial survey, including stationary, printing, postage (groups B-D), labor, and cost of any financial incentives. Cost of reminders to nonresponders was calculated at $5 per reminder, giving a total survey cost. Of 662 surveys sent, 54 were returned because of incorrect address/email, retirement, or death. Four hundred seventeen of the remaining 608 surveys were returned and analyzed. The response rate was lowest in the online group and highest in those mailed with a monetary incentive. Despite the convenience and low initial cost of web-based surveys, this generated the lowest response. We obtained statistically significant response rates (79% and 84%) only by using postal mail with monetary incentives and reminders. The inclusion of a $1 bill represented the greatest value and cost-effective survey method, based on cost per response.

An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta

PubMed Central

Thanh, Nguyen X.; Chuck, Anderson W.; Wasylak, Tracy; Lawrence, Jeannette; Faris, Peter; Ljungqvist, Olle; Nelson, Gregg; Gramlich, Leah M.

2016-01-01

Background In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000–$3 391 000), or $1768 (range $920–$2619) per patient. The probability for the program to be cost-saving was 73%–83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4–$5.1) in return. Conclusion The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites. PMID:28445024

Mortality after Renal Allograft Failure and Return to Dialysis.

PubMed

Brar, Amarpali; Markell, Mariana; Stefanov, Dimitre G; Timpo, Edem; Jindal, Rahul M; Nee, Robert; Sumrani, Nabil; John, Devon; Tedla, Fasika; Salifu, Moro O

2017-01-01

The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m2 at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes. © 2017 S. Karger AG, Basel.

Submicrosecond risetimes in lightning return-stroke fields

NASA Technical Reports Server (NTRS)

Weidman, C. D.; Krider, E. P.

1980-01-01

Measurements of lightning electric field, E, and dE/dt signatures have been made near Tampa Bay, Florida, under conditions where the lightning locations were known and where the results were not significantly affected by the response time of the measuring system or groundwave propagation. The fast transitions found on the initial portion of return-stroke fields have 10-90% risetimes ranging from 40 to 200 nsec, with a mean of 90 nsec. The maximum field derivatives during return strokes range from 5 to 75 V/m per microsec with a mean of 29 V/m per microsec when normalized to a distance of 100 km. These field risetime and derivative values suggest that return-stroke currents contain large, submicrosecond components, and this in turn suggests that it may be necessary to reevaluate the possible effects of lightning and the performance of lightning-protection devices in many situations.

Factors associated to continuing breastfeeding after returning to work in a group of mothers in Puerto Rico.

PubMed

García-Fragoso, Lourdes; Medina, Mariel; Ortiz, Nerian

2012-01-01

Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. To determine factors associated to breastfeeding after returning to work. Anonymous questionnaires distributed among breastfeeding working mothers. The study subjects were 100 mothers. Most of them (77%) worked for the government. Fifty-six percent continued breastfeeding after returning to work. In 33% of the workplaces there was an area designated for milk extraction.Thirty-six percent of employers allowed the 30 minute periods mandated by law for extraction. Factors associated to continuing breastfeeding were: working in the private setting, having a place designated for extraction, knowing that employers were mandated to have such a place, being allowed time for extraction, and knowing the laws protecting breastfeeding. There is need for more education to working mothers about their rights to continue breastfeeding after returning to work.

L-band radar sensing of soil moisture. [Kern County, California

NASA Technical Reports Server (NTRS)

Chang, A. T. C.; Atwater, S.; Salomonson, V. V.; Estes, J. E.; Simonett, D. S.; Bryan, M. L.

1980-01-01

The performance of an L-band, 25 cm wavelength imaging synthetic aperture radar was assessed for soil moisture determination, and the temporal variability of radar returns from a number of agricultural fields was studied. A series of three overflights was accomplished over an agricultural test site in Kern County, California. Soil moisture samples were collected from bare fields at nine sites at depths of 0-2, 2-5, 5-15, and 15-30 cm. These gravimetric measurements were converted to percent of field capacity for correlation to the radar return signal. The initial signal film was optically correlated and scanned to produce image data numbers. These numbers were then converted to relative return power by linear interpolation of the noise power wedge which was introduced in 5 dB steps into the original signal film before and after each data run. Results of correlations between the relative return power and percent of field capacity (FC) demonstrate that the relative return power from this imaging radar system is responsive to the amount of soil moisture in bare fields. The signal returned from dry (15% FC) and wet (130% FC) fields where furrowing is parallel to the radar beam differs by about 10 dB.

Gender and rural-urban migration in China.

PubMed

Davin, D

1996-02-01

Many men and women in China are migrating in search of better economic opportunities. Young women who migrate to urban centers in search of opportunity may stay away from their home villages for several years. At some point, however, they are likely to return home. This article considers the effect which such circular migration is having upon gender relations in China. The author's argument is presented in sections on China's 1990 census, migration and the sexual division of labor, migration and child care, the influence of returning migrants, the influence of young female returnees, and the fertility of returnees. She speculates that the demands and expectations of young women who return to their villages after spending some time earning high wages in urban areas will be affected by urban norms. While their return may lead to initial conflict, it is likely that the women will retain greater personal autonomy from their urban experience. Their return is also likely to lead to a higher degree of material consumption in the rural areas. Present circular migration in China has the potential to return human and financial resources to the villages, thereby helping to prevent the urban-rural gap between economic, social, cultural, and educational factors from growing even wider.

A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation.

PubMed

Silbernagel, Karin Grävare; Crossley, Kay M

2015-11-01

Synopsis Achilles tendinopathy is a common overuse injury in athletes involved in running and jumping activities and sports. The intervention with the highest level of evidence is exercise therapy, and it is recommended that all patients initially be treated with exercise for at least 3 months prior to considering other treatment options. Recovery from Achilles tendinopathy can take up to a year, and there is a high propensity for recurrence, especially during the return-to-sport phase. The extent of the tendon injury, the age and sex of the athlete, the magnitude of pain/symptoms, the extent of impairments, and the demands of the sport all need to be considered when planning for return to sport. This clinical commentary describes an approach to return to sport for patients with midportion Achilles tendinopathy. The aim of the return-to-sport program is to facilitate the decision-making process in returning an athlete with midportion Achilles tendinopathy back to full sport participation and to minimize the chances for recurrence of the injury. J Orthop Sports Phys Ther 2015;45(11):876-886. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5885.

Tethered Satellite System Contingency Investigation Board

NASA Technical Reports Server (NTRS)

1992-01-01

The Tethered Satellite System (TSS-1) was launched aboard the Space Shuttle Atlantis (STS-46) on July 31, 1992. During the attempted on-orbit operations, the Tethered Satellite System failed to deploy successfully beyond 256 meters. The satellite was retrieved successfully and was returned on August 6, 1992. The National Aeronautics and Space Administration (NASA) Associate Administrator for Space Flight formed the Tethered Satellite System (TSS-1) Contingency Investigation Board on August 12, 1992. The TSS-1 Contingency Investigation Board was asked to review the anomalies which occurred, to determine the probable cause, and to recommend corrective measures to prevent recurrence. The board was supported by the TSS Systems Working group as identified in MSFC-TSS-11-90, 'Tethered Satellite System (TSS) Contingency Plan'. The board identified five anomalies for investigation: initial failure to retract the U2 umbilical; initial failure to flyaway; unplanned tether deployment stop at 179 meters; unplanned tether deployment stop at 256 meters; and failure to move tether in either direction at 224 meters. Initial observations of the returned flight hardware revealed evidence of mechanical interference by a bolt with the level wind mechanism travel as well as a helical shaped wrap of tether which indicated that the tether had been unwound from the reel beyond the travel by the level wind mechanism. Examination of the detailed mission events from flight data and mission logs related to the initial failure to flyaway and the failure to move in either direction at 224 meters, together with known preflight concerns regarding slack tether, focused the assessment of these anomalies on the upper tether control mechanism. After the second meeting, the board requested the working group to complete and validate a detailed integrated mission sequence to focus the fault tree analysis on a stuck U2 umbilical, level wind mechanical interference, and slack tether in upper tether control mechanism and to prepare a detailed plan for hardware inspection, test, and analysis including any appropriate hardware disassembly.

Tethered Satellite System Contingency Investigation Board

NASA Astrophysics Data System (ADS)

1992-11-01

The Tethered Satellite System (TSS-1) was launched aboard the Space Shuttle Atlantis (STS-46) on July 31, 1992. During the attempted on-orbit operations, the Tethered Satellite System failed to deploy successfully beyond 256 meters. The satellite was retrieved successfully and was returned on August 6, 1992. The National Aeronautics and Space Administration (NASA) Associate Administrator for Space Flight formed the Tethered Satellite System (TSS-1) Contingency Investigation Board on August 12, 1992. The TSS-1 Contingency Investigation Board was asked to review the anomalies which occurred, to determine the probable cause, and to recommend corrective measures to prevent recurrence. The board was supported by the TSS Systems Working group as identified in MSFC-TSS-11-90, 'Tethered Satellite System (TSS) Contingency Plan'. The board identified five anomalies for investigation: initial failure to retract the U2 umbilical; initial failure to flyaway; unplanned tether deployment stop at 179 meters; unplanned tether deployment stop at 256 meters; and failure to move tether in either direction at 224 meters. Initial observations of the returned flight hardware revealed evidence of mechanical interference by a bolt with the level wind mechanism travel as well as a helical shaped wrap of tether which indicated that the tether had been unwound from the reel beyond the travel by the level wind mechanism. Examination of the detailed mission events from flight data and mission logs related to the initial failure to flyaway and the failure to move in either direction at 224 meters, together with known preflight concerns regarding slack tether, focused the assessment of these anomalies on the upper tether control mechanism. After the second meeting, the board requested the working group to complete and validate a detailed integrated mission sequence to focus the fault tree analysis on a stuck U2 umbilical, level wind mechanical interference, and slack tether in upper tether control mechanism and to prepare a detailed plan for hardware inspection, test, and analysis including any appropriate hardware disassembly.

Endoscopic surgery for young athletes with symptomatic unicameral bone cyst of the calcaneus.

PubMed

Innami, Ken; Takao, Masato; Miyamoto, Wataru; Abe, Satoshi; Nishi, Hideaki; Matsushita, Takashi

2011-03-01

Open curettage with bone graft has been the traditional surgical treatment for symptomatic unicameral calcaneal bone cyst. Endoscopic procedures have recently provided less invasive techniques with shorter postoperative morbidity. The authors' endoscopic procedure is effective for young athletes with symptomatic calcaneal bone cyst. Case series; Level of evidence, 4. Of 16 young athletes with symptomatic calcaneal bone cyst, 13 underwent endoscopic curettage and percutaneous injection of bone substitute under the new method. Three patients were excluded because of short-term follow-up, less than 24 months. For the remaining 10 patients, with a mean preoperative 3-dimensional size of 23 × 31 × 35 mm as calculated by computed tomography, clinical evaluation was made with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale just before surgery and at the most recent follow-up (mean, 36.2 months; range, 24-51 months), and radiologic assessment was performed at the most recent follow-up, to discover any recurrence or pathologic fracture. Furthermore, the 10 patients-all of whom returned to sports activities-were asked how long it took to return to initial sports activity level after surgery. Mean ankle-hindfoot scale score improved from preoperative 78.7 ± 4.7 points (range, 74-87) to postoperative 98.0 ± 4.2 points (range, 90-100) (P < .001). Pain and functional scores significantly improved after surgery (P < .01 and P < .05, respectively). Radiologic assessment at most recent follow-up revealed no recurrence or pathologic fracture, with retention of injected calcium phosphate cement in all cases. All patients could return to their initial levels of sports activities within 8 weeks after surgery (mean period, 7.1 weeks; range, 4-8 weeks), which was quite early as compared with past reports. Endoscopic curettage and injection of bone substitute appears to be an excellent option for young athletes with symptomatic calcaneal bone cyst for early return to sports activities, because it has the possibility to minimize the risk of postoperative pathologic fracture and local recurrence after early return to initial level of sports activities.

Partial anomalous pulmonary venous return in Turner syndrome.

PubMed

van den Hoven, Allard T; Chelu, Raluca G; Duijnhouwer, Anthonie L; Demulier, Laurent; Devos, Daniel; Nieman, Koen; Witsenburg, Maarten; van den Bosch, Annemien E; Loeys, Bart L; van Hagen, Iris M; Roos-Hesselink, Jolien W

2017-10-01

The aim of this study is to describe the prevalence, anatomy, associations and clinical impact of partial anomalous pulmonary venous return in patients with Turner syndrome. All Turner patients who presented at our Turner clinic, between January 2007 and October 2015 were included in this study and underwent ECG, echocardiography and advanced imaging such as cardiac magnetic resonance or computed tomography as part of their regular clinical workup. All imaging was re-evaluated and detailed anatomy was described. Partial anomalous pulmonary venous return was diagnosed in 24 (25%) out of 96 Turner patients included and 14 (58%) of these 24 partial anomalous pulmonary venous return had not been reported previously. Right atrial or ventricular dilatation was present in 11 (46%) of 24 partial anomalous pulmonary venous return patients. When studied with advanced imaging modalities and looked for with specific attention, PAPVR is found in 1 out of 4 Turner patients. Half of these patients had right atrial and/or ventricular dilatation. Evaluation of pulmonary venous return should be included in the standard protocol in all Turner patients. Copyright © 2017. Published by Elsevier B.V.

Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus.

PubMed

Farid, Mohamed; Youssef, Tamer; Mahdy, Tarek; Omar, Waleed; Moneim, Hesham Abdul; El Nakeeb, Ayman; Youssef, Mohamed

2009-03-01

The objective of this study was to compare the results of partial division of puborectalis (PDPR) versus local botulinum toxin type A (BTX-A) injection in treating patients with anismus. This prospective randomized study included 30 male patients suffering from anismus. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and electromyography. Patients were randomized into: group I which included 15 patients who were injected with BTX-A and group II which included 15 patients who underwent bilateral PDPR. Follow-up was conducted for about 1 year. Improvement was considered when patients returned to their normal habits. BTX-A injection achieved initial success in 13 patients (86.7%). However, long-term success persisted only in six patients (40%). This was in contrast to PDPR which achieved initial success in all patients (100%) with a long-term success in ten patients (66.6%). Recurrence was observed in seven patients (53.8%) and five patients (33.4%) following BTX-A injection and PDPR, respectively. Minor degrees of incontinence were confronted in two patients (13.3%) following PDPR. BTX-A injection seems to be successful for temporary treatment of anismus.

Economic Return From the Women’s Health Initiative Estrogen Plus Progestin Clinical Trial

PubMed Central

Roth, Joshua A.; Etzioni, Ruth; Waters, Teresa M.; Pettinger, Mary; Rossouw, Jacques E.; Anderson, Garnet L.; Chlebowski, Rowan T.; Manson, JoAnn E.; Hlatky, Mark; Johnson, Karen C.; Ramsey, Scott D.

2014-01-01

Background The findings of the Women’s Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial’s $260 million cost (2012 U.S. dollars). Objective To estimate the economic return from the WHI E+P trial. Design Decision model to simulate health outcomes for a “WHI scenario” with observed cHT use and a “no-WHI scenario” with cHT use extrapolated from the pretrial period. Data Sources Primary analyses of WHI outcomes, peer-reviewed literature, and government sources. Target Population Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy. Time Horizon 2003 to 2012. Perspective Payer. Intervention Combined hormone therapy. Outcome Measures Disease incidence, expenditure, quality-adjusted life-years, and net economic return. Results of Base-Case Analysis The WHI scenario resulted in 4.3 million fewer cHT users, 126 000 fewer breast cancer cases, 76 000 fewer cardiovascular disease cases, 263 000 more fractures, 145 000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100 000 per quality-adjusted life-year. Results of Sensitivity Analysis The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion. Limitation No evaluation of indirect costs or outcomes beyond 2012. Conclusion The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects. Primary Funding Source National Heart, Lung, and Blood Institute. PMID:24798522

Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative

PubMed Central

Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

2016-01-01

Background Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting. Methods Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year. Exclusion criteria include Plasmodium falciparum malaria, and fulfilment of admission criteria such as unstable vital signs or significant laboratory derangements. We performed a time series analysis preimplementation and postimplementation, with primary outcome of wait time to tropical medicine consultation. Secondary outcomes included number of ED visits averted for repeat malaria testing, and algorithm adherence. Results From February 2014 to December 2015, 154 patients were seen in the RAFT clinic: 68 men and 86 women. Median age was 36 years (range 16–78 years). Mean time to RAFT clinic assessment was 1.2±0.07 days (range 0–4 days) postimplementation, compared to 5.4±1.8 days (range 0–26 days) prior to implementation (p<0.0001). The RAFT clinic averted 132 repeat malaria screens in the ED over the study period (average 6 per month). Common diagnoses were: traveller's diarrhoea (n=27, 17.5%), dengue (n=12, 8%), viral upper respiratory tract infection (n=11, 7%), chikungunya (n=10, 6.5%), laboratory-confirmed influenza (n=8, 5%) and lobar pneumonia (n=8, 5%). Conclusions In addition to provision of more timely care to ambulatory febrile returned travellers, we reduced ED bed-usage by providing an alternate setting for follow-up malaria screening, and treatment of infectious diseases manageable in an outpatient setting, but requiring specific therapy. PMID:27473947

Backward Planetary Protection Issues and Possible Solutions for Icy Plume Sample Return Missions from Astrobiological Targets

NASA Astrophysics Data System (ADS)

Yano, Hajime; McKay, Christopher P.; Anbar, Ariel; Tsou, Peter

The recent report of possible water vapor plumes at Europa and Ceres, together with the well-known Enceladus plume containing water vapor, salt, ammonia, and organic molecules, suggests that sample return missions could evolve into a generic approach for outer Solar System exploration in the near future, especially for the benefit of astrobiology research. Sampling such plumes can be accomplished via fly-through mission designs, modeled after the successful Stardust mission to capture and return material from Comet Wild-2 and multiple, precise trajectory controls of the Cassini mission to fly through Enceladus’ plume. The proposed LIFE (Life Investigation For Enceladus) mission to Enceladus, which would sample organic molecules from the plume of that apparently habitable world, provides one example of the appealing scientific return of such missions. Beyond plumes, the upper atmosphere of Titan could also be sampled in this manner. The SCIM mission to Mars, also inspired by Stardust, would sample and return aerosol dust in the upper atmosphere of Mars and thus extends this concept even to other planetary bodies. Such missions share common design needs. In particular, they require large exposed sampler areas (or sampler arrays) that can be contained to the standards called for by international planetary protection protocols that COSPAR Planetary Protection Policy (PPP) recommends. Containment is also needed because these missions are driven by astrobiologically relevant science - including interest in organic molecules - which argues against heat sterilization that could destroy scientific value of samples. Sample containment is a daunting engineering challenge. Containment systems must be carefully designed to appropriate levels to satisfy the two top requirements: planetary protection policy and the preserving the scientific value of samples. Planning for Mars sample return tends to center on a hermetic seal specification (i.e., gas-tight against helium escape). While this is an ideal specification, it far exceeds the current PPP requirements for Category-V “restricted Earth return”, which typically center on a probability of escape of a biologically active particle (e.g., < 1 in 10 (6) chance of escape of particles > 50 nm diameter). Particles of this size (orders of magnitude larger than a helium atom) are not volatile and generally “sticky” toward surfaces; the mobility of viruses and biomolecules requires aerosolization. Thus, meeting the planetary protection challenge does not require hermetic seal. So far, only a handful of robotic missions accomplished deep space sample returns, i.e., Genesis, Stardust and Hayabusa. This year, Hayabusa-2 will be launched and OSIRIS-REx will follow in a few years. All of these missions are classified as “unrestricted Earth return” by the COSPAR PPP recommendation. Nevertheless, scientific requirements of organic contamination control have been implemented to all WBS regarding sampling mechanism and Earth return capsule of Hayabusa-2. While Genesis, Stardust and OSIRIS-REx capsules “breathe” terrestrial air as they re-enter Earth’s atmosphere, temporal “air-tight” design was already achieved by the Hayabusa-1 sample container using a double O-ring seal, and that for the Hayabusa-2 will retain noble gas and other released gas from returned solid samples using metal seal technology. After return, these gases can be collected through a filtered needle interface without opening the entire container lid. This expertise can be extended to meeting planetary protection requirements from “restricted return” targets. There are still some areas requiring new innovations, especially to assure contingency robustness in every phase of a return mission. These must be achieved by meeting both PPP and scientific requirements during initial design and WBS of the integrated sampling system including the Earth return capsule. It is also important to note that international communities in planetary protection, sample return science, and deep space engineering must meet to enable this game-changing opportunity of Outer Solar System exploration.

Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review.

PubMed

Hoefsmit, Nicole; Houkes, Inge; Nijhuis, Frans J N

2012-12-01

In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee's health and participation in labour. We performed a keyword search (systematic literature review) in seven databases (period: 1994-2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.

Desferrioxamine as an electron donor. Inhibition of membranal lipid peroxidation initiated by H2O2-activated metmyoglobin and other peroxidizing systems.

PubMed

Kanner, J; Harel, S

1987-01-01

Desferrioxamine (DFO) involvement in several peroxidative systems was studied. These systems included: a) membranal lipid peroxidation initiated by H2O2-activated metmyoglobin (or methemoglobin); b) phenol-red oxidation by activated metmyoglobin or horseradish peroxidase (HRP): c) beta-carotene-linoleate couple oxidation stimulated by lipoxygenase or hemin. Desferrioxamine was found to inhibit all these systems but not ferrioxamine (FO). Phenol-red oxidation by H2O2-horseradish peroxidase was inhibited competitively with DFO. Kinetic studies using the spectra changes in the Soret region of metmyoglobin suggest a mechanism by which H2O2 reacts with the iron-heme to form an intermediate of oxy-ferryl myoglobin that subsequently reacts with DFO to return the activated compound to the resting state. These activities of DFO resemble the reaction of other electron donors.

Delivering diversity: newly regulated midwifery returns to Manitoba, Canada, one community at a time.

PubMed

Kreiner, Meta

2009-01-01

Through its publicly funded health care system, Canada is committed to offering accessible, quality maternity health services to all its citizens, yet this remains a challenge in its First Nations, rural and immigrant communities. With the implementation of midwifery as a self-regulating health profession in Manitoba, Canada, in 2000, initiatives were incorporated into the structure of the profession to try to address this issue. This qualitative investigation documents and explores these initiatives through a case study combining semistructured interviews and documentary sources. The innovations discussed include the development of an Aboriginal midwifery degree program, the supports put in place to assist rural midwifery practices, and the efforts to increase ethnic diversity and cultural competence within the midwifery profession. What unites these efforts is a community building approach which attempts to strengthen communities through local midwifery services and midwives drawn from community members.

Assessing the Coverage of E-Health Services in Sub-Saharan Africa. A Systematic Review and Analysis.

PubMed

Adeloye, Davies; Adigun, Taiwo; Misra, Sanjay; Omoregbe, Nicholas

2017-05-18

E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were 'widely reported' (representing 50 % overall acceptance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges reported were technical problems, poor internet and connectivity, participants' selection biases, contextual issues, and lack of funds. E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.

Perspectives on the Future Search for Life on Mars and Beyond

NASA Technical Reports Server (NTRS)

Nealson, K. H.

1998-01-01

One can view the search for life on Mars in two ways: first, as the initial step in the search for life elsewhere, and second, as the one place where in situ methods for life detection can be tested and proved via sample return. After Mars, most of the life detection will he done via in situ studies with data return. Mars offers us the opportunity to fine tune our methods - perhaps for a long time to come. Our group is involved in the development of methods for life detection that are independent of specific signals used for detection of life on Earth. These approaches include general indicators of metabolic activity and organismal structure and composition. Using such approaches, we hope to detect the signals of life (biosignatures) that are independent of preconceived notions and yet are convincing and unambiguous. The approaches we are focusing on include stable isotopic analyses of metals, mineral formation and disolution, and elemental analysis. These methods allow us to examine samples at a variety of scales, looking for nonequilibrium distribution of elements that serve as biosignatures. For futures studies of Mars and beyond, they, or some variation of them, should allow inference or proof of life in non-Earth locations.

Cargo Commercial Orbital Transportation Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Thacker, Karen; Williams, Dave

2012-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, retired in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

Commercial Orbital Transportation Cargo Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Williams, Dave; Orozco, Nicole; Philistine, Cynthia

2010-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, will retire in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

Acoustical Engineering Controls and Estimated Return on Investment for DoD Selected High Noise Sources: A Roadmap for Future Noise Control in Acquisition

DTIC Science & Technology

2013-04-25

Room 2A534, 1155 Defense Pentagon, Washington, DC 20301-1155 1. DOCUMENTDESCruPTION a . TYPE b. TITLE Acoustical Engineering Controls and Estimated...Return on Investment for DoD Selected Report Hil!h Noise Sources: A Roadmap for Future Noise Control in Acquisition c. PAGE COUNT d. SUBJECT AREA...175 Acoustical Engineering - Noise Control - Acquisition 2. AUTHOR/SPEAKER a . NAME (Last, First, Middlo Initial) b. RANK c. TITLE Erdman, Joy GS-15

Return to sport after shoulder arthroplasty: a systematic review and meta-analysis.

