Roadmap to Guide U.S. Photovoltaics Industry in 21st Century

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industry wants them to have it. Solar-cell manufacturers and suppliers see photovoltaics (PV) producing at Roadmap to Guide U.S. Photovoltaics Industry in 21st Century Solar energy will provide emergency Douglas Golden, Colo., Jan. 20, 2000 - Americans want clean solar electricity. The U.S. photovoltaics

Newcomers

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commands are located on Peterson Air Force Base. The Base Guide describes some of the services available on our base to include information on the Joint Personal Property Shipping Office (the office in charge Base and in the local area, log into the 21st Force Support Squadron's web site. The 21st Force Support

National Centers for Environmental Prediction

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code. Press enter or select the go button to submit request Local forecast by "City, St" City , St Go Search NCEP Go Current Hazards Watches/Warnings Outlooks National Current Conditions

U.S. Strategic Command

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. Navy photo by Mass Communication Specialist 1st Class Julie R. Matyascik) VIDEO: NATO Secretary General . Navy photo by Mass Communication Specialist 1st Class Ronald Gutridge/Released) USS Nebraska promotes #innovation and a #CombatReadyForce during the monthly #ChiefChat. #Communication is key to

Delaware | Solar Research | NREL

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. Customer-generators interested in selling Solar Renewable Energy Credits (SRECs) into the Delaware spot periods starting on April 1st or October 1st as chosen by the customer. Net Metering Delaware modified the state net metering significantly in 2017, including expanding it to all customer classes, adding biogas

Home of Air National Guard

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Force AF announces changes to Courses 14 and 15 AF announces changes to Courses 14 and 15 AF announces changes to Courses 14 and 15 121st ARW recruiter hits career milestone in record time 121st ARW recruiter Force logistics team named best in the Air Force AF announces changes to Courses 14 and 15 RSS More

Publications - GMC 50 | Alaska Division of Geological & Geophysical Surveys

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DGGS GMC 50 Publication Details Title: Palynological analysis of core chips from the Mobil Oil Corporation Mikkelsen Bay State #13-9-19, Humble Oil East Mikkelsen Bay State #1, Mobil Oil Corporation West Staines St. #18-9-23 and the Exxon Alaska St. A-1 wells Authors: Marshall, Thomas, Union Oil Company of

Maxwell Air Force Base

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Social Media Guide (PDF) USAF Social Media Sites 42nd Medical Group 42nd Medical Group Voting Assistance : Open 24 hours a day, seven days a week. - Kelly St. Gate: Open Mon-Fri, 6:00 a.m. - 6 p.m., closed weekends, holidays and AETC down days. - Day St. Gate: Open Mon-Fri, 6:00 a.m. - 2:00 p.m. inbound traffic

OHD - OHD Staff

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Site Map News Organization Search NWS All NOAA Go Local forecast by "City, St" Search by city or zip code. Press enter or select the go button to submit request City, St Go Front Office OWP

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Epidemiological study of erythromycin-resistant Streptococcus pyogenes from Korea and Japan by emm genotyping and multilocus sequence typing.

PubMed

Takahashi, Takashi; Arai, Kazuaki; Lee, Dong Hyun; Koh, Eun Ha; Yoshida, Haruno; Yano, Hisakazu; Kaku, Mitsuo; Kim, Sunjoo

2016-01-01

We determined the epidemiological characteristics of erythromycin (EM)-resistant Streptococcus pyogenes (group A streptococci, GAS) strains isolated from Korea and Japan, using emm genotyping and multilocus sequence typing (MLST). Clinical isolates of GAS had been collected from 1992 to 2012 in Korea and from 2004 to 2009 in Japan. EM resistance was determined by the microdilution method, and resistance genotypes were assessed by PCR. The emm genotyping and MLST were performed by DNA sequencing. The emm genotypes and sequence types (STs) were concordant in 143 (85.1%) of 168 EM-resistant GAS strains from Korea. ST36/emm12 (35.1%), ST52/emm28 (22.6%), and ST49/emm75 (16.1%) were the most common types. Most of the ST36 (93.9%) and ST52 (95.8%) strains harbored erm(B), whereas strains ST49, ST42, and ST15 contained mef(A). The concordance between emm genotypes and STs was 41 (93.2%) among 44 EM-resistant GAS strains from Japan. ST36/emm12 (34.1%), ST49/emm75 (18.2%), and ST28/emm1 (15.9%) were the major types. ST36 isolates harbored either erm(B) (56.3%) or mef(A) (37.5%), whereas isolates ST28, ST49, and ST38 carried only mef(A). The proportion of erm(B) and mef(A) was 66.1% and 33.3% in Korea and 22.7% and 68.2% in Japan, respectively. The common STs in Korea and Japan were ST36 and ST49, whereas ST52 was present only in Korea and ST28 only in Japan. Genotype erm(B) was predominant in Korea, whereas mef(A) was frequent in Japan. There were differences between Korea and Japan regarding the frequencies of emm genotypes, STs, and EM resistance genes among the EM-resistant GAS.

Alternative Fuels Data Center: St. Landry Parish Turns Garbage into

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Renewable Natural GasA> St. Landry Parish Turns Garbage into Renewable Natural Gas to someone by natural gas to fuel its vehicles. For information about this project, contact Louisiana Clean Fuels - Television's Original Automotive Magazine Provided by Maryland Public Television Related Videos Photo of a car

MEDIA

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engagement taking place with the Tajikistan Peacekeeping Battalion of the Mobile Forces and the 648th Exercise Eager Lion 2018. (U.S. Army photo by Sgt. 1st Class Patrick J. DeGeorge, 139th Mobile Public . 1st Class Patrick J. DeGeorge, 139th Mobile Public Affairs Detachment) Hi-Res | Photo Gallery MacDill

OHD/HL - National Weather Hydrology Laboratory

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1997 News Releases | NREL

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Continues Day 8 - St. Francis, Kan. to Limon, Color. - (6/26/97) Sunrayce 97 Continues Day 7 - Smith Center to St. Francis - (6/25/97) Sunrayce 97 Continues Day 6 - Manhattan to Smith Center - (6/24/97

NREL: News - NREL Launches Fuel Research Lab in Denver

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said. Alternative fuel and technologically advanced vehicles will be on display at the event, including ethanol-powered race car. The event will also feature tours of various research components within the . The event begins at 10 a.m. at the ReFUEL facility, 1980 31st St., just west of Brighton Boulevard

Alternative Fuels Data Center: St. Louis Airport Relies on Biodiesel and

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Natural Gas VehiclesA> St. Louis Airport Relies on Biodiesel and Natural Gas Vehicles to someone International Airport relies on biodiesel and natural gas buses and trucks. For information about this project FuelEconomy.gov. Provided by Maryland Public Television Related Videos Photo of a car Electric Vehicles Charge up

Interactive Chart of Nuclides

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Chart of Nuclides Click on a nucleus for information Color code Half-life Decay Mode Qβ- QEC QÎ Radiation Help - Glossary This site is better seen using the latest version of internet browsers. Database ²+ Sn Sp Qα S2n S2p Q2β- Q2EC QECp Qβ-n BE/A (BE-LDM Fit)/A E1st ex. st. E2+ E3- E4+ E4+/E2+ β2 B(E2

Greg Wilson, D.Sc. | NREL

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Chemical Engineering from Washington University in St. Louis and a B.S. in Chemical Engineering from the Number 6,284,384. Gregory M. Wilson, et al., "Pressure Equalization System for Chemical Vapor

Glossary - NOAA's National Weather Service

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Organization Search NWS All NOAA Go Local forecast by "City, St" Search by city. Press enter or Text Bulletins By State By Message Type National Forecast Models Numerical Models Statistical Models

Military Applications of High-Altitude Satellite Orbits in a Multi-Body Dynamical Environment Using Numerical Methods and Dynamical Systems Theory

DTIC Science & Technology

2016-03-01

Anno vi Acknowledgments First, I would like to express my incredible gratitude...Earth-Moon and Sun-Earth systems in Table 1. 51 T a b le 1 . J a c o b i C o n st a n t V a lu e s a n d R o ta ti n g F ra m e C o o rd in a te s o...g C o o rd in a te s in S y st em E q u a l M a ss S y st em P o in t E a rt h -M o o n S y st em in J a co b i C o n st a n t

Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines.

PubMed

Mathews, Robin; Peterson, Eric D; Li, Shuang; Roe, Matthew T; Glickman, Seth W; Wiviott, Stephen D; Saucedo, Jorge F; Antman, Elliott M; Jacobs, Alice K; Wang, Tracy Y

2011-07-12

Activation of emergency medical services (EMS) is critical for the early triage and treatment of patients experiencing ST-segment-elevation myocardial infarction, yet data regarding EMS use and its association with subsequent clinical care are limited. We performed an observational analysis of 37 634 ST-segment-elevation myocardial infarction patients treated at 372 US hospitals participating in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines between January 2007 and September 2009, and examined independent patient factors associated with EMS transportation versus patient self-transportation. We found that EMS transport was used in only 60% of ST-segment-elevation myocardial infarction patients. Older patients, those living farther from the hospital, and those with hemodynamic compromise were more likely to use EMS transport. In contrast, race, income, and education level did not appear to be associated with the mode of transport. Compared with self-transported patients, EMS-transported patients had significantly shorter delays in both symptom-onset-to-arrival time (median, 89 versus 120 minutes; P<0.0001) and door-to-reperfusion time (median door-to-balloon time, 63 versus 76 minutes; P<0.0001; median door-to-needle time, 23 versus 29 minutes; P<0.0001). Emergency medical services transportation to the hospital is underused among contemporary ST-segment-elevation myocardial infarction patients. Nevertheless, use of EMS transportation is associated with substantial reductions in ischemic time and treatment delays. Community education efforts are needed to improve the use of emergency transport as part of system-wide strategies to improve ST-segment-elevation myocardial infarction reperfusion care.

Gayle Bentley | NREL

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Areas of Expertise Metabolic engineering Synthetic biology Molecular microbiology Gas chromatography biosynthesis Education Ph.D., Molecular Microbiology and Microbial Pathogenesis, Washington University in St

NOAA Workforce Management Office

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Home Careers at NOAA Search Criteria Click to Search WORKFORCE MANAGEMENT OFFICE NATIONAL OCEANIC Executive Service ST and SL Responsibilities Performance Management Performance Management Resources Portal Management Fellows (PMFs) Program Coordination Office - Leadership Development Program (PCO-LDP) Employee

Systems Engineering Workshops | Wind | NREL

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Workshops Systems Engineering Workshops The Wind Energy Systems Engineering Workshop is a biennial topics relevant to systems engineering and the wind industry. The presentations and agendas are available for all of the Systems Engineering Workshops: The 1st NREL Wind Energy Systems Engineering Workshop

Adam Warren | NREL

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, 2014 Wind Power Opportunities in St. Thomas, USVI: A Site-Specific Evaluation and Analysis. NREL , Canada B.S., Chemical Engineering, Texas A&M University, College Station, Texas Featured Publications Low Carbon Desalination: Status and Research, Development, and Demonstration Needs. Report of a

Explorers

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Atmosphere Explorers Patrick Megonigal Melissa McCormick Dennis Whigham Curator and Soil Ecologist Soil Scientist Brigham Young University Sophomore Waiakea High School Hilo, Hawaii Graduate Student USDA/NRCS St. Croix Field Office National Leader for World Soil Resources USDA/NRCS Soil Scientist USDA

Alida Gerritsen | NREL

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research, such as proteomics and metabolomics, in order to develop a greater understanding of the organisms used for renewable energy resources. Research Interests Bioinformatics Novel analysis pipelines Education Ph.D., Evolutionary Biology, University of Oregon B.S., Biology, St. Lawrence University

Department of Chemistry and Biochemistry - University of Maryland,

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Access Analytical Facilities? New Labs Catalyze Chemistry Learning Inclusive & Interdisciplinary New Collaborative Research New Labs Catalyze Chemistry Learning Inclusive & Interdisciplinary New Molecule Shows Author's profile esj-lab New Labs Catalyze Chemistry Learning The Edward St. John Learning and Teaching

NWS Marine, Tropical, and Tsunami Services Branch Feedback

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George A. Olah, Carbocation and Hydrocarbon Chemistry

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. Final Technical Report. [HF:BF{sub 2}/H{sub 2}] , DOE Technical Report, 1980 Superacid Catalyzed Coal Conversion Chemistry. 1st and 2nd Quarterly Technical Progress Reports, September 1, 1983-March 30, 1984 , DOE Technical Report, 1984 Superacid Catalyzed Coal Conversion Chemistry. Final Technical Report

Peter St. John | NREL

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for microbial strain design to optimize the production of value-added chemicals from lignin using Pseudomonas putida. Featured Publications "A quantitative model for the prediction of sooting tendency

UChicago Argonne, LLC.

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Argonne National Laboratory - Energy Sciences Building dedication Argonne OutLoud: "Climate Change : Chicago in the 21st Century and Beyond "Invisible Influence: A Bacterial Guide to Your Health"

Air Force Special Operations Command > Home > POTFF

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Air Force Special Operations Command Air Force Special Operations Command Join the Air Force Home Sheets AFSOC Senior Leaders AFSOC Heritage Units 1st Special Operations Wing 24th Special Operations Wing 27th Special Operations Wing 352nd Special Operations Wing 353rd Special Operations Group 492nd Special

Climate Prediction Center - Outreach: 41st Annual Climate Diagnostics &

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the University of Maine Climate Change Institute and School of Earth and Climate Sciences and is co (drought, heat waves, severe weather, tropical cyclones) in the framework of climate variability and change and including the use of paleoclimate data. Arctic climate variability and change, and linkages to

Jon Weers | NREL

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; Innovation Group in the Strategic Energy Analysis Center. Areas of Expertise Data Management Solutions Geothermal Data Repository and the Future of Geothermal Data. Paper presented at the 41st Workshop on Geothermal Reservoir Engineering (SGW 2016), Stanford, California, February 2016. NREL/CP-6A20-65967. Weers

2007 Preserve America Presidential Awards

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the Private Preservation category, the two winners are: The History Channel, Save Our History Save Our History were Abbe Raven, president and CEO, A&E Television Networks; and Nancy Dubuc , executive vice president, The History Channel. Receiving the award for Downtown St. Louis Revitalization

Alaska Division of Geological and Geophysical Surveys

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; Divison of Geological & Geophysical Surveys> Engineering Geology Coastal Hazards Alaska's extensive shorelines are incompletely mapped and under-instrumented for the evaluation of coastal dynamics. The Coastal communities Updates to the Alaska Coastal Profile Tool including data in Norton Sound and St. Lawrence Island

OHD/HL: Presentations

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enter or select the go button to submit request City, St Go Science Research and Collaboration Hydrology River Forecasts, January 2002 AMS Short Course on Quantitative Precipitation Estimation and Forecasting

Mediation of early maladaptive schemas between perceptions of parental rearing style and personality disorder symptoms.

PubMed

Thimm, Jens C

2010-03-01

In schema therapy (ST), early maladaptive schemas (EMS) are proposed to be the defining core of personality disorders. Adverse relational experiences in childhood are assumed to be the main cause for the development of EMS. The present study explored the links between perceived parental rearing behaviours, EMS, and personality disorder symptoms in a clinical sample (N=108). Results from mediation analyses suggest that EMS mediate the relationships between recalled parenting rearing behaviours and personality disorder symptoms. Findings give support to the theoretical model ST is based on.

Mission Statement - NOAA's National Weather Service

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Defense.gov Special Report: Combined Federal Campaign

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250 words) and high resolution pictures (minimum 1MB) of your agencies campaign by emailing Ms Department of Defense Dependent Schools (DoDDS) High School Public Service Announcement (PSA) Contest . Contest judges recognized five high schools. View all winning PSAs below: 1st Place, Kadena High School

Hyun Suk Kang | NREL

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Hyun Suk Kang Albert Kang Postdoctoral Researcher-Chemistry Albert.Kang@nrel.gov | 303-384-6667 Dr , Chemistry, and Mathematics and his Master of Science degree in Chemistry from Northwestern University in 2009. He earned his Ph.D. degree in Physical Chemistry from Washington University in St. Louis in 2016

Job Fairs, Recruitments, and Workshops

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:30 am to 12:30 pm Midtown Job Center 3301 Eagle St. YK Delta MASST Orientations Regular Sessions Mature Alaskans Seeking Skills Training YK Delta Job Center - 460 Ridgecrest Drive, Suite 112 For more , Anchorage, Fairbanks YK Delta (Bethel) - Job Center Workshops Regular sessions YK Delta (Bethel) 460

NOAA's National Weather Service

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select the go button to submit request City, St Go Sign-up for Email Alerts RSS Feeds RSS Feeds Warnings prepares the Annual Flood Loss summary for the U.S. Army Corps of Engineers. 2014 2013 2012 2011 2010 2009 Skip Navigation Links weather.gov NOAA logo-Select to go to the NOAA homepage National Oceanic and

Home of the 151st Air Refueling Wing

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Air Force aerial porters RSS More Social Media Facebook Logo Congratulations to Hailee and Danny social media sites! But in doing so, let's practice good Social Med... https://t.co/NcqQji3diJ Facebook Flickr Air Force Social Media Guide (PDF) USAF Social Media Sites SAPR Sexual Assault Prevention and

National Maps - Alaska - NOAA's National Weather Service

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37th Training Wing > Units > Inter-American Air Forces Academy

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37th Training Wing 37th Training Wing Join the Air Force Home News Commentaries Features Photos Art Information CAC/ID Card Information Units 37th Training Group 341st Training Squadron 344th Training Squadron 37th Training Wing Staff Agency 737th Training Group Defense Language Institute English Language Center

Publications - GMC 53A | Alaska Division of Geological & Geophysical

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quartz sand grains from ARCO Alaska, Inc. West Mikkelsen St. #1 Authors: Unknown Publication Date Reference Unknown, [n.d.], Scanning electron micrographs of selected radiolarians and quartz sand grains

World Biotechnology Leaders to Gather for Conference

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Biotechnology Leaders to Gather for Conference For more information contact: e:mail: Public Affairs biotechnology leaders gather in Fort Collins, CO May 2-6 for the 21st Symposium on Biotechnology for Fuels and special session on funding opportunities for U.S. biotechnology projects. More than 175 presentations are

Publications - GMC 164 | Alaska Division of Geological & Geophysical

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Staines St. 10-09-23, Nora Fed #1, Sag Delta 33-12-16, Sag Delta #1, Kavik #1, BF-47 #1, OCS Y-0804-1 , Nora Fed #1, Sag Delta 33-12-16, Sag Delta #1, Kavik #1, BF-47 #1, OCS Y-0804-1 (Orion #1), OCS Y-0334

History of the National Weather Service - Public Affairs - NOAA's National

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enter or select the go button to submit request City, St Go About NWS -Mission -Strategic Plan -History and local government web resources and services. Home >> History History of the National Weather Service The National Weather Service has its beginnings in the early history of the United States. Weather

Forecasts - NOAA's National Weather Service

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Observations - NOAA's National Weather Service

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Warnings/Watches - NOAA's National Weather Service

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NOAA's National Hydrologic Assessment

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National Maps - Pacific - NOAA's National Weather Service

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Weather Education/Outreach - NOAA's National Weather Service

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Careers in Weather - NOAA's National Weather Service

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ACHP | News | ACHP Business Meeting Feb. 17 in Washington, D.C.