PubMed

Liu, Joseph N; Steinhaus, Michael E; Garcia, Grant H; Chang, Brenda; Fields, Kara; Dines, David M; Warren, Russell F; Gulotta, Lawrence V

2018-01-01

With increasing incidence and indications for shoulder arthroplasty, there is an increasing emphasis on the ability to return to sports. The main goal of this study was to determine the rate of return to sport after shoulder arthroplasty. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and meta-analysis. A search was performed on MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the Methodological Index for Nonrandomized Studies checklist. The main judgement outcome was the rate of return to sports activity after shoulder arthroplasty and the level of play upon return (identical or higher/lower level). Thirteen studies were reviewed, including 944 patients (506 athletes), treated with shoulder arthroplasty at an average follow-up of 5.1 years (range, 0.5-12.6 years). The most common sports were swimming (n = 169), golf (n = 144), fitness sports (n = 71), and tennis (n = 63). The overall rate of return to sport was 85.1% (95% CI, 76.5-92.3%), including 72.3% (95% CI, 60.6-82.8%) returning to an equivalent or improved level of play, after 1-36 months. Patients undergoing anatomic total shoulder arthroplasty returned at a significantly higher rate (92.6%) compared to hemiarthroplasty (71.1%, p = 0.02) or reverse total shoulder arthroplasty (74.9%, p = 0.003). Most patients are able to return to one or more sports following shoulder arthroplasty, with anatomic total shoulder arthroplasty having the highest rate of return. IV.

A population model of chaparral vegetation response to frequent wildfires.

PubMed

Lucas, Timothy A; Johns, Garrett; Jiang, Wancen; Yang, Lucie

2013-12-01

The recent increase in wildfire frequency in the Santa Monica Mountains (SMM) may substantially impact plant community structure. Species of Chaparral shrubs represent the dominant vegetation type in the SMM. These species can be divided into three life history types according to their response to wildfires. Nonsprouting species are completely killed by fire and reproduce by seeds that germinate in response to a fire cue, obligate sprouting species survive by resprouting from dormant buds in a root crown because their seeds are destroyed by fire, and facultative sprouting species recover after fire both by seeds and resprouts. Based on these assumptions, we developed a set of nonlinear difference equations to model each life history type. These models can be used to predict species survivorship under varying fire return intervals. For example, frequent fires can lead to localized extinction of nonsprouting species such as Ceanothus megacarpus while several facultative sprouting species such as Ceanothus spinosus and Malosma (Rhus) laurina will persist as documented by a longitudinal study in a biological preserve in the SMM. We estimated appropriate parameter values for several chaparral species using 25 years of data and explored parameter relationships that lead to equilibrium populations. We conclude by looking at the survival strategies of these three species of chaparral shrubs under varying fire return intervals and predict changes in plant community structure under fire intervals of short return. In particular, our model predicts that an average fire return interval of greater than 12 years is required for 50 % of the initial Ceanothus megacarpus population and 25 % of the initial Ceanothus spinosus population to survive. In contrast, we predict that the Malosma laurina population will have 90 % survivorship for an average fire return interval of at least 6 years.

A partial ban on sales to reduce high-risk drinking South of the border: seven years later.

PubMed

Voas, Robert B; Romano, Eduardo; Kelley-Baker, Tara; Tippetts, A Scott

2006-09-01

On weekend evenings, thousands of youths (ages 20 and younger) and young adults (ages 21-25) residing in communities along the U.S. border cross into Mexico to patronize all-night bars where the drinking age is 18, rather than 21, and where the price of alcohol is considerably less than in the United States. On January 1, 1999, Juárez, Mexico, implemented a 2 AM (instead of 5 AM) bar-closing policy. The number of crossers and their blood alcohol concentration levels on return were reduced in the year following this policy change. The present study's objective was to determine the long-term (7-year) effect of the earlier-closing bar policy on cross-border drinking in Mexico. Analyzed data (1998 to August 2005) were from quarterly breath-test surveys at the El Paso (Texas)/Juárez (Mexico) border, bar observations in Juárez, and trauma data in El Paso. Bar surveys in Juárez show that the 2 AM closing policy, initiated 7 years ago, continues to be enforced, as has the reduction (89%) in youthful crossers returning after 3 AM. The number of underage youths returning earlier in the evening (before 3 AM), however, unchanged for 2 years after the policy change, has doubled recently. The early closing of bars in Juárez has a continuing positive impact on the reduction of the number of those returning after 3 AM. Although initially there appeared to be no displacement of the late returnees into the early hours (before 3 AM), the number of bar visitors crossing and returning earlier has been steadily increasing. Suggestions for reducing cross-border heavy episodic drinking are described.

Financial returns on R&D: looking back at history, looking forward to adaptive licensing.

PubMed

Scannell, J W; Hinds, S; Evans, R

2015-01-01

Investment in R&D for drugs launched in the late 1970s to early 1990s generated good returns for investors. R&D was inexpensive. Clinical trial success rates were high. Consumption was increasing. Drug prices were outstripping inflation, which raised profit margins. Tax rates were falling. However, returns on R&D have been falling since the early 1990s given rising clinical trial costs, rising trial failure rates, and lower consumption growth in developed markets. Many investors believe that average financial returns on today's R&D will be below the cost of capital, particularly if US drug price inflation moderates. Thus R&D investment by major drug companies is flat or perhaps falling in real terms. Various regulatory initiatives have tried to streamline clinical development and approval. The latest is Adaptive Licensing (AL). The near-term effect of AL on industry-level financial returns will be modest. AL will, however, be salient for decisions to invest in specific trials and may make it easier for smaller companies to fund development. AL could become more important in the long run if it helps shift industry, regulators, and payers from what has been an increasingly linear model of innovation; predicated on the ideas that basic science predicts, trials test predictions, and trial results form a complete description of a drug's attributes. History shows that many drugs become important because doctors and patients discover utility that was not initially apparent to regulators, payers, or investors. One hope for AL, therefore, is that it will bring more acceptably safe chemical diversity into real world use at lower R&D cost.

The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

PubMed

Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

2017-01-01

Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series.

PubMed

Larson, Christopher M; Pierce, Bradley R; Giveans, M Russell

2011-06-01

The purpose of the study was to evaluate the results of surgical treatment in athletes with associated intra-articular hip pathology and extra-articular sports pubalgia. Between December 2003 and September 2009, 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology. There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes. Outcomes included an evaluation regarding return to sports and modified Harris Hip Score, Short Form 12 score, and visual analog scale score. We evaluated 37 hips at a mean of 29 months (range, 12 to 78 months) after the index surgery. Thirty-one hips underwent thirty-five athletic pubalgia surgeries. Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia). Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery. Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy. Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P < .05) and an unrestricted return to sporting activity in 89% of hips (24 of 27). When surgery only addressed either the athletic pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Can we use postal surveys with anonymous testing to monitor chlamydia prevalence in young women in England? Pilot study incorporating randomised controlled trial of recruitment methods.

PubMed

Woodhall, Sarah C; Nichols, Tom; Alexander, Sarah; da Silva, Filomeno Coelho; Mercer, Catherine H; Ison, Catherine; Gill, O Noel; Soldan, Kate

2015-09-01

Chlamydia prevalence in the general population is a potential outcome measure for the evaluation of chlamydia control programmes. We carried out a pilot study to determine the feasibility of using a postal survey for population-based chlamydia prevalence monitoring. Postal invitations were sent to a random sample of 2000 17-year-old to 18-year-old women registered with a general practitioner in two pilot areas in England. Recipients were randomised to receive either a self-sampling kit (n=1000), a self-sampling kit and offer of £5 voucher on return of sample (n=500) or a self-sampling kit on request (n=500). Participants returned a questionnaire and self-taken vulvovaginal swab sample for unlinked anonymous Chlamydia trachomatis testing. Non-responders were sent a reminder letter 3 weeks after initial invitation. We calculated the participation rate (number of samples returned/number of invitations sent) and cost per sample returned (including cost of consumables and postage) in each group. A total of 155/2000 (7.8%) samples were returned with consent for testing. Participation rates varied by invitation group: 7.8% in the group who were provided with a self-sampling kit, 14% in the group who were also offered a voucher and 1.0% in the group who were not sent a kit. The cost per sample received was lowest (£36) in the group who were offered both a kit and a voucher. The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England. (UKCRN ID 10913). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Clinical Outcomes after Conservative Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) in Women Ages 21-39 Years.

PubMed

Silver, Michelle I; Gage, Julia C; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Katki, Hormuzd A; Locke, Alexander; Kinney, Walter K; Castle, Philip E

2018-03-01

Cervical intraepithelial neoplasia grade 2 (CIN2) frequently regresses, is typically slow-growing, and rarely progresses to cancer. Some women forgo immediate treatment, opting for conservative management (heightened surveillance with cytology and colposcopy), to minimize overtreatment and increased risk of obstetric complications; however, there are limited data examining clinical outcomes in these women. We performed a retrospective cohort analysis of younger women diagnosed with initially untreated CIN1/2, CIN2 and CIN2/3 lesions at Kaiser Permanente Northern California between 2003 and 2015. Clinical outcomes were categorized into five mutually exclusive hierarchical groups: cancer, treated, returned to routine screening, persistent high-grade lesion, or persistent low-grade lesion. Median follow-up for the 2,417 women was 48 months. Six women were diagnosed with cancer (0.2%), all with history of high-grade cytology, and none after a negative cotest. Thirty percent of women were treated, and only 20% returned to routine screening; 50% remained in continued intensive follow-up, of which 86% had either low-grade cytology/histology or high-risk human papillomavirus (HPV) positivity, but not necessarily persistence of a single HPV type. No cancers were detected after a single negative cotest in follow-up. Almost half of initially untreated women did not undergo treatment, but remained by protocol in colposcopy clinic for 2 or more years in the absence of persisting CIN2 + Their incomplete return to total negativity was possibly due to sequential new and unrelated low-grade abnormalities. The prolonged colposcopic surveillance currently required to return to routine screening in the absence of persisting CIN2 + might not be necessary after a negative cotest. Significance: Many younger women under conservative management following an initial CIN2 result remain in a clinical protocol of prolonged intensified surveillance without a subsequent diagnosis of CIN2 or more severe diagnoses. More research is needed to determine whether such prolonged management might be unnecessary following a negative cotest for those women with an initial CIN2 but otherwise only low-grade findings. Cancer Prev Res; 11(3); 165-70. ©2018 AACR . ©2018 American Association for Cancer Research.

Distribution of Amino Acids in Lunar Regolith

NASA Technical Reports Server (NTRS)

Elsila, J. E.; Callahan, M. P.; Glavin, D. P.; Dworkin, J. P.; Noble, S. K.; Gibson, E. K., Jr.

2014-01-01

One of the most eagerly studied questions upon initial return of lunar samples was whether significant amounts of organic compounds, including amino acids, were present. Analyses during the 1970s produced only tentative and inconclusive identifications of indigenous amino acids. Those analyses were hampered by analytical difficulties including relative insensitivity to certain compounds, the inability to separate chiral enantiomers, and the lack of compound-specific isotopic measurements, which made it impossible to determine whether the detected amino acids were indigenous to the lunar samples or the results of contamination. Numerous advances have been made in instrumentation and methodology for amino acid characterization in extraterrestrial samples in the intervening years, yet the origin of amino acids in lunar regolith samples has been revisited only once for a single lunar sample, (3) and remains unclear. Here, we present initial data from the analyses of amino acid abundances in 12 lunar regolith samples. We discuss these abundances in the context of four potential amino acid sources: (1) terrestrial biological contamination; (2) contamination from lunar module (LM) exhaust; (3) derivation from solar windimplanted precursors; and (4) exogenous delivery from meteorites.

Optical GRB Afterglows Detected with UVOT

NASA Astrophysics Data System (ADS)

Marshall, F. E.

2008-05-01

The automated response of the UltraViolet and Optical Telescope (UVOT) on Swift to new GRBs has several parameters, including exposure time, filter sequence and data mode, that can be adjusted to optimize the science return of early afterglow observations. After some initial changes, the response has remained stable since March 15, 2006. From then through August 10, 2007, UVOT observed 122 of the 130 GRBs detected with Swift's Burst Alert Telescope (BAT). UVOT typically takes an initial 100-s exposure with the White filter (160-650 nm) starting 60-180 s after the trigger and then takes exposures with the other 6 filters. In its first finding chart exposure UVOT detected 39% of the 84 long (T90>2.0 s) GRBs that were not heavily reddened in the Milky Way (EB-V<0.5) and were observed within 500 seconds of the trigger. Another 4% were detected after including subsequent exposures. Afterglow magnitudes ranged from 12.8 to the sensitivity limit of ~21. Only 1 of 11 short GRBs were detected, and its magnitude was near the sensitivity limit. We also report correlations of afterglow magnitudes with other GRB properties.

The Experiential Learning Initiative: A Student-Scientist Partnership for Urban Youth

NASA Astrophysics Data System (ADS)

Marshall, B. J.; Birdin, V. E.; Butler, J.

2001-05-01

The Experiential Learning Initiative is a student-scientist partnership initiated during the doctoral program of the author. Essential to the partnership were the cooperative relationships between the teaching and administrative staffs of Bellwood, IL School District 88 and the Michigan State University Department of Entomology. The use of insects, geophysical visualization activities, and extensive fieldwork by the students served as the foundation for non-traditional learning experiences. The university science partner worked with students in an after-school program several days each month. During these sessions, students were given opportunities to experience science as an on-going process based on personal curiosity and creativity. Through their personal investigations in laboratory, field, and field station situations, the students constructed knowledge of Earth processes and ecological interactions. Each academic year of the partnership was brought to closure with a capstone event that included travel to a major university or working field station for a week of on-site investigation, expanded exposure to practicing scientists, and residential living in a scientific community. All students presented posters about a topic of their own areas of interest at the end of the week and again upon return to their schools. The results of this partnership have included strong gains in both personal confidence among the students and in test scores from standardized state tests.

Incident and recurrent back injuries among union carpenters.

PubMed

Lipscomb, H J; Cameron, W; Silverstein, B

2008-12-01

To describe incident and recurrent work-related back injuries among union carpenters, describe the hazard function for each and associated risk factors, and explore predictors of subsequent musculoskeletal back injury based on different definitions of the initial injury. This study identified a dynamic cohort of 18 768 carpenters who worked in the State of Washington 1989-2003, their hours worked each month, and their work-related back injuries and medical claims for treatment including ICD-9 codes. Using Poisson regression we calculated rates and rate ratios (RRs) of incident and recurrent injury adjusting for age, gender, union tenure and type of carpentry work. Predictors of subsequent musculoskeletal back injury were explored based on different definitions of the incident injury, as were time periods of greatest risk following return to work. Recurrent back injuries occurred at a rate 80% higher than initial injuries. Survival curves were significantly different for incident and recurrent injuries, but patterns of relative risk were similar. Individuals with greatest union tenure were at lowest risk, likely reflecting a healthy worker effect or lower physical exposures with seniority. Individuals with long periods of work disability with their first injury were at particularly high risk of subsequent musculoskeletal injury compared with those with no prior history (RR 2.3; 95% CI 2.0 to 2.7), as were individuals with degenerative diagnoses (RR 2.0; 95% CI 1.5 to 2.6). Risk for second injury peaked between 1000 and 1500 h after return to work and then gradually declined. Carpenters with long periods of work disability following back injury warrant accommodation and perhaps better rehabilitation efforts to avoid re-injury. Challenges to workplace accommodation and limited ability to clearly define readiness to return to work following injury demonstrate the need for primary prevention of back injuries through attention to engineering solutions among carpenters involved in strenuous work.

Recurrent knee pain in an athletic adult: multiple schwannomas secondary to schwannomatosis: a case report.

PubMed

Maceroli, Michael; Uglialoro, Anthony D; Beebe, Kathleen S; Benevenia, Joseph

2010-11-01

Schwannomatosis has been used to describe patients with multiple nonvestibular schwannomas with no associated features of neurofibromatosis type 2. In our case, a 28-year-old athletic man underwent a right knee excisional biopsy for multifocal, benign schwannomatosis. After being asymptomatic for 4 years postresection, he returned to our musculoskeletal oncology service. Imaging studies revealed local recurrence identical to his initial presentation. Excisional biopsy of discrete masses was performed and histologic examination revealed recurrent benign schwannomatosis. To our knowledge, this is the second reported case of recurrent benign schwannomatosis. We review schwannomatosis, including its etiology, radiographic features, and relationship to neurofibromatosis.

Physical Therapy Protocols for Arthroscopic Bankart Repair.

PubMed

DeFroda, Steven F; Mehta, Nabil; Owens, Brett D

Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols. The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols. Descriptive epidemiology study. Level 3. Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport. Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 ± 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 ± 2.8 weeks) and full active range of motion (mean, 12.2 ± 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists' (ASSET) consensus protocol. Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients. This study highlights the importance of attending surgeons being very clear and specific with regard to their physical therapy instructions to patients and therapists.

Lunar lander and return propulsion system trade study

NASA Technical Reports Server (NTRS)

Hurlbert, Eric A.; Moreland, Robert; Sanders, Gerald B.; Robertson, Edward A.; Amidei, David; Mulholland, John

1993-01-01

This trade study was initiated at NASA/JSC in May 1992 to develop and evaluate main propulsion system alternatives to the reference First Lunar Outpost (FLO) lander and return-stage transportation system concept. Thirteen alternative configurations were developed to explore the impacts of various combinations of return stage propellants, using either pressure or pump-fed propulsion systems and various staging options. Besides two-stage vehicle concepts, the merits of single-stage and stage-and-a-half options were also assessed in combination with high-performance liquid oxygen and liquid hydrogen propellants. Configurations using an integrated modular cryogenic engine were developed to assess potential improvements in packaging efficiency, mass performance, and system reliability compared to non-modular cryogenic designs. The selection process to evaluate the various designs was the analytic hierarchy process. The trade study showed that a pressure-fed MMH/N2O4 return stage and RL10-based lander stage is the best option for a 1999 launch. While results of this study are tailored to FLO needs, the design date, criteria, and selection methodology are applicable to the design of other crewed lunar landing and return vehicles.

Determinants of the cost of capital for privately financed hospital projects in the UK.

PubMed

Colla, Paolo; Hellowell, Mark; Vecchi, Veronica; Gatti, Stefano

2015-11-01

Many governments make use of private finance contracts to deliver healthcare infrastructure. Previous work has shown that the rate of return to investors in these markets often exceeds the efficient level. Our focus is on the factors that influence that return. We examine the effect of macroeconomic, project- and firm-level variables using a detailed sample of 84 UK private finance initiative (PFI) contracts signed between 1997 and 2010. Of the above variables, macroeconomic conditions and lead sponsor size are related to the investor return. However, our results show a remarkable degree of stability in the return to investors over the 14-year period. We find evidence of a 'prevailing norm' that is robust to project- and firm-level variation. The sustainability of excess returns over a long period is indicative of a concentrated market structure. We argue that policymakers should consider new mechanisms for increasing competition in the equity market, while ensuring that authorities have the specialist resources required to negotiate efficient contract prices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Sustainable Mars Sample Return

NASA Technical Reports Server (NTRS)

Alston, Christie; Hancock, Sean; Laub, Joshua; Perry, Christopher; Ash, Robert

2011-01-01

The proposed Mars sample return mission will be completed using natural Martian resources for the majority of its operations. The system uses the following technologies: In-Situ Propellant Production (ISPP), a methane-oxygen propelled Mars Ascent Vehicle (MAV), a carbon dioxide powered hopper, and a hydrogen fueled balloon system (large balloons and small weather balloons). The ISPP system will produce the hydrogen, methane, and oxygen using a Sabatier reactor. a water electrolysis cell, water extracted from the Martian surface, and carbon dioxide extracted from the Martian atmosphere. Indigenous hydrogen will fuel the balloon systems and locally-derived methane and oxygen will fuel the MAV for the return of a 50 kg sample to Earth. The ISPP system will have a production cycle of 800 days and the estimated overall mission length is 1355 days from Earth departure to return to low Earth orbit. Combining these advanced technologies will enable the proposed sample return mission to be executed with reduced initial launch mass and thus be more cost efficient. The successful completion of this mission will serve as the next step in the advancement of Mars exploration technology.

Initial Nutritional Assessment of Infants With Cleft Lip and/or Palate: Interventions and Return to Birth Weight.

PubMed

Kaye, Alison; Thaete, Kristi; Snell, Audrey; Chesser, Connie; Goldak, Claudia; Huff, Helen

2017-03-01

  To assess and quantify cleft team practices with regard to nutritional support in the neonatal period Design :  Retrospective review.   Tertiary pediatric hospital.   One hundred consecutive newborn patients with a diagnosis of cleft lip and/or cleft palate between 2009 and 2012.   Birth weight, cleft type, initial cleft team weight measurements, initial feeding practices, recommended nutritional interventions, and follow-up nutritional assessments.   All patients in the study were evaluated by a registered dietitian and an occupational feeding therapist. Average birth weight and average age at the first cleft team visit were similar for each cleft type: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP). The calculated age (in days) for return to birth weight was significantly different between cleft types: CL = 13.58 days, CLP = 15.88 days, and CP = 21.93 days. Exclusive use of breast milk was 50% for patients with CL, 30.3% for patients with CLP, and 21.4% for patients with CP. Detailed nutritional interventions were made for 31 patients at the first visit: two with CL, 14 with CLP, and 15 with CP.   Distinct differences were seen in neonatal weight gain between cleft types. There was significantly greater total weight gain for patients with CL at their first visit and significantly slower return to birth weight for patients with isolated CP. Patients with CL required far fewer interventions at the initial assessment and were more likely to be provided breast milk exclusively or in combination with formula. Infants with CP were far less likely to receive any breast milk. Patients with CLP and CP required frequent nutritional interventions.

Measures to facilitate the reintegration of returning migrant workers: international experiences.

PubMed

Lohrmann, R

1988-06-01

Bilateral and multilateral measures implemented to assist migrants who return to their country of origin have been designed to respond to a number of different but specific situations. 2 bilateral agreements are briefly described: 1) an agreement between the Federal Republic of Germany and the Republic of Turkey signed in the early 1970s, and 2) an agreement between France and Algeria signed in 1980. 3 different types of multilateral activities are described: 1) the operation of the so-called Return of Talent program by the Intergovernmental Committee for Migration, 2) the Transfer of KNow-how Through Expatriate Nationals program of the UN Development Programme, and 3) the elaboration of a model machinery on return migration by the Organization for Economic Cooperation and Development. While the 1st 2 activities are operational programs, by which annually between 1000-2000 professionals are assisted in their permanent return to or temporary sojourn in their developing countries of origin, with the financial support of both the developed and the developing countries concerned, the 3rd initiative is a conceptual effort aimed at assisting governments to implement policy measures designed to make return migration commensurate with national development goals. 3 recent proposals include 1) the proposal for an international labor compensatory facility, 2) an international fund for vocational training, and 3) an international fund for manpower resources. A common factor shared by all these programs is that they have all involved on 1 side industrial receiving countries which feel themselves obliged to observe a number of principles guaranteed by law and which govern employment conditions and working relations. The reintegration measures implemented or proposed in cooperation with them have been adopted in full consideration of the prevailing standards of these countries, as different as they may be from 1 country to another. A common consideration has been that the returning migrant should reintegrate in his country of origin as far as possible in conditions allowing the returnee to attain self-sufficiency and social security coverage. However, this underlying context does not necessarily prevail in all world regions where different forms of labor migration take place. Therefore the measures experienced in the relationship of specific countries cannot be easily copied for implementation in other countries. Multilateral measures benefited a rather limited number of individuals only, in many instances skilled and highly skilled migrants.

Planetary protection on international waters: An onboard protocol for capsule retrieval and biosafety control in sample return mission

NASA Astrophysics Data System (ADS)

Takano, Yoshinori; Yano, Hajime; Sekine, Yasuhito; Funase, Ryu; Takai, Ken

2014-04-01

Planetary protection has been recognized as one of the most important issues in sample return missions that may host certain living forms and biotic signatures in a returned sample. This paper proposes an initiative of sample capsule retrieval and onboard biosafety protocol in international waters for future biological and organic constituent missions to bring samples from possible habitable bodies in the solar system. We suggest the advantages of international waters being outside of national jurisdiction and active regions of human and traffic affairs on the condition that we accept the Outer Space Treaty. The scheme of onboard biological quarantine definitely reduces the potential risk of back-contamination of extraterrestrial materials to the Earth.

Environmental Exposure Effects on Composite Materials for Commercial Aircraft

NASA Technical Reports Server (NTRS)

Hoffman, D. J.

1981-01-01

This period's activities were highlighted by continued long term and accelerated lab exposure testing, and by completion of all fabrication tasks on the optional material systems, AS1/3501-6 and Kevlar 49/F161-188. Initial baseline testing was performed on the two optional material systems. Long term exposure specimens were returned from three of the four ground rack sites and from two of the three aircraft locations. Test data from specimens returned from Dryden after 2 years exposure do not indicate continuing trends of strength reduction from the 1 year data. Test data from specimens returned from the Wellington, new Zealand ground rack and on Air New Zealand aircraft after 1 year exposure show strength changes fairly typical of other locations.

Fixed-Base Simulator Studies of the Ability of the Human Pilot to Provide Energy Management Along Abort and Deep-Space Entry Trajectories

NASA Technical Reports Server (NTRS)

Young, J. W.; Goode, M. W.