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- America's Great Outdoors Initiative report issued Developing a 21st Century Conservation Agenda - America's Great Outdoors Initiative report issued On Feb. 16, President Obama unveiled the report titled " involved in development of the report and will play a role in its implementation to help weave cultural

Public Affairs - Brochures Available

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Go About Fermilab What is Fermilab? Contributions to Science and Society Virtual Tour Research at Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Tome (Sao Tome) & Principe Sudan National Accelerator Laboratory Office of Science/U.S. Department of Energy Managed by Fermi Research

National Weather Service - Strategic Planning and Policy

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Publications - GMC 383 | Alaska Division of Geological & Geophysical

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Alaska MAPTEACH Tsunami Inundation Mapping Energy Resources Gas Hydrates STATEMAP Program information DGGS GMC 383 Publication Details Title: Makushin Geothermal Project ST-1R, A-1, D-2 Core 2009 re -sampling and analysis: Analytical results for anomalous precious and base metals associated with geothermal

Publications - GMC 366 | Alaska Division of Geological & Geophysical

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Alaska MAPTEACH Tsunami Inundation Mapping Energy Resources Gas Hydrates STATEMAP Program information DGGS GMC 366 Publication Details Title: Makushin Geothermal Project ST-1R Core 2009 re-sampling and analysis: Analytical results for anomalous precious and base metals associated with geothermal systems

Home

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Tajikistan Peacekeeping Battalion of the Mobile Forces and the 648th Military Engagement Team, Georgia Army . Army photo by Sgt. 1st Class Patrick J. DeGeorge, 139th Mobile Public Affairs Detachment) Jordanian and Mobile Public Affairs Detachment) Hi-Res | Photo Gallery MacDill AFB, Fla. (April, 6, 2018) - His

National Operational Hydrologic Remote Sensing Center - The ultimate source

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Analysis Satellite Obs Forecasts Data Archive SHEF Products Observations near City, ST Go Science Database Airborne Snow Surveys Satellite Snow Cover Mapping Snow Modeling and Data Assimilation Analyses polar-orbiting and geostationary satellite imagery. Maps are provided for the U.S. and the northern

Defense.gov Special Report: Fort Hood Shooting

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in the assailant's background, medical or military profile that might have provided an early warning Shootings President Barack Obama commended the military personnel, first responders and medical staff who interactive planar photo of Fort Hood, highlighting six buildings: 61st First Medical Brigade Annex

Home of the 161st Air Refueling Wing

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integrity, hard work and dedication. (U.S. Air National Guard photo by 2nd Lt. Tinashe Machona) Tinashe the Casy Gala! Thank you for your hard ... Facebook Logo Congratulations to our newest Airman

Escleroterapia de safena associada a enxerto de pele no tratamento de úlceras venosas

PubMed Central

de Oliveira, Alexandre Faraco; de Oliveira, Horácio

2017-01-01

Resumo Contexto Úlceras são a resultante final de varizes associadas a refluxo de veias safenas. Objetivo Demonstrar a possibilidade de associar dois procedimentos, a escleroterapia com espuma de veias safenas e o enxerto de pele parcial, para o tratamento de pacientes com úlceras venosas relacionadas a refluxo de veias safenas. Métodos Foram tratados 20 membros em 20 pacientes, todos com ulcerações relacionadas a refluxo de veias safenas. Realizamos o enxerto de pele expandida, seguido da escleroterapia ecoguiada com espuma de polidocanol nas veias associadas às úlceras, através de punção ou dissecção da veia. Resultados Em todos os casos, houve melhora dos sintomas relacionados à úlcera e cicatrização da lesão. Em 11 casos, obtivemos a viabilidade do enxerto de pele por completo; em quatro casos, houve cicatrização de cerca de 50% da lesão; e nos cinco casos restantes, houve cicatrização de aproximadamente 75% da lesão. A primeira ultrassonografia de controle revelou esclerose completa dos vasos tratados em 19 dos 20 casos e esclerose parcial sem refluxo detectável em um caso. Na segunda ultrassonografia, realizada após 45 dias, observamos esclerose completa de 15 casos; em cinco casos, houve esclerose parcial, dos quais três sem refluxo detectável e dois com refluxo em segmentos isolados associados a varizes. A complicação mais frequente foi a pigmentação nos trajetos venosos, observada em 13 pacientes. Um caso apresentou trombose assintomática de veias musculares da perna. Conclusão Essa associação de procedimentos consiste em uma opção válida com potencial para promover um tratamento mais breve e de menor custo. PMID:29930660

Defense.gov Special Report: 2011 ESGR Employer Support Freedom Awards

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dating to 1919 when the American Legion was first established in St. Louis at the utility's headquarters fact, 3M's CEO and president personally requested to be the executive sponsor when MSN was founded. The when I returned." More Hide Story U.S. Army National Guard Command Sergeant Major John Gipe, in

DefenseLink Special: Horn of Africa

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training. (U.S. Coast Guard Photo by Petty Officer 2nd Class Mariana O'Leary) “I think it was a good Civic Action Programs, better known as MEDCAPS and VETCAPS. Story Ethiopian Defense Training Caption Below Search Training - U.S. Army Sgt. Jason Gogue, of 1st Battalion, 294th Infantry Regiment (Light

NOAA Photo Library - Meet the Photographers/Mary Hollinger

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Oceanographic Data Center in 1971, after receiving a BS degree in Biology from St. Mary's College of MD. She and marine life. Only pictures of her two daughters might compete in shear numbers! Shortly after

Defense.gov - Special Report: Travels with Gates

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take a hard, realistic look at what defense capabilities America really needs in the 21st Century. The Defense Department must take a hard look at every aspect of how it is organized, staffed and operated

Command Home Page

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Jeffrey J. Hanshaw (Released) 151024-N-YO069-030 Vice Chief of Naval Operations (VCNO) Adm. Michelle . Navy photo by Hospital Corpsman 2nd Class Jeffrey J. Hanshaw (Released) 151024-N-YO069-130 Secretary of Justin Wolpert (Released) 150815-N-VC599-264 Boatswain's Mate 1st Class Michael S. Napoleon, assigned to

Command Home Page

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Fabrizio (Released) 180525-N-ES994-0002 Medal of Honor recipient retired Master Chief Special Warfare . Navy photo by Mass Communication Specialist 2nd Class Paul L. Archer (Released) 180525-N-DM308-088 Communication Specialist 1st Class Raymond D. Diaz III (Released) 180524-N-BB269-003 President Donald J. Trump

Goldfein nominated as 21st CSAF > U.S. Air Force > Article Display

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Speeches Archive Former AF Top 3 Viewpoints and Speeches Air Force Warrior Games 2017 Events 2018 Air Force Strategic Documents Desert Storm 25th Anniversary Observances DoD Warrior Games Portraits in Courage

Publications - GMC 415 | Alaska Division of Geological & Geophysical

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from the Kalubik #3, Colville Delta #2, and E. Harrison Bay St. #1 wells Authors: Raven, R., and emission and mass spectrometry data of cuttings from the Kalubik #3, Colville Delta #2, and E. Harrison Bay

Doença cística adventicial da artéria poplítea: relato de caso

PubMed Central

de Oliveira, Julio Cesar Peclat; Barreto, Fernando Tebet Ramos; Souza, Diogo Di Battista de Abreu e; Fonseca, João Marcos Fonseca e; Chimelli, Bernardo de Castro Abi Ramia; Peclat, Ana Paula Rolim Maia; Marques, Marcos Arêas; Fiorelli, Stenio Karlos Alvim

2018-01-01

Resumo A doença cística adventicial da artéria poplítea é uma doença pouco frequente, que deve ser considerada no diagnóstico diferencial de pacientes jovens com claudicação intermitente e sem fatores de risco para doença arterial periférica aterosclerótica. Apresentamos um caso de claudicação intermitente de membros inferiores em paciente masculino de 51 anos no qual essa doença foi diagnosticada. Foi submetido a ressecção do segmento de artéria comprometido e interposição de safena autóloga ipsilateral. Discutimos alternativas diagnósticas e terapêuticas. PMID:29930682

Geologic Materials Center - Hours and Location | Alaska Division of

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AKGeology.info Helpful Tools Related Websites Follow us on Twitter Join our fan page on Facebook DGGS News Downtown Anchorage Head east on W 6th Ave for about 2 miles Take a right on Airport Heights Dr. Take a left on Penland Pkwy and drive 0.4 miles The GMC is on your left just before S. Bragaw St. From the North

DefenseLink Feature: Travels with Mullen

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of the Joint Chiefs of Staff, after laying a memorial wreath in honor of the 17,202 troops killed in and Memorial, Republic of the Philippines, June 2, 2008. Defense Dept. photo by Petty Officer 1st Joint Chiefs of Staff placed at the American Cemetery and Memorial represented one generation of U.S

Constraining Dust and Color Variations of High-z SNe Using NICMOS on the

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Hubble SAO/NASA ADS Astronomy Abstract Service Title: Constraining Dust and Color Variations of Road, Oxford OX1 3RH, UK), AN(Department of Astronomy and Astrophysics, University of Toronto, 60 St ). Publication Date: 08/2009 Origin: IOP Astronomy Keywords: cosmology: observations, cosmological parameters

ACHP | Q&A | The ACHP Interview: Dr. Julia King, associate professor of

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specific nav links Home arrow The ACHP Interview: Dr. Julia King, associate professor of archaeology and anthropology at St. Mary’s College of Maryland, expert member ACHP The ACHP Interview: Dr. Julia King With the recent Society for Historical Archaeology conference concluded, and former chairman John Nau

Doppler Radar National Mosaic - NOAA's National Weather Service

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Skip Navigation Links weather.gov NOAA logo-Select to go to the NOAA homepage National Oceanic and Atmospheric Administration's Select to go to the NWS homepage National Weather Service Site Map News select the go button to submit request City, St Go Sign-up for Email Alerts RSS Feeds RSS Feeds Warnings

SPACE TODAY ONLINE - Space Today Online covering Space from Earth to the

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Space Rockets 300 Flights Delta Proton Search for Meteorites American Weather Satellites Artist concept Rockets: Spaceports Plowshares 21st Century Experimental Europe's Vega Brazil's Difficulties U.S. Delta 4 , Atlas 5 America's 300th Delta Russia's 300th Proton Spaceflight Museum Space Station: Jules Verne Cargo

Rite of Passage: Making Basic Training Tougher

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entire 54 hour exercise," said Sgt. Roger Summers, a Delta Company drill instructor in the 1st positive thing I have done in my life." Delta Company begins the Crucible at 3 a.m. with a six-mile ; photo Delta Company recruits rumble during pugil stick competitions at Parris Island Marine Recruit

Sunrayce 97 Continues Day 7 - Smith Center to St. Francis

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Angeles driver and team leader Roman Vasquez says, "We haven't had any problems. The car's been withdraw from the race yesterday due to suspension problems. The team was presented an "Inspector's . The team worked as a group in arriving at their decision to withdraw from the competition. Sunrayce 97

DefenseLink Feature: Comrades, Loved Ones Provide Reminders of Memorial

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northeast of Baghdad when their UH-60 Black Hawk helicopter was shot down. U.S. Army photo by Sgt. Mary Black Hawk helicopter was shot down near Baghdad on Jan. 20, 2007. Courtesy photo Navy Petty Officer 1st

NREL, Governor's Office Help Coloradans Make Clean Energy Choices

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phone at 303-275-4363. For more information about clean energy in Colorado, contact OEMC online or by phone at 303-894-2383 or 800-632-6662. CLEAN ENERGY FOR THE 21st CENTURY Visit NREL online for up-to

Fermilab Tours

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is limited. Check the calendar for dates and registration. Visitors meet in the Wilson Hall atrium and making your way to the 1st floor of Wilson Hall in time for the tour. Fermilab is a busy lab so Fermilab's exhibit and viewing areas on the 15th floor of Wilson Hall are open Monday-Friday from 8 a.m. to 4

U.S. Department of Defense Official Website - Martin Luther King Jr.

Science.gov Websites

Danger on Jan. 17. Chief Warrant Officer 2 Drayton L. Gilyard, a pastor with Headquarters and Luther King was a good man,'" said Col. Keith L. Cooper, 1st ID's chief of staff, after he returned , caption below. Chief Warrant Officer 2 Drayton L. Gilyard , a pastor with Headquarters and Headquarters

Alternative Fuels Data Center: Missouri Transportation Data for Alternative

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Laboratory Case Studies Video thumbnail for Kansas City Home to Nation's Largest Network of EV Charging Stations Kansas City Home to Nation's Largest Network of EV Charging Stations Aug. 19, 2015 Video thumbnail Transportation Company Rolling May 16, 2014 Video thumbnail for The Heat Is on in St. Louis Buses The Heat Is on

DefenseLink Special: Sgt. 1st Class Paul R. Smith, Medal of Honor Recipient

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DefenseLink.mil Aug. 04, 2015 War on Terror Transformation News Products Press Resources Images Websites Contact awarded for service in Operation Iraqi Freedom and the global war on terror. Story | Photos See caption Against Terror WASHINGTON, April 4, 2005 - Two years to the day after his father died saving more than 100

EMS workforce for the 21st century : a national assessment

DOT National Transportation Integrated Search

2008-06-01

Emergency medical technicians (EMTs) and paramedics are a critical component of any communitys Emergency Medical Services (EMS) system. Assuring the continued viability of the prehospital EMS workforce is a key concern for many local, State, Feder...

Defense.gov - Special Report - Travels With Mullen

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Base, Ill., Feb. 19, 2009. DoD photo by U.S. Navy Petty Officer 1st Class Chad J. McNeeley Top Stories said. Story» Chairman Cites Need for More ‘Dwell Time’ Between Deployments SCOTT AIR FORCE BASE, Ill during a town-hall meeting on Scott Air Force Base, Ill. Story» Air Force Revamps Nuclear Mission MINOT

Enterprise Terrain Data Standards for Joint Training

DTIC Science & Technology

2017-10-03

e.g., bombs /shells, vehicles, etc.) or environmental factors (e.g., weather). • Riverine and ocean surface and bathymetry. o Wave/swell generation...Attachment 2 Terrain Generation Capability St an da rd iz ed S ch em a & At tr ib ut es...F or m at Pl at fo rm In de pe nd en t O pe ra tin g Sy st em In de pe nd en t Geospatial Source & Industry Formats Utilized by the Specification

TrkB Activators for the Treatment of Traumatic Vision Loss

DTIC Science & Technology

2017-06-01

em ( do i: 10 .1 08 9/ ne u. 20 17 .5 10...Im m un e Sy st em ( do i: 10 .1 08 9/ ne u. 20 17 .5 10 4) T hi s ar tic le h as b ee n pe er -r ev ie w ed a nd a cc ep te d fo r pu bl ic...Sy st em ( do i: 10 .1 08 9/ ne u. 20 17 .5 10 4) T hi s ar tic le h as b ee n pe er -r ev ie w ed a nd a cc ep te d fo r pu bl ic at io

Utilizations and Perceptions of Emergency Medical Services by Patients with ST-Segments Elevation Acute Myocardial Infarction in Abu Dhabi: A Multicenter Study

PubMed Central

Callachan, Edward Lance; Alsheikh-Ali, Alawi A.; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A.

2016-01-01

Background: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. Objectives: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. Methods: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi. Semi-structured interviews were conducted with patients to assess the rationale for choosing their prehospital mode of transport and their knowledge of EMS services. Results: Of 587 patients with STEMI (age 51 ± 11 years, male 95%), only 15% presented through EMS, and the remainder came via private transport. Over half of the participants (55%) stated that they did not know the telephone number for EMS. The most common reasons stated for not using EMS were that private transport was quicker (40%) or easier (11%). A small percentage of participants (7%) did not use EMS because they did not think their symptoms were cardiac-related or warranted an EMS call. Stated reasons for not using EMS did not significantly differ by age, gender, or primary language of the patients. Conclusions: EMS care for STEMI is grossly underutilized in Abu Dhabi. Patient knowledge and perceptions may contribute to underutilization, and public education efforts are needed to raise their perception and knowledge of EMS. PMID:27512532

An evaluation of pre-hospital emergency medical systems for suspected ST-elevation myocardial infarction in Colorado.

PubMed

Engelman, Glenn H; Carry, Patrick M; Kubes, Kyle M; Gleason, Michael J

2016-11-01

Patients presenting with ST-elevation myocardial infarction (STEMI) benefit from rapid cardiac reperfusion therapy. Emergency medical service (EMS) agencies can improve patient outcomes by calling STEMI alerts to the receiving facility. The aim of this study was to evaluate the use of pre-hospital activation systems for suspected ST-elevation myocardial infarctions (STEMI) throughout Colorado. A cross sectional, survey design was utilized to collect all data from EMS agencies in Colorado. A univariable logistic regression model was used to identify factors predictive of an agency reporting that they utilize a STEMI activation protocol. 84.5% [95% CI: 78.3 to 90.7%] of agencies included indicate that they utilize a STEMI activation protocol. Based on the logistic regression analysis, the number of EMT employees was significantly associated with whether or not an agency indicates that they utilize a STEMI activation protocol. For every 10% increase in the number of EMTs employed by an EMS agency, there was a 3.0 [95% CI: 1.5 to 6.0, p = 0.0012] fold increase in the odds of the agency indicating they utilize a STEMI activation protocol. Our study provides evidence that larger agencies are more likely to utilize a STEMI activation protocol. In areas without a STEMI system of care, improvements in smaller agencies that cover more ground (with longer transport times) should be the focus for protocol implementation. Based on the current prevalence of such training, competency based training in reading ST-elevations on ECG should be considered by EMS agencies.

KINETICS OF GROWTH AND ETHANOL PRODUCTION ON DIFFERENT CARBON SUBSTRATES USING GENETICALLY ENGINEERED XYLOSE-FERMENTING YEAST

EPA Science Inventory

Saccharomyces cerevisiae 424A (LNH-ST) strain was used for fermentation of glucose and xylose. Growth kinetics and ethanol productivity were calculated for batch fermentation on media containing different combinations of glucose and xylose to give a final sugar concentra...

IEEE 1990 International Symposium on Electromagnetic Compatibility, Washington, DC, Aug. 21-23, 1990, Record

NASA Astrophysics Data System (ADS)

The present conference discusses topics in EM shielding effectiveness, system-level EMC, EMP effects, circuit-level EMI testing, EMI control, analysis techniques for system-level EMC, EMP protective measures, EMI test methods, electrostatic-discharge testing, printed circuit-board design for EMC, and EM environment effects. Also discussed are EMI measurement procedures, EM spectrum-management issues for the 21st century, antenna and propagation effects on EMI testing, EMI control in cables, socioeconomic aspects of EMC, systemwide EMI controls, and EM radiation and coupling.

Physician perceptions and recommendations about pre-hospital emergency medical services for patients with ST-elevation acute myocardial infarction in Abu Dhabi

PubMed Central

Callachan, Edward L.; Alsheikh-Ali, Alawi A.; Bruijns, Stevan; Wallis, Lee A.

2015-01-01

Introduction Physician perceptions about emergency medical services (EMS) are important determinants of improving pre-hospital care for cardiac emergencies. No data exist on physician attitudes towards EMS care of patients with ST-Elevation Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi. Objectives To describe the perceptions towards EMS among physicians caring for patients with STEMI in Abu Dhabi. Methods We surveyed a convenience sample of physicians involved in the care of patients with STEMI (emergency medicine, cardiology, cardiothoracic surgery and intensive care) in four government facilities with 24/7 Primary PCI in the Emirate of Abu Dhabi. Surveys were distributed using dedicated email links, and used 5-point Likert scales to assess perceptions and attitudes to EMS. Results Of 106 physician respondents, most were male (82%), practicing in emergency medicine (47%) or cardiology (44%) and the majority (63%) had been in practice for >10 years. Less than half of the responders (42%) were “Somewhat Satisfied” (35%) or “Very Satisfied” (7%) with current EMS level of care for STEMI patients. Most respondents were “Very Likely” (67%) to advise a patient with a cardiac emergency to use EMS, but only 39% felt the same for themselves or their family. Most responders were supportive (i.e. “Strongly Agree”) of the following steps to improve EMS care: 12-lead ECG and telemetry to ED by EMS (69%), EMS triage of STEMI to PCI facilities (65%), and activation of PCI teams by EMS (58%). Only 19% were supportive of pre-hospital fibrinolytics by EMS. There were no significant differences in the responses among the specialties. Conclusions Most physicians involved in STEMI care in Abu Dhabi are very likely to advise patients to use EMS for a cardiac emergency, but less likely to do so for themselves or their families. Different specialties had concordant opinions regarding steps to improve pre-hospital EMS care for STEMI. PMID:26778900

The Soils and Groundwater – EM-20 S&T Roadmap Quality Assurance Project Plan

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

Fix, N. J.

The Soils and Groundwater – EM-20 Science and Technology Roadmap Project is a U.S. Department of Energy, Office of Environmental Management-funded initiative designed to develop new methods, strategies and technology for characterizing, modeling, remediating, and monitoring soils and groundwater contaminated with metals, radionuclides, and chlorinated organics. This Quality Assurance Project Plan provides the quality assurance requirements and processes that will be followed by EM-20 Roadmap Project staff.

Emergency medical services as a strategy for improving ST-elevation myocardial infarction system treatment times.

PubMed

Langabeer, James R; Dellifraine, Jami; Fowler, Raymond; Jollis, James G; Stuart, Leilani; Segrest, Wendy; Griffin, Russell; Koenig, William; Moyer, Peter; Henry, Timothy D

2014-03-01

Reducing delays in time to treatment is a key goal of ST-elevation myocardial infarction (STEMI) emergency care. Emergency medical services (EMS) are a critical component of the STEMI chain of survival. We sought to assess the impact of the careful integration of EMS as a strategy for improving systemic treatment times for STEMI. We conducted a study of all 747 nontransfer STEMI patients who underwent primary percutaneous coronary intervention (PCI) in Dallas County, Texas from October 1, 2010 through December 31, 2011. EMS leaders from 24 agencies and 15 major PCI receiving hospitals collected and shared common, de-identified patient data. We used 15 months of data to develop a generalized linear regression to assess the impact of EMS on two treatment metrics-hospital door to balloon (D2B) time, and symptom onset to arterial reperfusion (SOAR) time, a new metric we developed to assess total treatment times. We found statistically significant reductions in median D2B (11.1-min reduction) and SOAR (63.5-min reduction) treatment times when EMS transported patients to the receiving facility, compared to self-transport. In addition, when trained EMS paramedics field-activated the cardiac catheterization laboratory using predefined specified protocols, D2B times were reduced by 38% (43 min) after controlling for confounding variables, and field activation was associated with a 21.9% reduction (73 min) in the mean SOAR time (both with p < 0.001). Active EMS engagement in STEMI treatment was associated with significantly lower D2B and total coronary reperfusion times. Copyright © 2014 Elsevier Inc. All rights reserved.

Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps).

PubMed

AlHabib, Khalid F; Sulaiman, Kadhim; Al Suwaidi, Jassim; Almahmeed, Wael; Alsheikh-Ali, Alawi A; Amin, Haitham; Al Jarallah, Mohammed; Alfaleh, Hussam F; Panduranga, Prashanth; Hersi, Ahmad; Kashour, Tarek; Al Aseri, Zohair; Ullah, Anhar; Altaradi, Hani B; Nur Asfina, Kazi; Welsh, Robert C; Yusuf, Salim

2016-01-01

Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries. Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015. We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes. Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities.

Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps)

PubMed Central

AlHabib, Khalid F.; Sulaiman, Kadhim; Al Suwaidi, Jassim; Almahmeed, Wael; Alsheikh-Ali, Alawi A.; Amin, Haitham; Al Jarallah, Mohammed; Alfaleh, Hussam F.; Panduranga, Prashanth; Hersi, Ahmad; Kashour, Tarek; Al Aseri, Zohair; Ullah, Anhar; Altaradi, Hani B.; Nur Asfina, Kazi; Welsh, Robert C.; Yusuf, Salim

2016-01-01

Background Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015. Results We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes. Conclusion Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities. PMID:26807577

Extracellular adenosine 5'-triphosphate concentrations changes in rat spinal cord associated with the activation of urinary bladder afferents. A microdialysis study.

PubMed

Rocha, Jeová Nina

2016-01-01

To determine adenosine 5'-triphosphate levels in the interstice of spinal cord L6-S1 segment, under basal conditions or during mechanical and chemical activation of urinary bladder afferents. A microdialysis probe was transversally implanted in the dorsal half of spinal cord L6-S1 segment in female rats. Microdialysate was collected at 15 minutes intervals during 135 minutes, in anesthetized animals. Adenosine 5'-triphosphate concentrations were determined with a bioluminescent assay. In one group of animals (n=7) microdialysate samples were obtained with an empty bladder during a 10-minutes bladder distension to 20 or 40cmH2O with either saline, saline with acetic acid or saline with capsaicin. In another group of animals (n=6) bladder distention was performed and the microdialysis solution contained the ectonucleotidase inhibitor ARL 67156. Basal extracellular adenosine triphosphate levels were 110.9±35.34fmol/15 minutes, (mean±SEM, n=13), and bladder distention was associated with a significant increase in adenosine 5'-triphosphate levels which was not observed after bladder distention with saline solution containing capsaicin (10µM). Microdialysis with solution containing ARL 67156 (1mM) was associated with significantly higher extracellular adenosine 5'-triphosphate levels and no further increase in adenosine 5'-triphosphate was observed during bladder distension. Adenosine 5'-triphosphate was present in the interstice of L6-S1 spinal cord segments, was degraded by ectonucleotidase, and its concentration increased following the activation of bladder mechanosensitive but not of the chemosensitive afferents fibers. Adenosine 5'-triphosphate may originate either from the central endings of bladder mechanosensitive primary afferent neurons, or most likely from intrinsic spinal neurons, or glial cells and its release appears to be modulated by capsaicin activated bladder primary afferent or by adenosine 5'-triphosphate itself. Determinar as concentrações extracelulares do 5'-trifosfato de adenosina no interstício dos segmentos medulares L6-S1, em condições basais ou durante a ativação mecânica e química das fibras aferentes vesicais. Um cateter de microdiálise foi implantado no sentido transversal na parte dorsal da medula espinal, entre os segmentos L6-S1 de ratas. O microdialisado foi coletado em intervalos de 15 minutos, durante 135 minutos, com os animais anestesiados. A concentração de 5'-trifosfato de adenosina nas amostras foi determinada mediante ensaio de bioluminescência. Em um grupo de animais (n=7), as amostras de microdialisado foram obtidas com a bexiga vazia, com distensão da bexiga para volume de 20 ou 40cmH2O, com solução salina, solução salina com ácido acético, ou solução salina com capsaicina. Em outro grupo (n=6), foi realizada com a bexiga distendida, e a solução para microdiálise continha o inibidor de ectonucleotidase ARL 67156. Os níveis extracelulares de trifosfato de adenosina no início do estudo foram 110,9±35,36fmol/15 minutos (média±EPM, n=13), e a distensão da bexiga causou um aumento nos níveis de 5'-trifosfato de adenosina, o que não foi observado após a distensão da bexiga com solução salina contendo capsaicina (10µM). A microdiálise com solução contendo ARL 67156 (1mM) foi associada com significante aumento dos níveis de trifosfato de adenosina extracelular, e nenhum aumento do trifosfato de adenosina foi observado durante a distensão da bexiga. O 5'-trifosfato de adenosina está presente no interstício do segmento L6-S1 da medula espinal, é degradado por ectonucleotidases, e sua concentração aumentou com a ativação das fibras aferentes mecanossensíveis da bexiga, mas não das quimiossensíveis. O 5'-trifosfato de adenosina pode ter sido liberado das terminações centrais dos neurônios aferentes primários mecanossensíveis ou, mais provavelmente, de neurônios espinais intrínsecos, ou ainda de células gliais. Sua liberação parece ser modulada por fibras aferentes primárias da bexiga ativadas pela capsaicina ou pelo próprio 5'-trifosfato de adenosina.

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

PubMed Central

Viarengo, Luiz Marcelo Aiello; Viarengo, Gabriel; Martins, Aline Meira; Mancini, Marília Wechellian; Lopes, Luciana Almeida

2017-01-01

Resumo Contexto Desde a introdução do laser endovenoso para tratamento das varizes, há uma busca pelo comprimento de onda ideal, capaz de produzir o maior dano seletivo possível com maior segurança e menor incidência de efeitos adversos. Objetivos Avaliar os resultados de médio e longo prazo do laser de diodo de 1940 nm no tratamento de varizes, correlacionando os parâmetros utilizados com a durabilidade do desfecho anatômico. Métodos Revisão retrospectiva de pacientes diagnosticados com insuficiência venosa crônica em estágio clínico baseado em clínica, etiologia, anatomia e patofisiologia (CEAP) C2 a C6, submetidos ao tratamento termoablativo endovenoso de varizes tronculares, com laser com comprimento de onda em 1940 nm com fibra óptica de emissão radial, no período de abril de 2012 a julho de 2015. Uma revisão sistemática dos registros médicos eletrônicos foi realizada para obter dados demográficos e dados clínicos, incluindo dados de ultrassom dúplex, durante o período de seguimento pós-operatório. Resultados A média de idade dos pacientes foi de 53,3 anos; 37 eram mulheres (90,2%). O tempo médio de seguimento foi de 803 dias. O calibre médio das veias tratadas foi de 7,8 mm. A taxa de sucesso imediato foi de 100%, com densidade de energia endovenosa linear (linear endovenous energy density, LEED) média de 45,3 J/cm. A taxa de sucesso tardio foi de 95,1%, com duas recanalizações por volta de 12 meses pós-ablação. Não houve nenhuma recanalização nas veias tratadas com LEED superior a 30 J/cm. Conclusões O laser 1940 nm mostrou-se seguro e efetivo, em médio e longo prazo, para os parâmetros propostos, em segmentos venosos com até 10 mm de diâmetro. PMID:29930619

Precision Strike Technology Symposium (PSTS 09)

DTIC Science & Technology

2009-10-29

Control System) AUR (All-Up-Round) UHF SATCOM GPS JIC Threat and Target Data NGA Mapping, Charting & Geodesy 5 0 IRAQ SAU DI AR ABIA OM AN EM IRA TES JO...d M il it ary Ci ty Abu Dhabi qom Ahraz Shiraz Esfahan Yaz d Kerman Rafha 5 0 IRAQ SAU DI AR ABIA OM AN EM IRA TES JO RDAN SYRIA PAKI ST AN

Limitations in the application of the Gibbs equation to anionic surfactants at the air/water surface: sodium dodecylsulfate and sodium dodecylmonooxyethylenesulfate above and below the CMC.

PubMed

Xu, Hui; Li, Pei Xun; Ma, Kun; Thomas, Robert K; Penfold, Jeffrey; Lu, Jian Ren

2013-07-30

This is a second paper responding to recent papers by Menger et al. and the ensuing discussion about the application of the Gibbs equation to surface tension (ST) data. Using new neutron reflection (NR) measurements on sodium dodecylsulfate (SDS) and sodium dodecylmonooxyethylene sulfate (SLES) above and below their CMCs and with and without added NaCl, in conjunction with the previous ST measurements on SDS by Elworthy and Mysels (EM), we conclude that (i) ST measurements are often seriously compromised by traces of divalent ions, (ii) adsorption does not generally reach saturation at the CMC, making it difficult to obtain the limiting Gibbs slope, and (iii) the significant width of micellization may make it impossible to apply the Gibbs equation in a significant range of concentration below the CMC. Menger et al. proposed ii as a reason for the difficulty of applying the Gibbs equation to ST data. Conclusions i and iii now further emphasize the failings of the ST-Gibbs analysis for determining the limiting coverage at the CMC, especially for SDS. For SDS, adsorption increases above the CMC to a value of 10 × CMC, which is about 25% greater than at the CMC and about the same as at the CMC in the presence of 0.1 M NaCl. In contrast, the adsorption of SLES reaches a limit at the CMC with no further increase up to 10 × CMC, but the addition of 0.1 M NaCl increases the surface excess by 20-25%. The results for SDS are combined with earlier NR results to generate an adsorption isotherm from 2 to 100 mM. The NR results for SDS are compared to the definitive surface tension (ST) measurements of EM, and the surface excesses agree over the range where they can safely be compared, from 2 to 6 mM. This confirms that the anomalous decrease in the slope of EM's σ - ln c curve between 6 mM and the CMC at 8.2 mM results from changes in activity associated with a significant width of micellization. This anomaly shows that it is impossible to apply the Gibbs equation usefully from 6 to 8.2 mM (i.e., the lack of knowledge of the activity in this range is the same as above the CMC (8.2 mM)). It was found that a mislabeling of the original data in EM may have prevented the use of this excellent ST data as a standard by other authors. Although NR and ST results for SDS in the absence of added electrolyte show that the discrepancies can be rationalized, ST is generally shown to be less accurate and more vulnerable to impurities, especially divalent ions, than NR. The radiotracer technique is shown to be less accurate than ST-Gibbs in that the four radiotracer measurements of the surface excess are consistent neither with each other nor with ST and NR. It is also shown that radiotracer results on aerosol-OT are likely to be incorrect. Application of the mass action (MA) model of micellization to the ST curves of SDS and SLES through and above the CMC shows that they can be explained by this model and that they depend on the degree of dissociation of the micelle, which leads to a larger change in the mean activity, and hence the adsorption, for the more highly dissociated SDS micelles than for SLES. Previous measurements of the activity of SDS above the CMC were found to be semiquantitatively consistent with the change in mean activity predicted by the MA model but inconsistent with the combined ST, NR, and Gibbs equation results.

Prehospital system delay in ST-segment elevation myocardial infarction care: a novel linkage of emergency medicine services and in hospital registry data.

PubMed

Fosbøl, Emil L; Granger, Christopher B; Peterson, Eric D; Lin, Li; Lytle, Barbara L; Shofer, Frances S; Lohmeier, Chad; Mears, Greg D; Garvey, J Lee; Corbett, Claire C; Jollis, James G; Glickman, Seth W

2013-03-01

Emergency medical services (EMS) are critical in the treatment of ST-segment elevation myocardial infarction (STEMI). Prehospital system delays are an important target for improving timely STEMI care, yet few limited data are available. Using a deterministic approach, we merged EMS data from the North Carolina Pre-hospital Medical Information System (PreMIS) with data from the Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments-Emergency Response (RACE-ER) Project. Our sample included all patients with STEMI from June 2008 to October 2010 who arrived by EMS and who had primary percutaneous coronary intervention (PCI). Prehospital system delays were compared using both RACE-ER and PreMIS to examine agreement between the 2 data sources. Overall, 8,680 patients with STEMI in RACE-ER arrived at a PCI hospital by EMS; 21 RACE-ER hospitals and 178 corresponding EMS agencies across the state were represented. Of these, 6,010 (69%) patients were successfully linked with PreMIS. Linked and notlinked patients were similar. Overall, 2,696 patients were treated with PCI only and were taken directly to a PCI-capable hospital by EMS; 1,750 were transferred from a non-PCI facility. For those being transported directly to a PCI center, 53% reached the 90-minute target guideline goal. For those transferred from a non-PCI facility, 24% reached the 120-minute target goal for primary PCI. We successfully linked prehospital EMS data with in hospital clinical data. With this linked STEMI cohort, less than half of patients reach goals set by guidelines. Such a data source could be used for future research and quality improvement interventions. Copyright © 2013 Mosby, Inc. All rights reserved.

The Weaponization Of Migration: Examining Migration As a 21st Century Tool Of Political Warfare

DTIC Science & Technology

2017-12-01

em ittan ces / D iasp o ra T ax Pre...YEAR CHALLENGER ASSISTED BY TARGET LOCATION M ig ran ts U sed fo r M an p o w er In filtratio n D isru p t / D ep riv e E n em y...counterinsurgency move. In Syria, indiscriminate bombing by Russian and Syrian forces continues to cause significant population displacement

Data from the German Chest Pain Unit Registry: The well known gap between knowledge and practice.

PubMed

Fernández-Bergés, Daniel

2017-11-01

In-hospital mortality of acute myocardial infarction with ST segment elevation remains high and is influenced by many factors, some of which are modifiable such as time to treatment initiation and modality of treatment. It is well established that reperfusion therapy is the gold-standard in the management of ST-elevation acute myocardial infarction. Despite recent developments and clear, comprehensible guidelines recommendations, it remains difficult to disseminate this knowledge to medical practitioners. The German Chest Pain Unit shows that the best door-to-balloon time is reached when patients contact the Emergency Medical Systems (EMS) directly, rather than when referred by the general practitioner (GP), or are transferred from another hospital, or present as a self-referral. In order to improve mortality in ST-elevation acute myocardial infarction, patients must be able to recognize symptoms and call the EMS as soon as possible, in addition to having an ECG within ten minutes and direct access to reperfusion therapy (PPCI preferred). The German Registry has highlighted the importance of training both patients and doctors. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of emergency medical services in the second gulf registry of acute coronary events.

PubMed

AlHabib, Khalid F; Alfaleh, Hussam; Hersi, Ahmad; Kashour, Tarek; Alsheikh-Ali, Alawi A; Suwaidi, Jassim Al; Sulaiman, Kadhim; Saif, Shukri Al; Almahmeed, Wael; Asaad, Nidal; Amin, Haitham; Al-Motarreb, Ahmed; Thalib, Lukman

2014-09-01

Data are scarce regarding emergency medical service (EMS) usage by patients with acute coronary syndrome (ACS) in the Arabian Gulf region. This 9-month in-hospital prospective ACS registry was conducted in Arabian Gulf countries, with 30-day and 1-year follow-up mortality rates. Of 5184 patients with ACS, 1293 (25%) arrived at the hospital by EMS. The EMS group (vs non-EMS) was more likely to be male, have cardiac arrest on presentation, be current or exsmokers, and have moderate or severe left ventricular dysfunction and ST-segment elevation myocardial infarction (STEMI). The EMS group had higher crude mortality rates during hospitalization and after hospital discharge but not after adjustment for clinical factors and treatments. The EMSs are underused in the Arabian Gulf region. Short- and long-term mortality rates in patients with ACS are similar between those who used and did not use EMS. Quality improvement in the EMS infrastructure and establishment of integrated STEMI networks are urgently needed. © The Author(s) 2013.

[In vitro indirect pathogenesis of Pseudomonas aeruginosa against anti MRSA chemotherapy].

PubMed

Satoh, Naotake; Kondo, Shigemi; Yamada, Toshihiko; Saionji, Katsu; Oguri, Toyoko; Igari, Jun

2004-09-01

In the patient with a chronic respiratory disease, both Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) are frequently detected from expectoration. Vancomycin (VCM) and arbekacin (ABK) are both recommended for the chemotherapy of MRSA infection in Japan. Minocycline (MINO) is also selected for the treatment of MRSA infection. While rifampicin (RFP) and a trimetoprim-sulfamethoxazole combination (ST) are also recommended in Europe and USA but not recommended in Japan for the chemotherapy of MRSA infection. It is pointed out that coexistence bacteria affect chemotherapy as an indirect pathogen. Not only an antibacterial action but the immunological action or the metabolic effect against chronic P. aeruginosa infection such as DPB is known by the administration of 14-membered ring macrolides including erythromycin (EM). We considered the influence of P. aeruginosa isolated with MRSA on the activity against anti-MRSA agents by the disk diffusion method with bilayer flat agar in vitro. Moreover, we also examined the influence of EM against the activity of the anti-MRSA agents when P. aeruginosa was coexistence. One strain of MRSA as an indicator strain and 100 strains of P. aeruginosa as test strains, which were obtained from clinical materials, were used for the following experiment. P. aeruginosa was streaked on to the Mueller-Hinton agar culture medium (MHA), and they incubated at 35 degrees C for 24 hours. Then, the blood agar plate was piled up, MRSA was streaked on the blood agar surface, the susceptibility test disks (VCM, ABK, MINO, RFP, ST) were put on it, and incubated at 35 degrees C for a further 24 hours. The diameter of the zone of inhibition around the susceptibility disks against MRSA was measured and compared with P. aeruginosa free experiments. The anti-MRSA activity of MINO, ST and ABK was reduced by coexistence of P. aeruginosa. In RFP and VCM, the anti-MRSA activity was reinforced by coexistence of P. aeruginosa. Although the anti-MRSA activity of ST and ABK has improved by EM addition in the MHA plates, the anti-MRSA activity has not improved in MINO. These results are suggesting that in a MRSA infection, the chemotherapy by anti-MRSA agents were affected by coexistence of P. aeruginosa as an indirect pathogen. The macrolides such as EM may be useful as a modulator for chemotherapy by ST or ABK when MRSA and P. aeruginosa are isolated at the same time from the patient.

A reciprocity formulation for the EM scattering by an obstacle within a large open cavity

NASA Technical Reports Server (NTRS)

Pathak, Prabhakar H.; Burkholder, Robert J.

1993-01-01

A formulation based on a generalized reciprocity theorem is developed for analyzing the external high frequency EM scattering by a complex obstacle inside a relatively arbitrary open-ended waveguide cavity when it is illuminated by an external source. This formulation is also extended to include EM fields whose time dependence may be nonperiodic. A significant advantage of this formulation is that it allows one to break up the analysis into two independent parts; one deals with the waveguide cavity shape alone and the other with the obstacle alone. The external scattered field produced by the obstacle (in the presence of the waveguide cavity structure) is given in terms of a generalized reciprocity integral over a surface S(T) corresponding to the interior waveguide cavity cross section located conveniently but sufficiently close to the obstacle. Furthermore, the fields coupled into the cavity from the source in the exterior region generally need to propagate only one-way via the open front end (which is directly illuminated) to the interior surface S(T) in this approach, and not back, in order to find the external field scattered by the obstacle.

Identifying Water on Mt. Baker and Mt. St. Helens, WA with Geophysics: Implications for Volcanic Landslide Hazards

NASA Astrophysics Data System (ADS)

Finn, C.; Bedrosian, P.; Wisniewski, M.; Deszcz-Pan, M.

2015-12-01

Groundwater position, abundance, and flow rates within a volcano affect the transmission of fluid pressure, transport of mass and heat and formation of mechanically weak hydrothermal alteration influencing the stability of volcanoes. In addition, eruptions can shatter volcanic rocks, weakening the edifice. Helicopter magnetic and electromagnetic (HEM) data collected over Mt. Baker and Mt. St. Helens volcanoes reveal the distribution of water, shattered volcanic rocks and hydrothermal alteration essential to evaluating volcanic landslide hazards. These data, combined with geological mapping and rock property measurements, indicate the presence of localized <100 m thick zones of water-saturated hydrothermally altered rock beneath Sherman Crater and the Dorr Fumarole Fields at Mt. Baker. Nuclear magnetic resonance data indicate that the hydrothermal clays contain ~50% bound water with no evidence for free water ponded beneath the ice. The HEM data suggest water-saturated fresh volcanic rocks from the surface to the detection limit (~100 m) over the entire summit of Mt. Baker (below the ice). A 50-100 m thick high resistivity layer (>1500 ohm-m) corresponding to domes, debris avalanche, volcanic rocks and glaciers mantles the crater at Mt. St. Helens. Shallow low resistivity layers corresponding to fresh, cold water and hot brines are observed below the high resistivity surface in EM data. Shallow ground water mainly concentrates in shattered dome material in the crater of Mt. St. Helens. Aeromagnetic data indicate the location of basalts sandwiched between debris avalanche deposits and shattered dome material. The combination of the EM and magnetic data help map the location of the shattered dome material that is considered to be the failure surface for the 1980 debris avalanche. The EM data image the regional groundwater table near the base of the volcano. The geophysical identification of groundwater and weak layers constrain landslide hazards assessments.