1962-01-01

A simulation study has been made to determine a pilot's ability to control a low L/D vehicle to a desired point on the earth with initial conditions ranging from parabolic orbits to abort conditions along the boost phase of a deep-space mission. The program was conducted to develop procedures which would allow the pilot to perform the energy management functions required while avoiding the high deceleration or skipout region and to determine the information display required to aid the pilot in flying these procedures. The abort conditions studied extend from a region of relatively high flight-path angles at suborbital velocities while leaving the atmosphere to a region between orbital and near-escape velocity outside the atmosphere. The conditions studied included guidance from suborbital and superorbital aborts as well as guidance following return from a deepspace mission. In this paper, the role of the human pilot?s ability to combine safe return abort procedures with guidance procedures has been investigated. The range capability from various abort and entry conditions is also presented.

The effects of a documentary film on public stigma related to mental illness among genetic counselors

PubMed Central

Anderson, Kelly; Austin, Jehannine C.

2013-01-01

Many people, including genetic counselors (GCs), have been found to hold stigmatizing attitudes towards people with mental illnesses. We aimed to determine whether these attitudes could be changed by exposing GCs/GC students to a documentary film about people with mental illness. We screened the documentary at the 2010 North American conferences for GCs. Immediately before (T1), immediately after (T2), and one month after (T3) watching the documentary, participants self-rated their comfort with asking patients about mental illness, and completed scales measuring two aspects of stigma: stereotype endorsement (SE) and desire for social distance (SD). A total of 87 T1 and T2 questionnaires, and 39 T3 questionnaires were returned. At T2 and T3, 34.5% and 48.7% respectively reported feeling more comfortable to ask patients about mental illness. Scores on SD and SE scales decreased significantly from T1 to T2, but returned to initial levels at T3. The documentary increased GC/GC students’ comfort with asking about mental illness and temporarily decreased stigmatizing attitudes. PMID:22037897

Test of the principle of operation of a wideband magnetic direction finder for lightning return strokes

NASA Technical Reports Server (NTRS)

Herrman, B. D.; Uman, M. A.; Brantley, R. D.; Krider, E. P.

1976-01-01

The principle of operation of a wideband crossed-loop magnetic-field direction finder is studied by comparing the bearing determined from the NS and EW magnetic fields at various times up to 155 microsec after return stroke initiation with the TV-determined lightning channel base direction. For 40 lightning strokes in the 3 to 12 km range, the difference between the bearings found from magnetic fields sampled at times between 1 and 10 microsec and the TV channel-base data has a standard deviation of 3-4 deg. Included in this standard deviation is a 2-3 deg measurement error. For fields sampled at progressively later times, both the mean and the standard deviation of the difference between the direction-finder bearing and the TV bearing increase. Near 150 microsec, means are about 35 deg and standard deviations about 60 deg. The physical reasons for the late-time inaccuracies in the wideband direction finder and the occurrence of these effects in narrow-band VLF direction finders are considered.

Lunar exploration: opening a window into the history and evolution of the inner Solar System

PubMed Central

Crawford, Ian A.; Joy, Katherine H.

2014-01-01

The lunar geological record contains a rich archive of the history of the inner Solar System, including information relevant to understanding the origin and evolution of the Earth–Moon system, the geological evolution of rocky planets, and our local cosmic environment. This paper provides a brief review of lunar exploration to-date and describes how future exploration initiatives will further advance our understanding of the origin and evolution of the Moon, the Earth–Moon system and of the Solar System more generally. It is concluded that further advances will require the placing of new scientific instruments on, and the return of additional samples from, the lunar surface. Some of these scientific objectives can be achieved robotically, for example by in situ geochemical and geophysical measurements and through carefully targeted sample return missions. However, in the longer term, we argue that lunar science would greatly benefit from renewed human operations on the surface of the Moon, such as would be facilitated by implementing the recently proposed Global Exploration Roadmap. PMID:25114318

Lunar exploration: opening a window into the history and evolution of the inner Solar System.

PubMed

Crawford, Ian A; Joy, Katherine H

2014-09-13

The lunar geological record contains a rich archive of the history of the inner Solar System, including information relevant to understanding the origin and evolution of the Earth-Moon system, the geological evolution of rocky planets, and our local cosmic environment. This paper provides a brief review of lunar exploration to-date and describes how future exploration initiatives will further advance our understanding of the origin and evolution of the Moon, the Earth-Moon system and of the Solar System more generally. It is concluded that further advances will require the placing of new scientific instruments on, and the return of additional samples from, the lunar surface. Some of these scientific objectives can be achieved robotically, for example by in situ geochemical and geophysical measurements and through carefully targeted sample return missions. However, in the longer term, we argue that lunar science would greatly benefit from renewed human operations on the surface of the Moon, such as would be facilitated by implementing the recently proposed Global Exploration Roadmap. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Managing Sports-related Concussions From Time of Injury Through Return to Play.

PubMed

Shirley, Eric; Hudspeth, L Jared; Maynard, Jennifer R

2018-06-01

Sports-related concussions continue to generate widespread interest. A concussion is a complex pathophysiologic process, with or without loss of consciousness, that results in a disturbance of brain function. Risk factors include age <18 years, female sex, and history of a previous concussion. A sideline physical examination with standardized assessment tools can assist diagnosis. Management for suspected concussion begins with immediate removal from play and requires clinical follow-up. Symptoms are usually self-limited and resolve within 2 to 3 weeks. Initial treatment consists of a reduction in cognitive activity and physical rest. A stepwise return-to-play protocol, taking into consideration state laws, with a gradual increase in activity until the athlete is able to perform full activity without symptoms should be followed. Neuropsychologic testing may be used as a tool in management. For prolonged concussion, physical rehabilitation or medications for headaches, mood, or sleep disturbance may be required. Education, rule changes, and equipment improvements may assist in prevention. The long-term consequences of concussions are not fully understood and merit additional research.

A Framework to Understand Extreme Space Weather Event Probability.

PubMed

Jonas, Seth; Fronczyk, Kassandra; Pratt, Lucas M

2018-03-12

An extreme space weather event has the potential to disrupt or damage infrastructure systems and technologies that many societies rely on for economic and social well-being. Space weather events occur regularly, but extreme events are less frequent, with a small number of historical examples over the last 160 years. During the past decade, published works have (1) examined the physical characteristics of the extreme historical events and (2) discussed the probability or return rate of select extreme geomagnetic disturbances, including the 1859 Carrington event. Here we present initial findings on a unified framework approach to visualize space weather event probability, using a Bayesian model average, in the context of historical extreme events. We present disturbance storm time (Dst) probability (a proxy for geomagnetic disturbance intensity) across multiple return periods and discuss parameters of interest to policymakers and planners in the context of past extreme space weather events. We discuss the current state of these analyses, their utility to policymakers and planners, the current limitations when compared to other hazards, and several gaps that need to be filled to enhance space weather risk assessments. © 2018 Society for Risk Analysis.

Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes.

PubMed

Kudaş, Savaş; Dönmez, Gürhan; Işık, Çetin; Çelebi, Mesut; Çay, Nurdan; Bozkurt, Murat

2016-12-01

To describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players. A case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures. The complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24-42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42-56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19-77 months). Non-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails. Level IV, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Telephone hotline is an important part of overall patient management in upper gastrointestinal malignancies.

PubMed

Bjerring, Ole Steen; Fristrup, Claus; Mortensen, Michael Bau

2012-08-01

As seven out of every ten patients with upper gastrointestinal malignancies (UGIM) are not eligible for curative treatment, life after diagnosis is characterised by a rapid deterioration and uncertainty. To accommodate these issues, we established a telephone hotline. In a two-year period, all patients evaluated for UGIM were given the hotline phone number. The hotline was staffed by either a nurse or a secretary, and subsequently the specialist in charge of the patient would return the call. All calls were registered in a prospective database. The following data were recorded: diagnosis, time from call to return call, problem and solution to the problem. A total of 477 patients were included, and 172 (36%) patients used the Hotline a total of 254 times. Of the 254 calls, 210 (83%) were returned the same day. A total of 104 (41%) calls were made due to elaborative questions and 89% of these were solved over the phone. Dysphagia was the problem in 51 cases which gave rise to an endoscopy in 86% of cases. Pain was the problem in 35. Overall, of the 254 calls, 152 (60%) problems were solved over the phone. Furthermore, 75 calls triggered a hospital visit and 27 calls led to the patient being referred for further examinations. The establishment of a telephone hotline was feasible and it was used by some patients. Most of the callers only made one call. Nearly all calls (96%) were returned the day after the initial call, at the latest. The problem pattern did not differ between disease groups apart from dysphagia in oesophageal cancer. We found that the hotline was an effective and inexpensive part of overall patient management. not relevant. not relevant.

Factors influencing return to work after illness in France.

PubMed

Pélissier, C; Fontana, L; Chauvin, F

2014-01-01

Few studies have been published about the factors influencing return to work after sickness absence. To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.

PubMed

Ardern, Clare L; Glasgow, Philip; Schneiders, Anthony; Witvrouw, Erik; Clarsen, Benjamin; Cools, Ann; Gojanovic, Boris; Griffin, Steffan; Khan, Karim M; Moksnes, Håvard; Mutch, Stephen A; Phillips, Nicola; Reurink, Gustaaf; Sadler, Robin; Silbernagel, Karin Grävare; Thorborg, Kristian; Wangensteen, Arnlaug; Wilk, Kevin E; Bizzini, Mario

2016-07-01

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport. 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/

Are Samples Obtained after Return to Earth Reflective of Spaceflight or Increased Gravity?

NASA Technical Reports Server (NTRS)

Wade, C. R.; Holton, E.; Baer, L.; Moran, M.

2001-01-01

Upon return to Earth, following space flight, living systems are immediately exposed to an increase in gravity of 1G. It has been difficult to differentiate between changes that are residuals of the acclimation to space flight from those resulting from acute exposure to an increase in =gravity upon re-entry. We compared previously reported changes observed in male Sprague-Dawley rats upon return to Earth to those induced by centrifugation, because both paradigms result in an increase of 1G. With both treatments there was a reduction in body mass, due to reduced food intake and increased urine output. The decrease in food intake was initially greater with centrifugation. The magnitudes of the changes in food intake and urine output were similar in both treatments. However, the slightly greater initial loss in body mass with centrifugation was due to a decrease in water intake not seen after space flight. The absence of pronounced differences between these treatments suggest the responses observed after landing are not residuals of adaptation to the space flight environment, but the result of adaptation to an increase in the level of gravity.

[Sulfide ooze mud and sodium chloride baths in treating osteoarthrosis patients].

PubMed

Novikova, N V

1989-01-01

Humoral immunity initially affected in patients with osteoarthrosis returns to normal under the influence of a multiple-modality treatment involving application of sulphide moor in combination with sodium chloride baths.

IONIZATION EQUILIBRIUM TIMESCALES IN COLLISIONAL PLASMAS

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

Smith, Randall K.; Hughes, John P., E-mail: rsmith@cfa.harvard.ed, E-mail: jph@physics.rutgers.ed

2010-07-20

Astrophysical shocks or bursts from a photoionizing source can disturb the typical collisional plasma found in galactic interstellar media or the intergalactic medium. The spectrum emitted by this plasma contains diagnostics that have been used to determine the time since the disturbing event, although this determination becomes uncertain as the elements in the plasma return to ionization equilibrium. A general solution for the equilibrium timescale for each element arises from the elegant eigenvector method of solution to the problem of a non-equilibrium plasma described by Masai and Hughes and Helfand. In general, the ionization evolution of an element Z inmore » a constant electron temperature plasma is given by a coupled set of Z + 1 first-order differential equations. However, they can be recast as Z uncoupled first-order differential equations using an eigenvector basis for the system. The solution is then Z separate exponential functions, with the time constants given by the eigenvalues of the rate matrix. The smallest of these eigenvalues gives the scale of the slowest return to equilibrium independent of the initial conditions, while conversely the largest eigenvalue is the scale of the fastest change in the ion population. These results hold for an ionizing plasma, a recombining plasma, or even a plasma with random initial conditions, and will allow users of these diagnostics to determine directly if their best-fit result significantly limits the timescale since a disturbance or is so close to equilibrium as to include an arbitrarily long time.« less

Why seek a second consultation at an emergency centre? A qualitative study

PubMed Central

2017-01-01

Background The inappropriate use of emergency centres (ECs) is an expanding problem globally. The high attendance of non-urgent return presentations to ECs is recognised as part of the problem, placing an unnecessary demand on limited staff and resources. Of unscheduled returns 34% of cases had no change to diagnosis or treatment with the conclusion that 80% of re-attendance could be attributed to deficiencies in the initial consultation. This study aimed to evaluate the reasons why patients sought an early second consultation for the same complaint at a hospital EC in South Africa, by exploring the patient’s experience and shortcomings in the first consultation. Method A qualitative study was conducted using in-depth, semi-structured interviews with 20 purposively selected participants who presented to a rural regional provincial hospital’s EC within 7 days of a prior consultation for the same complaint. Verbatim transcripts were analysed using the framework method. Results The main reasons for a second consultation were symptom related factors and the need for diagnostic certainty. The major themes around patient experience of the initial consultation were shortcomings in effective evaluation and management of pain, diagnostic uncertainty including poor examination, poor explanation, uncertain access and follow-up and societal encouragement to utilise a hospital EC. Conclusion Further interventions should explore pain as a presenting symptom of the illness experience, and promote competence in addressing physical and psychological causative factors within a patient-centred approach for all health staff, especially in primary care services. PMID:28828871

Why seek a second consultation at an emergency centre? A qualitative study.

PubMed

Crafford, Lize; Jenkins, Louis S

2017-07-27

The inappropriate use of emergency centres (ECs) is an expanding problem globally. The high attendance of non-urgent return presentations to ECs is recognised as part of the problem, placing an unnecessary demand on limited staff and resources. Of unscheduled returns 34% of cases had no change to diagnosis or treatment with the conclusion that 80% of re-attendance could be attributed to deficiencies in the initial consultation. This study aimed to evaluate the reasons why patients sought an early second consultation for the same complaint at a hospital EC in South Africa, by exploring the patient's experience and shortcomings in the first consultation. A qualitative study was conducted using in-depth, semi-structured interviews with 20 purposively selected participants who presented to a rural regional provincial hospital's EC within 7 days of a prior consultation for the same complaint. Verbatim transcripts were analysed using the framework method. The main reasons for a second consultation were symptom related factors and the need for diagnostic certainty. The major themes around patient experience of the initial consultation were shortcomings in effective evaluation and management of pain, diagnostic uncertainty including poor examination, poor explanation, uncertain access and follow-up and societal encouragement to utilise a hospital EC. Further interventions should explore pain as a presenting symptom of the illness experience, and promote competence in addressing physical and psychological causative factors within a patient-centred approach for all health staff, especially in primary care services.

On the electromagnetic fields, Poynting vector, and peak power radiated by lightning return strokes

NASA Technical Reports Server (NTRS)

Krider, E. P.

1992-01-01

The initial radiation fields, Poynting vector, and total electromagnetic power that a vertical return stroke radiates into the upper half space have been computed when the speed of the stroke, nu, is a significant fraction of the speed of light, c, assuming that at large distances and early times the source is an infinitesimal dipole. The initial current is also assumed to satisfy the transmission-line model with a constant nu and to be perpendicular to an infinite, perfectly conducting ground. The effect of a large nu is to increase the radiation fields by a factor of (1-beta-sq cos-sq theta) exp -1, where beta = nu/c and theta is measured from the vertical, and the Poynting vector by a factor of (1-beta-sq cos-sq theta) exp -2.

Oral progestin induces rapid, reversible suppression of ovarian activity in the cat

PubMed Central

Stewart, R.A.; Pelican, K.M.; Brown, J.L.; Wildt, D.E.; Ottinger, M.A.; Howard, J.G.

2010-01-01

The influence of oral progestin (altrenogest; ALT) on cat ovarian activity was studied using non-invasive fecal steroid monitoring. Queens were assigned to various ALT dosages: 1) 0 mg/kg (control; n = 5 cats); 2) 0.044 mg/kg (LOW; n = 5); 3) 0.088 mg/kg (MID; n = 6); or 4) 0.352 mg/kg (HIGH; n = 6). Fecal estrogen and progestagen concentrations were quantified using enzyme immunoassays for 60 days before, 38 days during and 60 days after ALT treatment. Initiation of follicular activity was suppressed in all cats during progestin treatment, whereas controls continued to cycle normally. Females (n = 6) with elevated fecal estrogens at treatment onset completed a normal follicular phase before returning to baseline and remained suppressed until treatment withdrawal. All cats receiving oral progestin reinitiated follicular activity after treatment, although MID cats experienced the most synchronized return (within 10-16 days). Mean baseline fecal estrogens and progestagens were higher (P < 0.05) after treatment in HIGH, but not LOW or MID cats compared to pre-treatment values. Results demonstrate that: 1) oral progestin rapidly suppresses initiation of follicular activity in the cat, but does not influence a follicular phase that exists before treatment initiation; and 2) queens return to normal follicular activity after progestin withdrawal. This study provides foundational information for research aimed at using progestin priming to improve ovarian response in felids scheduled for ovulation induction and assisted breeding. PMID:20051246

Return to work of breast cancer survivors: a systematic review of intervention studies

PubMed Central

2009-01-01

Background Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work. Methods The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included. Results Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group. Conclusion The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated. PMID:19383123

Converting baker's waste into alcohol. Revised final progress report

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

Halsey, R.; Wilson, P.B.

All types of baker's waste (including waste from candy manufacturers) can be converted into alcohol to be used as a fuel. All types of waste at any stage in process can be converted, such as: basic ingredients (including floor sweepings); dry mixes (including floor sweepings); dough at any stage; partially or fully cooked products; and day old returned products. The basic steps are the same, only the initial preparation will vary slightly. The variation will be: amount of water to be added and amount and type of nutrients (if any) to be added. The basic steps are: slurrying, liquefying tomore » put starch into liquid state, saccharifying to convert starch into fermentable sugars, fermentation to convert sugars into alcohol, and distillation to separate the alcohol from the mash. Each step is discussed in detail along with problems that may arise. Directions are given and materials (enzymes, yeast, etc.) and equipment are descibed briefly.« less

Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge.

PubMed

Rodehaver, Claire; Fearing, Deb

2005-07-01

Several factors contribute to the potential for patient confusion regarding his or her medication regimen, including multiple names for a single drug and formulary variations when the patient receives medications from more than one pharmacy. A 68-year-old woman was discharged from the hospital on a HMG-CoA reductase inhibitor (statin) and resumed her home statin. Eleven days later she returned to the hospital with a diagnosis of severe rhabdomyolysis due to statin overdose. IMPLEMENTING SOLUTIONS: Miami Valley Hospital, Dayton, Ohio, implemented a reconciliation process and order form at admission and discharge to reduce the likelihood that this miscommunication would recur. Initial efforts were trialed on a 44-bed orthopedic unit, with spread of the initiative to the cardiac units and finally to the remaining 22 nursing units. The team successfully implemented initiation of the order sheet, yet audits indicated the need for improvement in reconciling the medications within 24 hours of admission and in reconciling the home medications at the point of discharge. Successful implementation of the order sheet to drive reconciliation takes communication, perseverance, and a multidisciplinary team approach.

Microgravity Testing of a Surface Sampling System for Sample Return from Small Solar System Bodies

NASA Technical Reports Server (NTRS)

Franzen, M. A.; Preble, J.; Schoenoff, M.; Halona, K.; Long, T. E.; Park, T.; Sears, D. W. G.

2004-01-01

The return of samples from solar system bodies is becoming an essential element of solar system exploration. The recent National Research Council Solar System Exploration Decadal Survey identified six sample return missions as high priority missions: South-Aitken Basin Sample Return, Comet Surface Sample Return, Comet Surface Sample Return-sample from selected surface sites, Asteroid Lander/Rover/Sample Return, Comet Nucleus Sample Return-cold samples from depth, and Mars Sample Return [1] and the NASA Roadmap also includes sample return missions [2] . Sample collection methods that have been flown on robotic spacecraft to date return subgram quantities, but many scientific issues (like bulk composition, particle size distributions, petrology, chronology) require tens to hundreds of grams of sample. Many complex sample collection devices have been proposed, however, small robotic missions require simplicity. We present here the results of experiments done with a simple but innovative collection system for sample return from small solar system bodies.

Return to Sport After Rotator Cuff Tear Repair: A Systematic Review and Meta-analysis.

PubMed

Klouche, Shahnaz; Lefevre, Nicolas; Herman, Serge; Gerometta, Antoine; Bohu, Yoann

2016-07-01

One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play. The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears. Meta-analysis and systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level). Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play. Most recreational athletes return to sports at the same level of play as before their injury, but only half of professional and competitive athletes return to an equivalent level of play. © 2015 The Author(s).

Repeat neuroimaging of mild traumatic brain-injured patients with acute traumatic intracranial hemorrhage: clinical outcomes and radiographic features.

PubMed

Kreitzer, Natalie; Lyons, Michael S; Hart, Kim; Lindsell, Cristopher J; Chung, Sora; Yick, Andrew; Bonomo, Jordan

2014-10-01

Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging. This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS < 14, injury > 24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs). Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED within 1 week. Of the 92 who were hospitalized, three (0.9%, 95% CI = 0.2% to 2.7%) required neurosurgical intervention. Discharge after a repeat head CT and brief period of observation in the ED allowed early discharge of a cohort of mild TBI patients with traumatic ICH without delayed adverse outcomes. Whether this justifies the cost and radiation exposure involved with this pattern of practice requires further study. © 2014 by the Society for Academic Emergency Medicine.

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

PubMed Central

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton

2016-01-01

Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Design Prospective observational cohort study. Setting Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Participants Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Intervention Epinephrine given within two minutes after the first defibrillation. Main outcome measures Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were “at risk” of receiving epinephrine within the same minute but who did not receive it. Results 2978patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001). Conclusion Half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome. PMID:27053638

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

PubMed

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W

2016-04-06

To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001). Half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Return-to-Work Program for Injured Workers: Factors of Successful Return to Employment.

PubMed

Awang, Halimah; Shahabudin, Sharifah Muhairah; Mansor, Norma

2016-11-01

This study examined the factors of successful return to employment among participants in the return to work program (RTW) following work-related injury. Data were obtained from the Social Security Organization database containing 9850 injured workers who underwent RTW in 2010 to 2013. About 65% had successfully returned to employment. Significant factors of successful return include gender, employer interest, motivation, age, intervention duration, and type of injury. Male and motivated employees were more likely to return to employment compared with female and unmotivated employees, respectively. Participants from interested employers were 23.22 times more likely to return to work than those from uninterested employers, whereas participants whose intervention period exceeded 5 months were 41% less likely to return to work compared with those whose intervention period was within 3 months. Appropriate strategy and enhanced collaboration between the stakeholders would improve the proportion of successful return to employment. © 2016 APJPH.

[Crisis unit at the general hospital: Determinants of further hospitalization].

PubMed

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of hospitalization were the presence of a personality disorder (OR=0.31), a precipitating conflict situation (OR=0.41), age between 20 and 39 years (OR=0.42), being employed (OR=0.49). Our study confirms that clinical factors such as the presence of a personality disorder or the context of a precipitating conflict situation are predictive of a community return. Interestingly, it points out the importance of the patient's initial wish in the hospitalization decision. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

SGLT2 inhibitors and renal outcomes in type 2 diabetes with or without renal impairment: A systematic review and meta-analysis.

PubMed

Seidu, Samuel; Kunutsor, Setor K; Cos, Xavier; Gillani, Syed; Khunti, Kamlesh

2018-06-01

Sodium-glucose co-transporter 2 (SGLT2) inhibitors may have renal protective effects in people with impaired kidney function. We assessed the use of SGLT2 inhibitors in people with type 2 diabetes with or without renal impairment [defined as estimated glomerular filtration rate (eGFR) of ≥30 and <60ml/min/1.73m 2 and/or UACR>300 and ≤5000mg/g] by conducting a systematic review and meta-analysis of available studies. Randomised controlled trials (RCTs) were identified from MEDLINE, EMABASE, Web of Science, the Cochrane Library, and search of bibliographies to March 2017. No relevant observational study was identified. Summary measures were presented as mean differences and narrative synthesis performed for studies that could not be pooled. 42 articles which included 40 RCTs comprising 29,954 patients were included. In populations with renal impairment, SGLT2 inhibition compared with placebo was consistently associated with an initial decrease in eGFR followed by an increase and return to baseline levels. In pooled analysis of 17 studies in populations without renal impairment, there was no significant change in eGFR comparing SGLT2 inhibitors with placebo (mean difference, 0.51ml/min/1.73m 2 ; 95% CI: -0.69, 1.72; p=403). SGLT2 inhibition relative to placebo was associated with preservation in serum creatinine levels or initial increases followed by return to baseline levels in patients with renal impairment, but levels were preserved in patients without renal impairment. In populations with or without renal impairment, SGLT2 inhibitors (particularly canagliflozin and empagliflozin) compared with placebo were associated with decreased urine albumin, improved albuminiuria, slowed progression to macroalbuminuria, and reduced the risk of worsening renal impairment, the initiation of kidney transplant, and death from renal disease. Emerging data suggests that with SGLT2 inhibition, renal function seems to be preserved in people with diabetes with or without renal impairment. Furthermore, SGLT2 inhibition prevents further renal function deterioration and death from kidney disease in these patients. Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Meta-analysis: accuracy of rapid tests for malaria in travelers returning from endemic areas.