Growth of Regional Acute Stroke Systems of Care in the United States in the First Decade of the 21st Century

PubMed Central

Song, Sarah; Saver, Jeffrey

2012-01-01

Background and Purpose States and counties in the US began implementing regional systems of acute stroke care in the first decade of the 21st century, whereby emergency medical services (EMS) systems preferentially route acute stroke patients directly to primary stroke centers (PSCs). The pace, geographic range, and population reach of regional stroke system implementation has not been previously delineated. Methods Review of legislative archives, internet and media reports, consultation with American Heart Association/American Stroke Association and Centers for Disease Control staff, and phone interviews with state public health and emergency medical service officials from each of the fifty states. Results The first counties to adopt regional regulations supporting routing of acute stroke patients to PSCs were in Alabama and Texas in 2000; the first states were Florida and Massachusetts in 2004. By 2010, 16 states had state-level legislation or regulations to enable EMS routing to PSCs, as did counties in 3 additional states. The US population covered by routing protocols increased substantially in the latter half of the decade, from 1.5% in 2000, to 53% of the U.S. population by the end of 2010. Conclusions The first decade of the 21st century witnessed a remarkable structural transformation in acute stroke care - by the end of 2010, over half of all Americans were living in states/counties with EMS routing protocols supporting the direct transport of acute stroke patients to primary stroke centers. Additional efforts are needed to extend regional stroke systems of care to the rest of the US. PMID:22669404

Helicopter Maneuverability and Agility Design Sensitivity and Air Combat Maneuver Data Correlation Study

DTIC Science & Technology

1991-10-01

o n tr o l sy st em St ic ks , m ix in g, S A S , se rv os L an d in g I n te rf ac e - V er ti ca l lo ad s - In pl an e lo ad s E xt...ROUTINE ALPNPlt ,INPUT VARIABLE QFiQWrM »OUTPUT VARIABLE OP1LO ;LOW ANGLE BAP NABE EXP -30.0,30.0,5.0 jLOWER LIBIT. UPPER LIMIT, DELTA ; LOK ANGLE BAP

Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates

PubMed Central

Callachan, Edward L.; Alsheikh-Ali, Alawi A.; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A.

2017-01-01

Introduction The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. Methods This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal–Wallis tests were used to examine differences in variables by mode of transportation. Results Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8–4.3), 3.2 (2.1–5.3), and 4.5 (3.0–7.5), respectively; door-to-balloon time in minutes, 70 (48–78), 81 (64–105), and 62 (46–77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group. Conclusion Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI. PMID:28435484

Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates.

PubMed

Callachan, Edward L; Alsheikh-Ali, Alawi A; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A

2017-04-01

The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal-Wallis tests were used to examine differences in variables by mode of transportation. Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1-5.3), and 4.5 (3.0-7.5), respectively; door-to-balloon time in minutes, 70 (48-78), 81 (64-105), and 62 (46-77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group. Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.

Characterizing the influence of transportation infrastructure on Emergency Medical Services (EMS) in urban area-A case study of Seoul, South Korea.

PubMed

Cho, Jungwoo; You, Myoungsoon; Yoon, Yoonjin

2017-01-01

In highly urbanized area where traffic condition fluctuates constantly, transportation infrastructure is one of the major contributing factors to Emergency Medical Service (EMS) availability and patient outcome. In this paper, we assess the impact of traffic fluctuation to the EMS first response availability in urban area, by evaluating the k-minute coverage under 21 traffic scenarios. The set of traffic scenarios represents the time-of-day and day-of-week effects, and is generated by combining road link speed information from multiple historical speed databases. In addition to the k-minute area coverage calculation, the k-minute population coverage is also evaluated for every 100m by 100m grid that partitions the case study area of Seoul, South Korea. In the baseline case of traveling at the speed limit, both the area and population coverage reached nearly 100% when compared to the five-minute travel time national target. Employing the proposed LoST (Loss of Serviceability due to Traffic) index, which measures coverage reduction in percentage compared to the baseline case, we find that the citywide average LoST for area and population coverage are similar at 34.2% and 33.8%. However, district-wise analysis reveals that such reduction varies significantly by district, and the magnitude of area and population coverage reduction is not always proportional. We conclude that the effect of traffic variation is significant to successful urban EMS first response performance, and regional variation is evident among local districts. Complexity in the urban environment requires a more adaptive approach in public health resource management and EMS performance target determination.

Sensor de orvalho/chuva aplicado à operação de telescópios

NASA Astrophysics Data System (ADS)

Raffaelli, J. C.; Neres, N. L.; Strauss, C.

2003-08-01

Foi desenvolvida uma estação meteorológica para o telescópio robótico Obelix do Observatório Abrahão de Moraes que inclui sensores de temperatura e umidade, além de um inédito sensor de orvalho e chuva que comanda o fechamento automático da cúpula caso haja perigo de condensação. Este sensor é composto de uma malha de segmentos metálicos próximos e detecta o aumento da condutividade do ar que precede a condensação. Esse método é mais confiável que o critério de 100% de umidade, que pode causar falsos alarmes devido a imprecisão dos sensores de umidade em geral e por não considerar a influência dos ventos que dificultam a condensação. O trabalho apresenta o método de construção desse sensor e os testes de avaliação. Sugere-se portanto a inclusão desse sensor nas estações meteorológicas dos telescópios do país.

Characterization and referral patterns of ST-elevation myocardial infarction patients admitted to chest pain units rather than directly to catherization laboratories. Data from the German Chest Pain Unit Registry.

PubMed

Schmidt, Frank P; Perne, Andrea; Hochadel, Matthias; Giannitsis, Evangelos; Darius, Harald; Maier, Lars S; Schmitt, Claus; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Gori, Tommaso; Senges, Jochen; Münzel, Thomas

2017-03-15

Direct transfer to the catheterization laboratory for primary percutaneous coronary intervention (PCI) is standard of care for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, a significant number of STEMI-patients are initially treated in chest pain units (CPUs) of admitting hospitals. Thus, it is important to characterize these patients and to define why an important deviation from recommended clinical pathways occurs and in particular to quantify the impact of deviation on critical time intervals. 1679 STEMI patients admitted to a CPU in the period from 2010 to 2015 were enrolled in the German CPU registry (8.5% of 19,666). 55.9% of the patients were delivered by an emergency medical system (EMS), 16.1% transferred from other hospitals and 15.2% referred by a general practitioner (GP). 12.7% were self-referrals. 55% did not get a pre-hospital ECG. Compared to the EMS, referral by GPs markedly delayed critical time intervals while a pre-hospital ECG demonstrating ST-segment elevation reduced door-to-balloon time. When compared to STEMI patients (n=21,674) enrolled in the ALKK-registry, CPU-STEMI patients had a lower risk profile, their treatment in the CPU was guideline-conform and in-hospital mortality was low (1.5%). CPU-STEMI patients represent a numerically significant group because a pre-hospital ECG was not documented. Treatment in the CPU is guideline-conform and the intra-hospital mortality is low. The lack of a pre-hospital ECG and admission via the GP substantially delay critical time intervals suggesting that in patients with symptoms suggestive an ACS, the EMS should be contacted and not the GP. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Fondaparinux versus Enoxaparin - Which is the Best Anticoagulant for Acute Coronary Syndrome? - Brazilian Registry Data.

PubMed

Soeiro, Alexandre de Matos; Silva, Pedro Gabriel Melo de Barros E; Roque, Eduardo Alberto de Castro; Bossa, Aline Siqueira; César, Maria Cristina; Simões, Sheila Aparecida; Okada, Mariana Yumi; Leal, Tatiana de Carvalho Andreucci Torres; Pedroti, Fátima Cristina Monteiro; Oliveira, Múcio Tavares de

2016-09-01

Recent studies have shown fondaparinux's superiority over enoxaparin in patients with non-ST elevation acute coronary syndrome (ACS), especially in relation to bleeding reduction. The description of this finding in a Brazilian registry has not yet been documented. To compare fondaparinux versus enoxaparin in in-hospital prognosis of non-ST elevation ACS. Multicenter retrospective observational study. A total of 2,282 patients were included (335 in the fondaparinux group, and 1,947 in the enoxaparin group) between May 2010 and May 2015. Demographic, medication intake and chosen coronary treatment data were obtained. Primary outcome was mortality from all causes. Secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). Comparison between the groups were done through Chi-Square test and T test. Multivariate analysis was done through logistic regression, with significance values defined as p < 0.05. With regards to treatment, we observed the performance of a percutaneous coronary intervention in 40.2% in the fondaparinux group, and in 35.1% in the enoxaparin group (p = 0.13). In the multivariate analysis, we observed significant differences between fondaparinux and enoxaparin groups in relation to combined events (13.8% vs. 22%. OR = 2.93, p = 0.007) and bleeding (2.3% vs. 5.2%, OR = 4.55, p = 0.037), respectively. Similarly to recently published data in international literature, fondaparinux proved superior to enoxaparin for the Brazilian population, with significant reduction of combined events and bleeding. Estudos recentes têm apresentado superioridade do fondaparinux em relação à enoxaparina em pacientes com síndrome coronariana aguda (SCA) sem supradesnivelamento de ST, principalmente relacionada à redução de sangramentos. A descrição desse achado em registro brasileiro ainda não foi documentada. Comparar fondaparinux versus enoxaparina no prognóstico intrahospitalar em SCA sem supradesnivelamento de ST. Estudo retrospectivo, multicêntrico e observacional. Foram incluídos 2.282 pacientes (335 no grupo fondaparinux e 1.947 no grupo enoxaparina) entre maio de 2.010 e maio de 2.015. Foram obtidos dados demográficos, medicações utilizadas e tratamento coronariano adotado. O desfecho primário foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramentos). A comparação entre os grupos foi realizada por meio de Q-quadrado e teste-T. A análise multivariada foi realizada por regressão logística, sendo considerado significativo p < 0,05. Em relação ao tratamento, observou-se realização de intervenção coronária percutânea em 40,2% no grupo fondaparinux e 35,1% no grupo enoxaparina (p = 0,13). Na análise multivariada, observaram-se diferenças significativas entre os grupos fondaparinux e enoxaparina em relação a eventos combinados (13,8% vs. 22%, OR = 2,93, p = 0,007) e sangramentos (2,3% vs. 5,2%, OR = 4,55, p = 0,037), respectivamente. Semelhante aos dados recentemente publicados na literatura mundial, fondaparinux mostrou-se superior à enoxaparina para a população brasileira, com redução significativa de eventos combinados e sangramentos.

Mantle End-Members: The Trace Element Perspective

NASA Astrophysics Data System (ADS)

Willbold, M.; Stracke, A.; Hofmann, A. W.

2004-12-01

On the basis of their isotopic composition, ocean island basalts (OIB) have been classified into three to four end-members; HIMU with the most radiogenic Pb isotope ratios of OIB and Enriched Mantle 1 and 2 (EM1, EM2) with less radiogenic but variable Pb isotope and highly radiogenic Sr isotope signatures. It has also been argued that each of these isotopic families has common trace element characteristics that distinguish them from one another and so substantiated this classification. Here, we present new high-precision trace element data for samples from St. Helena, Tristan da Cunha and Gough in the Atlantic Ocean. The overall data-set is augmented by OIB data from the GEOROC database and includes data from all major isotopic families (HIMU: St. Helena, Mangaia, Tubuai, and Rururtu; EM1: Tristan da Cunha, Gough, Pitcairn; and EM2: Samoa, Marquesas, and Society). For each locality we use only islands defining the most extreme isotopic compositions. The entire data-set has been screened to exclude altered and highly differentiated samples. HIMU basalts have a very uniform trace element composition. Compared to HIMU-type basalts, EM-type basalts are enriched in Rb, Ba, and K, and depleted in U, Nb, and Ta, relative to La. Different EM-type OIBs from the same isotopic family (EM1 or EM2), have distinct trace element characteristics that can ultimately only be caused by different source compositions. For example, Ba/Th ratios in samples from both Tristan da Cunha (EM1) and Samoa (EM2) are similarly high (ca. 110) whereas Ba/Th ratios in samples from Pitcairn (EM1) and Society (EM2) samples are consistently lower (ca. 70). Thus on the basis of their trace element composition, EM-type OIB cannot be classified into EM1 and EM2 type basalts, nor can any other grouping be identified. The remarkably uniform isotopic and trace element composition of HIMU-type basalts suggests derivation from a single common source reservoir, most likely subduction-modified oceanic crust. Although there are some trace element characteristics common to all EM-type basalts, which distinguish them from HIMU-type basalts (e.g. uniformly high Th/U ratios of 4.7 ± 0.3, and enrichment in Cs-U), each suite of EM-type basalts has unique trace element signatures that distinguish them from any other suite of EM-type basalts. This is especially obvious when comparing the trace element composition of EM basalts from one isotopic family, for example EM1-type basalts from Tristan, Gough and Pitcairn. Consequently, the trace element systematics of EM-type basalts suggest that there are many different EM-type sources, whereas the isotopic composition of EM-type basalts suggest derivation from two broadly similar sources, i.e. EM1 and EM2. The large variability in subducting sediments with respect to both parent-daughter (e.g. Rb/Sr, Sm/Nd, U/Pb, Th/Pb,...) and other trace element ratios makes it unlikely that there are reproducible mixtures of sediments leading to two different isotopic evolution paths (EM1 and EM2) while preserving a range of incompatible element contents for each isotopic family, as would be required to reconcile the isotopic and trace element characteristics of EM-type basalts. Although this does not a priori argue against sediments as possible source components for OIB, it does argue against two distinct groups of sediments as EM1 and EM2 sources. Further characterization of sources with the same general origin (e.g. a certain type of crust or lithosphere) or identification of processes leading to reservoirs with similar parent-daughter ratio characteristics but different incompatible trace element contents could resolve the apparent conundrum.

Improving Use of Prehospital 12-Lead Electrocardiography for Early Identification and Treatment of Acute Coronary Syndrome and ST-Elevation Myocardial Infarction

PubMed Central

Daudelin, Denise H.; Sayah, Assaad J.; Kwong, Manlik; Restuccia, Marc C.; Porcaro, William A.; Ruthazer, Robin; Goetz, Jessica D.; Lane, William M.; Beshansky, Joni R.; Selker, Harry P.

2010-01-01

Background Performance of Prehospital electrocardiograms (PH-ECGs) expedites identification of ST-elevation myocardial infarction (STEMI) and reduces door-to-balloon (D2B) times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service (EMS) performance must be measured and used in feedback reporting and quality improvement (QI). Methods and Results This quasi-experimental design trial tested an approach to improving EMS PH-ECG using feedback reporting and QI interventions in two cities' EMS agencies and receiving hospitals. All patients ≥ 30 years, calling 9-1-1 with possible acute coronary syndrome (ACS) were included. In total 6,994 patients were included: 1,589 patients in the baseline period without feedback and 5,405 in the intervention period when there were feedback reports and QI interventions. Mean age (SD) was 66 (±17) and women represented 51%. Feedback and QI increased PH-ECG performance for patients with ACS from 76% to 93% (p=<.0001) and for patients with STEMI from 77% to 99% (p= <.0001). Aspirin administration increased from 75% to 82% (p=0.001) but the median total EMS run time remained the same at 22 minutes. The proportion of patients with D2B times of ≤90 minutes increased from 27% to 67% (p=0.006). Conclusion Feedback reports and QI improved PH-ECG performance for patients with ACS and STEMI and increased aspirin administration, without prehospital transport delays. Improvements in D2B times were also seen. PMID:20484201

75 FR 64719 - Environmental Management Site-Specific Advisory Board, Northern New Mexico

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Northern New Mexico... the Environmental Management Site-Specific Advisory Board (EM SSAB), Northern New Mexico. The Federal... at Santa Fe, 750 North St. Francis Drive, Santa Fe, New Mexico. FOR FURTHER INFORMATION CONTACT...

Compositions of HIMU, EM1, and EM2 from Global Trends between Radiogenic Isotopes and Major Elements in Ocean Island Basalts

NASA Astrophysics Data System (ADS)

Jackson, M. G.; Dasgupta, R.

2008-12-01

Sr and Pb isotopes exhibit global trends with the concentrations of major elements (SiO2, TiO2, FeO, Al2O3 and K2O) and major elements ratios (CaO/Al2O3 and K2O/TiO2) in the shield-stage lavas from 18 oceanic hotspots (including Hawaii, Iceland, Galapagos, Cook-Australs, St. Helena, Cape Verde, Cameroon, Canary, Madeira, Comoros, Azores, Samoa, Society, Marquesas, Mascarene, Kerguelen, Pitcairn, and Selvagen). Based on the relationships between major elements and isotopes in ocean island basalts (OIBs), we find that the lavas derived from the mantle end members, HIMU (or high 'ì' = 238U/204Pb), EM1 (enriched mantle 1), EM2 (enriched mantle 2), and DMM (depleted MORB [mid-ocean ridge basalt] mantle) exhibit distinct major element characteristics: When compared to oceanic hotspots globally, the hotspots with a HIMU (radiogenic Pb-isotopes and low 87Sr/86Sr) component, such as St. Helena and Cook-Australs, exhibit high CaO/Al2O3, FeOT, and TiO2 and low SiO2 and Al2O3. EM1 (enriched mantle 1; intermediate 87Sr/86Sr and low 206Pb/204Pb; sampled by hotspots like Pitcairn and Kerguelen) and EM2 (enriched mantle 2; high 87Sr/86Sr and intermediate 206Pb/204Pb; sampled by hotspots like Samoa and Societies) exhibit higher K2O concentrations and K2O/TiO2 weight ratios than HIMU lavas. EM1 lavas exhibit the lowest CaO/Al2O3 in the OIB dataset, and this sets EM1 apart from EM2. A plot of CaO/Al2O3 vs K2O/TiO2 perfectly resolves the four mantle end member lavas. Melting processes (pressure, temperature and degree of melting) fail to provide an explanation for the full spectrum of major element concentrations in OIBs. Such processes also fail to explain the correlations between major elements and radiogenic isotopes. Instead, a long, time integrated history of various parent- daughter elements appears to be coupled to major element and/or volatile heterogeneity in the mantle source. End member lava compositions are compared with experimental partial melt compositions to place constraints on the lithological characteristics of the mantle end members.

Compositions of HIMU, EM1, and EM2 from global trends between radiogenic isotopes and major elements in ocean island basalts

NASA Astrophysics Data System (ADS)

Jackson, Matthew G.; Dasgupta, Rajdeep

2008-11-01

Sr and Pb isotopes exhibit global trends with the concentrations of major elements (SiO 2, TiO 2, FeO, Al 2O 3 and K 2O) and major elements ratios (CaO/Al 2O 3 and K 2O/TiO 2) in the shield-stage lavas from 18 oceanic hotspots (including Hawaii, Iceland, Galapagos, Cook-Australs, St. Helena, Cape Verde, Cameroon, Canary, Madeira, Comoros, Azores, Samoa, Society, Marquesas, Mascarene, Kerguelen, Pitcairn, and Selvagen). Based on the relationships between major elements and isotopes in ocean island basalts (OIBs), we find that the lavas derived from the mantle end members, HIMU (or high 'μ' = 238U/ 204Pb), EM1 (enriched mantle 1), EM2 (enriched mantle 2), and DMM (depleted MORB [mid-ocean ridge basalt] mantle) exhibit distinct major element characteristics: When compared to oceanic hotspots globally, the hotspots with a HIMU (radiogenic Pb-isotopes and low 87Sr/ 86Sr) component, such as St. Helena and Cook-Australs, exhibit high CaO/Al 2O 3, FeO T, and TiO 2 and low SiO 2 and Al 2O 3. EM1 (enriched mantle 1; intermediate 87Sr/ 86Sr and low 206Pb/ 204Pb; sampled by hotspots like Pitcairn and Kerguelen) and EM2 (enriched mantle 2; high 87Sr/ 86Sr and intermediate 206Pb/ 204Pb; sampled by hotspots like Samoa and Societies) exhibit higher K 2O concentrations and K 2O/TiO 2 weight ratios than HIMU lavas. EM1 lavas exhibit the lowest CaO/Al 2O 3 in the OIB dataset, and this sets EM1 apart from EM2. A plot of CaO/Al 2O 3 vs K 2O/TiO 2 perfectly resolves the four mantle end member lavas. Melting processes (pressure, temperature and degree of melting) fail to provide an explanation for the full spectrum of major element concentrations in OIBs. Such processes also fail to explain the correlations between major elements and radiogenic isotopes. Instead, a long, time integrated history of various parent-daughter elements appears to be coupled to major element and/or volatile heterogeneity in the mantle source. End member lava compositions are compared with experimental partial melt compositions to place constraints on the lithological characteristics of the mantle end members.

12th Annual Systems Engineering Conference

DTIC Science & Technology

2009-10-29

pl em en...io n of Le sso ns L ea rn ed fr om C om pl ex S ys te m o f Sy ste m s A cq ui sit io ns D r. Ri ch ar d Tu rn er , St ev en s I ns tit ut...hn ol og y Tr an sit io n Pl an ni ng Th ro ug h th e U se o f St ag e- G at es – U pd at e M r. R an dy B ul la rd , U .S . A ir Fo

Care processes associated with quicker door-in-door-out times for patients with ST-elevation-myocardial infarction requiring transfer: results from a statewide regionalization program.

PubMed

Glickman, Seth W; Lytle, Barbara L; Ou, Fang-Shu; Mears, Greg; O'Brien, Sean; Cairns, Charles B; Garvey, J Lee; Bohle, David J; Peterson, Eric D; Jollis, James G; Granger, Christopher B

2011-07-01

The ability to rapidly identify patients with ST-segment elevation-myocardial infarction (STEMI) at hospitals without percutaneous coronary intervention (PCI) and transfer them to hospitals with PCI capability is critical to STEMI regionalization efforts. Our objective was to assess the association of prehospital, emergency department (ED), and hospital processes of care implemented as part of a statewide STEMI regionalization program with door-in-door-out times at non-PCI hospitals. Door-in-door-out times for 436 STEMI patients at 55 non-PCI hospitals were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of standardized protocols as part of a statewide regionalization program (Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, RACE). The association of 8 system care processes (encompassing emergency medical services [EMS], ED, and hospital settings) with door-in-door-out times was determined using multivariable linear regression. Median door-in-door-out times improved significantly with the intervention (before: 97.0 minutes, interquartile range, 56.0 to 160.0 minutes; after: 58.0 minutes, interquartile range, 35.0 to 90.0 minutes; P<0.0001). Hospital, ED, and EMS care processes were each independently associated with shorter door-in-door-out times (-17.7 [95% confidence interval, -27.5 to -7.9]; -10.1 [95% confidence interval, -19.0 to -1.1], and -7.3 [95% confidence interval, -13.0 to -1.5] minutes for each additional hospital, ED, and EMS process, respectively). Combined, adoption of EMS processes was associated with the shortest median treatment times (44 versus 138 minutes for hospitals that adopted all EMS processes versus none). Prehospital, ED, and hospital processes of care were independently associated with shorter door-in-door-out times for STEMI patients requiring transfer. Adoption of several EMS processes was associated with the largest reduction in treatment times. These findings highlight the need for an integrated, system-based approach to improving STEMI care.

Prehospital administration of tenecteplase for ST-segment elevation myocardial infarction in a rural EMS system.

PubMed

Crowder, Joseph S; Hubble, Michael W; Gandhi, Sanjay; McGinnis, Henderson; Zelman, Stacie; Bozeman, William; Winslow, James

2011-01-01

In the setting of ST-segment elevation myocardial infarction (STEMI), early reperfusion yields better patient outcomes. Emergency medical services (EMS) is the first medical contact for half of the afflicted population, and prehospital thrombolysis may result in considerably faster reperfusion compared with percutaneous coronary intervention (PCI) in rural settings. However, there are few reports of prehospital thrombolysis in rural EMS systems. To describe a rural EMS system's experience with tenecteplase in STEMI. Data were retrospectively abstracted from the medical records of patients receiving tenecteplase using standard chart review guidelines. Primary outcomes included time saved by EMS-initiated thrombolysis, aborted infarctions, serious bleeding events, and in-hospital mortality. Secondary outcomes included reinfarction, rescue angioplasty, and appropriateness of treatment. Time savings was defined as transport time after tenecteplase administration plus 90 minutes, which is the typical door-to-balloon time for PCI laboratories. Aborted infarction was defined as resolution of the cumulative ST-segment elevation to ≤ 50% of that on the initial electrocardiogram (ECG) within two hours after treatment, and peak creatine kinase (CK)/CK-MB levels less than or equal to twice the upper limit of normal. Seventy-three patients received prehospital tenecteplase; this treatment was determined to be appropriate in 86.4% of cases. The mean patient age was 59 years, and 71.6% of the patients were male. Mean (± standard deviation) scene-arrival-to-drug time was 26.2 (± 11.4) minutes, the mean scene-arrival-to-hospital-arrival time was 73.0 (± 20.6) minutes, and the mean transport time was 46.0 (± 11.1) minutes. Tenecteplase was administered 35.9 (± 25.0) minutes prior to hospital arrival, and the estimated reperfusion time savings over PCI was 125.9 (± 25.0) minutes. Aborted infarctions were observed in 24.1% of patients, whereas 9.6% suffered reinfarction, 47.9% underwent rescue angioplasty, and 16.7% required coronary artery bypass grafting (CABG). Serious bleeding events occurred in 15 patients (20.5%), and four (5.5%) died. In this retrospective review of rural STEMI patients, tenecteplase was administered 36 minutes prior to hospital arrival, saving approximately two hours over typical PCI strategies and resulting in aborted infarctions in one-fourth of patients. In a rural setting with lengthy transport times to PCI facilities, tenecteplase appears to be a feasible prehospital intervention. Randomized controlled trials are needed to fully evaluate the safety and effectiveness of this intervention prior to widespread adoption.

[Quality indicators for the assessment of ST-segment elevation acute myocardial infarction (STEMI) networks. How hospital discharge records could be integrated with Emergency medical services data: the Emilia-Romagna STEMI network experience].

PubMed

Pavesi, Pier Camillo; Guastaroba, Paolo; Casella, Gianni; Berti, Elena; De Palma, Rossana; Di Bartolomeo, Stefano; Di Pasquale, Giuseppe

2015-09-01

The assessment of the regional network for ST-segment elevation acute myocardial infarction (STEMI) is fundamental for quality assurance. Since 2011 all Italian Health Authorities, in addition to hospital discharge records (HDR), must provide a standardized information flow (ERD) about emergency department (ED) and emergency medical system (EMS) activities. The aim of this study was to evaluate whether data integration of ERD with HDR may allow the development of appropriate quality indicators. Patients admitted to coronary care units (CCU) for STEMI between January 1 to December 31, 2013, were identified from the regional HDR database. All data were linked to those of the regional ERD database. Four quality indicators were defined: 1) rates of EMS activation, 2) rates of EMS direct transfer to the catheterization laboratory (Cath-lab), 3) transfer rates from a Spoke to a Hub hospital with angioplasty facilities, and 4) median time spent in ED. In 2013, 2793 patients with STEMI were admitted to the CCU. Of these, 1684 patients (60%) activated EMS and were transported to Spoke or Hub hospitals; 955 (57%) entered directly in CCU/Cath-lab; 677 were transferred directly to a Hub hospital ED without being admitted to a Spoke hospital. The median ED time in Hub hospital was 47 min (IQR 24-136) and in Spoke hospital 53 min (IQR 30-131). The integration among administrative data banks (i.e., HDR with ERD) allowed the assessment of the regional STEMI network and the identification of potentially useful quality indicators. Their easy availability should enable comparisons with local, national and international standards, and may favor quality improvement.

[Implementation of an emergency clinical pathway for ST-elevation myocardial infarction in the Lazio Region: results of a pilot study].

PubMed

De Luca, Assunta; Gabriele, Stefania; Lauria, Laura; Francia, Carlo; Caminiti, Alessandro; Tubaro, Marco; Pillon, Sergio; Pristipino, Christian; Ammirati, Fabrizio; Guasticchi, Gabriella

2008-02-01

Timely reperfusion therapies (primary angioplasty and pre-hospital thrombolysis) remain a key component in improving the survival of patients with ST-segment elevation myocardial infarction (STEMI). The Lazio Region emergency organization has a complex mixed logistic (the large city of Rome, presence of complex orography), therefore the use of telemedicine technologies by the emergency medical system (EMS) is mandatory. Emergency clinical pathways (ECP) for the management of STEMI patients were designed, focusing on early pre-hospital diagnosis and best appropriate treatment through the ECG transmission and teleconsultation among EMS and cardiologists in coronary care units (CCU). To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observational cohort study of ambulance-transported patients with cardiovascular symptoms was conducted in a selected area of the Lazio Region during a 6-month period. The implementation of the ECP was carried out by educational activities for the EMS personnel based on the "experiential learning" methods. From October 2005 to March 2006, 287 patients were enrolled in the study and a pre-hospital ECG was performed in 66% of them. One hundred and fifty-two patients were referred to hospital and only 34 had discharged diagnosis of acute myocardial infarction, of whom 23 were STEMI. In the 34 acute myocardial infarction patients the medium time from "call to the EMS" to "arrival to the hospital" was 41 min (range 29-63 min) and 3 had their ECG telematically transmitted from the ambulance to the CCU. All of these cases were STEMI. Twenty-eight acute myocardial infarctions were discharged alive, 2 were transferred in other hospitals, 4 died. No patients received pre-hospital thrombolysis. Prior to the ECP implementation the ECG for STEMI patients has never been transmitted by EMS to the CCU in the Lazio Region. Our study suggests that adherence to ECP improved the appropriateness of STEMI patient referral and treatment in the CCU in the Lazio Region. The EMS personnel, during the study, showed a high interest in the protocol trying to change their current practice. The Regional Administration plans to expand the utilization of ECP to all regional emergency network (EMS and Emergency Departments) and to improve its use.

Effect of varying concentrations of dietary crude protein and metabolizable energy on laying performance of Pearl Grey guinea fowl hens.

PubMed

Nahashon, S N; Adefope, N A; Amenyenu, A; Wright, D

2007-08-01

This study was conducted to evaluate optimum dietary concentrations of ME and CP for egg production performance of the Pearl Gray guinea fowl laying hens. In a 2 x 3 factorial arrangement, 360 Pearl Gray guinea fowl replacement pullets (22 wk of age) were randomly assigned to experimental diets with 2,800 and 2,900 kcal of ME/kg of diet, each containing 14, 16, and 18% CP, respectively. Each dietary treatment was replicated 4 times, and feed and water were provided ad libitum. Experimental birds were raised in laying cages and received 16 h of light throughout the study period. The birds were observed for feed consumption, hen-day egg production (HDEP), egg weight (EW), egg mass (EM), feed conversion ratio, internal egg quality, shell thickness (ST), and BW at the end of each 28-d lay period at 26 to 50 wk of age and at 62 to 86 wk of age. Mortality was recorded as it occurred. Mean HDEP, EW, EM, and ST were higher (P < 0.05) in hens receiving diets with 2,800 kcal of ME/kg of feed than those fed diets containing 2,900 kcal of ME/kg of diet. Hens on 14% CP diets also exhibited higher (P < 0.05) HDEP, EM, and ST than those fed diets containing 16 and 18% CP diets. Mean feed conversion ratio of birds on 2,800 kcal of ME/kg of diet and 14% CP diets were significantly lower than those of hens on other dietary treatments. Differences in feed consumption, EW, internal egg quality, BW, and mortality among dietary ME and CP concentrations were not significant (P > 0.05). Overall, diets composed of 2,800 kcal of ME/kg of diet and 14% CP were utilized more efficiently by the Pearl Gray guinea fowl laying hens at 26 to 50 and 62 to 86 wk of age.

Optimal Runge-Kutta Schemes for High-order Spatial and Temporal Discretizations

DTIC Science & Technology

2015-06-23

y – FS A L – Fi rs t i s th e Sa m e A s La st 7 D is tr ib ut io n A – A pp ro ve d fo r p ub lic re le as e; D is tr...lit y of s ch em es •  Vo n N eu m an n an al ys is is u se d to co m pa re s ch em es fo r a cc ur ac y – D is si pa tio n er ro r...Temporal Discretizations 5a.

The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign.

PubMed

Cartledge, Susie; Finn, Judith; Straney, Lahn; Ngu, Phillip; Stub, Dion; Patsamanis, Harry; Shaw, James; Bray, Janet

2017-07-01

Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS. Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35-75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use. Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting. In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Face Detection and Modeling for Recognition

DTIC Science & Technology

2002-01-01

gi st er ed ra n ge an d co lo r im ag es . 16 F ig u re 1. 12 . S y st em d ia gr...it h an d w it h ou t th e tr an sf or m ar e sh ow n . F or ea ch ex am p le , th e im ag es sh ow n in th e fi rs t co lu m n ar e sk in re gi on s...software/products /perflib/ipl/index.htm>. [187] Intel Open Source Computer Vision Library, <http://developer.intel.com/ soft- ware/opensource/cvfl/ opencv

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital.

PubMed

Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

2016-10-01

ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time ≤ 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.

Naval Science & Technology: Enabling the Future Force

DTIC Science & Technology

2013-04-01

corn for disruptive technologies Laser Cooling Spintronics Bz 1st U.S. Intel satellite GRAB Semiconductors GaAs, GaN, SiC GPS...Payoff • Innovative and game-changing • Approved by Corporate Board • Delivers prototype Innovative Naval Prototypes (5-10 Year) Disruptive ... Technologies Free Electron Laser Integrated Topside EM Railgun Sea Base Enablers Tactical Satellite Large Displacement UUV AACUS Directed

Ground System Survivability Overview

DTIC Science & Technology

2012-03-27

Avoidance Blast Mitigation Optimization Customer ILIR RDT&E Funding 5.0 % 0.5% GSS has a proven, technically proficient workforce that meets...Evaluation of Defensive-Aid Suites (ARMED) Common Automatic Fire Extinguishing System ( CAFES ) Transparent Armor Development Ground Combat Vehicle...Survey TRADOC (WFO, CNA, etc) Voice of the Customer Sy st em s En gi ne er in g Publish overarching MIL-STD, design guidelines, technical

Emergency management of patients with ST-segment elevation myocardial infarction in Eastern Austria: a descriptive quality control study.

PubMed

Trimmel, Helmut; Bayer, Thomas; Schreiber, Wolfgang; Voelckel, Wolfgang G; Fiedler, Lukas

2018-05-09

Myocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria. The Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km 2 . Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres. Treatment guidelines were updated in 2012 and documentation within a web-based STEMI registry became mandatory. For this retrospective qualitative control study, data from February 2012-April 2015 was assessed. A total of 416 STEMI cases were documented, and 99% were identified by EMS within 6 (4.0-8.0) minutes after arrival. Median time loss between onset of pain and EMS call was 54 (20-135) minutes; response, pre-hospital and door-to-balloon times were 14 (10-20), 46 (37-59) and 45 (32-66) minutes, respectively. When general practitioners were involved, time between onset of pain and balloon inflation significantly increased from 180 (135-254) to 218 (155-348) minutes (p < .001). A pre-hospital time < 30 min was achieved in 25.8% of all patients during the day vs. 11.6% during the night (p < .001). Three hundred forty-five patients (83%) were subjected to primary percutaneous coronary intervention (PPCI), and 6.5% were thrombolysed by EMS. Pre-hospital complication rate was 18% (witnessed cardiac arrest 7%, threatening arrhythmias 6%, cardiogenic shock 5%). Twenty-four hours and hospital mortality rate were 1.2 and 2.8%, respectively. Optimal patient care and subsequently outcome of STEMI is strongly determined by a short patient-decision time to call EMS and by the first medical contact to balloon time (FMCBT). Supra-regional networks are key in order to increase the efficacy and efficiency of health care. The goal of 120 min FMCBT was achieved in 78% of our patients immediately managed by EMS, thus indicating room for improvement. In conclusion, results from the Eastern Austrian STEMI network shed light on the necessity of increasing patient awareness in order to minimize any time loss derived by delayed EMS calls. Involvement of family physicians resulted in prolonged FMCBT. A stronger utilization of rescue helicopters could further improve the efficacy of this supra-regional network. Nevertheless PPCI rates, time intervals and outcome rates compare well with international benchmarks.

Diagnostic Reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) Interpretation Is Preserved Despite Fatigue

PubMed Central

Kellogg, Adam R.; Coute, Ryan A.; Garra, Gregory

2015-01-01

Background Fatigue and sleepiness contribute to medical errors, although the effect of circadian disruption and fatigue on diagnostic reasoning skills is largely unknown. Objective To determine whether circadian disruption and fatigue negatively affect the emergency medicine (EM) resident's ability to make important clinical decisions based on electrocardiogram (ECG) interpretation. Methods Senior EM residents at 2 programs completed a questionnaire consisting of various measures of fatigue followed by an ECG test packet of ST-segment elevation myocardial infarction (STEMI) and STEMI mimics. Participants were asked to examine each ECG and determine whether cardiac catheterization laboratory activation (CLA) was indicated, and to report their confidence in their decision making on an 11-point, numeric rating scale. The primary outcome measured was a pairwise difference in accuracy of CLA between daytime and overnight testing. Results A total of 23 residents were enrolled in 2011 and 2012. Subjects demonstrated significant differences in multiple measures of sleepiness and fatigue during overnight periods. The median (interquartile range [IQR]) accuracy of CLA was not significantly different between daytime and overnight (70% [IQR, 50–80] versus 70% [IQR, 60–70], P  =  .82). There were no significant differences in the median number of overcalls (CLA when not a STEMI) and undercalls (no CLA when a STEMI was present; P  =  .57 and .37, respectively). Diagnostic confidence and confidence in CLA were not statistically different between daytime and overnight. Conclusions Despite a measurable degree of fatigue, senior EM residents experienced no decrease in their ability to accurately make CLA decisions based on ECG interpretation. PMID:26217418

Diagnostic Reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) Interpretation Is Preserved Despite Fatigue.

PubMed

Kellogg, Adam R; Coute, Ryan A; Garra, Gregory

2015-03-01

Fatigue and sleepiness contribute to medical errors, although the effect of circadian disruption and fatigue on diagnostic reasoning skills is largely unknown. To determine whether circadian disruption and fatigue negatively affect the emergency medicine (EM) resident's ability to make important clinical decisions based on electrocardiogram (ECG) interpretation. Senior EM residents at 2 programs completed a questionnaire consisting of various measures of fatigue followed by an ECG test packet of ST-segment elevation myocardial infarction (STEMI) and STEMI mimics. Participants were asked to examine each ECG and determine whether cardiac catheterization laboratory activation (CLA) was indicated, and to report their confidence in their decision making on an 11-point, numeric rating scale. The primary outcome measured was a pairwise difference in accuracy of CLA between daytime and overnight testing. A total of 23 residents were enrolled in 2011 and 2012. Subjects demonstrated significant differences in multiple measures of sleepiness and fatigue during overnight periods. The median (interquartile range [IQR]) accuracy of CLA was not significantly different between daytime and overnight (70% [IQR, 50-80] versus 70% [IQR, 60-70], P  =  .82). There were no significant differences in the median number of overcalls (CLA when not a STEMI) and undercalls (no CLA when a STEMI was present; P  =  .57 and .37, respectively). Diagnostic confidence and confidence in CLA were not statistically different between daytime and overnight. Despite a measurable degree of fatigue, senior EM residents experienced no decrease in their ability to accurately make CLA decisions based on ECG interpretation.

Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial.

PubMed

Mateos, Alonso; García-Lunar, Inés; García-Ruiz, José M; Pizarro, Gonzalo; Fernández-Jiménez, Rodrigo; Huertas, Pilar; García-Álvarez, Ana; Fernández-Friera, Leticia; Bravo, Jesús; Flores-Arias, José; Barreiro, María V; Chayán-Zas, Luisa; Corral, Ervigio; Fuster, Valentín; Sánchez-Brunete, Vicente; Ibáñez, Borja

2015-03-01

We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)-administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty. This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours. From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference -11.4; 95% confidence interval [CI] -18.6 to -4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference -11.1; 95% CI -21.5 to -0.6). Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Improving Future Construction Project Quality Through Analysis of Completed Contract Documentation

DTIC Science & Technology

1992-06-01

S lO\\\\ei taicit~y opciai~tIion and( mnaintenanice costs. and(In i sonic Cases lo\\\\ Ceill al conistmictmoii Colst. 6.2 H IItR F uSIA1Wl( - Sminilam...scotut limil Inlspect(ilonlhi inc l,st I eniult .i3 it ems concem lng, patching glass Customler Pr esent tlnal Ins111lwpectinn1 Yes Release (4

EM-1 Countdown Simulation with Charlie Blackwell-Thompson

NASA Image and Video Library

2018-03-29

NASA Test Director Christine St. Germain monitors operations in Firing Room 1 at the Kennedy Space Center's Launch Control Center during a countdown simulation for Exploration Mission 1. It was the agency's first simulation of a portion of the countdown for the first launch of a Space Launch System rocket and Orion spacecraft that will eventually take astronauts beyond low-Earth orbit to destinations such as the Moon and Mars.