PubMed

Marx, Arthur; Pewsner, Daniel; Egger, Matthias; Nüesch, Reto; Bucher, Heiner C; Genton, Blaise; Hatz, Christoph; Jüni, Peter

2005-05-17

Microscopic diagnosis of malaria is unreliable outside specialized centers. Rapid tests have become available in recent years, but their accuracy has not been assessed systematically. To determine the accuracy of rapid diagnostic tests for ruling out malaria in nonimmune travelers returning from malaria-endemic areas. The authors searched MEDLINE, EMBASE, CAB Health, and CINAHL (1988 to September 2004); hand-searched conference proceedings; checked reference lists; and contacted experts and manufacturers. Diagnostic accuracy studies in nonimmune individuals with suspected malaria were included if they compared rapid tests with expert microscopic examination or polymerase chain reaction tests. Data on study and patient characteristics and results were extracted in duplicate. The main outcome was the likelihood ratio for a negative test result (negative likelihood ratio) for Plasmodium falciparum malaria. Likelihood ratios were combined by using random-effects meta-analysis, stratified by the antigen targeted (histidine-rich protein-2 [HRP-2] or parasite lactate dehydrogenase [LDH]) and by test generation. Nomograms of post-test probabilities were constructed. The authors included 21 studies and 5747 individuals. For P. falciparum, HRP-2-based tests were more accurate than parasite LDH-based tests: Negative likelihood ratios were 0.08 and 0.13, respectively (P = 0.019 for difference). Three-band HRP-2 tests had similar negative likelihood ratios but higher positive likelihood ratios compared with 2-band tests (34.7 vs. 98.5; P = 0.003). For P. vivax, negative likelihood ratios tended to be closer to 1.0 for HRP-2-based tests than for parasite LDH-based tests (0.24 vs. 0.13; P = 0.22), but analyses were based on a few heterogeneous studies. Negative likelihood ratios for the diagnosis of P. malariae or P. ovale were close to 1.0 for both types of tests. In febrile travelers returning from sub-Saharan Africa, the typical probability of P. falciparum malaria is estimated at 1.1% (95% CI, 0.6% to 1.9%) after a negative 3-band HRP-2 test result and 97% (CI, 92% to 99%) after a positive test result. Few studies evaluated 3-band HRP-2 tests. The evidence is also limited for species other than P. falciparum because of the few available studies and their more heterogeneous results. Further studies are needed to determine whether the use of rapid diagnostic tests improves outcomes in returning travelers with suspected malaria. Rapid malaria tests may be a useful diagnostic adjunct to microscopy in centers without major expertise in tropical medicine. Initial decisions on treatment initiation and choice of antimalarial drugs can be based on travel history and post-test probabilities after rapid testing. Expert microscopy is still required for species identification and confirmation.

Impacts of Return-to-Work Type and Period on Job Retention in Workers with Occupational Injuries and Diseases

PubMed Central

2017-01-01

Background Despite the necessity of job retention in achieving return-to-work (RTW) goals, many workers leave their jobs after returning to work. The objective of this study was to examine the impacts of RTW type and period on job retention in Korean workers with occupational injuries and diseases. Methods Data were derived from the Panel Study of Worker's Compensation Insurance, including data from 2,000 systemically sampled workers who had finished recuperation in 2012; three waves of survey data were included in the analyses. Workers who returned to work (n = 1,610) were included in the analysis of the relationship between RTW type and job retention, and 664 workers who returned to their original workplaces were included in the analysis of the relationship between RTW period and job retention. The participants completed a questionnaire, and administrative data were provided by workers' compensation insurance. Results A Cox proportional-hazards regression analysis showed an increased hazard ratio (HR) for non-retention of 2.66 (95% confidence interval, 2.11–3.35) in reemployed workers compared to that in workers returning to their original workplaces. Among workers returning to their original workplaces, HRs for non-retention were increased in workers with a RTW period of 13–24 months (3.03 [1.52–6.04]) and > 24 months (5.33 [2.14–13.25]) compared to workers with a RTW period of ≤ 3 months. Conclusion RTW type and period were significantly related to job retention, suggesting that policies for promoting job retention rate should be implemented. PMID:29215811

Impacts of Return-to-Work Type and Period on Job Retention in Workers with Occupational Injuries and Diseases.

PubMed

Jeong, Inchul; Park, Jae Bum; Kim, Hyoung Ryoul; Yoon, Jin Ha; Won, Jong Uk; Roh, Jaehoon

2018-01-01

Despite the necessity of job retention in achieving return-to-work (RTW) goals, many workers leave their jobs after returning to work. The objective of this study was to examine the impacts of RTW type and period on job retention in Korean workers with occupational injuries and diseases. Data were derived from the Panel Study of Worker's Compensation Insurance, including data from 2,000 systemically sampled workers who had finished recuperation in 2012; three waves of survey data were included in the analyses. Workers who returned to work (n = 1,610) were included in the analysis of the relationship between RTW type and job retention, and 664 workers who returned to their original workplaces were included in the analysis of the relationship between RTW period and job retention. The participants completed a questionnaire, and administrative data were provided by workers' compensation insurance. A Cox proportional-hazards regression analysis showed an increased hazard ratio (HR) for non-retention of 2.66 (95% confidence interval, 2.11-3.35) in reemployed workers compared to that in workers returning to their original workplaces. Among workers returning to their original workplaces, HRs for non-retention were increased in workers with a RTW period of 13-24 months (3.03 [1.52-6.04]) and > 24 months (5.33 [2.14-13.25]) compared to workers with a RTW period of ≤ 3 months. RTW type and period were significantly related to job retention, suggesting that policies for promoting job retention rate should be implemented. © 2018 The Korean Academy of Medical Sciences.

26 CFR 301.6103(a)-1 - Disclosures after December 31, 1976, by officers and employees of Federal agencies of returns and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Disclosures after December 31, 1976, by officers and employees of Federal agencies of returns and return information (including taxpayer return information) disclosed to such officers and employees by the Internal Revenue Service before January 1, 1977, for a purpose not involving tax...

The Federal Government's Deinstitutionalization Program Initiatives: A Status Report (A Litany of Reports, Studies, Recommendations, Policy Debates, and Even Some Progress).

ERIC Educational Resources Information Center

Ross, E. Clarke

1979-01-01

Analysis of six federal government studies on deinstitutionalization is followed by a discussion of initiatives enacted by the 95th Congress and proposals under consideration in the 96th. Among studies described are reports by the U.S. Government Accounting Office ("Returning the Mentally Disabled to the Community: Government Needs to Do…

The Installation Funding Dilemma

DTIC Science & Technology

2008-04-04

role in supporting the Army’s plans for supporting base realignment and closure (BRAC) requirements, global defense posture realignment ( GDPR ...relation to their affect on installation management funding. First, the initiative known as the GDPR will return many units to the United States from...three initiatives ( GDPR , BRAC and Modularity) and certain other restationing moves, the Army expects a net gain of about 154,000 personnel at its domestic

Superfund Redevelopment Initiative

EPA Pesticide Factsheets

Provides information at the national level to ensure that at every Superfund site, EPA and its partners have an effective process and the necessary tools and information needed to return the country’s most hazardous sites to productive use.

Return to sport following tibial plateau fractures: A systematic review

PubMed Central

Robertson, Greg A J; Wong, Seng J; Wood, Alexander M

2017-01-01

AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods. METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords “tibial”, “plateau”, “fractures”, “knee”, “athletes”, “sports”, “non-operative”, “conservative”, “operative”, “return to sport”. All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded “return to sport” rates. Only one study recorded a “return to sport” time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF. CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation. PMID:28808629

Return to Sport After Shoulder Arthroplasty in Recreational Athletes: A Systematic Review and Meta-analysis.

PubMed

Aim, Florence; Werthel, Jean-David; Deranlot, Julien; Vigan, Marie; Nourissat, Geoffroy

2018-04-01

One of the most frequent demands from patients after shoulder replacement surgery is to return to sport. To determine the rate of return to sport after shoulder arthroplasty (total shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty) in recreational athletes. Meta-analysis and systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating return to sport after shoulder replacement surgery and on patients practicing a sport regularly, whatever the level, with all ages and sports included. The main criterion was the rate of patients who returned to a sport activity. Nine studies were selected among the 35 identified, including a total of 613 patients (39% male and 61% female) with a mean age of 71.7 years (range, 22.6-92.6 years). All the included patients practiced sports before surgery. The most common reported sports were golf (n = 140), swimming (n = 128), and tennis (n = 54). The mean rate of return to sport was 80.7% (range, 57.1%-97.3%). All patients who returned to sport were practicing in the 3 months before surgery. No radiological data were reported in the literature. The subgroup analysis for resuming golf after shoulder arthroplasty revealed a rate of return to sport of 79.2% (95% CI, 62.9%-89.5%). In the swimming subgroup, the rate was 75.6% (95% CI, 61.3%-85.8%) and in the tennis subgroup was 63.5% (95% CI, 34.1%-85.5%). The subgroup analysis for reverse shoulder arthroplasty reported a lower rate of return to sport than for all types of shoulder arthroplasty combined: 76.5% (95% CI, 60%-87%) versus 80.7% (95% CI, 70.9%-87.8%), respectively. Most patients returned to sport after surgery, and all who returned to sport were practicing their sport in the 3 months before surgery. No radiological data were reported in the literature.

Multiple Smaller Missions as a Direct Pathway to Mars Sample Return

NASA Technical Reports Server (NTRS)

Niles, P. B.; Draper, D. S.; Evans, C. A.; Gibson, E. K.; Graham, L. D.; Jones, J. H.; Lederer, S. M.; Ming, D.; Seaman, C. H.; Archer, P. D.;

The development of a flash flood severity index

NASA Astrophysics Data System (ADS)

Schroeder, Amanda J.; Gourley, Jonathan J.; Hardy, Jill; Henderson, Jen J.; Parhi, Pradipta; Rahmani, Vahid; Reed, Kimberly A.; Schumacher, Russ S.; Smith, Brianne K.; Taraldsen, Matthew J.

2016-10-01

Flash flooding is a high impact weather event that requires clear communication regarding severity and potential hazards among forecasters, researchers, emergency managers, and the general public. Current standards used to communicate these characteristics include return periods and the United States (U.S.) National Weather Service (NWS) 4-tiered river flooding severity scale. Return periods are largely misunderstood, and the NWS scale is limited to flooding on gauged streams and rivers, often leaving out heavily populated urban corridors. To address these shortcomings, a student-led group of interdisciplinary researchers came together in a collaborative effort to develop an impact-based Flash Flood Severity Index (FFSI). The index was proposed as a damage-based, post-event assessment tool, and preliminary work toward the creation of this index has been completed and presented here. Numerous case studies were analyzed to develop the preliminary outline for the FFSI, and three examples of such cases are included in this paper. The scale includes five impact-based categories ranging from Category 1 very minor flooding to Category 5 catastrophic flooding. Along with the numerous case studies used to develop the initial outline of the scale, empirical data in the form of semi-structured interviews were conducted with multiple NWS forecasters across the country and their responses were analyzed to gain more perspective on the complicated nature of flash flood definitions and which tools were found to be most useful. The feedback from these interviews suggests the potential for acceptance of such an index if it can account for specific challenges.

Integrated Network Architecture for NASA's Orion Missions

NASA Technical Reports Server (NTRS)

Bhasin, Kul B.; Hayden, Jeffrey L.; Sartwell, Thomas; Miller, Ronald A.; Hudiburg, John J.

2008-01-01

NASA is planning a series of short and long duration human and robotic missions to explore the Moon and then Mars. The series of missions will begin with a new crew exploration vehicle (called Orion) that will initially provide crew exchange and cargo supply support to the International Space Station (ISS) and then become a human conveyance for travel to the Moon. The Orion vehicle will be mounted atop the Ares I launch vehicle for a series of pre-launch tests and then launched and inserted into low Earth orbit (LEO) for crew exchange missions to the ISS. The Orion and Ares I comprise the initial vehicles in the Constellation system of systems that later includes Ares V, Earth departure stage, lunar lander, and other lunar surface systems for the lunar exploration missions. These key systems will enable the lunar surface exploration missions to be initiated in 2018. The complexity of the Constellation system of systems and missions will require a communication and navigation infrastructure to provide low and high rate forward and return communication services, tracking services, and ground network services. The infrastructure must provide robust, reliable, safe, sustainable, and autonomous operations at minimum cost while maximizing the exploration capabilities and science return. The infrastructure will be based on a network of networks architecture that will integrate NASA legacy communication, modified elements, and navigation systems. New networks will be added to extend communication, navigation, and timing services for the Moon missions. Internet protocol (IP) and network management systems within the networks will enable interoperability throughout the Constellation system of systems. An integrated network architecture has developed based on the emerging Constellation requirements for Orion missions. The architecture, as presented in this paper, addresses the early Orion missions to the ISS with communication, navigation, and network services over five phases of a mission: pre-launch, launch from T0 to T+6.5 min, launch from T+6.5 min to 12 min, in LEO for rendezvous and docking with ISS, and return to Earth. The network of networks that supports the mission during each of these phases and the concepts of operations during those phases are developed as a high level operational concepts graphic called OV-1, an architecture diagram type described in the Department of Defense Architecture Framework (DoDAF). Additional operational views on organizational relationships (OV-4), operational activities (OV-5), and operational node connectivity (OV-2) are also discussed. The system interfaces view (SV-1) that provides the communication and navigation services to Orion is also included and described. The challenges of architecting integrated network architecture for the NASA Orion missions are highlighted.

The propagation speed of a positive lightning return stroke

NASA Technical Reports Server (NTRS)

Idone, Vincent P.; Orville, Richard E.; Mach, Douglas M.; Rust, W. David

1987-01-01

The first direct determination of the propagation speed of a lightning return stroke lowering positive charge to ground has been made. This stroke was the third of eight otherwise negative strokes in a triggered lightning flash initiated at the Kennedy Space Center, FL. Two independent optical systems, one photographic and the other photoelectric, yielded common recordings for the third and fourth strokes; the respective two-dimensional return stroke propagation speeds were 1.0 vs 0.93 x 10 to the 8th m/s for the positive (third) stroke and 1.0 vs 1.0 x 10 to the 8th m/s for the fourth stroke. Using fast electric-field data, the positive stroke peak current was estimated to be 21 kA. Photoelectric data only yielded propagation speeds of 1.4, 1.6, 1.2, 1.3, 1.0 and 0.90 x 10 to the 8th m/s for the first, second and fifth through eighth return strokes, respectively.

Recovery of short-term memory and psychomotor speed but not postural stability with long-term sobriety in alcoholic women.

PubMed

Rosenbloom, Margaret J; Pfefferbaum, Adolf; Sullivan, Edith V

2004-07-01

The authors assessed effects of extended abstinence on cognitive and motor function deficits previously observed in a group of alcoholic women (n = 43) initially tested after 15 weeks of sobriety. Alcoholic women were retested 1 and 4 years later, and control women were retested 3 years later. At Year 1, 14 of 23 returners had maintained sobriety, but they did not perform significantly better than relapsers; the group as a whole continued to show deficits relative to age norms. By Year 4, 13 of 14 returners had maintained sobriety for more than 30 months; as a group, these women had returned to normal levels on tests of memory and psychomotor speed but remained impaired in standing balance.

A spreadsheet template compatible with Microsoft Excel and iWork Numbers that returns the simultaneous confidence intervals for all pairwise differences between multiple sample means.

PubMed

Brown, Angus M

2010-04-01

The objective of the method described in this paper is to develop a spreadsheet template for the purpose of comparing multiple sample means. An initial analysis of variance (ANOVA) test on the data returns F--the test statistic. If F is larger than the critical F value drawn from the F distribution at the appropriate degrees of freedom, convention dictates rejection of the null hypothesis and allows subsequent multiple comparison testing to determine where the inequalities between the sample means lie. A variety of multiple comparison methods are described that return the 95% confidence intervals for differences between means using an inclusive pairwise comparison of the sample means. 2009 Elsevier Ireland Ltd. All rights reserved.

Neutron Activation Analysis of Single Grains Recovered by the Hayabusa Spacecraft

NASA Technical Reports Server (NTRS)

Ebihara, M.; Sekimoto, S.; Hamajima, Y.; Yamamoto, M.; Kumagai, K.; Oura, Y.; Shirai, N.; Ireland. T. R.; Kitajima, F.; Nagao, K.;

A NOVEL APPROACH TO TREATMENT FOR CHRONIC AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY IN THREE ADOLESCENT ATHLETES: A CASE SERIES

PubMed Central

Nilsson, Kurt J.

2014-01-01

Background and Incidence: Ischial tuberosity fracture and its associated complications are an under recognized diagnosis in the adolescent athlete. Apophyseal injuries of the pelvis in the skeletally immature athlete can occur in multiple locations but are most common at the ischial tuberosity, affecting males more commonly than females. Description of Injury and Current Management: The most common cause of ischial tuberosity avulsion fracture is a quick eccentric load to the proximal hamstrings, occurring with kicking as in soccer, football, or dance. Signs and symptoms are similar to a proximal hamstring injury but avulsion injuries often go undiagnosed, as radiographs are not frequently obtained. In acute cases, rest and relative immobilization are the recommended course of care. In chronic cases, including those with delayed diagnosis, or those that remain symptomatic after initial care due to non‐union or associated sciatic nerve adhesions, surgery is often performed in order to restore normal anatomy, alleviate symptoms, and help return the athlete to full activity. Purpose: The authors' share a novel treatment approach consisting of ultrasound guided percutaneous needle fenestration for the treatment of three adolescent athletes with symptomatic delayed diagnoses of ischial tuberosity fractures. Needle fenestration was followed by a physical therapy progression which was developed based on tissue healing rates, symptom presentation, and the available literature related to proximal hamstring injuries. Outcomes: Two athletes reported elimination of pain, full functional recovery and return to sport without limitations as measured by use of the Numeric Pain Rating Scale, the Global Rating of Change Scale, and the Lower Extremity Functional Scale. One athlete reported elimination of pain and full functional recovery and chose to return to a new sport. Symptoms of possible concurrent hamstring syndrome are discussed as well the management of this condition. Discussion/Conclusions: This case series introduced a novel approach for treatment of symptomatic delayed union ischial tuberosity fractures in three adolescents prior to consideration of surgical intervention. Percutanous needle fenestration and the described subsequent rehabilitation provided positive treatment outcomes in the presented cases, including full return to athletic and recreational endeavors. Level of Evidence: Level 5 PMID:25540712

Early development and the point of no return in pikeperch ( Sander lucioperca L.) larvae

NASA Astrophysics Data System (ADS)

Xu, Zhengchao; Li, Caijuan; Ling, Qufei; Gaughan, Sarah; Wang, Guocheng; Han, Xiaofei

2017-11-01

The objectives of the present study were to evaluate the yolk-sac and oil globule absorption and point of no return (PNR) of pikeperch ( Sander lucioperca L.) larvae. Artificial propagation of pikeperch was performed at (15±2)°C. Yolk-sac absorption, oil globule absorption, larval growth and the first initial feeding rate were observed to analyze the early growth and to determine the PNR of pikeperch larvae. The total length of newly hatched (0 day after hatching, DAH) pikeperch larvae was (4.25±0.22) mm and the volume of the yolk-sac and the oil globule was (0.30±0.12) mm3 and (5.14±2.28) 10-2 mm3 respectively. The yolk-sac and the oil globule were exhausted at 11 DAH and 14 DAH, respectively. Pikeperch larvae began feeding at 8 DAH with an initial feeding rate about 10.0%. From 9 to 14 DAH, the initial feeding rate increased rapidly, and reached its highest (about 82.7%) at 14 DAH. It declined thereafter, 48.9% at 15 DAH and 35.6% at 16 DAH, thus the pikeperch larvae reached PNR by 15-16 DAH. The appropriate first feeding time for the pikeperch larvae is 11-12 DAH, when the initial feeding rate is higher than half of the maximum initial feeding rate.

26 CFR 1.482-5 - Comparable profits method.

Code of Federal Regulations, 2010 CFR

2010-04-01

... operating profit represents a return for the investment of resources and assumption of risks. Therefore... from a sufficient number of years of data to reasonably measure returns that accrue to uncontrolled... party and uncontrolled comparables include the following— (i) Rate of return on capital employed. The...

47 CFR 54.301 - Local switching support.

Code of Federal Regulations, 2010 CFR

2010-10-01

... requirement by summing the components listed in this paragraph. (1) Return on Investment attributable to COE... investment by the authorized interstate rate of return. Projected unseparated local switching net investment... paragraph (c) of this section: [Return on Investment attributable to COE Category 3—Included in Account 7300...

Modeling the distribution of extreme share return in Malaysia using Generalized Extreme Value (GEV) distribution

NASA Astrophysics Data System (ADS)

Hasan, Husna; Radi, Noor Fadhilah Ahmad; Kassim, Suraiya

2012-05-01

Extreme share return in Malaysia is studied. The monthly, quarterly, half yearly and yearly maximum returns are fitted to the Generalized Extreme Value (GEV) distribution. The Augmented Dickey Fuller (ADF) and Phillips Perron (PP) tests are performed to test for stationarity, while Mann-Kendall (MK) test is for the presence of monotonic trend. Maximum Likelihood Estimation (MLE) is used to estimate the parameter while L-moments estimate (LMOM) is used to initialize the MLE optimization routine for the stationary model. Likelihood ratio test is performed to determine the best model. Sherman's goodness of fit test is used to assess the quality of convergence of the GEV distribution by these monthly, quarterly, half yearly and yearly maximum. Returns levels are then estimated for prediction and planning purposes. The results show all maximum returns for all selection periods are stationary. The Mann-Kendall test indicates the existence of trend. Thus, we ought to model for non-stationary model too. Model 2, where the location parameter is increasing with time is the best for all selection intervals. Sherman's goodness of fit test shows that monthly, quarterly, half yearly and yearly maximum converge to the GEV distribution. From the results, it seems reasonable to conclude that yearly maximum is better for the convergence to the GEV distribution especially if longer records are available. Return level estimates, which is the return level (in this study return amount) that is expected to be exceeded, an average, once every t time periods starts to appear in the confidence interval of T = 50 for quarterly, half yearly and yearly maximum.

Ballistic intercept missions to Comet Encke

NASA Technical Reports Server (NTRS)

Mumma, M. (Compiler)

1975-01-01

The optimum ballistic intercept of a spacecraft with the comet Encke is determined. The following factors are considered in the analysis: energy requirements, encounter conditions, targeting error, comet activity, spacecraft engineering requirements and restraints, communications, and scientific return of the mission. A baseline model is formulated which includes the basic elements necessary to estimate the scientific return for the different missions considered. Tradeoffs which have major impact on the cost and/or scientific return of a ballistic mission to comet Encke are identified and discussed. Recommendations are included.

Circumlunar Free-Return Cycler Orbits for a Manned Earth-Moon Space Station

NASA Technical Reports Server (NTRS)

Genova, Anthony L.; Aldrin, Buzz

2015-01-01

Multiple free-return circumlunar cycler orbits were designed to allow regular travel between the Earth and Moon by a manned space station. The presented cycler orbits contain circumlunar free-return "figure-8" segments and yield lunar encounters every month. Smaller space "taxi" vehicles can rendezvous with (and depart from) the cycling Earth-Moon space station to enter lunar orbit (and/or land on the lunar surface), return to Earth, or reach destinations including Earth-Moon L1 and L2 halo orbits, near-Earth objects (NEOs), Venus, and Mars. To assess the practicality of the selected orbits, relevant cycler characteristics (including (Delta)V maintenance requirements) are presented and compared.

Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures.

PubMed

Lentz, Trevor A; Zeppieri, Giorgio; Tillman, Susan M; Indelicato, Peter A; Moser, Michael W; George, Steven Z; Chmielewski, Terese L

2012-11-01

Cross-sectional cohort. (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. Ninety-four patients (60 men; mean age, 22.4 years) 1 year post-anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into "yes return to sports" or "no return to sports" groups based on their answer to the question, "Have you returned to the same level of sports as before your injury?" Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-characteristic curves determined the discriminatory accuracy of the identified clinical variables. Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee joint effusion, episodes of knee instability, and score on the International Knee Documentation Committee Subjective Knee Evaluation Form were identified as the factors most strongly associated with self-reported return-to-sport status. The highest positive likelihood ratio for the yes-return-to-sports group classification (14.54) was achieved when patients met all of the following criteria: no knee effusion, no episodes of instability, and International Knee Documentation Committee Subjective Knee Evaluation Form score greater than 93. In multivariate analysis, the factors most strongly associated with return-to-sport status included only self-reported knee function, episodes of knee instability, and knee joint effusion.

Implementation of a post-cardiac arrest care bundle including therapeutic hypothermia and hemodynamic optimization in comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a feasibility study.