A Cubesat to Image Comet Wirtanen at its 2018 Close Approach?

NASA Astrophysics Data System (ADS)

Dunham, David W.; Stakkestad, Kjell; Hardgrove, Craig; Vedder, Peter W.; Gaylor, David; Kidd, John; Hergenrother, Carl W.

2016-10-01

In Dec. 2018, Comet Wirtanen will pass 0.077 AU from Earth, the best opportunity for a fly by of an active comet on a low-energy orbit in the next 40 years. In 2013, the late Robert Farquhar presented a paper, "A Unique Multi-Comet Mission Opportunity for China in 2018" [1]. He used a 1.4-year-Earth-return orbit with launch C3 <3 km^2/s^2 that, after flying by Wirtanen, would use an Earth swingby to fly by SW3C in 2022. While at the 2013 conference, Dr. Farquhar visited the China National Space Administration, which said that all of their funds were committed to their lunar program, precluding a new mission. Other agencies Farquhar approached had similar views.NASA announced its SIMPLEx opportunity in 2014 for cubesats deployed from the second stage of the 1st SLS mission (EM-1) to the Moon. We are on the Arizona State Univ. team that is developing the Lunar Polar Hydrogen Mapper (LunaH-Map) cubesat selected for EM-1. LunaH-Map will use an iodine solar electric propulsion system by Busek (Natick, MA) to enter an elliptical lunar orbit with periselene over the lunar south pole. The 1st launch date for EM-1 was in Dec. 2017, but in May 2016, NASA changed it to October 7, 2018. That's 2 months before Wirtanen's closest approach, so we looked into sending a cubesat with LunaH-Map's propulsion system to Wirtanen. The lunar swingby that might send a cubesat to Wirtanen would occur on Oct. 12 when the Earth C3 to reach Wirtanen is 2.25 km^2/s^2. We tried realistic simulations, finding that a LunaH-Map-like cubesat could not reach Wirtanen, but a spacecraft with 4 times the thrust could. Another cubesat with a more capable propulsion system might reach Wirtanen from EM-1. EM-1 can deploy 13 cubesats, all taken except for 3 for foreign partners. If EM-1 launches a month earlier, then a LunaH-Map-like cubesat could reach Wirtanen; the lowest C3 is 0.95 km^2/s^2 with an Earth departure on Sept. 5. If there is another launch with the possibility of carrying a cubesat then, the authors would be interested.[1] Farquhar, R., Jing, Qian, Veverka, and Dunham, Paper IAC-13-!3.4.12, Proceedings of the International Astronautical Congress (Beijing, 2013 September).

Development status of the mechanical cryocoolers for the Soft X-ray Spectrometer on board Astro-H

NASA Astrophysics Data System (ADS)

Sato, Yoichi; Sawada, Kenichiro; Shinozaki, Keisuke; Sugita, Hiroyuki; Nishibori, Toshiyuki; Sato, Ryota; Mitsuda, Kazuhisa; Yamasaki, Noriko Y.; Takei, Yoh; Goto, Ken; Nakagawa, Takao; Fujimoto, Ryuichi; Kikuchi, Kenichi; Murakami, Masahide; Tsunematsu, Shoji; Ootsuka, Kiyomi; Kanao, Kenichi; Narasaki, Katsuhiro

2014-11-01

Astro-H is the Japanese X-ray astronomy satellite to be launched in 2015. The Soft X-ray Spectrometer (SXS) on board Astro-H is a high energy resolution spectrometer utilizing an X-ray micro-calorimeter array, which is operated at 50 mK by the ADR with the 30 liter superfluid liquid helium. The mechanical cryocoolers, 4 K-class Joule Thomson (JT) cooler and 20 K-class double-staged Stirling (2ST) cooler, are key components of the SXS cooling system to extend the lifetime of LHe cryogen beyond 3 years as required. Higher reliability was therefore investigated with higher cooling capability based on the heritage of existing cryocoolers. As the task of assessing further reliability dealt with the pipe-choking phenomena by contaminant solidification of the on-orbit SMILES JT cryocooler, outgassing from materials and component parts used in the cryocoolers was measured quantitatively to verify the suppression of carbon dioxide gas by their storage process and predict the total accumulated carbon dioxide for long-term operation. A continuous running test to verify lifetime using the engineering model (EM) of the 4 K-JT cooler is underway, having operated for a total of 720 days as of June 2013 and showing no remarkable change in cooling performance. During the current development phase, prototype models (PM) of the cryocoolers were installed to the test SXS dewar (EM) to verify the overall cooling performance from room temperature to 50 mK. During the EM dewar test, the requirement to reduce the transmitted vibration from the 2ST cooler compressor was recognized as mitigating the thermal instability of the SXS microcalorimeter at 50 mK.

The role of the emergency services in the optimisation of primary angioplasty: experience from London and the Heart Attack Team.

PubMed

Dalby, Miles; Whitbread, Mark

2013-08-22

Early ambulance services often confined their activities to a "scoop and run" approach, conveying sick patients quickly to the nearest emergency department. With the advent of modern ST-elevation myocardial infarction (STEMI) management and primary percutaneous coronary intervention (PPCI), the role of the emergency medical service (EMS) has expanded significantly. This review discusses the critical and evolving collaboration between the EMS and the heart attack centre. Speed of reperfusion is a major determinant of outcome in STEMI and, whilst the patient delay (symptom to call time) has a central role in this, system delay (first medical contact to balloon time) is linked to mortality and is used to measure the response of a PPCI programme and is a key element of contemporary guidelines. In addition to rapid diagnosis and transfer to the heart attack centre, the EMS has to deliver a growing number of established treatments including resuscitation and drug therapy. EMS also continually needs to develop expertise in new techniques such as advanced management of cardiac arrest patients, including automated cardiopulmonary resuscitation, and will need to deliver newer therapies if trials support their use, including cooling and preconditioning. Ultimately, the EMS has a central role in the management of STEMI patients which needs to be fully aligned with the heart attack centres. This integration of services is perhaps best regarded as the Heart Attack Team.

Knowledge-Based Systems Workshop: Proceedings of a Workshop Held in St. Louis, Missouri on April 21-23, 1987

DTIC Science & Technology

1987-04-01

the use of the blackboard metaphor Erman 80j as a system design technique, with the BBD framework providing an environment for im- mediately...OUTPUT .3 (lET-inpijT i 3 . (IIT-OUTPUT • 3 9i FPEE EHD-OP-PflCt.CT 2: FPEE EM[i-OF-P*i:fET 2; FPEE FPEE l( tD -OF-P«CKST

Evaluation of a Method Using Three Genomic Guided Escherichia coli Markers for Phylogenetic Typing of E. coli Isolates of Various Genetic Backgrounds

PubMed Central

Hamamoto, Kouta; Ueda, Shuhei; Yamamoto, Yoshimasa

2015-01-01

Genotyping and characterization of bacterial isolates are essential steps in the identification and control of antibiotic-resistant bacterial infections. Recently, one novel genotyping method using three genomic guided Escherichia coli markers (GIG-EM), dinG, tonB, and dipeptide permease (DPP), was reported. Because GIG-EM has not been fully evaluated using clinical isolates, we assessed this typing method with 72 E. coli collection of reference (ECOR) environmental E. coli reference strains and 63 E. coli isolates of various genetic backgrounds. In this study, we designated 768 bp of dinG, 745 bp of tonB, and 655 bp of DPP target sequences for use in the typing method. Concatenations of the processed marker sequences were used to draw GIG-EM phylogenetic trees. E. coli isolates with identical sequence types as identified by the conventional multilocus sequence typing (MLST) method were localized to the same branch of the GIG-EM phylogenetic tree. Sixteen clinical E. coli isolates were utilized as test isolates without prior characterization by conventional MLST and phylogenetic grouping before GIG-EM typing. Of these, 14 clinical isolates were assigned to a branch including only isolates of a pandemic clone, E. coli B2-ST131-O25b, and these results were confirmed by conventional typing methods. Our results suggested that the GIG-EM typing method and its application to phylogenetic trees might be useful tools for the molecular characterization and determination of the genetic relationships among E. coli isolates. PMID:25809972

Evaluation of a Method Using Three Genomic Guided Escherichia coli Markers for Phylogenetic Typing of E. coli Isolates of Various Genetic Backgrounds.

PubMed

Hamamoto, Kouta; Ueda, Shuhei; Yamamoto, Yoshimasa; Hirai, Itaru

2015-06-01

Genotyping and characterization of bacterial isolates are essential steps in the identification and control of antibiotic-resistant bacterial infections. Recently, one novel genotyping method using three genomic guided Escherichia coli markers (GIG-EM), dinG, tonB, and dipeptide permease (DPP), was reported. Because GIG-EM has not been fully evaluated using clinical isolates, we assessed this typing method with 72 E. coli collection of reference (ECOR) environmental E. coli reference strains and 63 E. coli isolates of various genetic backgrounds. In this study, we designated 768 bp of dinG, 745 bp of tonB, and 655 bp of DPP target sequences for use in the typing method. Concatenations of the processed marker sequences were used to draw GIG-EM phylogenetic trees. E. coli isolates with identical sequence types as identified by the conventional multilocus sequence typing (MLST) method were localized to the same branch of the GIG-EM phylogenetic tree. Sixteen clinical E. coli isolates were utilized as test isolates without prior characterization by conventional MLST and phylogenetic grouping before GIG-EM typing. Of these, 14 clinical isolates were assigned to a branch including only isolates of a pandemic clone, E. coli B2-ST131-O25b, and these results were confirmed by conventional typing methods. Our results suggested that the GIG-EM typing method and its application to phylogenetic trees might be useful tools for the molecular characterization and determination of the genetic relationships among E. coli isolates. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Urinary tract infection: a cohort of older people with urinary incontinence.

PubMed

Melo, Laís Samara de; Ercole, Flávia Falci; Oliveira, Danilo Ulisses de; Pinto, Tatiana Saraiva; Victoriano, Mariana Avendanha; Alcoforado, Carla Lúcia Goulart Constant

2017-01-01

To evaluate epidemiological aspects of urinary tract infection in older patients with urinary incontinence living in long-term care institutions in Belo Horizonte. Method: Concurrent cohort held from April 1st to October 1st, 2015. The study was conducted in two long-term care institutions in the city of Belo Horizonte, Minas Gerais, with 84 incontinent older people. Cumulative incidence of urinary tract infection was 19% (95% CI: 7.83-23.19) and the incidence density was 3.6 cases/100 people-month of follow-up period. The variables Bacteriuria and Institution presented statistical association with the occurrence of urinary tract infection. It is observed that the incidence of urinary tract infection in the study was smaller than in other similar international and national studies, however this is an important world health problem for the older population, with impact on mortality of these individuals. Avaliar aspectos epidemiológicos da infecção do trato urinário em pacientes idosos com incontinência urinária, residentes em instituições de longa permanência, de Belo Horizonte. Coorte concorrente realizada no período de 01 de abril a 01 de outubro de 2015. O estudo foi realizado em duas instituições de longa permanência, na cidade de Belo Horizonte, MG, com 84 idosos incontinentes. A incidência acumulada de infecção do trato urinário foi de 19% (IC 95%: 7,83-23,19) e a densidade de incidência foi de 3,6 casos/100 pessoas-mês de seguimento. As variáveis Bacteriúria e Instituição apresentaram associação estatística com a ocorrência de infecção do trato urinário. Observa-se que a incidência de infecção do trato urinário no estudo foi menor que em outros estudos nacionais e internacionais semelhantes, no entanto trata-se de um importante problema de saúde mundial para os idosos, com impacto na mortalidade desses indivíduos.

Electrocardiograhic findings resulting in inappropriate cardiac catheterization laboratory activation for ST-segment elevation myocardial infarction

PubMed Central

Shamim, Shariq; McCrary, Justin; Wayne, Lori; Gratton, Matthew

2014-01-01

Background Prompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations. Objectives One of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain. Methods We report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution. Results There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy. Conclusions In this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy. PMID:25009790

Department of Defense Manpower Requirements Report FY 1995

DTIC Science & Technology

1994-05-01

lm& INYI 94 III aIII$• ~ BY 9 SUBMI Sam 1 mm I Em 1 am m I am- ITv too a" mT amsITTm aSM . cm 10 ARMA 31 a 21 137 M1 st 1 33 157 179 to I to Ha3 201 am...determined by the DoD Retirement Board of Actuaries . This Board of Actuaries also determines an amortization schedule for the transfer of funds from the

Effect of Drugs on the Lethality in Mice of the Venoms and Neurotoxins from Sundry Snakes

DTIC Science & Technology

1990-07-10

nicergoline , primaquine, verapamil, and vesamicol protected mice from the lethality6_)f B. caeruleus venom, B. multicinctus venom, r " and/or’l...the venom or toxin was recorded 24 hr later. Diltia.-em. nicergoline . primaquine, verapamil. and vesamicol protected mice from the lethality of B...hydrochloride were purchased from Sigma Chemical Co., St. Louis, MO, U.S.A. Nicergoline (10-methoxy-1,6-dimethylergoline-8-r-methanol 5

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction.

PubMed

Hsia, Renee Y; Sabbagh, Sarah; Sarkar, Nandita; Sporer, Karl; Rokos, Ivan C; Brown, John F; Brindis, Ralph G; Guo, Joanna; Shen, Yu-Chu

2017-10-01

California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends. Using survey responses collected from all California emergency medical services (EMS) agencies, we developed four categories - no, partial, substantial, and complete regionalization - to capture prehospital and inter-hospital components of regionalization in each EMS agency's jurisdiction between 2005-2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline. STEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California's STEMI patient population, but over half of these counties, representing 86% of California's STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial. Potential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.

Age-related changes in bone architecture.

PubMed

Giordano, Vincenzo; Franco, José Sérgio; Koch, Hilton Augusto; Labronici, Pedro José; Pires, Robinson Esteves S; Amaral, Ney Pecegueiro DO

2016-01-01

: to evaluate the histologic and morphometric characteristics of bone biopsies of the anterior iliac crest of patients of different age groups. : we studied 30 bone samples from the iliac crest, using brightfield optical microscopy. We divided the samples by donors' age groups in three groups: Group 1 (n = 10), subjects aged between 25 and 39 years; Group 2 (n = 10), subjects aged between 40 and 64 years; Group 3 (n = 10), individuals aged 65 years and over. We randomly divided the samples into two sets with 15 specimens. In the first study segment (n = 15), we used histological to assess the osteogenic property of the graft, through the analysis of cell reserve in the periosteum, the number of osteocytes in the lacunae and the number of Haversian and Volkmann's canals. In the second study segment (n = 15), we investigated the morphology of osteoconductive property of the graft, through quantification of the trabecular meshwork (Vv) and trabecular area (Sv). : histologically, we observed degeneration of bone occurring with age, characterized by thinning of the periosteum, with gradual replacement of the steogenic layer by fibrous tissue, small amount of Haversian and Volkmann's canals, osteocyte lacunae voids and fine spongy bone trabeculae, allowing ample medullary space, usually occupied by fat cells and adipocytes. Morphologically, with respect to the quantification of the trabecular meshwork (Vv), we found statistically significant differences between Groups 1 and 3 and between Groups 2 and 3, with reduction of the trabecular meshwork of about 45% in the elderly over 65 years old ; there was no statistically significant difference between Groups 1 and 2. There was also no statistical difference between the Groups regarding Sv. : the results of this experiment suggest that, in the elderly (over 65 years old), the osteogenic property of autologous bone graft decreases and the osteoconductive property is compromised. avaliar as características histológicas e morfométricas de biópsias ósseas da região anterior da crista ilíaca de pacientes de diferentes faixas etárias. foram estudadas 30 amostras de osso da crista ilíaca, utilizando-se microscopia óptica de campo claro. As amostras foram divididas pela faixa etária dos doadores em três grupos: Grupo 1 (n = 10), indivíduos com idade entre 25 e 39 anos; Grupo 2 (n = 10), indivíduos com idade entre 40 e 64 anos; Grupo 3 (n = 10), indivíduos com idade igual ou superior a 65 anos. As amostras foram separadas aleatoriamente em dois conjuntos com 15 peças. No primeiro segmento do estudo (n = 15), foi avaliada histologicamente a propriedade osteogênica do enxerto, através da análise da reserva celular no periósteo, do número de osteócitos nas lacunas e da quantidade de canais de Havers e de Volkmann. No segundo segmento do estudo (n = 15), investigou-se morfologicamente a propriedade osteocondutora do enxerto, através da quantificação da rede trabecular (Vv) e da área trabecular (Sv). histologicamente, observou-se que ocorre degeneração do tecido ósseo com a idade, caracterizada pelo adelgaçamento do periósteo, com substituição gradual da camada osteogênica por tecido fibroso, pequena quantidade de canais de Havers e de Volkmann, osteoplastos vazios e trabéculas finas de osso esponjoso, permitindo amplo espaço medular, em geral ocupado por células lipídicas e adipócitos. Morfologicamente, com relação à quantificação da rede trabecular (Vv), foi observada diferença estatisticamente significante entre os Grupos 1 e 3 e entre os Grupos 2 e 3, com redução da rede trabecular de cerca de 45% no idoso acima de 65 anos de idade; não foi observada diferença estatisticamente significante entre os Grupos 1 e 2. Não foi observada diferença estatística entre os grupos quanto à Sv. os achados do presente experimento sugerem que nos indivíduos idosos (acima de 65 anos de idade), a propriedade osteogênica do enxerto ósseo autólogo diminui e a propriedade osteocondutora está comprometida.

Unexpected HIMU-type late-stage volcanism on the Walvis Ridge

NASA Astrophysics Data System (ADS)

Homrighausen, S.; Hoernle, K.; Geldmacher, J.; Wartho, J.-A.; Hauff, F.; Portnyagin, M.; Werner, R.; van den Bogaard, P.; Garbe-Schönberg, D.

2018-06-01

Volcanic activity at many oceanic volcanoes, ridges and plateaus often reawakens after hiatuses of up to several million years. Compared to the earlier magmatic phases, this late-stage (rejuvenated/post-erosional) volcanism is commonly characterized by a distinct geochemical composition. Late-stage volcanism raises two hitherto unanswered questions: Why does volcanism restart after an extended hiatus and what is the origin of this volcanism? Here we present the first 40Ar/39Ar age and comprehensive trace element and Sr-Nd-Pb-Hf isotopic data from seamounts located on and adjacent to the Walvis Ridge in the South Atlantic ocean basin. The Walvis Ridge is the oldest submarine part of the Tristan-Gough hotspot track and is famous as the original type locality for the enriched mantle one (EM I) end member. Consistent with the bathymetric data, the age data indicates that most of these seamounts are 20-40 Myr younger than the underlying or nearby Walvis Ridge basement. The trace element and isotope data reveal a distinct compositional range from the EM I-type basement. The composition of the seamounts extend from the St. Helena HIMU (high time-integrated 238U/204Pb mantle with radiogenic Pb isotope ratios) end member to an enriched (E) Mid-Ocean-Ridge Basalt (MORB) type composition, reflecting a two-component mixing trend on all isotope diagrams. The EMORB end member could have been generated through mixing of Walvis Ridge EM I with normal (N) MORB source mantle, reflecting interaction of Tristan-Gough (EM I-type) plume melts with the upper mantle. The long volcanic quiescence and the HIMU-like geochemical signature of the seamounts are unusual for classical hotspot related late-stage volcanism, indicating that these seamounts are not related to the Tristan-Gough hotspot volcanism. Two volcanic arrays in southwestern Africa (Gibeon-Dicker Willem and Western Cape province) display similar ages to the late-stage Walvis seamounts and also have HIMU-like compositions, suggesting a larger-scale event at ∼77-49 Ma. We propose that the EM I-like mantle plumes rise from the edges of the African Large Low Shear Velocity Province (LLSVP; Tristan-Gough, Discovery and Shona hotspot), whereas the HIMU-dominated intraplate lavas (St. Helena, Gibeon-Dicker Willem and Western Cape province) and the late-stage Walvis seamounts tap material from internal portions of the African LLSVP, suggesting possible lateral and/or vertical chemical zonation of the African LLSVP.

Support for Afghanistan’s Justice Sector: State Department Programs Need Better Management and Stronger Oversight

DTIC Science & Technology

2014-01-01

note that the uraJt report down played the D value or fNL ’s deployment (in Novemher 2012) of the MctaSt’orm business process managemen t .sysl.em...effectiveness of the project operations under t he terms of this agreement . At the termination of the project a completion report shall be issued as an...including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215

Inventory of Physical and Cultural Elements, Middle Mississippi River Floodplain (River Reach - St. Louis, Missouri, to Cairo, Illinois)

DTIC Science & Technology

1975-01-01

Environmental Effects Laboratory in July 1971 *. the floodplain. This report was written by Mr. Stoll and CPT R. D. Brown, formerly of ESB. Directors of...Middle Mississippi River for 1971 « ’ It should be noted that these tables exclude Government em- ployees, railroad employees, and self-employed...pipeline. 180. A breakdown of 1971 cargo tonnage for commodity groups car- 1+1 ried on the Middle Mississippi River is presented in Table 19. Spe

Assessment of peak skin dose in interventional cardiology: A comparison between Gafchromic film and dosimetric software em.dose.