PubMed

Walters, Elizabeth Lea; Morawski, Kyle; Dorotta, Ihab; Ramsingh, Davinder; Lumen, Kelly; Bland, David; Clem, Kathleen; Nguyen, H Bryant

2011-04-01

Patients who present to the emergency department (ED) with return of spontaneous circulation after cardiac arrest generally have poor outcomes. Guidelines for treatment can be complicated and difficult to implement. This study examined the feasibility of implementing a care bundle including therapeutic hypothermia (TH) and early hemodynamic optimization for comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest. The study included patients over a 2-year period in the ED and intensive care unit of an academic tertiary-care medical center. The first year (prebundle) provided a historical control, followed by a prospective observational period of bundle implementation during the second year. The bundle elements included (a) TH initiated; (b) central venous pressure/central venous oxygen saturation monitoring in 2 h; (c) target temperature in 4 h; (d) central venous pressure greater than 12 mmHg in 6 h; (e) MAP greater than 65 mmHg in 6 h; (f) central venous oxygen saturation greater than 70% in 6 h; (g) TH maintained for 24 h; and (h) decreasing lactate in 24 h. Fifty-five patients were enrolled, 26 patients in the prebundle phase and 29 patients in the bundle phase. Seventy-seven percent of bundle elements were completed during the bundle phase. In-hospital mortality in bundle compared with prebundle patients was 55.2% vs. 69.2% (P = 0.29). In the bundle patients, those patients who received all elements of the care bundle had mortality 33.3% compared with 60.9% in those receiving some of the bundle elements (P = 0.22). Bundle patients tended to achieve good neurologic outcome compared with prebundle patients, Cerebral Performance Category 1 or 2 in 31 vs. 12% patients, respectively (P = 0.08). Our study demonstrated that a post-cardiac arrest care bundle that incorporates TH and early hemodynamic optimization can be implemented in the ED and intensive care unit collaboratively and can achieve similar clinical benefits compared with those observed in previous clinical trials.

NASA CEV Reference Entry GN&C System and Analysis

NASA Technical Reports Server (NTRS)

Munday, S.; Madsen, C.; Broome, J.; Gay, R.; Tigges, M.; Strahan, A.

2007-01-01

As part of its overall objectives, the Orion spacecraft will be required to perform entry and Earth landing functions for Low Earth Orbit (LEO) and Lunar missions. Both of these entry scenarios will begin with separation of the Service Module (SM), making them unique from other Orion mission phases in that only the Command Module (CM) portion of the Crew Exploration Vehicle (CEV) will be involved, requiring a CM specific Guidance, Navigation and Control (GN&C) system. Also common to these mission scenarios will be the need for GN&C to safely return crew (or cargo) to earth within the dynamic thermal and structural constraints of entry and within acceptable accelerations on the crew, utilizing the limited aerodynamic performance of the CM capsule. The lunar return mission could additionally require an initial atmospheric entry designed to support a precision skip and second entry, all to maximize downrange performance and ensure landing in the United States. This paper describes the Entry GN&C reference design, developed by the NASA-led team, that supports these entry scenarios and that was used to validate the Orion System requirements. Description of the reference design will include an overview of the GN&C functions, avionics, and effectors and will relate these to the specific design drivers of the entry scenarios, as well as the desire for commonality in vehicle systems to support the different missions. The discussion will also include the requirement for an Emergency Entry capability beyond that of the nominal performance of the multi-string GNC system, intended to return the crew to the earth in a survivable but unguided manner. Finally, various analyses will be discussed, including those completed to support validation efforts of the current CEV requirements, along with those on-going and planned with the intention to further refine the requirements and to support design development work in conjunction with the prime contractor. Some of these ongoing analyses will include work to size effectors (jets) and fuel budgets, to refine skip entry concepts, to characterize navigation performance and uncertainties, to provide for SM disposal offshore and to identify requirements to support target site selection.

Mars Sample Return Using Commercial Capabilities: ERV Trajectory and Capture Requirements

NASA Technical Reports Server (NTRS)

Faber, Nicolas F.; Foster, Cyrus James; Wilson, David; Gonzales, Andrew; Stoker, Carol R.

2013-01-01

Mars Sample Return was presented as the highest priority planetary science mission of the next decade [1]. Lemke et al. [2] present a Mars Sample Return mission concept in which the sample is returned directly from the surface of Mars to an Earth orbit. The sample is recovered in Earth Orbit instead of being transferred between spacecraft in Mars Orbit. This paper provides the details of this sample recovery in Earth orbit and presents as such a sub-element of the overall Mars sample return concept given in [2]. We start from the assumption that a Mars Ascent Vehicle (MAV), initially landed on Mars using a modified SpaceX Dragon capsule, has successfully delivered the sample, already contained within an Earth Return Vehicle (ERV), to a parking orbit around Mars. From the parking orbit, the ERV imparts sufficient Delta-V to inject itself into an earthbound trajectory and to be captured into an Earth orbit eventually. We take into account launch window and Delta-V considerations as well as the additional constraint of increased safety margins imposed by planetary protection regulations. We focus on how to overcome two distinct challenges of the sample return that are driven by the issues of planetary protection: (1) the design of an ERV trajectory meeting all the requirements including the need to avoid contamination of Earth's atmosphere; (2) the concept of operations for retrieving the Martian samples in Earth orbit in a safe way. We present an approach to retrieve the samples through a rendezvous between the ERV and a second SpaceX Dragon capsule. The ERV executes a trajectory that brings it from low Mars orbit (LMO) to a Moon-trailing Earth orbit at high inclination with respect to the Earth-Moon plane. After a first burn at Trans-Earth Injection (TEI), the trajectory uses a second burn at perigee during an Earth flyby maneuver to capture the ERV in Earth orbit. The ERV then uses a non-propulsive Moon flyby to come to a near-circular Moon-trailing orbit. To perform the Earth Orbit Rendezvous (EOR), a second Dragon capsule is then launched from Earth and a similar lunar flyby is performed to rendezvous with the ERV. The requirements for rendezvous, close proximity operations and capture of the sample canister are described. A concept of operations for sample retrieval is presented along with design specifications of the ERV, the required modifications to the Dragon capsule, as well as the hardware, software, sensors, actuators, and capture mechanisms used. In our concept, a container is mounted to the front hatch of Dragon, capable of accommodating the sample canister and sealing it from the rest of the capsule. The sample canister is captured using a robotic arm with a magnetic grappling mechanism. Dragon then performs a propulsive maneuver to return to Earth for a controlled re-entry while the ERV (sans sample container) is left in the Moon trailing orbit. Contingency cases and related mitigation strategies are also discussed, including the advantages and disadvantages of performing the ERV rendezvous with a crew.

32 CFR 154.48 - Issuing clearance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Chiefs of Staff, initiates an SBI (or PR) for access to SCI on a military member, DIS will return the... agency will then forward the completed SBI on to DIA for the SCI adjudication in accordance with DCID 1...

32 CFR 154.48 - Issuing clearance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Chiefs of Staff, initiates an SBI (or PR) for access to SCI on a military member, DIS will return the... agency will then forward the completed SBI on to DIA for the SCI adjudication in accordance with DCID 1...

Variation in light intensity with height and time from subsequent lightning return strokes

NASA Technical Reports Server (NTRS)

Jordan, D. M.; Uman, M. A.

1983-01-01

Photographic measurements of relative light intensity as a function of height and time have been conducted for seven return strokes in two lightning flashes at 7.8 and 8.7 km ranges, using film which possesses an approximately constant spectral response in the 300-670 nm range. The amplitude of the initial light peak is noted to decrease exponentially with height, with a decay constant of 0.6-0.8 km. The logarithm of the peak light intensity near the ground is found to be approximately proportional to the initial peak electric field intensity, implying that the current decrease with height may be much slower than the light decrease. Absolute light intensity is presently estimated through the integration of the photographic signals from individual channel segments, in order to simulate the calibrated, all-sky photoelectric data of Guo and Krider (1982).

Mars Surface Mobility Leading to Sustainable Exploration

NASA Technical Reports Server (NTRS)

Linne, Diane L.; Barsi, Stephen J.; Sjauw En Wa, Waldy K.; Landis, Geoffrey A.

2012-01-01

A Mars rocket-propelled hopper concept was evaluated for feasibility through analysis and experiments. The approach set forth in this paper is to combine the use of in-situ resources in a new Mars mobility concept that will greatly enhance the science return while providing the first opportunity towards reducing the risk of incorporating ISRU into the critical path for the highly coveted, but currently unaffordable, sample return mission. Experimental tests were performed on a high-pressure, self-throttling gaseous oxygen/methane propulsion system to simulate a two-burn-with-coast hop profile. Analysis of the trajectory, production plant requirements, and vehicle mass indicates that a small hopper vehicle could hop 2 km every 30 days with an initial mass of less than 60 kg. A larger vehicle can hop 15 km every 30 to 60 days with an initial mass of 300 to 430 kg.

Disruptive Influences on Research in Academic Pathology Departments: Proposed Changes to the Common Rule Governing Informed Consent for Research Use of Biospecimens and to Rules Governing Return of Research Results.

PubMed

Sobel, Mark E; Dreyfus, Jennifer C

2017-01-01

Academic pathology departments will be dramatically affected by proposed United States federal government regulatory initiatives. Pathology research will be substantially altered if proposed changes to the Common Rule (Code of Federal Regulations: Protection of Human Subjects title 45 CFR 46) and regulations governing the return of individual research results are approved and finalized, even more so now that the Precision Medicine initiative has been launched. Together, these changes are disruptive influences on academic pathology research as we know it, straining limited resources and compromising advances in diagnostic and academic pathology. Academic research pathologists will be challenged over the coming years and must demonstrate leadership to ensure the continued availability of and the ethical use of research pathology specimens. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Aftermarket Performance of Health Care and Biopharmaceutical IPOs: Evidence From ASEAN Countries

PubMed Central

Komenkul, Kulabutr; Kiranand, Santi

2017-01-01

We examine the evidence from the long-run abnormal returns using data for 76 health care and biopharmaceutical initial public offerings (IPOs) listed in a 29-year period between 1986 and 2014 in the Association of Southeast Asian Nations (ASEAN) countries such as Indonesia, Malaysia, Singapore, Thailand, the Philippines, Vietnam, Myanmar, and Laos. Based on the event-time approach, the 3-year stock returns of the IPOs are investigated using cumulative abnormal return (CAR) and buy-and-hold abnormal return (BHAR). As a robustness check, the calendar-time approach, related to the market model as well as Fama-French and Carhart models, was applied for verifying long-run abnormal returns. We found evidence that the health care IPOs overperform in the long-run, irrespective of the alternative benchmarks and methods. In addition, when we divide our sample into 5 groups by listing countries, our results show that the health care stock prices of the Singaporean firms behaved differently from those of most of the other firms in ASEAN. The Singaporean IPOs are characterized by a worse post-offering performance, whereas the IPOs of Malaysian and Thai health care companies performed better in the long-run. PMID:28853306

Aftermarket Performance of Health Care and Biopharmaceutical IPOs: Evidence From ASEAN Countries.

PubMed

Komenkul, Kulabutr; Kiranand, Santi

2017-01-01

We examine the evidence from the long-run abnormal returns using data for 76 health care and biopharmaceutical initial public offerings (IPOs) listed in a 29-year period between 1986 and 2014 in the Association of Southeast Asian Nations (ASEAN) countries such as Indonesia, Malaysia, Singapore, Thailand, the Philippines, Vietnam, Myanmar, and Laos. Based on the event-time approach, the 3-year stock returns of the IPOs are investigated using cumulative abnormal return (CAR) and buy-and-hold abnormal return (BHAR). As a robustness check, the calendar-time approach, related to the market model as well as Fama-French and Carhart models, was applied for verifying long-run abnormal returns. We found evidence that the health care IPOs overperform in the long-run, irrespective of the alternative benchmarks and methods. In addition, when we divide our sample into 5 groups by listing countries, our results show that the health care stock prices of the Singaporean firms behaved differently from those of most of the other firms in ASEAN. The Singaporean IPOs are characterized by a worse post-offering performance, whereas the IPOs of Malaysian and Thai health care companies performed better in the long-run.

26 CFR 1.458-1 - Exclusion for certain returned magazines, paperbacks, or records.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 6 2014-04-01 2014-04-01 false Exclusion for certain returned magazines... Income Included § 1.458-1 Exclusion for certain returned magazines, paperbacks, or records. (a) In... the income attributable to qualified sales during the taxable year of magazines, paperbacks, or...

26 CFR 1.458-1 - Exclusion for certain returned magazines, paperbacks, or records.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 6 2012-04-01 2012-04-01 false Exclusion for certain returned magazines... Income Included § 1.458-1 Exclusion for certain returned magazines, paperbacks, or records. (a) In... the income attributable to qualified sales during the taxable year of magazines, paperbacks, or...

26 CFR 1.458-1 - Exclusion for certain returned magazines, paperbacks, or records.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 6 2011-04-01 2011-04-01 false Exclusion for certain returned magazines... Income Included § 1.458-1 Exclusion for certain returned magazines, paperbacks, or records. (a) In... the income attributable to qualified sales during the taxable year of magazines, paperbacks, or...

26 CFR 1.458-1 - Exclusion for certain returned magazines, paperbacks, or records.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 6 2013-04-01 2013-04-01 false Exclusion for certain returned magazines... Income Included § 1.458-1 Exclusion for certain returned magazines, paperbacks, or records. (a) In... the income attributable to qualified sales during the taxable year of magazines, paperbacks, or...

The Returns to Quality in Graduate Education

ERIC Educational Resources Information Center

Stevenson, Adam

2016-01-01

This paper estimates the monetary return to quality in US graduate education, controlling for cognitive ability and self-selection across award level, program quality, and field-of-study. In most program types, I cannot reject the hypothesis of no returns to either degree completion or program quality. Important exceptions include master's…

Everywoman's Guide to College.

ERIC Educational Resources Information Center

Gray, Eileen

Information and advice in this guide focuses on the emotional, financial, and academic realities of women returning to school. Chapter One examines the opportunities available today, including such topics as special programs for returning women and the societal factors causing women to return to school. In Chapter Two the decision-making process…

COMPREHENSIVE STRENGTH TRAINING PROGRAM FOR A RECREATIONAL SENIOR GOLFER 11-MONTHS AFTER A ROTATOR CUFF REPAIR

PubMed Central

Meira, Erik P.; En Gilpin, Hui; Brunette, Meredith

2011-01-01

Background and Purpose: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. Case Description: The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. Outcomes: The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program. Discussion: The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery. PMID:22163096

Psychological profile and work status of a predominantly Hispanic worker's compensation population with chronic limb pain.

PubMed

Monsivais, Jose J; Robinson, Kris

2008-12-01

The purposes of this study were to describe the psychosocial profile and to measure function (posttreatment work status) after surgical and non-surgical treatment in a predominantly Hispanic worker's compensation population with chronic limb pain. We conducted an archival review of records from 91 patients treated for neuropathic pain in a specialty clinic over a 10-year period who had extreme difficulty accepting or managing pain. Medical records from individuals with proven nerve dysfunction experiencing pain >3 months and whose record contained a full psychological evaluation were included. All patients received patient-centered care, a prescription to return to work, periodic pain assessment, and clinical evaluation of sensory and motor function plus pharmacologic pain management. Surgery was determined by the degree of sensory-motor abnormalities in the absence of untreated psychological distress regardless of pain level or worker's compensation status. The majority of patients returned to work after treatment of nerve injury. No differences were noted between surgical/non-surgical treatment groups on initial pain level (p = 0.2), litigation status (p > 0.5), and posttreatment work status (p > 0.05). However, individuals expecting surgery also expected total relief of pain with surgical intervention. Psychosocial assessment, support, and adequate pain treatment seem to mediate the ability of an individual with chronic limb pain to return to work regardless of surgical/non-surgical treatment. Patients' expectations of surgery may be unrealistic and are best addressed prior to treatment.

Psychological Profile and Work Status of a Predominantly Hispanic Worker’s Compensation Population With Chronic Limb Pain

PubMed Central

Monsivais, Jose J.

2008-01-01

The purposes of this study were to describe the psychosocial profile and to measure function (posttreatment work status) after surgical and non-surgical treatment in a predominantly Hispanic worker’s compensation population with chronic limb pain. We conducted an archival review of records from 91 patients treated for neuropathic pain in a specialty clinic over a 10-year period who had extreme difficulty accepting or managing pain. Medical records from individuals with proven nerve dysfunction experiencing pain >3 months and whose record contained a full psychological evaluation were included. All patients received patient-centered care, a prescription to return to work, periodic pain assessment, and clinical evaluation of sensory and motor function plus pharmacologic pain management. Surgery was determined by the degree of sensory-motor abnormalities in the absence of untreated psychological distress regardless of pain level or worker’s compensation status. The majority of patients returned to work after treatment of nerve injury. No differences were noted between surgical/non-surgical treatment groups on initial pain level (p = 0.2), litigation status (p > 0.5), and posttreatment work status (p > 0.05). However, individuals expecting surgery also expected total relief of pain with surgical intervention. Psychosocial assessment, support, and adequate pain treatment seem to mediate the ability of an individual with chronic limb pain to return to work regardless of surgical/non-surgical treatment. Patients’ expectations of surgery may be unrealistic and are best addressed prior to treatment. PMID:18780006

Evaluating an employee wellness program.

PubMed

Mukhopadhyay, Sankar; Wendel, Jeanne

2013-12-01

What criteria should be used to evaluate the impact of a new employee wellness program when the initial vendor contract expires? Published academic literature focuses on return-on-investment as the gold standard for wellness program evaluation, and a recent meta-analysis concludes that wellness programs can generate net savings after one or two years. In contrast, surveys indicate that fewer than half of these programs report net savings, and actuarial analysts argue that return-on-investment is an unrealistic metric for evaluating new programs. These analysts argue that evaluation of new programs should focus on contract management issues, such as the vendor's ability to: (i) recruit employees to participate and (ii) induce behavior change. We compute difference-in-difference propensity score matching estimates of the impact of a wellness program implemented by a mid-sized employer. The analysis includes one year of pre-implementation data and three years of post-implementation data. We find that the program successfully recruited a broad spectrum of employees to participate, and it successfully induced short-term behavior change, as manifested by increased preventive screening. However, the effects on health care expenditures are positive (but insignificant). If it is unrealistic to expect new programs to significantly reduce healthcare costs in a few years, then focusing on return-on-investment as the gold standard metric may lead to early termination of potentially useful wellness programs. Focusing short-term analysis of new programs on short-term measures may provide a more realistic evaluation strategy.

Vacuum to Antimatter-Rocket Interstellar Explorer System (VARIES): A Proposed Program for an Interstellar Rendezvous and Return Architecture

NASA Astrophysics Data System (ADS)

Obousy, R.

While interstellar missions have been explored in the literature, one mission architecture has not received much attention, namely the interstellar rendezvous and return mission that could be accomplished on timescales comparable with a working scientist's career. Such a mission would involve an initial boost phase followed by a coasting phase to the target system. Next would be the deceleration and rendezvous phase, which would be followed by a period of scientific data gathering. Finally, there would be a second boost phase, aimed at returning the spacecraft back to the solar system, and subsequent coasting and deceleration phases upon return to our solar system. Such a mission would represent a precursor to a future manned interstellar mission; which in principle could safely return any astronauts back to Earth. In this paper a novel architecture is proposed that would allow for an unmanned interstellar rendezvous and return mission. The approach utilized for the Vacuum to Antimatter-Rocket Interstellar Explorer System (VARIES) would lead to system components and mission approaches that could be utilized for autonomous operation of other deep-space probes. Engineering solutions for such a mission will have a significant impact on future exploration and sample return missions for the outer planets. This paper introduces the general concept, with a mostly qualitative analysis. However, a full research program is introduced, and as this program progresses, more quantitative papers will be released.

Java Radar Analysis Tool

NASA Technical Reports Server (NTRS)

Zaczek, Mariusz P.

2005-01-01

Java Radar Analysis Tool (JRAT) is a computer program for analyzing two-dimensional (2D) scatter plots derived from radar returns showing pieces of the disintegrating Space Shuttle Columbia. JRAT can also be applied to similar plots representing radar returns showing aviation accidents, and to scatter plots in general. The 2D scatter plots include overhead map views and side altitude views. The superposition of points in these views makes searching difficult. JRAT enables three-dimensional (3D) viewing: by use of a mouse and keyboard, the user can rotate to any desired viewing angle. The 3D view can include overlaid trajectories and search footprints to enhance situational awareness in searching for pieces. JRAT also enables playback: time-tagged radar-return data can be displayed in time order and an animated 3D model can be moved through the scene to show the locations of the Columbia (or other vehicle) at the times of the corresponding radar events. The combination of overlays and playback enables the user to correlate a radar return with a position of the vehicle to determine whether the return is valid. JRAT can optionally filter single radar returns, enabling the user to selectively hide or highlight a desired radar return.

Plan for Subdividing Genesis Mission Diamond-on-Silicon 60000 Solar Wind Collector

NASA Technical Reports Server (NTRS)

Burkett, Patti J.; Allton, J. A.; Clemett, S. J.; Gonzales, C. P.; Lauer, H. V., Jr.; Nakamura-Messenger, K.; Rodriquez, M. C.; See, T. H.; Sutter, B.

2013-01-01

NASA's Genesis solar wind sample return mission experienced an off nominal landing resulting in broken, albeit useful collectors. Sample 60000 from the collector is comprised of diamond-like-carbon film on a float zone (FZ) silicon wafer substrate Diamond-on-Silicon (DOS), and is highly prized for its higher concentration of solar wind (SW) atoms. A team of scientist at the Johnson Space Center was charged with determining the best, nondestructive and noncontaminating method to subdivide the specimen that would result in a 1 sq. cm subsample for allocation and analysis. Previous work included imaging of the SW side of 60000, identifying the crystallographic orientation of adjacent fragments, and devising an initial cutting plan.

Space Station tethered waste disposal

NASA Technical Reports Server (NTRS)

Rupp, Charles C.

1988-01-01

The Shuttle Transportation System (STS) launches more payload to the Space Station than can be returned creating an accumulation of waste. Several methods of deorbiting the waste are compared including an OMV, solid rocket motors, and a tether system. The use of tethers is shown to offer the unique potential of having a net savings in STS launch requirement. Tether technology is being developed which can satisfy the deorbit requirements but additional effort is required in waste processing, packaging, and container design. The first step in developing this capability is already underway in the Small Expendable Deployer System program. A developmental flight test of a tether initiated recovery system is seen as the second step in the evolution of this capability.

A Cubesat Asteroid Mission: Propulsion Trade-offs

NASA Technical Reports Server (NTRS)

Landis, Geoffrey A.; Oleson, Steven R.; McGuire, Melissa L.; Bur, Michael J.; Burke, Laura M.; Fittje, James E.; Kohout, Lisa L.; Fincannon, James; Packard, Thomas W.; Martini, Michael C.

2014-01-01

A conceptual design was performed for a 6-U cubesat for a technology demonstration to be launched on the NASA Space Launch System (SLS) test launch EM-1, to be launched into a free-return translunar trajectory. The mission purpose was to demonstrate use of electric propulsion systems on a small satellite platform. The candidate objective chosen was a mission to visit a Near-Earth asteroid. Both asteroid fly-by and asteroid rendezvous missions were analyzed. Propulsion systems analyzed included cold-gas thruster systems, Hall and ion thrusters, incorporating either Xenon or Iodine propellant, and an electrospray thruster. The mission takes advantage of the ability of the SLS launch to place it into an initial trajectory of C3=0.

Concomitant Posterior Hip Dislocation, Ipsilateral Intertrochanteric- and Proximal Tibial- Fractures with Popliteal Artery Injury: A Challenging Trauma Mélange.

PubMed

Chotai, Pranit N; Ebraheim, Nabil A; Hart, Ryan; Wassef, Andrew

2015-11-05

Constellation of ipsilateral posterior hip dislocation, intertrochanteric- and proximal tibial fracture with popliteal artery injury is rare. Management of this presentation is challenging. A motor vehicle accident victim presented with these injuries, but without any initial signs of vascular compromise. Popliteal artery injury was diagnosed intra-operatively and repaired. This was followed by external fixation of tibial fracture, open reduction of dislocated hip and internal fixation of intertrochanteric fracture. Patient regained bilateral complete weight bearing and returned to pre-accident activity level. Apt surgical management including early repair of vascular injury in such a trauma mélange allows for a positive postoperative outcome.

Return of research results from pharmacogenomic versus disease susceptibility studies: what’s drugs got to do with it?

PubMed Central

Dressler, Lynn G

2012-01-01

One of the most controversial ethical issues in genomics research is the return of individual research results to research subjects. As new technologies, including whole-genome sequencing, provide an increased opportunity for researchers to find clinically relevant research results, the questions related to if, when and how individual research results should be returned become more central to the ethical conduct of genomic research. In the absence of federal guidance on this issue, many groups and individuals have developed recommendations and suggestions to address these questions. Most of these recommendations have focused on the return of individual results from disease susceptibility studies. However, in addition to predicting the development of disease, genomic research also includes predicting an individual’s response to drugs, especially the risk of developing adverse events. This article evaluates and compares the return of individual research results from disease susceptibility studies versus pharmacogenomic studies. PMID:22676197

Return of research results from pharmacogenomic versus disease susceptibility studies: what's drugs got to do with it?

PubMed

Dressler, Lynn G

2012-06-01

One of the most controversial ethical issues in genomics research is the return of individual research results to research subjects. As new technologies, including whole-genome sequencing, provide an increased opportunity for researchers to find clinically relevant research results, the questions related to if, when and how individual research results should be returned become more central to the ethical conduct of genomic research. In the absence of federal guidance on this issue, many groups and individuals have developed recommendations and suggestions to address these questions. Most of these recommendations have focused on the return of individual results from disease susceptibility studies. However, in addition to predicting the development of disease, genomic research also includes predicting an individual's response to drugs, especially the risk of developing adverse events. This article evaluates and compares the return of individual research results from disease susceptibility studies versus pharmacogenomic studies.

Return of Individual Research Results & Incidental Findings: Facing the Challenges of Translational Science

PubMed Central

Wolf, Susan M.

2014-01-01

The debate over return of individual research results and incidental findings to research participants is a key frontier in research ethics and practice. Fundamentally, this is a problem of translational science, a question of when information about an individual that is generated in research should be communicated for clinical attention, as the technology itself is moving into clinical care. There is growing consensus that investigators should offer participants at least those individual findings of high clinical importance and actionability. Increasing attention to what information biobanks and secondary researchers owe people who provide data and samples offers an opportunity to treat these source individuals as research partners. Cutting-edge issues include return of results in pediatric populations and return to kin and family, including after death of the proband. Progress will require facing the continuum linking research and clinical care and developing standards and models for return. PMID:23875796

Work and health, a blind spot in curative healthcare? A pilot study.

PubMed

Lötters, Freek J B; Foets, Marleen; Burdorf, Alex

2011-09-01

Most workers with musculoskeletal disorders on sick leave often consult with regular health care before entering a specific work rehabilitation program. However, it remains unclear to what extent regular healthcare contributes to the timely return to work (RTW). Moreover, several studies have indicated that it might postpone RTW. There is a need to establish the influence of regular healthcare on RTW as outcome; "Does visiting a regular healthcare provider influence the duration of sickness absence and recurrent sick leave due to musculoskeletal disorders?". A cohort of workers on sick leave for 2-6 weeks due to a-specific musculoskeletal disorders was followed for 12 months. The main outcomes for the present analysis were: duration of sickness absence till 100% return to work and recurrent sick leave after initial RTW. Cox regression analyses were conducted with visiting a general health practitioner, physical therapist, or medical specialist during the sick leave period as independent variables. Each regression model was adjusted for variables known to influence health care utilization like age, sex, diagnostic group, pain intensity, functional disability, general health perception, severity of complaints, job control, and physical load at work. Patients visiting a medical specialist reported higher pain intensity and more functional limitations and also had a worse health perception at start of the sick leave period compared with those not visiting a specialist. Visiting a medical specialist delayed return to work significantly (HR = 2.10; 95%CI 1.43-3.07). After approximately 8 weeks on sick leave workers visiting a physical therapist returned to work faster than other workers. A recurrent episode of sick leave during the follow up quick was initiated by higher pain intensity and more functional limitations at the moment of fully return to work. Visiting a primary healthcare provider during the sickness absence period did not influence the occurrence of a new sick leave period. Despite the adjustment for severity of the musculoskeletal disorder, visiting a medical specialist was associated with a delayed full return to work. More attention to the factor 'labor' in the regular healthcare is warranted, especially for those patients experiencing substantial functional limitations due to musculoskeletal disorders.

Pharmacy in Space: A Session on NASA Technologies

NASA Technical Reports Server (NTRS)

Richmond, Robert C.

1998-01-01

In 1993, Vice-president Gore was charged with creation of a correctional plan for the poor findings from an efficiency study of governmental agencies. That correctional analysis was then used to support efforts to balance the budget in ways anticipated to improve the value returned per tax payer dollar spent. The final result was a broad initiative collectively termed "reinventing the government", which included major restructuring within NASA as well, termed "reinventing NASA This included substantial elimination of middle management and downsizing such that about 2 million government workers employed in 1992 has shrunk now to about 1.2 million government workers who are employed in ways that at least somewhat decrease bureaucratic and programmatic inefficiencies. Today, "reinvented NASA" has an awareness of contractual commitment to the public. NASA now operates within a so-called "strategic plan" that requires awareness and response to domestic needs. This is important to this audience because it means that NASA is committed to exploring interactions that you may wish to initiate. That is, you are urged to explore with NASA on topics of educational support, collaborative research, or commercial partnerships in drug development and application, as the pertinent examples here, in ways that can include involvement of central NASA resources and missions.

Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review.

PubMed

Tien, T; Athem, R; Arulampalam, T

2018-05-31

Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. More recently minimally invasive approaches have been described. Our aim was to review the current literature on endoscopic pilonidal sinus treatment (EPSiT) and its outcomes. A systematic literature review was conducted and reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of EMBASE, MEDLINE and Cochrane Library was conducted in November 2017. Full-text studies on the use of endoscopy for the treatment of pilonidal sinus were included in the review. Initial search results returned 52 articles. Eight studies (eight case series and one randomised control trial) were included in the final qualitative synthesis. These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates. There was also a high level of patient satisfaction and little time taken off work. Two studies reported modifications to the original technique. The main limitation was the lack of comparative studies. Initial studies on EPSiT have shown promising results. However, there is a need for a standardised technique and more comparative studies to validate this novel procedure.

Geology of Potential Landing Sites for Martian Sample Returns

NASA Technical Reports Server (NTRS)

Greeley, Ronald

2003-01-01

This project involved the analysis of potential landing sites on Mars. As originally proposed, the project focused on landing sites from which samples might be returned to Earth. However, as the project proceeded, the emphasis shifted to missions that would not include sample return, because the Mars Exploration Program had deferred sample returns to the next decade. Subsequently, this project focused on the study of potential landing sites for the Mars Exploration Rovers.

Curating NASA's future extraterrestrial sample collections: How do we achieve maximum proficiency?

NASA Astrophysics Data System (ADS)

McCubbin, Francis; Evans, Cynthia; Allton, Judith; Fries, Marc; Righter, Kevin; Zolensky, Michael; Zeigler, Ryan

2016-07-01

Introduction: The Astromaterials Acquisition and Curation Office (henceforth referred to herein as NASA Curation Office) at NASA Johnson Space Center (JSC) is responsible for curating all of NASA's extraterrestrial samples. Under the governing document, NASA Policy Directive (NPD) 7100.10E "Curation of Extraterrestrial Materials", JSC is charged with "The curation of all extraterrestrial material under NASA control, including future NASA missions." The Directive goes on to define Curation as including "…documentation, preservation, preparation, and distribution of samples for research, education, and public outreach." Here we describe some of the ongoing efforts to ensure that the future activities of the NASA Curation Office are working to-wards a state of maximum proficiency. Founding Principle: Curatorial activities began at JSC (Manned Spacecraft Center before 1973) as soon as design and construction planning for the Lunar Receiving Laboratory (LRL) began in 1964 [1], not with the return of the Apollo samples in 1969, nor with the completion of the LRL in 1967. This practice has since proven that curation begins as soon as a sample return mission is conceived, and this founding principle continues to return dividends today [e.g., 2]. The Next Decade: Part of the curation process is planning for the future, and we refer to these planning efforts as "advanced curation" [3]. Advanced Curation is tasked with developing procedures, technology, and data sets necessary for curating new types of collections as envisioned by NASA exploration goals. We are (and have been) planning for future curation, including cold curation, extended curation of ices and volatiles, curation of samples with special chemical considerations such as perchlorate-rich samples, curation of organically- and biologically-sensitive samples, and the use of minimally invasive analytical techniques (e.g., micro-CT, [4]) to characterize samples. These efforts will be useful for Mars Sample Return, Lunar South Pole-Aitken Basin Sample Return, and Comet Surface Sample Return, all of which were named in the NRC Planetary Science Decadal Survey 2013-2022. We are fully committed to pushing the boundaries of curation protocol as humans continue to push the boundaries of space exploration and sample return. However, to improve our ability to curate astromaterials collections of the future and to provide maximum protection to any returned samples, it is imperative that curation involvement commences at the time of mission conception. When curation involvement is at the ground floor of mission planning, it provides a mechanism by which the samples can be protected against project-level decisions that could undermine the scientific value of the re-turned samples. A notable example of one of the bene-fits of early curation involvement in mission planning is in the acquisition of contamination knowledge (CK). CK capture strategies are designed during the initial planning stages of a sample return mission, and they are to be implemented during all phases of the mission from assembly, test, and launch operations (ATLO), through cruise and mission operations, to the point of preliminary examination after Earth return. CK is captured by witness materials and coupons exposed to the contamination environment in the assembly labs and on the space craft during launch, cruise, and operations. These materials, along with any procedural blanks and returned flight-hardware, represent our CK capture for the returned samples and serves as a baseline from which analytical results can be vetted. Collection of CK is a critical part of being able to conduct and interpret data from organic geochemistry and biochemistry investigations of returned samples. The CK samples from a given mission are treated as part of the sample collection of that mission, hence they are part of the permanent archive that is maintained by the NASA curation Office. We are in the midst of collecting witness plates and coupons for the OSIRIS-REx mission, and we are in the planning stages for similar activities for the Mars 2020 rover mission, which is going to be the first step in a multi-stage campaign to return martian samples to Earth. Concluding Remarks: The return of every extraterrestrial sample is a scientific investment, and the CK samples and any procedural blanks represent an insurance policy against imperfections in the sample-collection and sample-return process. The curation facilities and personnel are the primary managers of that investment, and the scientific community, at large, is the beneficiary. The NASA Curation Office at JSC has the assigned task of maintaining the long-term integrity of all of NASA's astromaterials and ensuring that the samples are distributed for scientific study in a fair, timely, and responsible manner. It is only through this openness and global collaboration in the study of astromaterials that the return on our scientific investments can be maximized. For information on requesting samples and becoming part of the global study of astromaterials, please visit curator.jsc.nasa.gov References: [1] Mangus, S. & Larsen, W. (2004) NASA/CR-2004-208938, NASA, Washington, DC. [2] Allen, C. et al., (2011) Chemie Der Erde-Geochemistry, 71, 1-20. [3] McCubbin, F.M. et al., (2016) 47th LPSC #2668. [4] Zeigler, R.A. et al., (2014) 45th LPSC #2665.

Technical Excellence: A Requirement for Good Engineering

NASA Technical Reports Server (NTRS)

Gill, Paul S.; Vaughan, William W.

2008-01-01

Technical excellence is a requirement for good engineering. Technical excellence has many different ways of expressing itself within engineering. NASA has initiatives that address the enhancement of the Agency's technical excellence and thrust to maintain the associated high level of performance by the Agency on current programs/projects and as it moves into the Constellation Program and the return to the Moon with plans to visit Mars. This paper addresses some of the key initiatives associated with NASA's technical excellence thrust. Examples are provided to illustrate some results being achieved and plans to enhance these initiatives.

Microprogramming for real-time data acquisition

NASA Technical Reports Server (NTRS)

Patella, F. J.

1977-01-01

Transmit microcode trap logic is conditioned by preset clock. Measurement request or issuance of command is controlled by set of software-initialized polling tables. Receive microcode trap logic is conditioned by transmit/receive hardware when response is returned on data bus.

Return probability after a quench from a domain wall initial state in the spin-1/2 XXZ chain

NASA Astrophysics Data System (ADS)

Stéphan, Jean-Marie

2017-10-01

We study the return probability and its imaginary (τ) time continuation after a quench from a domain wall initial state in the XXZ spin chain, focusing mainly on the region with anisotropy \\vert Δ\\vert < 1 . We establish exact Fredholm determinant formulas for those, by exploiting a connection to the six-vertex model with domain wall boundary conditions. In imaginary time, we find the expected scaling for a partition function of a statistical mechanical model of area proportional to τ2 , which reflects the fact that the model exhibits the limit shape phenomenon. In real time, we observe that in the region \\vert Δ\\vert <1 the decay for long time t is nowhere continuous as a function of anisotropy: it is Gaussian at roots of unity and exponential otherwise. We also determine that the front moves as x_f(t)=t\\sqrt{1-Δ^2} , by the analytic continuation of known arctic curves in the six-vertex model. Exactly at \\vert Δ\\vert =1 , we find the return probability decays as e-\\zeta(3/2) \\sqrt{t/π}t1/2O(1) . It is argued that this result provides an upper bound on spin transport. In particular, it suggests that transport should be diffusive at the isotropic point for this quench.

Characteristics of Lapsed German Whole Blood Donors and Barriers to Return Four Years after the Initial Donation

PubMed Central

Weidmann, Christian; Müller-Steinhardt, Michael; Schneider, Sven; Weck, Eberhard; Klüter, Harald

2012-01-01

Background The aim of the study was to identify characteristics of lapsed donors 4 years after the initial donation as well as self-reported barriers to return for further blood donations. Methods A random number of 8,000 blood donors, donating for the German Red Cross Blood Service Baden-Württemberg – Hessen, were asked to fill in a self-administered questionnaire. The response rate was 38.5%. Donors were categorized as ‘lapsed’ if they had not donated within the last 24 months. The odds of being a lapsed donor were determined in a multivariate logistic regression. Results Multivariate analysis showed that lapsed donors were more likely to be female, between 26 and 33 years old, not employed, have moved, and were dissatisfied with the last donation experience. Furthermore, lapsed donors were less likely to have family members or friends who also donate blood. Medical reasons and having moved to another city were the most frequently named reasons preventing lapsed donors from continuing to donate blood. Conclusion The importance of medical reasons and having moved was rated much higher than in previous studies. We conclude that barriers to return may vary considerably between countries and blood services. Therefore, donor surveys are required to guide reactivation campaigns. PMID:22896761

Optimal contrast elastic lidar sensing of clear and aerosol-loaded atmosphere

NASA Astrophysics Data System (ADS)

Evgenieva, Tsvetina T.; Gurdev, Ljuan L.

2016-01-01

The sensing laser radiation wavelength is one of the most significant factors conditioning the elastic lidar efficiency. Nevertheless, its role in the process of lidar sensing has not been investigated systematically so far. Therefore, the main purpose of the present work is to develop and perform an initial examination of an approach to solve this problem based on modeling the profile of the lidar return signal (the lidar profile) and evaluating, in a specific way, the corresponding profile of the measurement signal-to-noise ratio (SNR). The measurement fluctuations are considered as mainly due to the Poisson shot noise that is intrinsic to the dark current and the photocurrent induced by the useful signal itself and the atmospheric background. The initial results obtained show for instance that for ground-based lidar facilities the maximum Rayleigh return signal is obtainable at wavelengths about 350nm. The roles are changed when sensing clouds using wavelength from 400nm to 1000-2000nm. Then, the longer wavelengths provide higher return power from clouds, and the effect is magnified in aerosol-loaded (and especially hazy) atmosphere. The results of such investigations are useful when selecting optimal lidar-design characteristics ensuring maximum brightness and contrast of the lidar-acquired images of specific aerosol strata and objects in the atmosphere.

Portfolio theory and cost-effectiveness analysis: a further discussion.

PubMed

Sendi, Pedram; Al, Maiwenn J; Rutten, Frans F H

2004-01-01

Portfolio theory has been suggested as a means to improve the risk-return characteristics of investments in health-care programs through diversification when costs and effects are uncertain. This approach is based on the assumption that the investment proportions are not subject to uncertainty and that the budget can be invested in toto in health-care programs. In the present paper we develop an algorithm that accounts for the fact that investment proportions in health-care programs may be uncertain (due to the uncertainty associated with costs) and limited (due to the size of the programs). The initial budget allocation across programs may therefore be revised at the end of the investment period to cover the extra costs of some programs with the leftover budget of other programs in the portfolio. Once the total budget is equivalent to or exceeds the expected costs of the programs in the portfolio, the initial budget allocation policy does not impact the risk-return characteristics of the combined portfolio, i.e., there is no benefit from diversification anymore. The applicability of portfolio methods to improve the risk-return characteristics of investments in health care is limited to situations where the available budget is much smaller than the expected costs of the programs to be funded.

The effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric emergency department.

PubMed

Lawrence, Laurie M; Jenkins, Cathy A; Zhou, Chuan; Givens, Timothy G

2009-11-01

The number of patients returning to the pediatric emergency department (PED) within 72 hours of discharge is frequently cited as a benchmark for quality patient care. The purpose of this study was to determine whether the introduction of diagnosis-specific computer-generated discharge instructions would decrease the number of medically unnecessary return visits to the PED. A retrospective chart review of patients who returned to the PED within 72 hours of discharge was performed. Charts were reviewed from 2 comparable periods: September 2004 to February 2005, when handwritten discharge instructions were issued to each patient, and September 2005 to February 2006, when each patient received computer-generated diagnosis-specific discharge instructions. The patient's age, primary care provider, insurance status, chief complaint, vital signs, history, physical examination, plan of care, and diagnosis at each visit were recorded. Cases were excluded if the patient left against medical advice or without being seen, was admitted to the hospital on the first visit, or had incomplete or missing records. The medical necessity of the return visit was rated as "yes," "no," or "indeterminate" based on review of the visit noting reason for return, history and physical examination, diagnosis, and interventions or changes in the initial care plan. Of all return visits to the PED within 72 hours of discharge, 13% were deemed unnecessary for patients receiving handwritten instructions compared with 15% for patients receiving computer-generated instructions (P = 0.5, not significant). For each additional year of age, the return visit was 1.07 times as likely to be medically appropriate (95% confidence interval, 1.03-1.12; P = 0.002). Patients who returned to the PED more than once were 2.69 times more likely to have a medically appropriate visit as were those with only 1 return visit (95% confidence interval, 0.95-7.58; P = 0.062). Computer-generated diagnosis-specific discharge instructions do not decrease the number of medically unnecessary repeat visits to the PED.

An interval kicking progression for return to soccer following lower extremity injury.

PubMed

Arundale, Amelia; Silvers, Holly; Logerstedt, David; Rojas, Jaime; Snyder-Mackler, Lynn

2015-02-01

The majority of all soccer injuries affect the lower extremities. Regardless of whether the injured limb is an athlete's preferred kicking or stance leg, a lower extremity injury may affect their ability to impact the ball. Sport-specific biomechanical progressions to augment loading and gradually reintroduce a player to the demands of sport have been developed for upper extremity sports such as baseball, softball, tennis, and golf. Generalized return to soccer progressions have also been published in order to assist clinicians in safely returning athletes to sport; however, there are no specific progressions for the early stages of kicking designed to introduce stance leg loading and kicking leg impact. Thus, the purpose of this clinical commentary was to review the existing literature elucidating the biomechanics of kicking a soccer ball and propose a progressive kicking program to support clinicians in safely returning their soccer athletes to the demands of sport. The interval kicking program (IKP) describes clinical guidelines for readiness to begin a kicking program as well as possible readiness to return to sport measures. The program is performed on alternate days integrating therapeutic exercise and cardiovascular fitness. The IKP gradually introduces a player to the loading and impact of kicking. The progression increases kicking distance (using the markings of a soccer field as a guide), volume, and intensity and uses proposed soreness rules, effusion guidelines, and player feedback in order to assist clinicians in determining readiness for advancement though the stages. The IKP also recommends utility of specific tests and measures to determine readiness for return to sport. Gradual reintroduction to sport specific demands is essential for a safe return to soccer. This return to sport progression provides a framework integrating injury specific therapeutic exercise, cardiovascular fitness, and the return to kicking progression, to assist clinicians in initiating an athletes' return to soccer. Level 5.

26 CFR 301.6103(h)(2)-1 - Disclosure of returns and return information (including taxpayer return information) to and by...

Code of Federal Regulations, 2010 CFR

2010-04-01

... in Federal grand jury proceeding, or in preparation for proceeding or investigation, involving tax... Federal grand jury proceeding, or in preparation for proceeding or investigation, involving tax... use in, any Federal grand jury proceeding, or preparation for any proceeding (or for their necessary...

26 CFR 301.6103(i)-1 - Disclosure of returns and return information (including taxpayer return information) to and by...

Code of Federal Regulations, 2010 CFR

2010-04-01

... another Federal agency for use in Federal grand jury proceeding, or preparation for proceeding or... grand jury proceeding, or preparation for proceeding or investigation, involving enforcement of Federal... in, and for their necessary use in, any Federal grand jury proceeding, or preparation for any...

77 FR 36150 - Portability of a Deceased Spousal Unused Exclusion Amount

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

... tax return and establishing and substantiating the values reported on such return for those estates... tax return, the executor must estimate the total value of the gross estate (including the values of... for Form 706'') will provide ranges of dollar values, and the executor must identify on the estate tax...

NASA Sample Return Missions: Recovery Operations

NASA Technical Reports Server (NTRS)

Pace, L. F.; Cannon, R. E.

2017-01-01

The Utah Test and Training Range (UTTR), southwest of Salt Lake City, Utah, is the site of all NASA unmanned sample return missions. To date these missions include the Genesis solar wind samples (2004) and Stardust cometary and interstellar dust samples (2006). NASA’s OSIRIS-REx Mission will return its first asteroid sample at UTTR in 2023.

The heterogeneous management of pediatric ankle traumas: A retrospective descriptive study.

PubMed

Voizard, Philippe; Moore, James; Leduc, Stéphane; Nault, Marie-Lyne

2018-06-01

Frequent misdiagnosis of pediatric ankle traumas leads to inappropriate management, which may result in residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the consistency of diagnosis, management, and the treatment of acute lateral pediatric ankle trauma in a tertiary care pediatric hospital. The hypothesis was that the initial diagnosis is often incorrect, and the treatment varies considerably amongst orthopedic surgeons.We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Primary outcome was the difference between initial and final diagnosis.Among 3047 cases reviewed, 31 matched our inclusion criteria. Initial diagnosis was 20 SH1 fractures, 8 acute ankle sprains, and 3 uncertain, with a change in diagnosis for 48.5% at follow-up.Accurate diagnosis can be difficult in pediatric ankle trauma, with case management and specific treatments varying considerably. This study reinforces the need to evaluate the safety of a general treatment algorithm for all lateral ankle trauma with normal radiographs.Level of evidence III.

Apparatus for supplying conditioned air at a substantially constant temperature and humidity

NASA Technical Reports Server (NTRS)

Obler, H. D. (Inventor)

1980-01-01

The apparatus includes a supply duct coupled to a source of supply air for carrying the supply air therethrough. A return duct is coupled to the supply duct for carrying return conditioned air therethrough. A temperature reducing device is coupled to the supply duct for decreasing the temperature of the supply and return conditioned air. A by-pass duct is coupled to the supply duct for selectively directing portions of the supply and return conditioned air around the temperature reducing device. Another by-pass duct is coupled to the return duct for selectively directing portions of the return conditioned air around the supply duct and the temperature reduction device. Controller devices selectively control the flow and amount of mixing of the supply and return conditioned air.

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma

PubMed Central

2010-01-01

Background To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma Methods Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Results Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. Conclusions Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability. PMID:20051124

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma.

PubMed

Clay, Fiona J; Newstead, Stuart V; Watson, Wendy L; Ozanne-Smith, Joan; McClure, Roderick J

2010-01-05

To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.

The costs of turnover in nursing homes.

PubMed

Mukamel, Dana B; Spector, William D; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-10-01

Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The instrumental variable estimate of turnover costs was negative and significant (P = 0.039). The marginal cost savings associated with a 10% point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs.

Hospital protocols for targeted glycemic control: Development, implementation, and models for cost justification.

PubMed

Magee, Michelle F

2007-05-15

Evolving elements of best practices for providing targeted glycemic control in the hospital setting, clinical performance measurement, basal-bolus plus correction-dose insulin regimens, components of standardized subcutaneous (s.c.) insulin order sets, and strategies for implementation and cost justification of glycemic control initiatives are discussed. Best practices for targeted glycemic control should address accurate documentation of hyperglycemia, initial patient assessment, management plan, target blood glucose range, blood glucose monitoring frequency, maintenance of glycemic control, criteria for glucose management consultations, and standardized insulin order sets and protocols. Establishing clinical performance measures, including desirable processes and outcomes, can help ensure the success of targeted hospital glycemic control initiatives. The basal-bolus plus correction-dose regimen for insulin administration will be used to mimic the normal physiologic pattern of endogenous insulin secretion. Standardized insulin order sets and protocols are being used to minimize the risk of error in insulin therapy. Components of standardized s.c. insulin order sets include specification of the hyperglycemia diagnosis, finger stick blood glucose monitoring frequency and timing, target blood glucose concentration range, cutoff values for excessively high or low blood glucose concentrations that warrant alerting the physician, basal and prandial or nutritional (i.e., bolus) insulin, correction doses, hypoglycemia treatment, and perioperative or procedural dosage adjustments. The endorsement of hospital administrators and key physician and nursing leaders is needed for glycemic control initiatives. Initiatives may be cost justified on the basis of the billings for clinical diabetes management services and/or the return- on-investment accrued to reductions in hospital length of stay, readmissions, and accurate documentation and coding of unrecognized or uncontrolled diabetes, and diabetes complications. Standardized insulin order sets and protocols may minimize risk of insulin errors. The endorsement of these protocols by administrators, physicians, nurses, and pharmacists is also needed for success.

Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Rehabilitation Provider in Deployed and Non-deployed Settings

DTIC Science & Technology

2014-01-01

RPE and references are also included as part of the CST. DCoE Clinical Recommendation | January 2014 Progressive Return to Activity Following Acute...Recommendation | January 2014 Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Rehabilitation Provider...days Symptoms are worsening 3 DCoE Clinical Recommendation | January 2014 Progressive Return to Activity Following Acute Concussion/Mild Traumatic

Return to sports after shoulder arthroplasty

PubMed Central

Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

2016-01-01

Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

Understanding Breaks in Flare X-Ray Spectra: Evaluation of a Cospatial Collisional Return-current Model

NASA Astrophysics Data System (ADS)

Alaoui, Meriem; Holman, Gordon D.