PubMed

Greffier, J; Van Ngoc Ty, C; Bonniaud, G; Moliner, G; Ledermann, B; Schmutz, L; Cornillet, L; Cayla, G; Beregi, J P; Pereira, F

2017-06-01

To compare the use of a dose mapping software to Gafchromic film measurement for a simplified peak skin dose (PSD) estimation in interventional cardiology procedure. The study was conducted on a total of 40 cardiac procedures (20 complex coronary angioplasty of chronic total occlusion (CTO) and 20 coronary angiography and coronary angioplasty (CA-PTCA)) conducted between January 2014 to December 2015. PSD measurement (PSD Film ) was obtained by placing XR-RV3 Gafchromic under the patient's back for each procedure. PSD (PSD em.dose ) was computed with the software em.dose©. The calculation was performed on the dose metrics collected from the private dose report of each procedure. Two calculation methods (method A: fluoroscopic kerma equally spread on cine acquisition and B: fluoroscopic kerma is added to one air Kerma cine acquisition that contributes to the PSD) were used to calculate the fluoroscopic dose contribution as fluoroscopic data were not recorded in our interventional room. Statistical analyses were carried out to compare PSD Film and PSD em.dose . The PSD Film median (1st quartile; 3rd quartile) was 0.251(0.190;0.336)Gy for CA-PTCA and 1.453(0.767;2.011)Gy for CTO. For method-A, the PSD em.dose was 0.248(0.182;0.369)Gy for CA-PTCA and 1.601(0.892;2.178)Gy for CTO, and 0.267(0.223;0.446)Gy and 1.75 (0.912;2.584)Gy for method-B, respectively. For the two methods, the correlation between PSD Film and PSD em.dose was strong. For all cardiology procedures investigated, the mean deviation between PSD Film and PSD em.dose was 3.4±21.1% for method-A and 17.3%±23.9% for method-B. The dose mapping software is convenient to calculate peak skin dose in interventional cardiology. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Potential for bioremediation of agro-industrial effluents with high loads of pesticides by selected fungi.

PubMed

Karas, Panagiotis A; Perruchon, Chiara; Exarhou, Katerina; Ehaliotis, Constantinos; Karpouzas, Dimitrios G

2011-02-01

Wastewaters from the fruit packaging industry contain a high pesticide load and require treatment before their environmental discharge. We provide first evidence for the potential bioremediation of these wastewaters. Three white rot fungi (WRF) (Phanerochaete chrysosporium, Trametes versicolor, Pleurotus ostreatus) and an Aspergillus niger strain were tested in straw extract medium (StEM) and soil extract medium (SEM) for degrading the pesticides thiabendazole (TBZ), imazalil (IMZ), thiophanate methyl (TM), ortho-phenylphenol (OPP), diphenylamine (DPA) and chlorpyrifos (CHL). Peroxidase (LiP, MnP) and laccase (Lac) activity was also determined to investigate their involvement in pesticide degradation. T. versicolor and P. ostreatus were the most efficient degraders and degraded all pesticides (10 mg l⁻¹) except TBZ, with maximum efficiency in StEM. The phenolic pesticides OPP and DPA were rapidly degraded by these two fungi with a concurrent increase in MnP and Lac activity. In contrast, these enzymes were not associated with the degradation of CHL, IMZ and TM implying the involvement of other enzymes. T. versicolor degraded spillage-level pesticide concentrations (50 mg l⁻¹) either fully (DPA, OPP) or partially (TBZ, IMZ). The fungus was also able to rapidly degrade a mixture of TM/DPA (50 mg l⁻¹), whereas it failed to degrade IMZ and TBZ when supplied in a mixture with OPP. Overall, T. versicolor and P. ostreatus showed great potential for the bioremediation of wastewaters from the fruit packaging industry. However, degradation of TBZ should be also achieved before further scaling up.

Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil.

PubMed

Servidoni, Maria Fátima; Gomez, Carla Cristina Souza; Marson, Fernando Augusto Lima; Toro, Adyléia Aparecida Dalbo Contrera; Ribeiro, Maria Ângela Gonçalves de Oliveira; Ribeiro, José Dirceu; Ribeiro, Antônio Fernando

2017-01-01

The sweat test (ST) measures chloride levels in sweat and is considered the gold standard for the diagnosis of cystic fibrosis (CF). However, the reliability of a ST depends on their being performed by experienced technicians and in accordance with strict guidelines. Our aim was to evaluate how sweat stimulation, sweat collection, and chloride measurement are performed at 14 centers (9 public centers and 5 private centers) that routinely perform STs in the state of São Paulo, which has the highest frequency of CF in Brazil. This was a cross-sectional cohort study, using a standardized questionnaire administered in loco to the staff responsible for conducting STs. No uniformity regarding the procedures was found among the centers. Most centers were noncompliant with the international guidelines, especially regarding the collection of sweat (the samples were insufficient in 10-50% of the subjects tested); availability of stimulation equipment (which was limited at 2 centers); modernity and certification of stimulation equipment (most of the equipment having been used for 3-23 years); and written protocols (which were lacking at 12 centers). Knowledge of ST guidelines was evaluated at only 1 center. Our results show that STs largely deviate from internationally accepted guidelines at the participating centers. Therefore, there is an urgent need for standardization of STs, training of qualified personnel, and acquisition/certification of suitable equipment. These are essential conditions for a reliable diagnosis of CF, especially with the increasing demand due to newborn screening nationwide, and for the assessment of a possible clinical benefit from the use of modulator drugs. O teste do suor (TS) mede os níveis de cloro no suor e é considerado o padrão ouro para o diagnóstico da fibrose cística (FC). Contudo, a confiabilidade do TS depende de sua realização por técnicos experientes e segundo diretrizes rígidas. Nosso objetivo foi avaliar como são realizadas a estimulação e coleta do suor e a dosagem de cloro em 14 centros (9 públicos e 5 privados) que realizam TS rotineiramente no estado de São Paulo, que possui a maior frequência de FC do Brasil. Estudo de coorte transversal utilizando um questionário padronizado aplicado in loco ao pessoal responsável pela realização dos TS. Não houve uniformidade entre os centros quanto aos procedimentos. A maioria dos centros não era aderente às diretrizes internacionais, especialmente quanto à coleta do suor (amostras insuficientes em 10-50% dos indivíduos testados), disponibilidade de equipamentos de estimulação (limitada em 2 centros), modernidade e certificação dos mesmos (a maioria utilizada há 3-23 anos) e protocolos escritos (ausentes em 12 centros). Avaliou-se o conhecimento sobre diretrizes para TS em apenas 1 centro. Nossos resultados mostram que, nos centros participantes, os TS estão muito distantes das diretrizes internacionalmente aceitas. Portanto, há necessidade urgente de padronização dos TS, de treinamento de pessoal qualificado e de aquisição/certificação de equipamentos adequados. Essas são condições essenciais para um diagnóstico confiável de FC, especialmente com a crescente demanda resultante da triagem neonatal em todo o país, e para a avaliação do possível benefício clínico do uso de moduladores.

Critical Technology Events (CTEs) that Support the Rationale for Army Laboratories Based on S&T Functions Performed

DTIC Science & Technology

2013-09-01

is very compatible to growth of mercury cadmium telluride (HgCdTe or MCT) on its surface. HgCdTe is the IR sensitive material. However, CdZnTe is...in Indiana which is one of the few test ranges in the developed world where battlefield smokes and live artillery fire could be 41 F. Shields, NV...spectral region of E&M spectrum) I2 – Image Intensification JIEDDO – Joint IED Defeat Office JPG – Jefferson Proving Ground, Indiana . JPO – Joint

Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents.

PubMed

Pourmand, Ali; Tanski, Mary; Davis, Steven; Shokoohi, Hamid; Lucas, Raymond; Zaver, Fareen

2015-01-01

Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI). We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation. 148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001). An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.

Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator.

PubMed

Jollis, James G; Al-Khalidi, Hussein R; Roettig, Mayme L; Berger, Peter B; Corbett, Claire C; Dauerman, Harold L; Fordyce, Christopher B; Fox, Kathleen; Garvey, J Lee; Gregory, Tammy; Henry, Timothy D; Rokos, Ivan C; Sherwood, Matthew W; Suter, Robert E; Wilson, B Hadley; Granger, Christopher B

2016-08-02

Up to 50% of patients fail to meet ST-segment-elevation myocardial infarction (STEMI) guideline goals recommending a first medical contact-to-device time of <90 minutes for patients directly presenting to percutaneous coronary intervention-capable hospitals and <120 minutes for transferred patients. We sought to increase the proportion of patients treated within guideline goals by organizing coordinated regional reperfusion plans. We established leadership teams, coordinated protocols, and provided regular feedback for 484 hospitals and 1253 emergency medical services (EMS) agencies in 16 regions across the United States. Between July 2012 and December 2013, 23 809 patients presented with acute STEMI (direct to percutaneous coronary intervention hospital: 11 765 EMS transported and 6502 self-transported; 5542 transferred). EMS-transported patients differed from self-transported patients in symptom onset to first medical contact time (median, 47 versus 114 minutes), incidence of cardiac arrest (10% versus 3%), shock on admission (11% versus 3%), and in-hospital mortality (8% versus 3%; P<0.001 for all comparisons). There was a significant increase in the proportion of patients meeting guideline goals of first medical contact-to-device time, including those directly presenting via EMS (50% to 55%; P<0.001) and transferred patients (44%-48%; P=0.002). Despite regional variability, the greatest gains occurred among patients in the 5 most improved regions, increasing from 45% to 57% (direct EMS; P<0.001) and 38% to 50% (transfers; P<0.001). This Mission: Lifeline STEMI Systems Accelerator demonstration project represents the largest national effort to organize regional STEMI care. By focusing on first medical contact-to-device time, coordinated treatment protocols, and regional data collection and reporting, we were able to increase significantly the proportion of patients treated within guideline goals. © 2016 American Heart Association, Inc.

Circuit models and three-dimensional electromagnetic simulations of a 1-MA linear transformer driver stage

NASA Astrophysics Data System (ADS)

Rose, D. V.; Miller, C. L.; Welch, D. R.; Clark, R. E.; Madrid, E. A.; Mostrom, C. B.; Stygar, W. A.; Lechien, K. R.; Mazarakis, M. A.; Langston, W. L.; Porter, J. L.; Woodworth, J. R.

2010-09-01

A 3D fully electromagnetic (EM) model of the principal pulsed-power components of a high-current linear transformer driver (LTD) has been developed. LTD systems are a relatively new modular and compact pulsed-power technology based on high-energy density capacitors and low-inductance switches located within a linear-induction cavity. We model 1-MA, 100-kV, 100-ns rise-time LTD cavities [A. A. Kim , Phys. Rev. ST Accel. Beams 12, 050402 (2009)PRABFM1098-440210.1103/PhysRevSTAB.12.050402] which can be used to drive z-pinch and material dynamics experiments. The model simulates the generation and propagation of electromagnetic power from individual capacitors and triggered gas switches to a radially symmetric output line. Multiple cavities, combined to provide voltage addition, drive a water-filled coaxial transmission line. A 3D fully EM model of a single 1-MA 100-kV LTD cavity driving a simple resistive load is presented and compared to electrical measurements. A new model of the current loss through the ferromagnetic cores is developed for use both in circuit representations of an LTD cavity and in the 3D EM simulations. Good agreement between the measured core current, a simple circuit model, and the 3D simulation model is obtained. A 3D EM model of an idealized ten-cavity LTD accelerator is also developed. The model results demonstrate efficient voltage addition when driving a matched impedance load, in good agreement with an idealized circuit model.

Affective Properties of Mothers' Speech to Infants With Hearing Impairment and Cochlear Implants

PubMed Central

Bergeson, Tonya R.; Xu, Huiping; Kitamura, Christine

2015-01-01

Purpose The affective properties of infant-directed speech influence the attention of infants with normal hearing to speech sounds. This study explored the affective quality of maternal speech to infants with hearing impairment (HI) during the 1st year after cochlear implantation as compared to speech to infants with normal hearing. Method Mothers of infants with HI and mothers of infants with normal hearing matched by age (NH-AM) or hearing experience (NH-EM) were recorded playing with their infants during 3 sessions over a 12-month period. Speech samples of 25 s were low-pass filtered, leaving intonation but not speech information intact. Sixty adults rated the stimuli along 5 scales: positive/negative affect and intention to express affection, to encourage attention, to comfort/soothe, and to direct behavior. Results Low-pass filtered speech to HI and NH-EM groups was rated as more positive, affective, and comforting compared with the such speech to the NH-AM group. Speech to infants with HI and with NH-AM was rated as more directive than speech to the NH-EM group. Mothers decreased affective qualities in speech to all infants but increased directive qualities in speech to infants with NH-EM over time. Conclusions Mothers fine-tune communicative intent in speech to their infant's developmental stage. They adjust affective qualities to infants' hearing experience rather than to chronological age but adjust directive qualities of speech to the chronological age of their infants. PMID:25679195

Effect of recombinant bovine somatotropin (rbST) on cytoplasmic maturation of bovine oocytes and their developmental competence in vitro.

PubMed

Kuzmina, Tatjana I; Alm, Hannelore; Denisenko, Vitaly; Tuchscherer, Armin; Kanitz, Wilhelm; Torner, Helmut

2007-04-01

The objectives of this study were to evaluate the effects of recombinant bovine somatotropin (rbST) on the nuclear and cytoplasmic maturation of bovine oocytes and their further developmental competence to blastocysts in vitro. We analyzed the mitochondrial activity and concentration of intracellular stored calcium ([Ca(2+)](is)) in matured oocytes and the morphology and chromatin status of produced embryos after in vitro fertilization. Cumulus-oocyte complexes were incubated in TCM 199 containing 10% fetal calf serum (control medium 1: CM 1) or 10% estrus cow serum (control medium 2: CM 2). The culture medium of the treatment groups was modified by supplementation of the control medium with 10 ng/ml rbST (CM 1A and CM 2A), 10(6)/ml granulosa cells (CM 1B and CM 2B), or 10 ng/ml rbST plus 10(6)/ml granulosa cells (CM 1C and CM 2C). No differences were observed in the percentages of oocytes reaching metaphase II between the groups. However, the proportion of blastocysts was highest in treatment groups CM 1C and CM 2C (P<0.05). The type of serum did not alter the positive effect of rbST on the developmental competence of embryos. The fluorescence intensity of metabolically active mitochondria measured by intensity per oocyte (Em 570) after MitoTracker CMTM Ros Orange labeling was significantly increased in oocytes matured in the presence of 10 ng/ml rbST and granulosa cells (309.21 vs. 119.97 microA; P<0.01). In parallel, the concentration of [Ca(2+)](is) in oocytes, determined using fluorophore chlortetracycline, was significantly decreased (0.85 +/- 0.02 vs. 0.97 +/- 0.03 AU; P<0.05). Based on these results, we concluded that rbST, in interaction with granulosa cells stimulates the oxidative activity of ooplasmic mitochondria and decreases the content of [Ca(2+)](is) in oocytes. These facts support the hypothesis that somatotropin influences the developmental competence of bovine oocytes during maturation in vitro, and this effect can be modulated by granulosa cells.

Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century

PubMed Central

Toohey, Shannon L.; Wray, Alisa; Wiechmann, Warren; Lin, Michelle; Boysen-Osborn, Megan

2016-01-01

Introduction Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner. Discussion These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. Conclusion While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices. PMID:27330668

Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century.

PubMed

Toohey, Shannon L; Wray, Alisa; Wiechmann, Warren; Lin, Michelle; Boysen-Osborn, Megan

2016-05-01

Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program's curriculum to accommodate the modern learner. These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

Comparative study between kidney transplantation with deceased donor expanded criteria and donor standard criteria in a single center in Brazil.

PubMed

Mota, Luana Soriano; Oliveira, Claudia Maria Costa de; Pinheiro, Francisco Martho Leal; Santos, Larissa Costa de Oliveira; Nóbrega, Danilo Gonçalves; Fernandes, Paula Fbc; Costa, Alda Angélica de Melo; Silva, Sônia Leite da

2016-01-01

Kidney transplants with expanded criteria donor have been associated with improved patient survival compared to those who remain on dialysis. To compare renal function and survival of the kidney graft of deceased donor with expanded criteria and standard criteria over a year in a single transplant center. 255 kidney transplant recipients with deceased donor were included in the study between the years 2011 to 2013 and they were separated into two groups according to the type of donor (expanded criteria donor - ECD - and standard criteria donor - SCD). 231 deceased donor transplants (90.6%) were performed with standard criteria donor (SCD) and 24 (9.4%) with expanded criteria donor (ECD). There was no difference in the prevalence of delayed graft function - DGF - (62.9% vs. 70.8%; p = 0.44). Expanded criteria donor group had lower glomerular filtration rate (GFR) at the end of the 1st year (56.8 ± 26.9 vs. 76.9 ± 23.7; p = 0.001). Patient survival was significantly lower in the ECD group, but the graft survival was not different after death-censored analysis. The ECD group was associated with significantly lower levels of GFR during the first year of transplant and a lower patient survival at the 1st year when compared to the SCD. A aceitação dos rins com critério expandido de doação tem sido associada com melhor sobrevida do paciente em comparação àqueles que permanecem em terapia dialítica. Comparar a função renal e a sobrevida do enxerto renal de doador falecido critério expandido com os de doador falecido critério padrão ao longo de um ano em um único centro de transplantes. Foram incluídos 255 receptores de transplante renal com doador falecido, realizados entre os anos de 2011 a 2013, sendo divididos em dois grupos segundo o tipo de doador (critério expandido - DCE - ou padrão -DCP). Foram avaliados 231 receptores com doador critério ideal (90,6%) e 24 com doador critério expandido (9,4%). Não houve diferença na prevalência de função retardada do enxerto - DGF - (62,9% no DCP vs. 70,8% no DCE; p = 0,44) nos dois grupos. Os transplantes com DCE apresentaram uma taxa de filtração glomerular (TFG) significativamente inferior aos 12 meses (56,8 ± 26,9 vs. 76,9 ± 23,7; p = 0,001). A sobrevida dos pacientes em 1 ano foi significativamente inferior no grupo de DCE, mas não houve diferença na sobrevida dos enxertos após exclusão de perdas por óbito com rim funcionante. O grupo com DCE associou-se com níveis significativamente mais baixos de TFG ao longo do primeiro ano de transplante, bem como uma menor sobrevida dos pacientes em 1 ano, quando comparado ao grupo com doador padrão.

Site Investigation Report. 161st Air Refueling Group, Arizona National Guard, Sky Harbor International Airport and Papago Military Reservation, Phoenix, Arizona. Volume 1. Report, Tables and Figures

DTIC Science & Technology

1992-11-01

Tennessee 37831-7606 NTIS GP’A t managed by O-C T MARTIN MARIETTA ENERGY SYSTEMS, INC. for the U.S. DEPARTMENT OF ENERGY 1Y under contract DE -ACO5...conductivity ECD electron capture detector S K • , . , i F.xii S List of Acronyms (Continued) S EM electromagnetic induction Energy Systems Martin Marietta...Energy Sytems, Inc. EWA East Washington Area FID flame ionization detector 9 Fr/DAY feet per day FS feasibility scudy FSP field sampling plan GC gas

Rationale and Design of the SENECA (StEm cell iNjECtion in cAncer survivors) Trial.