2017-12-01

Hard X-ray (HXR) spectral breaks are explained in terms of a one-dimensional model with a cospatial return current. We study 19 flares observed by the Ramaty High Energy Solar Spectroscopic Imager with strong spectral breaks at energies around a few deka-keV, which cannot be explained by isotropic albedo or non-uniform ionization alone. We identify these breaks at the HXR peak time, but we obtain 8 s cadence spectra of the entire impulsive phase. Electrons with an initially power-law distribution and a sharp low-energy cutoff lose energy through return-current losses until they reach the thick target, where they lose their remaining energy through collisions. Our main results are as follows. (1) The return-current collisional thick-target model provides acceptable fits for spectra with strong breaks. (2) Limits on the plasma resistivity are derived from the fitted potential drop and deduced electron-beam flux density, assuming the return current is a drift current in the ambient plasma. These resistivities are typically 2–3 orders of magnitude higher than the Spitzer resistivity at the fitted temperature, and provide a test for the adequacy of classical resistivity and the stability of the return current. (3) Using the upper limit of the low-energy cutoff, the return current is always stable to the generation of ion-acoustic and electrostatic ion-cyclotron instabilities when the electron temperature is nine times lower than the ion temperature. (4) In most cases, the return current is most likely primarily carried by runaway electrons from the tail of the thermal distribution rather than by the bulk drifting thermal electrons. For these cases, anomalous resistivity is not required.

Evaluation of gonorrhea test of cure at 1 week in a Los Angeles community-based clinic serving men who have sex with men.

PubMed

Beymer, Matthew R; Llata, Eloisa; Stirland, Ali M; Weinstock, Hillard S; Wigen, Christine L; Guerry, Sarah L; Mejia, Everardo; Bolan, Robert K

2014-10-01

Because of the decreasing susceptibility of Neisseria gonorrhoeae to cephalosporin therapy, the Centers for Disease Control and Prevention recommends test of cure (TOC) 1 week after gonorrhea (GC) treatment if therapies other than ceftriaxone are used. In addition, the Centers for Disease Control and Prevention asks clinicians, particularly those caring for men who have sex with men (MSM) on the west coast, to consider retesting all MSM at 1 week. However, it is unclear if this is acceptable to providers and patients or if nucleic acid amplification tests (NAATs) are useful for TOC at 7 days. Between January and July 2012, MSM with GC were advised to return 1 week after treatment for TOC using NAAT. A multivariate logistic regression model was used to determine demographic and behavioral differences between MSM who returned for follow-up and MSM who did not. Of 737 men with GC, 194 (26.3%) returned between 3 and 21 days of treatment. Individuals who returned were more likely to have no GC history (P = 0.0001) and to report no initial symptoms (P = 0.02) when compared with individuals who did not return for TOC. Of those who returned, 0% of urethral samples, 7.4% of rectal samples, and 5.3% of pharyngeal samples were NAAT positive at TOC. Although TOC may be an important strategy in reducing complications and the spread of GC, low return rates may make implementation challenging. If implemented, extra efforts should be considered to enhance return rates among individuals with a history of GC. If TOCs are recommended at 1 week and NAATs are used, the interpretation of positive results, particularly those from extragenital sites, may be difficult.

Non-FOOSH Scaphoid Fractures in Young Athletes

PubMed Central

Johnson, Michael R.; Fogarty, Brian T.; Alitz, Curt; Gerber, John P.

2013-01-01

Context: The scaphoid is the most commonly fractured bone in the wrist and can often be difficult to treat and manage, making healing of this fracture problematic. Evidence Acquisition: A search of the entire PubMed (MEDLINE) database using the terms scaphoid fracture management and scaphoid fracture evaluation returned several relevant anatomic and imaging references. Results: Wrist fractures most commonly occur in the scaphoid, which is implicated approximately 60% of the time. The most common mechanism of injury leading to a scaphoid fracture is a fall on an outstretched hand (FOOSH), causing a hyperextension force on the wrist. The following 2 cases, which occurred within 3 months of each other, highlight the difficulty of managing patients with possible scaphoid fractures. Neither patient had a typical FOOSH-related mechanism of injury, and neither was initially tender over the scaphoid. Conclusion: Differential diagnoses should include a scaphoid fracture with any hyperextension traumatic injury (FOOSH or non-FOOSH), even in the absence of scaphoid tenderness and when initial radiographic findings are normal. PMID:24427388

Preferences for the Return of Individual Results From Research on Pediatric Biobank Samples.

PubMed

Christensen, Kurt D; Savage, Sarah K; Huntington, Noelle L; Weitzman, Elissa R; Ziniel, Sonja I; Bacon, Phoebe L; Cacioppo, Cara N; Green, Robert C; Holm, Ingrid A

2017-04-01

Discussions about disclosing individual genetic research results include calls to consider participants' preferences. In this study, parents of Boston Children's Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0 to 10 scales increased from 4.7 to 7.2 ( p < .001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants' desires for information.

Preferences for the return of individual results from research on pediatric biobank samples

PubMed Central

Christensen, Kurt D.; Savage, Sarah K.; Huntington, Noelle L.; Weitzman, Elissa R.; Ziniel, Sonja I.; Bacon, Phoebe L.; Cacioppo, Cara N.; Green, Robert C.; Holm, Ingrid A.

2016-01-01

Discussions about disclosing individual genetic research results include calls to consider participants’ preferences. In this study, parents of Boston Children’s Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0–10 scales increased from 4.7 to 7.2 (p<0.001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants’ desires for information. PMID:28421887

STS-1 operational flight profile. Volume 5: Descent cycle 3. Appendix D: GRTLS six degree of freedom Monte Carlo dispersion analysis

NASA Technical Reports Server (NTRS)

Montez, M. N.

1980-01-01

The results of a six degree of freedom (6-DOF) nonlinear Monte Carlo dispersion analysis for the latest glide return to landing site (GRTLS) abort trajectory for the Space Transportation System 1 Flight are presented. For this GRTLS, the number two main engine fails at 262.5 seconds ground elapsed time. Fifty randomly selected simulations, initialized at external tank separation, are analyzed. The initial covariance matrix is a 20 x 20 matrix and includes navigation errors and dispersions in position and velocity, time, accelerometer bias, and inertial platform misalinements. In all 50 samples, speedbrake, rudder, elevon, and body flap hinge moments are acceptable. Transitions to autoland begin before 9,000 feet and there are no tailscrapes. Navigation derived dynamic pressure accuracies exceed the flight control system constraints above Mach 2.5. Three out of 50 landings exceeded tire specification limit speed of 222 knots. Pilot manual landings are expected to reduce landing speed by landing farther downrange.

Zinc in denture adhesive: a rare cause of copper deficiency in a patient on home parenteral nutrition

PubMed Central

Prasad, Rakesh; Hawthorne, Barney; Durai, Dharmaraj; McDowell, Ian

2015-01-01

A 65-year-old woman with Crohn's disease, who had been on home parenteral nutrition for many years, presented with perioral paraesthesia and a burning sensation in the mouth. Initial blood tests including serum ferritin, vitamin B12 and folate, were normal apart from mild pancytopaenia. Serum copper was low, in spite of receiving regular copper in her parenteral feeds. The copper in her parenteral feeds was increased initially, but when it did not improve, she was started on weekly intravenous copper infusions. She was using dental adhesive, which had zinc in it, and a possibility that this was causing her copper deficiency was raised. Serum zinc levels were normal, but urinary zinc was very high. The patient was advised to use zinc-free dental adhesive and her copper level returned to normal within a few months with normalisation of her pancytopaenia, and partial resolution of her oral paraesthesia. PMID:26452740

Planetary protection issues and human exploration of Mars

NASA Technical Reports Server (NTRS)

Devincenzi, D. L.

1991-01-01

A key feature of the Space Exploration Initiative involves human missions to Mars. The report describing the initiative cites the search for life on Mars, extant or extinct, as one of the five science themes for such an endeavor. Because of this, concerns for planetary protection (PP) have arisen of two fronts: (1) forward contamination of Mars by spacecraft-borne terrestrial microbes which could interfere with exobiological analyses; and (2) back contamination of Earth by species that may be present in returned Mars samples. The United States is also signatory to an international treaty designed to protect Earth and planets from harmful cross-contamination during exploration. Therefore, it is timely to assess the necessity for, and impact of, PP procedures on the mission set comprising the human exploration of Mars. The ground-rules adopted at a recent workshop which addressed PP questions of this type are presented. In addition, the workshop produced several recommendations for dealing with forward and back contamination concerns for non-scientific perspectives, including public relations, legal, regulatory, international, and environmental.

Return to play after chondroplasty of the knee in National Football League athletes.

PubMed

Scillia, Anthony J; Aune, Kyle T; Andrachuk, John S; Cain, E Lyle; Dugas, Jeffrey R; Fleisig, Glenn S; Andrews, James R

2015-03-01

Knee injuries, including articular cartilage damage, are common in football players and are potentially career threatening. The rate of return to play (RTP) as well as the factors affecting return after arthroscopic chondroplasty of the knee is performed in National Football League (NFL) athletes are not known. To determine the rate of return to regular season NFL competition after arthroscopic knee surgery including chondroplasty of articular cartilage lesions. In addition, identification of factors that influence successful return was investigated. Case series; Level of evidence, 4. Athletes in the NFL who underwent arthroscopic chondroplasty at a single institution were identified. Retrospective chart review and review of the NFL online database were utilized to determine the rate of RTP and factors affecting an athlete's ability to return. Chi-square and Student t tests were used to assess differences among players who were and were not able to RTP, and logistic regression was employed to determine a player's odds of return. There were 52 patients (54 procedures) identified from the surgical database who met the inclusion criteria for the study operated on between August 1, 2001, and March 31, 2011. Of these players, 36 (67%) were able to return to regular season NFL game play at an average of 8.2 months, including 13 (24%) who were still active in the NFL. The average time to follow-up was 5.9 years, and all players were allowed at least 2 years of follow-up. There was no significant correlation of RTP to athlete age, lesion size, lesion location, position played, or round selected in the NFL draft. Players who underwent concomitant microfracture were 4.4 times less likely to return to the NFL than were those who did not undergo this procedure (95% CI, 1.3-15.5). Athletes who played more than 11.6 games per season were 4.7 times more likely to RTP than were those who played fewer games per season (95% CI, 1.4-16.6). Athletes who returned to play competed in 56 fewer games, 3.3 fewer seasons, and played in 3.2 fewer games per season compared with their level of competition before surgery. A majority (67%) of NFL players are able to RTP after arthroscopic knee surgery including chondroplasty of articular cartilage lesions. Athletes who play more games per season are more likely to RTP after chondroplasty of articular cartilage lesions of the knee, but those undergoing concomitant microfracture are less likely to return. No statistical significance was determined when comparing the athletes who returned to play with respect to age at surgery, lesion location, lesion size, lesion grade, position that the athlete played, or draft round. © 2015 The Author(s).

Take Me “Home”: Return Migration among Germany’s Older Immigrants

PubMed Central

Yahirun, Jenjira J.

2013-01-01

This paper examines the determinants of return migration as foreign-born men approach old age in Germany. Return migration in later life engages a different set of conditions than return migration earlier on, including the framing of return as a possible retirement strategy. Using 23 years of longitudinal data from the German Socioeconomic Panel, this paper investigates how social and economic resources of immigrant men influence decisions to return “home.” Results suggest that immigrants from former guest worker recruitment countries within the European Union are more likely to return than non-E.U. immigrants. In addition, return migrants are “negatively selected” such that those with the least education and weakest attachments to the labor force are more likely to emigrate. However, findings vary greatly depending on the immigrant’s age and country of origin. Results from this paper highlight the heterogeneity of older immigrants and the factors that motivate their return “home.” PMID:25382866

Status of robotic mission studies for the Space Exploration Initiative - 1991

NASA Technical Reports Server (NTRS)

Bourke, Roger D.; Dias, William C.; Golombek, Matthew P.; Pivirotto, Donna L.; Sturms, Francis M.; Hubbard, G. S.

1991-01-01

Results of studies of robotic missions to the moon and Mars planned under the U.S. Space Exploration Initiative are summarized. First, an overall strategy for small robotic missions to accomplish the information gathering required by human missions is reviewed, and the principal robotic mission requirements are discussed. The discussion covers the following studies: the Lunar Observer, the Mars Environmental Survey mission, Mars Sample Return missions using microtechnology, and payloads.

Wildfire Health and Economic Impacts Case Study###

EPA Science Inventory

Since 2008 eastern North Carolina experienced 6 major wildfires, far exceeding the historic 50 year expected rate of return. Initiated by the lighting strikes, these fires spread across multiple feet deep, dry and extremely vulnerable peat bogs. The fires produced massive amounts...

21 CFR 522.775 - Doxapram.

Code of Federal Regulations, 2010 CFR

2010-04-01

... horses to stimulate respiration during and after general anesthesia; or to speed awakening and return of reflexes after anesthesia. Administer to neonate dogs and cats to initiate respiration following dystocia or caesarean section; or to stimulate respiration following dystocia or caesarean section. (3...

Emergency cardiopulmonary bypass for cardiac arrest refractory to pediatric advanced life support.

PubMed

Cochran, J B; Tecklenburg, F W; Lau, Y R; Habib, D M

1999-02-01

We report the application of emergent cardiopulmonary bypass (CPB) for three pediatric patients in the cardiac catheterization laboratory with cardiac arrest who did not respond to conventional resuscitation efforts. All three patients had return of baseline prearrest rhythms within minutes of the initiation of artificial cardiopulmonary support and the return of spontaneous circulation upon weaning CPB. Two patients had normal neurologic outcomes despite an interval of over 30 minutes from arrest to CPB. The continued judicious application and study of this technology in a small subpopulation of pediatric cardiac arrest patients is warranted.

Cuboid-Navicular Tarsal Coalition in an Adolescent Female Athlete: A Case Report.

PubMed

Kamiya, Tomoaki; Watanabe, Kota; Teramoto, Atsushi; Yamashita, Toshihiko

2015-01-01

A fourteen-year-old female shot-putter developed midfoot pain with activity that initially responded to nonoperative care. However, the symptoms subsequently returned and became persistent. Advanced imaging demonstrated a fibrous cuboid-navicular tarsal coalition. Surgical resection of the tarsal coalition was performed when the patient was seventeen years old, and she returned to sports activities postoperatively with no pain. Although fibrous cuboid-navicular tarsal coalition is a very rare condition, it should be considered as one cause of persistent midfoot pain in an adolescent athlete. Surgical resection of the tarsal coalition can lead to a resolution of symptoms.

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.

PubMed

Perkins, Gavin D; Davies, Robin P; Quinton, Sarah; Woolley, Sarah; Gao, Fang; Abella, Ben; Stallard, Nigel; Cooke, Matthew W

2011-10-18

Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. ISRCTN56583860.

Status of Liquid Oxygen/Liquid Methane Injector Study for a Mars Ascent Engine

NASA Technical Reports Server (NTRS)

Trinh, Huu Ogyic; Cramer, John M.

1998-01-01

Preliminary mission studies for human exploration of Mars have been performed at Marshall Space Flight Center (MSFC). These studies indicate that for non-toxic chemical rockets only a cryogenic propulsion system would provide high enough performance to be considered for a Mars ascent vehicle. Although the mission is possible with Earth-supplied propellants for this vehicle, utilization of in-situ propellants is highly attractive. This option would significantly reduce the overall mass of the return vehicle. Consequently, the cost of the mission would be greatly reduced because the number and size of the Earth launch vehicle(s) needed for the mission decrease. NASA/Johnson Space Center has initiated several concept studies (2) of in-situ propellant production plants. Liquid oxygen (LOX) is the primary candidate for an in-situ oxidizer. In-situ fuel candidates include methane (CH4), ethylene (C2H4), and methanol (CH3OH). MSFC initiated a technology development program for a cryogenic propulsion system for the Mars human exploration mission in 1998. One part of this technology program is the effort described here: an evaluation of propellant injection concepts for a LOX/liquid methane Mars Ascent Engine (MAE) with an emphasis on light-weight, high efficiency, reliability, and thermal compatibility. In addition to the main objective, hot-fire tests of the subject injectors will be used to test other key technologies including light-weight combustion chamber materials and advanced ignition concepts. This state-of-the-art technology will then be applied to the development of a cryogenic propulsion system that will meet the requirements of the planned Mars sample return (MSR) mission. The current baseline propulsion system for the MSR mission uses a storable propellant combination [monomethyl hydrazine/mixed oxides of nitrogen-25(MMH/MON-25)]. However, a mission option that incorporates in-situ propellant production and utilization for the ascent stage is being carefully considered as a subscale precursor to a future human mission to Mars.

Development of a Modified Vacuum Cleaner for Lunar Surface Systems

NASA Technical Reports Server (NTRS)

Toon, Katherine P.; Lee, Steve A.; Edgerly, Rachel D.

2009-01-01

The National Aeronautics and Space Administration (NASA) mission to expand space exploration will return humans to the Moon with the goal of maintaining a long-term presence. One challenge that NASA will face returning to the Moon is managing the lunar regolith found on the Moon's surface, which will collect on extravehicular activity (EVA) suits and other equipment. Based on the Apollo experience, the issues astronauts encountered with lunar regolith included eye/lung irritation, and various hardware failures (seals, screw threads, electrical connectors and fabric contamination), which were all related to inadequate lunar regolith mitigation. A vacuum cleaner capable of detaching, transferring, and efficiently capturing lunar regolith has been proposed as a method to mitigate the lunar regolith problem in the habitable environment on lunar surface. In order to develop this vacuum, a modified "off-the-shelf" vacuum cleaner has been used to determine detachment efficiency, vacuum requirements, and optimal cleaning techniques to ensure efficient dust removal in habitable lunar surfaces, EVA spacesuits, and air exchange volume. During the initial development of the Lunar Surface System vacuum cleaner, systematic testing was performed with varying flow rates on multiple surfaces (fabrics and metallics), atmospheric (14.7 psia) and reduced pressures (10.2 and 8.3 psia), different vacuum tool attachments, and several vacuum cleaning techniques to determine the performance requirements for the vacuum cleaner. The data recorded during testing was evaluated by calculating percent removal, relative to the retained simulant on the tested surface. In addition, Scanning Electron Microscopy (SEM) imaging was used to determine particle size distribution retained on the surface. The scope of this paper is to explain the initial phase of vacuum cleaner development, including historical Apollo mission data, current state-of-the-art vacuum cleaner technology, and vacuum cleaner testing that has focused on detachment capabilities varying pressure environments.

Development of a Modified Vacuum Cleaner for Lunar Surface Systems

NASA Technical Reports Server (NTRS)

Toon, Katherine P.; Lee, Steve A.; Edgerly, Rachel D.

2010-01-01

The National Aeronautics and Space Administration (NASA) mission to expand space exploration will return humans to the Moon with the goal of maintaining a long-term presence. One challenge that NASA will face returning to the Moon is managing the lunar regolith found on the Moon's surface, which will collect on extravehicular activity (EVA) suits and other equipment. Based on the Apollo experience, the issues astronauts encountered with lunar regolith included eye/lung irritation, and various hardware failures (seals, screw threads, electrical connectors and fabric contamination), which were all related to inadequate lunar regolith mitigation. A vacuum cleaner capable of detaching, transferring, and efficiently capturing lunar regolith has been proposed as a method to mitigate the lunar regolith problem in the habitable environment on lunar surface. In order to develop this vacuum, a modified "off-the-shelf' vacuum cleaner will be used to determine detachment efficiency, vacuum requirements, and optimal cleaning techniques to ensure efficient dust removal in habitable lunar surfaces, EVA spacesuits, and air exchange volume. During the initial development of the Lunar Surface System vacuum cleaner, systematic testing was performed with varying flow rates on multiple surfaces (fabrics and metallics), atmospheric (14.7 psia) and reduced pressures (10.2 and 8.3 psia), different vacuum tool attachments, and several vacuum cleaning techniques in order to determine the performance requirements for the vacuum cleaner. The data recorded during testing was evaluated by calculating particulate removal, relative to the retained simulant on the tested surface. In addition, optical microscopy was used to determine particle size distribution retained on the surface. The scope of this paper is to explain the initial phase of vacuum cleaner development, including historical Apollo mission data, current state-of-the-art vacuum cleaner technology, and vacuum cleaner testing that has focused on detachment capabilities at varying pressure environments.

Epidemic optic neuropathy in Cuba. Eye findings.

PubMed

Sadun, A A; Martone, J F; Muci-Mendoza, R; Reyes, L; DuBois, L; Silva, J C; Roman, G; Caballero, B

1994-05-01

To characterize and establish a clinical definition of the optic neuropathy that appeared in epidemic form in Cuba in 1992 and 1993. At the invitation of the Cuban Ministry of Health, Havana, members of ORBIS International and the Pan American Health Organization, assembled teams that traveled to Cuba in May 1993. We were initially briefed by Cuban national experts in the areas of virology, nutrition, toxicology, ophthalmology, neurology, and public health. We then examined 20 patients on our own. Thirteen of these patients underwent a comprehensive neuro-ophthalmologic examination, including neurologic examination, ophthalmologic examination, visual fields, optic nerve function studies, contrast sensitivity studies, and funduscopy. We returned 4 months later to perform an additional 12 comprehensive neuro-ophthalmologic and follow-up examinations. Only seven of the 13 patients who were alleged to have the optic form of the epidemic and who were rigorously and systematically examined on the first visit demonstrated a bilateral optic neuropathy. These seven patients had several features that included decreased visual acuity, poor color vision, central scotomas, decreased contrast sensitivity, saccadic eye movements, and most prominent and distinctive of all, nerve fiber layer wedge defects of the papillomacular bundle. Our clinical definition was then implemented by the Cuban ophthalmologists and epidemiologists. On returning 4 months later, we found that all newly presented patients were correctly diagnosed to have the epidemic disease. With the new case definition and the application of a few simple psychophysical tests, the false-positive rate of diagnosis became much lower. After vitamin therapy, we reexamined the patients seen on our initial visit, and all showed marked improvement. The Cuban epidemic was characterized by an optic neuropathy with features that were similar to those of tobacco/alcohol amblyopia and Leber's optic atrophy. Recent political, economic, and social changes in Cuba may have contributed to the nutritional and/or toxic compromise of mitochondrial function of an acquired nature, which led to selective retinal ganglion cell damage. We have termed this condition Cuban epidemic optic neuropathy.

Entry, Descent, and Landing Communications for the 2011 Mars Science Laboratory

NASA Technical Reports Server (NTRS)

Abilleira, Fernando; Shidner, Jeremy D.

2012-01-01

The Mars Science Laboratory (MSL), established as the most advanced rover to land on the surface of Mars to date, launched on November 26th, 2011 and arrived to the Martian Gale Crater during the night of August 5th, 2012 (PDT). MSL will investigate whether the landing region was ever suitable to support carbon-based life, and examine rocks, soil, and the atmosphere with a sophisticated suite of tools. This paper addresses the flight system requirement by which the vehicle transmitted indications of the following events using both X-band tones and UHF telemetry to allow identification of probable root causes should a mission anomaly have occurred: Heat-Rejection System (HRS) venting, completion of the cruise stage separation, turn to entry attitude, atmospheric deceleration, bank angle reversal commanded, parachute deployment, heatshield separation, radar ground acquisition, powered descent initiation, rover separation from the descent stage, and rover release. During Entry, Descent, and Landing (EDL), the flight system transmitted a UHF telemetry stream adequate to determine the state of the spacecraft (including the presence of faults) at 8 kbps initiating from cruise stage separation through at least one minute after positive indication of rover release on the surface of Mars. The flight system also transmitted X-band semaphore tones from Entry to Landing plus one minute although since MSL was occulted, as predicted, by Mars as seen from the Earth, Direct-To-Earth (DTE) communications were interrupted at approximately is approx. 5 min after Entry ( approximately 130 prior to Landing). The primary data return paths were through the Deep Space Network (DSN) for DTE and the existing Mars network of orbiting assets for UHF, which included the Mars Reconnaissance Orbiter (MRO), Mars Odyssey (ODY), and Mars Express (MEX) elements. These orbiters recorded the telemetry data stream and returned it back to Earth via the DSN. The paper also discusses the total power received during EDL and the robustness of the telecom design strategy used to ensure EDL communications coverage.

Biomarker assessment of the effects of coal strip-mine contamination on channel catfish.

PubMed

Martin, L K; Black, M C

1998-11-01

A suite of biomarkers was used to evaluate acute (1-day) to semichronic (3-month) heavy metal-induced toxicity in channel catfish, lctalurus punctatus, caged at an abandoned strip mine and a noncontaminated reference site. Assays performed include indicators of metabolic, hematological, osmoregulatory, and genotoxic stress. Two cage designs were used to evaluate the importance of exposure routes: one excluding contact with the sediments and the other allowing contact with water and sediments. Significant DNA strand breakage was observed in catfish exposed to both exposure regimens, but evidence of DNA repair was observed only in water-exposed catfish. Transient increases in hemoglobin, delta-aminolevulinic acid dehydratase, and hematocrit levels were observed at 1 month's exposure for both exposure regimens, followed by a return to control levels for the duration of the study. Environmental conditions (i.e., weather-related changes in water quality) may have contributed to the variable plasma chloride and glucose levels observed in all catfish exposed to strip-mine wastes. The transient changes in biomarkers followed by a return to reference values represent an initial stress and an acclimation to normal levels. Copyright 1998 Academic Press.

Trajectory Design Analysis over the Lunar Nodal Cycle for the Multi-Purpose Crew Vehicle (MPCV) Exploration Mission 2 (EM-2)

NASA Technical Reports Server (NTRS)

Gutkowski, Jeffrey P.; Dawn, Timothy F.; Jedrey, Richard M.

2014-01-01

The first crewed mission, Exploration Mission 2 (EM-2), for the MPCV Orion spacecraft is scheduled for August 2021, and its current mission is to orbit the Moon in a highly elliptical lunar orbit for 3 days. A 21-year scan was performed to identify feasible missions that satisfy the propulsive capabilities of the Interim Cryogenic Propulsion Stage (ICPS) and MPCV Service Module (SM). The mission is divided into 4 phases: (1) a lunar free return trajectory, (2) a hybrid maneuver, during the translunar coast, to lower the approach perilune altitude to 100 km, (3) lunar orbit insertion into a 100 x 10,000 km orbit, and (4) lunar orbit loiter and Earth return to a splashdown off the coast of Southern California. Trajectory data was collected for all feasible missions and converted to information that influence different subsystems including propulsion, power, thermal, communications, and mission operations. The complete 21-year scan data shows seasonal effects that are due to the Earth-Moon geometry and the initial Earth parking orbit. The data and information is also useful to identify mission opportunities around the current planned launch date for EM-2.

Effects of a documentary film on public stigma related to mental illness among genetic counselors.

PubMed

Anderson, Kelly; Austin, Jehannine C

2012-08-01

Many people, including genetic counselors, have been found to hold stigmatizing attitudes towards people with mental illnesses. We aimed to determine whether these attitudes could be changed by exposing genetic counselors and genetic counseling students to a documentary film about people with mental illness. We screened the documentary at the 2010 North American conferences for genetic counselors. Immediately before (T1), immediately after (T2), and one month after (T3) watching the documentary, participants self-rated their comfort with asking patients about mental illness, and they completed scales measuring two aspects of stigma: stereotype endorsement, and desire for social distance. A total of 87 T1 and T2 questionnaires, and 39 T3 questionnaires were returned. At T2 and T3, 34.5% and 48.7% respectively reported feeling more comfortable to ask patients about mental illness. Scores on the social distance and stereotype endorsement scales decreased significantly from T1 to T2, but returned to initial levels at T3. The findings suggest the documentary increased genetic counselors' and genetic counseling students' comfort with asking about mental illness and temporarily decreased their stigmatizing attitudes.

Shipborne LF-VLF oceanic lightning observations and modeling

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M. B.; Said, R. K.; Lehtinen, N. G.; Inan, U. S.

2015-10-01

Approximately 90% of natural lightning occurs over land, but recent observations, using Global Lightning Detection (GLD360) geolocation peak current estimates and satellite optical data, suggested that cloud-to-ground flashes are on average stronger over the ocean. We present initial statistics from a novel experiment using a Low Frequency (LF) magnetic field receiver system installed aboard the National Oceanic Atmospheric Agency (NOAA) Ronald W. Brown research vessel that allowed the detection of impulsive radio emissions from deep-oceanic discharges at short distances. Thousands of LF waveforms were recorded, facilitating the comparison of oceanic waveforms to their land counterparts. A computationally efficient electromagnetic radiation model that accounts for propagation over lossy and curved ground is constructed and compared with previously published models. We include the effects of Earth curvature on LF ground wave propagation and quantify the effects of channel-base current risetime, channel-base current falltime, and return stroke speed on the radiated LF waveforms observed at a given distance. We compare simulation results to data and conclude that previously reported larger GLD360 peak current estimates over the ocean are unlikely to fully result from differences in channel-base current risetime, falltime, or return stroke speed between ocean and land flashes.

Pilot Study of Topical Acetyl Hexapeptide-8 in Treatment of Blepharospasm in Patients Receiving Botulinum Neurotoxin Therapy

PubMed Central

Lungu, Codrin; Considine, Elaine; Zahir, Sana; Ponsati, Berta; Arrastia, Silvia; Hallett, Mark

2016-01-01

Background Injectable botulinum neurotoxin (BoNT) is the principal effective treatment for blepharospasm (BSP). This trial explores the safety and efficacy of topical Acetyl Hexapeptide-8 (AH8), a competitive SNAP25 inhibitor, as a potential new therapy in BSP. Methods Double-blind, placebo-controlled, randomized trial of daily topical application of AH8 in 24 patients with BSP. The primary outcome was time to return to baseline Jankovic Rating Scale (JBRS) after a BoNT injection simultaneously with initiation of AH8. Patients displaying a strictly regular pattern of response to 3-monthly injections of BoNT were included. Results There were no significant adverse events. There was a trend for longer time until return to baseline JBRS after injection in the active group compared to placebo (3.7 vs 3.0 months), and for better scores in the active group. One third (4/12) of the patients in the active group had a significant extension of symptom control after BoNT (range: 3.3-7.1 months). Conclusions Topical AH8 is safe and promising for extending the duration of action of BoNT therapy for BSP. PMID:23146065

Genetic identification of children of the disappeared in Argentina.

PubMed

Penchaszadeh, V B

1997-01-01

During the military dictatorship that ruled Argentina between 1976 and 1983, the security forces engaged in well-planned repression that included the abduction, torture, and disappearance of thousands of dissidents. Repression spared neither children nor pregnant women. Approximately 220 babies and children of the disappeared victims were abducted and kept mostly by families with connections with the military. After the restoration of democracy, attempts to find and identify the missing children were made, with the goal of restoring their personal and familial identities and returning them to their surviving relatives. The Association of Grandmothers of Plaza de Mayo and a number of geneticists who developed and applied methods of genetic identification to this human rights cause were instrumental in this quest. Initial use of histocompatibility (HLA) typing for genetic identification was later followed by nuclear DNA typing and mitochondrial DNA sequencing. Of 56 children found and identified, 30 were returned to their legitimate families, 13 remained with the families who had adopted them in good faith, 6 are still the subject of custody litigation in the courts, and 7 were found dead. Psychological and ethical guidelines protecting the best interests of the children were followed in all proceedings.

Evaluation of discharge medication orders following automatic therapeutic substitution of commonly exchanged drug classes.

PubMed

Glaholt, Sarah; Hayes, Genevieve L; Wisniewski, Christopher S

2014-04-01

Automatic therapeutic substitution (ATS) is a mechanism that, upon patient hospitalization, prompts the pharmacist to exchange an equivalent formulary drug for a nonformulary medication, typically without prescriber contact. In facilities utilizing ATS, there is the possibility that physicians and patients may be unaware of the substitution, potentially leading to drug-drug interactions, therapeutic duplication, and/or increased patient expense following discharge should the original regimen not be resumed. The purpose of this study was to determine the frequency with which hospitalized patients subjected to an ATS protocol were not returned to outpatient drug therapy. A retrospective chart review of adult patients admitted to an academic medical center between January 1 and June 30, 2011, was conducted. Patients were included if they were admitted on angiotensin-converting enzyme (ACE) inhibitors, antidepressants, nonsedating antihistamines, histamine (H2) receptor antagonists, or proton pump inhibitors (PPIs), and were then prescribed a different agent via ATS. Admission and discharge medication reconciliation documents, dictated discharge summaries, and patient education documentation reports were reviewed for drug therapies and doses, as well as medication counseling evidence. The primary endpoint was the percentage of patients not returned to original outpatient therapy following ATS. Secondary endpoints included prescribing events in patients not returned to original therapy, the rate and source of drug therapy counseling at discharge, and the number of patients discharged on a potentially cost-prohibitive drug, defined as any drug available only as a branded product during the study period. A total of 317 interventions were identified through review of pharmacy records. Of these, 47 patients (15%) were not returned to original outpatient therapy. Within this subsection, 15 patients (32%) were discharged on the substituted drug, eight patients (17%) resumed initial therapy but received a dosage adjustment from previous outpatient therapy, and three patients (6%) were discharged on a drug that was neither the substituted product nor the previous outpatient therapy. The remaining 21 patients had therapy discontinued (n = 12/47, 26%) or lacked documentation of discharge therapy (9/47, 19%). Nursing staff provided medication counseling to 288 of the 317 patients (91%). Overall, 51 patients (16%) were identified as receiving a cost-prohibitive drug. Patients subject to ATS of commonly substituted drug classes were returned to their original outpatient drug therapy more than 85% of the time following inpatient hospitalizations, with similar rates of medication counseling at discharge. The prescribing of cost-prohibitive drugs has been identified as a potential area for pharmacist intervention at discharge.

NASA needs a long-term sample return strategy

NASA Astrophysics Data System (ADS)

Agee, C.

Sample return missions, as demonstrated by Apollo, can have a huge payoff for plan- etary science. Beyond NASAAfs current Discovery missions, Stardust and Genesis, there are no future U.S. sample return missions on the books. At this juncture, it would be desirable for NASA to develop a coherent, long-term strategy for sample return missions to prime targets such as Mars, Venus, and other solar system bodies. The roster of missions planned for this decade in NASAAfs Mars Program no longer includes a sample return. Arguments against an early Mars sample return (MSR) in- clude the high cost, high risk, and not knowing the Agright placeAh on the Martian surface to sample. On the other hand, answering many of the key scientific questions about Mars, including the search for life, may require sample return. In lieu of MSR, NASA plans, out to 2009, a mix of orbital and landed missions that will perform re- mote and in-situ science at Mars. One approach to MSR that may lead to success in the opportunities beyond 2009 is a series of simple missions where large rovers and complex instruments are replaced by robust Mars ascent vehicles and lander-based sampling techniques. AgMobilityAh and Agsample diversityAh in these early reconnaissance sample return missions are accomplished by sending each mission to a distinctly different location based on our understanding of Martian geology prior to launch. The expected wealth of knowledge from these simple sample return missions will help guide Mars exploration beyond 2020. Venus sample return (VSR) should also be a high priority in NASAAfs exploration of the solar system. Our understanding of the Venusian surface is fragmentary at best and the mineralogy in unknown. We have no verified meteorites from Venus and thus radiometric ages of the crust do not exist. Venusian science best done on Earth from a VSR would include (1) precise isotopic measurements of atmospheric gases, soil, and rock, (2) age dating of rock, (3) trace element chemistry of soil and rock, (4) charac- terization of very small phases, (5) characterization of complex weathering products, (6) detailed rock mineralogy and petrology.

Physiological implications of altitude training for endurance performance at sea level: a review.

PubMed Central

Bailey, D M; Davies, B

1997-01-01

Acclimatisation to environmental hypoxia initiates a series of metabolic and musculocardio-respiratory adaptations that influence oxygen transport and utilisation, or better still, being born and raised at altitude, is necessary to achieve optimal physical performance at altitude, scientific evidence to support the potentiating effects after return to sea level is at present equivocal. Despite this, elite athletes continue to spend considerable time and resources training at altitude, misled by subjective coaching opinion and the inconclusive findings of a large number of uncontrolled studies. Scientific investigation has focused on the optimisation of the theoretically beneficial aspects of altitude acclimatisation, which include increases in blood haemoglobin concentration, elevated buffering capacity, and improvements in the structural and biochemical properties of skeletal muscle. However, not all aspects of altitude acclimatisation are beneficial; cardiac output and blood flow to skeletal muscles decrease, and preliminary evidence has shown that hypoxia in itself is responsible for a depression of immune function and increased tissue damage mediated by oxidative stress. Future research needs to focus on these less beneficial aspects of altitude training, the implications of which pose a threat to both the fitness and the health of the elite competitor. Paul Bert was the first investigator to show that acclimatisation to a chronically reduced inspiratory partial pressure of oxygen (P1O2) invoked a series of central and peripheral adaptations that served to maintain adequate tissue oxygenation in healthy skeletal muscle, physiological adaptations that have been subsequently implicated in the improvement in exercise performance during altitude acclimatisation. However, it was not until half a century later that scientists suggested that the additive stimulus of environmental hypoxia could potentially compound the normal physiological adaptations to endurance training and accelerate performance improvements after return to sea level. This has stimulated an exponential increase in scientific research, and, since 1984, 22 major reviews have summarised the physiological implications of altitude training for both aerobic and anaerobic performance at altitude and after return to sea level. Of these reviews, only eight have specifically focused on physical performance changes after return to sea level, the most comprehensive of which was recently written by Wolski et al. Few reviews have considered the potentially less favourable physiological responses to moderate altitude exposure, which include decreases in absolute training intensity, decreased plasma volume, depression of haemopoiesis and increased haemolysis, increases in sympathetically mediated glycogen depletion at altitude, and increased respiratory muscle work after return to sea level. In addition, there is a risk of developing more serious medical complications at altitude, which include acute mountain sickness, pulmonary oedema, cardiac arrhythmias, and cerebral hypoxia. The possible implications of changes in immune function at altitude have also been largely ignored, despite accumulating evidence of hypoxia mediated immunosuppression. In general, altitude training has been shown to improve performance at altitude, whereas no unequivocal evidence exists to support the claim that performance at sea level is improved. Table 1 summarises the theoretical advantages and disadvantages of altitude training for sea level performance. This review summarises the physiological rationale for altitude training as a means of enhancing endurance performance after return to sea level. Factors that have been shown to affect the acclimatisation process and the subsequent implications for exercise performance at sea level will also be discussed. Studies were located using five major database searches, which included Medline, Embase, Science Citation Index, Sports Discus, and Sport, in Images Figure 1 Figure 2 PMID:9298550

Conducting Return on Investment Analyses for Secondary and Postsecondary CTE: A Framework

ERIC Educational Resources Information Center

Hollenbeck, Kevin M.

2011-01-01

In recent work, the author has estimated the rate of return for several workforce development programs in the State of Washington, including secondary and postsecondary career and technical education (CTE; Hollenbeck, 2008). The returns are based on estimates of the net impact of CTE on individuals' labor market experiences and government income…

Income Tax and the FAFSA for Unaccompanied Homeless Youth

ERIC Educational Resources Information Center

National Association for the Education of Homeless Children and Youth, 2009

2009-01-01

This two-page brief answers various questions about the relationship between the filing of tax returns and a youth's completion of the FAFSA. Questions answered include: How does a youth's decision to file a tax return affect the FAFSA?; Are youth required to file tax returns?; and What should an unaccompanied youth do if his/her parents claim…

40 CFR 98.453 - Calculating GHG emissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) + (Pounds of SF6 returned to site after off-site recycling). Disbursements of SF6 = (Pounds of SF6 contained...) + (Pounds of SF6 returned to suppliers) + (Pounds of SF6 sent off site for recycling) + (Pounds of SF6 sent... including for recycling, for destruction or to be returned to suppliers using Equation SS-2 of this section...

40 CFR 98.453 - Calculating GHG emissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) + (Pounds of SF6 returned to site after off-site recycling). Disbursements of SF6 = (Pounds of SF6 contained...) + (Pounds of SF6 returned to suppliers) + (Pounds of SF6 sent off site for recycling) + (Pounds of SF6 sent... including for recycling, for destruction or to be returned to suppliers using Equation SS-2 of this section...

40 CFR 98.453 - Calculating GHG emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) + (Pounds of SF6 returned to site after off-site recycling). Disbursements of SF6 = (Pounds of SF6 contained...) + (Pounds of SF6 returned to suppliers) + (Pounds of SF6 sent off site for recycling) + (Pounds of SF6 sent... including for recycling, for destruction or to be returned to suppliers using Equation SS-2 of this section...

40 CFR 98.453 - Calculating GHG emissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) + (Pounds of SF6 returned to site after off-site recycling). Disbursements of SF6 = (Pounds of SF6 contained...) + (Pounds of SF6 returned to suppliers) + (Pounds of SF6 sent off site for recycling) + (Pounds of SF6 sent... including for recycling, for destruction or to be returned to suppliers using Equation SS-2 of this section...

26 CFR 301.7216-1 - Penalty for disclosure or use of tax return information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... information. 301.7216-1 Section 301.7216-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... the business of providing auxiliary services in connection with the preparation of tax returns, including a person who develops software that is used to prepare or file a tax return and any Authorized IRS...

75 FR 94 - Amendments to the Section 7216 Regulations-Disclosure or Use of Information by Preparers of Returns

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

... use of statistical compilations of data under section 7216 of the Internal Revenue Code (Code) by a... preparation business, including identification of additional limited circumstances when a tax return preparer... tax return business under Sec. 301.7216-2(n); disclose and use statistical compilations of data...

A Long, Long Time Ago: Student Perceptions of Geologic Time Using a 45.6-foot-long Timeline

NASA Astrophysics Data System (ADS)

Gehman, J. R.; Johnson, E. A.

2008-12-01

In this study we investigated preconceptions of geologic time held by students in five large (50-115 students each) sections of introductory geology and Earth science courses. Students were randomly divided into groups of eleven individuals, and each group was assigned a separate timeline made from a roll of adding machine paper. Students were encouraged to work as a group to place the eleven geological or biological events where they thought they should belong on their timeline based only on their previous knowledge of geologic time. Geologic events included "Oldest Known Earth Rock" and "The Colorado River Begins to Form the Grand Canyon" while biological events included such milestones as "First Fish," "Dinosaurs go Extinct," and "First Modern Humans." Students were asked in an anonymous survey how they decided to place the events on the timeline in this initial exercise. After the eleven event cards were clipped to the timeline and marks were made to record the initial location of each event, students returned to the classroom and were provided with a scale and the correct dates for the events. Each paper timeline was 45.6 ft. long to represent the 4.56 billion years of Earth history (each one-foot-wide floor tile in the hallways outside the classroom equals 100 million years). Student then returned to their timelines and moved the event cards to the correct locations. At the end of the exercise, survey questions and the paper timelines with the markings of the original position of geologic events were collected and compiled. Analysis of the timeline data based on previous knowledge revealed that no group of students arranged all of the events in the proper sequence, although several groups misplaced only two events in relative order. Students consistently placed events further back in time than their correct locations based on absolute age dates. The survey revealed that several student groups used one "old" event such as the "First Dinosaurs Appear" or "Oldest Known Earth Rock" as a marker from which they based relative placement of other events on the timeline. The most recent events including "First Modern Humans" showed the greatest percentage error of placement.

Evaluation of a programme for 'Rapid Assessment of Febrile Travelers' (RAFT): a clinic-based quality improvement initiative.

PubMed

Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

2016-07-29

Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting. Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year. Exclusion criteria include Plasmodium falciparum malaria, and fulfilment of admission criteria such as unstable vital signs or significant laboratory derangements. We performed a time series analysis preimplementation and postimplementation, with primary outcome of wait time to tropical medicine consultation. Secondary outcomes included number of ED visits averted for repeat malaria testing, and algorithm adherence. From February 2014 to December 2015, 154 patients were seen in the RAFT clinic: 68 men and 86 women. Median age was 36 years (range 16-78 years). Mean time to RAFT clinic assessment was 1.2±0.07 days (range 0-4 days) postimplementation, compared to 5.4±1.8 days (range 0-26 days) prior to implementation (p<0.0001). The RAFT clinic averted 132 repeat malaria screens in the ED over the study period (average 6 per month). Common diagnoses were: traveller's diarrhoea (n=27, 17.5%), dengue (n=12, 8%), viral upper respiratory tract infection (n=11, 7%), chikungunya (n=10, 6.5%), laboratory-confirmed influenza (n=8, 5%) and lobar pneumonia (n=8, 5%). In addition to provision of more timely care to ambulatory febrile returned travellers, we reduced ED bed-usage by providing an alternate setting for follow-up malaria screening, and treatment of infectious diseases manageable in an outpatient setting, but requiring specific therapy. 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/

Characteristics of unscheduled emergency department return visit patients within 48 hours in Thammasat University Hospital.

PubMed

Imsuwan, Intanon

2011-12-01

Auditing the return visit charts of patients who returned within 48 hours is a very important method of quality assurance. Several factors can be possible causes of unscheduled emergency return visits. Therefore, identifying these factors is critical to decreasing the number of unnecessary visits in this group. To determine rate, common initial presentation and cause of unscheduled emergency department return visits within 48 hours at Thammasat University Hospital. The present study design involves retrospective observational study of patients who returned to the Emergency department (ED) within 48 hours after being discharged from the ED. Data was collected from August 1, 2009 to July 31, 2010. Patient age, gender triage level, patient-in time, patient-out time, length of stay, chief complaint, first and second visit diagnoses and disposition after second visit were recorded by chart review. The factors and causes of revisits were classified by the author as illness-related, patient-related, doctor-related and/or healthcare system-related. A total of 307 (0.92%) patients returned visit to the ED within 48 hours during August 1, 2009 to July 31, 2010. The most common chief complaint were dyspnea (75 cases or 24.4%), abdominal pain (53 cases or 17.3%), bleeding per vagina (28 cases or 9.1%). The rates of revisit that were related to factors of illness, patients, doctors and healthcare system were 60.6, 8.5, 28.3 and 2.6, respectively. Chi-squared was used for categorical data. Unscheduled ED return visit patients represent high risk patients. Patients in this group are associated with various factors. The present study indicates that the most common factor behind return visits were illness-related. Illness-related and patient-related factors were significantly associated with discharged patient. Observational units could reduce unnecessary return visit in this group. Doctor-related and healthcare-related factors were significantly associated with admitted return visit patients. Emergency physician training system and guideline implementation for doctors could reduce unexpected early discharge in this group.

Sexual function of young women with myelomeningocele.

PubMed

Gamé, Xavier; Moscovici, Jacques; Guillotreau, Julien; Roumiguié, Mathieu; Rischmann, Pascal; Malavaud, Bernard

2014-06-01

To assess the sexual function of young women with spina bifida and myelomeningocele and to determine the factors influencing their sexual function. A postal cross-sectional study using a self-administered questionnaire was performed in 44 women, mean age 27.66 ± 5.89 years, with spina bifida and myelomeningocele. The questionnaire included the Brief Index of Sexual Functioning for Women and questions about voiding mode, urinary symptoms, socioeconomic status, education level, lifestyle, and partnership. In parallel, data were also collected from the paediatric surgery records of patients who returned the questionnaire. The response rate was 56.8% (25/44). All domains of female sexual function (thoughts/desires, arousal, frequency of sexual activity, receptivity/initiation, pleasure/orgasm, relationship satisfaction) were altered. Urinary incontinence was likely to be the main factor responsible for altered sexual function and was associated with lower thoughts/desires, arousal, and receptivity/initiation scores. Wearing pads also constituted a limitation to achieving intimacy. Young myelomeningocele women report poor sexual functioning. The presence of urinary incontinence is associated with lower thoughts/desire, arousal, and receptivity/initiation. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Comparison of the effects of sodium bicarbonate jet prophylaxis on blood pressure in normotensive individuals and patients with controlled hypertension: a controlled clinical trial.

PubMed

Ferreira, Camila Lopes; De Marco, Andrea Carvalho; Lazzari, Thiago Rodrigues; Amorim, José Benedito Oliveira; Santamaria, Mauro Pedrine; Jardini, Maria Aparecida Neves

2017-01-01

This study assessed the blood pressure (BP) of normotensive subjects and subjects with pharmacologically controlled hypertension after sodium bicarbonate jet prophylaxis. Forty subjects were divided into 2 groups: a normotensive control group (n = 20) and a hypertensive group (n = 20). Blood pressure measurements were conducted at 4 timepoints: prior to the dental prophylaxis (T0), immediately after treatment (Ti), 15 minutes after treatment (T15), and 30 minutes after treatment (T30). The systolic BP (SBP) values for both groups were significantly increased at Ti (P < 0.05) and returned to their initial state at T15. Both groups also showed a significant increase in diastolic BP (DBP) values at Ti (P < 0.05); however, the basal conditions in hypertensive subjects were not restored until T30, whereas the values for normotensive subjects were restored at T15. The results indicated that systemic BP changed significantly after sodium bicarbonate jet prophylaxis in both study groups; while initial SBP values were restored by 15 minutes in both groups, the return to initial DBP values took longer in the hypertensive group than in the normotensive group.

Factors associated with delayed recovery in athletes with concussion treated at a pediatric neurology concussion clinic.

PubMed

Bock, Suzanne; Grim, Rod; Barron, Todd F; Wagenheim, Andrew; Hu, Yaowen Eliot; Hendell, Matthew; Deitch, John; Deibert, Ellen

2015-11-01

With the increase in knowledge and management of sport-related concussion over the last 15 years, there has been a shift from a grading scale approach to an individualized management approach. As a result, there is an increased need to better understand the factors involved in delayed recovery of concussion. The purpose of this retrospective study was to examine factors that may be associated with recovery from sport-related concussion in student athletes aged 11 to 18 years old. Of the 366 patients who met the inclusion criteria, 361 were included in our analysis. The primary dependent variable included days until athlete was able to return to play (RTP). Independent variables of interest included age, gender, academic performance, comorbid factors, sports, on-field markers, days until initial neurological evaluation, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) scores, acute headache rescue medications, chronic headache medication, sleep medication, and referral to concussion rehabilitation program. Variables associated with longer median RTP were being female (35 days), having a referral to concussion rehabilitation program (53 days), being prescribed acute headache rescue therapy (34 days), and having chronic headache treatment (53 days) (all p < 0.05). Variables associated with shorter RTP were on-field marker of headache (23 days) and evaluation within 1 week of concussion by a concussion specialist (16 days) (Both p < 0.05). This study supports the need for a concussed athlete to have access to a provider trained in concussion management in a timely fashion in order to prevent delayed recovery and return to play.