PubMed

Bolli, Roberto; Hare, Joshua M; Henry, Timothy D; Lenneman, Carrie G; March, Keith L; Miller, Kathy; Pepine, Carl J; Perin, Emerson C; Traverse, Jay H; Willerson, James T; Yang, Phillip C; Gee, Adrian P; Lima, João A; Moyé, Lem; Vojvodic, Rachel W; Sayre, Shelly L; Bettencourt, Judy; Cohen, Michelle; Ebert, Ray F; Simari, Robert D

2018-07-01

SENECA (StEm cell iNjECtion in cAncer survivors) is a phase I, randomized, double-blind, placebo-controlled study to evaluate the safety and feasibility of delivering allogeneic mesenchymal stromal cells (allo-MSCs) transendocardially in subjects with anthracycline-induced cardiomyopathy (AIC). AIC is an incurable and often fatal syndrome, with a prognosis worse than that of ischemic or nonischemic cardiomyopathy. Recently, cell therapy with MSCs has emerged as a promising new approach to repair damaged myocardium. The study population is 36 cancer survivors with a diagnosis of AIC, left ventricular (LV) ejection fraction ≤40%, and symptoms of heart failure (NYHA class II-III) on optimally-tolerated medical therapy. Subjects must be clinically free of cancer for at least two years with a ≤ 30% estimated five-year risk of recurrence. The first six subjects participated in an open-label, lead-in phase and received 100 million allo-MSCs; the remaining 30 will be randomized 1:1 to receive allo-MSCs or vehicle via 20 transendocardial injections. Efficacy measures (obtained at baseline, 6 months, and 12 months) include MRI evaluation of LV function, LV volumes, fibrosis, and scar burden; assessment of exercise tolerance (six-minute walk test) and quality of life (Minnesota Living with Heart Failure Questionnaire); clinical outcomes (MACE and cumulative days alive and out of hospital); and biomarkers of heart failure (NT-proBNP). This is the first clinical trial using direct cardiac injection of cells for the treatment of AIC. If administration of allo-MSCs is found feasible and safe, SENECA will pave the way for larger phase II/III studies with therapeutic efficacy as the primary outcome. Copyright © 2018. Published by Elsevier Inc.

ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction (STAT-MI) trial.

PubMed

Dhruva, Vivek N; Abdelhadi, Samir I; Anis, Ather; Gluckman, William; Hom, David; Dougan, William; Kaluski, Edo; Haider, Bunyad; Klapholz, Marc

2007-08-07

Our goal was to examine the effects of implementing a fully automated wireless network to reduce door-to-intervention times (D2I) in ST-segment elevation myocardial infarction (STEMI). Wireless technologies used to transmit prehospital electrocardiograms (ECGs) have helped to decrease D2I times but have unrealized potential. A fully automated wireless network that facilitates simultaneous 12-lead ECG transmission from emergency medical services (EMS) personnel in the field to the emergency department (ED) and offsite cardiologists via smartphones was developed. The system is composed of preconfigured Bluetooth devices, preprogrammed receiving/transmitting stations, dedicated e-mail servers, and smartphones. The network facilitates direct communication between offsite cardiologists and EMS personnel, allowing for patient triage directly to the cardiac catheterization laboratory from the field. Demographic, laboratory, and time interval data were prospectively collected and compared with calendar year 2005 data. From June to December 2006, 80 ECGs with suspected STEMI were transmitted via the network. Twenty patients with ECGs consistent with STEMI were triaged to the catheterization laboratory. Improvement was seen in mean door-to-cardiologist notification (-14.6 vs. 61.4 min, p < 0.001), door-to-arterial access (47.6 vs. 108.1 min, p < 0.001), time-to-first angiographic injection (52.8 vs. 119.2 min, p < 0.001), and D2I times (80.1 vs. 145.6 min, p < 0.001) compared with 2005 data. A fully automated wireless network that transmits ECGs simultaneously to the ED and offsite cardiologists for the early evaluation and triage of patients with suspected STEMI can decrease D2I times to <90 min and has the potential to be broadly applied in clinical practice.

Social media in the emergency medicine residency curriculum: social media responses to the residents' perspective article.

PubMed

Hayes, Bryan D; Kobner, Scott; Trueger, N Seth; Yiu, Stella; Lin, Michelle

2015-05-01

In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Comparative Effectiveness of STEMI Regionalization Strategies

PubMed Central

Concannon, Thomas W.; Kent, David M.; Normand, Sharon-Lise; Newhouse, Joseph P.; Griffith, John L.; Cohen, Joshua; Beshansky, Joni R.; Wong, John B.; Aversano, Thomas; Selker, Harry P.

2010-01-01

BACKGROUND Primary percutaneous coronary intervention (PCI) is more effective on average than fibrinolytic therapy (FT) in the treatment of ST-segment elevation myocardial infarction (STEMI). Yet most U.S. hospitals are not equipped for PCI and FT is still widely used. This study evaluated the comparative effectiveness of STEMI regionalization strategies to increase the use of PCI against standard emergency transport and care. METHODS AND RESULTS We estimated incremental treatment costs and quality-adjusted life expectancies of 2,000 patients with STEMI who received PCI or FT in simulations of emergency care in a regional hospital system. To increase access to PCI across the system, we compared a base case strategy to 12 hospital-based strategies of building new PCI labs or extending the hours of existing labs, and one emergency medical services (EMS)-based strategy of transporting all patients with STEMI to existing PCI-capable hospitals. The base case resulted in 609 (569, 647) patients getting PCI. Hospital-based strategies increased the number of patients receiving PCI, the costs of care, and quality-adjusted life years (QALYs) saved, and were cost effective under a variety of conditions. An EMS-based strategy of transporting every patient to an existing PCI facility was less costly and more effective than all hospital expansion options. CONCLUSION Our results suggest that new construction and staffing of PCI labs may not be warranted if an EMS strategy is both available and feasible. PMID:20664025

Water fluoridation in Brazilian cities at the first decade of the 21st century.

PubMed

Frazão, Paulo; Narvai, Paulo Capel

2017-05-15

To assess the coverage of the fluoridation of the public water supply in Brazilian municipalities at the first decade of the 21st century, according to population size and municipal human development index (MHDI). We have used data produced by national information agencies and the United Nations Development Programme. Population size was separated into < 10,000, 10,000-50,000, and > 50,000 inhabitants. The MHDI was classified into < 0.600, 0.600-0.699, 0.700-0.799, and > 0.799. Absolute and relative inequalities between categories were evaluated using indicators of effect and total impact. We have obtained information for 5,558 municipalities. The coverage rate of water fluoridation increased from 67.7% to 76.3%. Approximately 884 (15.9%) municipalities and 29,600,000 inhabitants started being benefited by the measure. We have observed a significant expansion in municipalities with < 10,000 inhabitants (increase of 21.0 percentage points) and low or very low MHDI (17.7 percentage points). Population coverage of the public policy has increased 8.6%, and we can also see significant reductions in absolute and relative inequality according to population size and MHDI. Regarding municipal coverage rate, there was also a reduction in inequality in all comparisons except for absolute inequality between the categories of MHDI. The public policy has operated as a factor of health protection in the context of the ongoing social protection policies in the country. Avaliar a cobertura da fluoretação da água de abastecimento público em municípios brasileiros na primeira década do século XXI, segundo porte demográfico e nível de desenvolvimento humano municipal (IDH-M). Foram utilizados dados produzidos por agências nacionais de informação e pelo Programa das Nações Unidas para o Desenvolvimento. O porte demográfico foi separado em < 10 mil; 10-50 mil; > 50 mil habitantes. O IDH-M foi classificado em < 0,600; 0,600-0,699; 0,700-0,799; > 0,799. As desigualdades absoluta e relativa entre as categorias foram avaliadas por meio de indicadores de efeito e de impacto total. Foram obtidas informações para 5.558 municípios. A taxa de cobertura da fluoretação da água aumentou de 67,7% para 76,3%. Passaram a ser beneficiados pela medida 884 (15,9%) municípios, e 29,6 milhões de habitantes. Observou-se ampliação expressiva em municípios com < 10 mil habitantes (aumento de 21,0 pontos percentuais) e com IDH-M baixo ou muito baixo (17,7 pontos percentuais). A cobertura populacional da política pública aumentou 8,6%, sendo expressivas as reduções das desigualdades absoluta e relativa segundo o porte demográfico e o IDH-M. Quanto à taxa de cobertura municipal, houve também redução da desigualdade em todas as comparações com exceção da desigualdade absoluta entre as categorias de IDH-M. A política pública operou como fator de proteção sanitária no contexto das políticas de proteção social em curso no país.

Is it time to stop chilling? Induced therapeutic hypothermia doesn't appear to have the prehospital effect we thought it did.

PubMed

Bledsoe, Bryan E

2015-02-01

The evidence is quite clear that ITH in the prehospital setting is of dubious benefit. But what is the harm in continuing the practice? Well, prehospital ITH most likely takes away from more beneficial therapies such as high-quality CPR, rapid defibrillation, recognition of ST-segment elevation myocardial infarction (STEMI), and similar essential treatments. Several studies have shown prehospital ITH, in many cases, delays hospital transport. When the initial studies of ITH were released, I was immediately on the ITH bandwagon. Interestingly, the American Heart Association (AHA) has never recommended prehospital ITH. Even the position paper on ITH by the National Association of EMS Physicians (NAEMSP) was cautious, saying, "A lack of evidence on induced hypothermia in the prehospital setting currently precludes recommending this treatment modality as standard of care for all emergency medical services (EMS) patients resuscitated from cardiac arrest. A systematic review of ITH recently published states, "In cardiac arrest, the initiation of therapeutic hypothermia in the out-of-hospital environment has not been shown to improve neurologic outcomes, although studies to date have been limited. We now know that caution Fxercised by the AHA and preMSP was appropriate. One medmy mentors in residency and ays said, "Never be the first- Univtor to prescribe a new drug or of Mlast doctor to prescribe an old is th" Lik" many things in EMS, EMS tms something that was put in Practe with good intent but lim- scientific evidence. We now P ITH is probably not a good ice and it is time to abandon it. However, we should still carry chilled IV fluids for hyperthermia, excited delirium and to main- tainormothermia in patients in cardiac arrest where transport times are long.

Smart Water Conservation System for Irrigated Landscape

DTIC Science & Technology

2016-05-01

Ir ri ga tio n Sy st em s Ir ri... ire d fo r i rr ig at io n. Le ss w at er u se d re su lts in re du ce d en er gy us ag e. C on tro lle r c ol le ct s a nd e va lu at es re...al -ti m e se ns or d at a to de te rm in e w he n it is n ec es sa ry to ir rig at e an d ho w m uc h w at er to a pp ly b as ed

Architecting the Human Space Flight Program with Systems Modeling Language (SysML)

NASA Technical Reports Server (NTRS)

Jackson, Maddalena M.; Fernandez, Michela Munoz; McVittie, Thomas I.; Sindiy, Oleg V.

2012-01-01

The next generation of missions in NASA's Human Space Flight program focuses on the development and deployment of highly complex systems (e.g., Orion Multi-Purpose Crew Vehicle, Space Launch System, 21st Century Ground System) that will enable astronauts to venture beyond low Earth orbit and explore the moon, near-Earth asteroids, and beyond. Architecting these highly complex system-of-systems requires formal systems engineering techniques for managing the evolution of the technical features in the information exchange domain (e.g., data exchanges, communication networks, ground software) and also, formal correlation of the technical architecture to stakeholders' programmatic concerns (e.g., budget, schedule, risk) and design development (e.g., assumptions, constraints, trades, tracking of unknowns). This paper will describe how the authors have applied System Modeling Language (SysML) to implement model-based systems engineering for managing the description of the End-to-End Information System (EEIS) architecture and associated development activities and ultimately enables stakeholders to understand, reason, and answer questions about the EEIS under design for proposed lunar Exploration Missions 1 and 2 (EM-1 and EM-2).

[Provision of assistive devices in amyotrophic lateral sclerosis. Analysis of 3 years case management in an internet-based supply network].

PubMed

Funke, A; Grehl, T; Großkreutz, J; Münch, C; Walter, B; Kettemann, D; Karnapp, C; Gajewski, N; Meyer, R; Maier, A; Gruhn, K M; Prell, T; Kollewe, K; Abdulla, S; Kobeleva, X; Körner, S; Petri, S; Meyer, T

2015-08-01

The provision of assistive devices (PAD) is a key element of care in amyotrophic lateral sclerosis (ALS). Since 2011, assistive devices (AD) have been coordinated in an internet-supported care network at university-based ALS centers in Berlin, Bochum, Hannover and Jena. The digitization of PAD processes has facilitated the evaluation of real-life ALS care. Orthotics (OT), augmentative and alternative communication (AAC), supported treadmill (ST) and powered wheelchair (PW) were the PAD groups analyzed for delivery rates (proportion of delivered AD vs. medically indicated AD), rejection by patients and payers and latency of provision of care. Between June 2011 and October 2014 a total of 1479 patients and 12,478 AD were coordinated, among which 3313 PAD were related to OT, AAC, ST or EM. The median delivery rate was 64.3 %. The mean rejection rate by patients was 9.8 % (OT 5.4 %, AAC 9.8 %, ST 10.2 % and PW 15.6 %). Marked differences were noted in the rejection rate by payers and in care provision latency: OT (16.2 %, 68 days, n = 734), AAC (30.4 %, 96 days, n = 392), ST (34.8 %, 113 days, n = 164) and PW (35.6 %, 129 days, n = 259). Analysis of rejection rates showed significant differences among insurers. Only two thirds of the medically indicated AD reached the patients. Rejection rates by patients and payers and latency of provision of care were high. The PAD can substantially vary among health insurance companies. The establishment of consented criteria for PAD and their integration into treatment regimens and guidelines are crucial tasks for the future.

EVALUATION OF LYMPHATIC SPREAD, VISCERAL METASTASIS AND TUMORAL LOCAL INVASION IN ESOPHAGEAL CARCINOMAS.

PubMed

Tustumi, Francisco; Kimura, Cintia Mayumi Sakurai; Takeda, Flavio Roberto; Sallum, Rubens Antônio Aissar; Ribeiro-Junior, Ulysses; Cecconello, Ivan

2016-01-01

Knowing esophageal tumors behavior in relationship to lymph node involvement, distant metastases and local tumor invasion is of paramount importance for the best esophageal tumors management. To describe lymph node involvement, distant metastases, and local tumor invasion in esophageal carcinoma, according to tumor topography and histology. A total of 444 patients with esophageal squamous cell carcinoma and 105 adenocarcinoma were retrospectively analyzed. They were divided into four groups: adenocarcinoma and squamous cell carcinoma in the three esophageal segments: cervical, middle, and distal. They were compared based on their CT scans at the time of the diagnosis. Nodal metastasis showed great relationship with of primary tumor site. Lymph nodes of hepatogastric, perigastric and peripancreatic ligaments were mainly affected in distal tumors. Periaortic, interaortocaval and portocaval nodes were more commonly found in distal squamous carcinoma; subcarinal, paratracheal and subaortic nodes in middle; neck chains were more affected in cervical squamous carcinoma. Adenocarcinoma had a higher frequency of peritoneal involvement (11.8%) and liver (24.5%) than squamous cell carcinoma. Considering the local tumor invasion, the more cranial neoplasia, more common squamous invasion of airways, reaching 64.7% in the incidence of cervical tumors. Middle esophageal tumors invade more often aorta (27.6%) and distal esophageal tumors, the pericardium and the right atrium (10.4%). Esophageal adenocarcinoma and squamous cell carcinoma in different topographies present peculiarities in lymph node involvement, distant metastasis and local tumor invasion. These differences must be taken into account in esophageal cancer patients' care. Conhecer o comportamento das neoplasias esofágicas em relação à disseminação linfonodal, distribuição de metástases e invasão local do tumor, pode auxiliar o manejo dos pacientes. Descrever o envolvimento linfonodal, disseminação metastática e invasão local dos carcinomas esofágicos, de acordo com a topografia e o tipo histológico do tumor. Pacientes com diagnóstico de carcinoma espinocelular de esôfago (n=444) e adenocarcinoma de esôfago (n=105) foram retrospectivamente analisados. Foram divididos em quatro grupos: adenocarcinoma e carcinoma espinocelular do segmento cervical, médio e distal. Tais grupos foram comparados baseando-se em tomografias computadorizadas realizadas no momento do diagnóstico. Disseminação linfonodal mostrou grande associação com topografia do tumor. Linfonodos do ligamento hepatogástrico, perigástricos e peripancreáticos foram acometidos principalmente por tumores de esôfago distal; linfonodos periaórticos, interaortocavais, portocavais no carcinoma espinocelular de esôfago distal; e linfonodos subcarinais, paratraqueais, subaórticos nos tumores de esôfago médio. Cadeias cervicais foram acometidas por espinocelulares cervicais. Adenocarcinoma teve maior frequência de acometimento peritoneal (11,8%) e hepático (24,5%) do que carcinoma espinocelular. Considerando invasão tumoral local, quanto mais cranial a neoplasia, mais comum a invasão do espinocelular em vias aéreas, chegando à incidência de 64,7% nos tumores cervicais. Tumores de esôfago médio invadem mais frequentemente aorta (27,6%) e tumores de esôfago distal, o pericárdio e átrio direito (10,4%). Adenocarcinoma e carcinoma espinocelular de esôfago em diferentes topografias apresentam peculiaridades na disseminação linfática, metástases à distância e invasão local do tumor. Tais diferenças devem ser consideradas no manejo do paciente com carcinoma esofágico.

Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

PubMed

Brunetti, Natale Daniele; Di Pietro, Gaetano; Aquilino, Ambrogio; Bruno, Angela I; Dellegrottaglie, Giulia; Di Giuseppe, Giuseppe; Lopriore, Claudio; De Gennaro, Luisa; Lanzone, Saverio; Caldarola, Pasquale; Antonelli, Gianfranco; Di Biase, Matteo

2014-09-01

We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated. Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41 ± 0:17 vs 1:34 ± 1:11 h, p<0.001, -0:53 h, -56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the 'inner' zone closer to PCI catheterisation laboratories (0:34 ± 0:13 vs 0:54 ± 0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the 'outer' zone (0:52 ± 0:17 vs 1:41 ± 1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63-0.80, p<0.001; 1.39, 95% CI 1.25-1.55, p<0.001, for timely primary-PCI). Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas. © The European Society of Cardiology 2014.

Electrocardiographic Indicators of Acute Coronary Syndrome are More Common in Patients with Ambulance Transport Compared to Those who Self-Transport to the Emergency Department Journal of Electrocardiology

PubMed Central

Pickham, David; Pelter, Michele M

2016-01-01

Introduction The American Heart Association recommends individuals with symptoms suggestive of acute coronary syndrome (ACS) activate the Emergency Medical Services’ (EMS) 911 system for ambulance transport to the emergency department (ED), which enables treatment to begin prior to hospital arrival. Despite this recommendation, the majority of patients with symptoms suspicious of ACS continue to self-transport to the ED. The IMMEDIATE AIM study was a prospective study that enrolled individuals who presented to the ED with ischemic symptoms. Objectives The purpose of this secondary analysis was to determine differences in patients presenting the ED for possible ACS who arrive by ambulance versus self-transport on: 1) Time-to-initial hospital electrocardiogram (ECG), 2) presence of ischemic ECG changes, and 3) patient characteristics. Methods Initial 12-lead ECGs acquired upon patient arrival to the ED were evaluated for ST-elevation, ST-depression, and T-wave inversion. ECG signs of ischemia were analyzed both individually and collapsed into an independent dichotomous variable (ED ECG ischemia yes/no) for statistical analysis. Patient characteristics tested included: gender, age, race, ethnicity, English speaking, living alone, mode of transport, and presenting symptoms (chest pain, jaw pain, shortness of breath, nausea/vomiting, syncope, and clinical history). Results In 1299 patients (mean age 63.9, 46.7% male), 384 (29.6%) patients arrived by ambulance to the ED. The mean time-to-initial ECG was 47 minutes for ambulance patients versus 53 minutes for self-transport patients (p<0.001). Mode of transport was found to be an independent predictor for time-to-initial ECG controlling for age, gender, and race (p=0.004). There were significantly higher rates of ECG changes of ischemia for patients who arrived by ambulance versus self-transport (p=0.02), and patient characteristics differed by mode of transport to the ED. Discussion Our findings indicate that less than 30% of individuals with symptoms of ACS activate the EMS ‘911’ system for ambulance transport to the ED. Individuals more likely to activate 911 have timelier ECG but higher rates of ischemic changes, specifically ST-depression and T-wave inversion. Individuals least likely to activate 911 are women, younger individuals, Latino ethnicity, live with a significant other, and those experiencing chest or jaw pain. PMID:27614946

Telescópio de pequeno porte como suporte ao ensino em cidades com intensa poluição luminosa II

NASA Astrophysics Data System (ADS)

Pereira, P. C. R.; Santos-Júnior, J. M.; Cruz, W. S.

2003-08-01

Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmissão de fatos que devem ser guardados para um exame, a habilidade para lembrar fórmulas e, eventualmente, a repetição de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, é conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da ciência. Acreditamos que a Astronomia, pelo seu caráter observacional, é uma das áreas do conhecimento que pode contribuir neste cenário. A Fundação Planetário da Cidade do Rio de Janeiro possui um telescópio Meade LX-200 (25cm) que, juntamente com as câmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino médio desde o ano 2000. Tais projetos envolvem a condução de um projeto de pesquisa observacional num nível apropriado, e possibilitam o contato com técnicas e novas tecnologias: computador, software para manipulação de dados e gráficos, programas de tratamento e redução de dados, uso de equipamentos óptico-eletrônicos (telescópio e CCD), bem como o processo de aquisição de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenômenos que apresentem variabilidade com intervalo de recorrência relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o céu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no último ano, com 25 estudantes. Apresentamos os resultados da observação da variável pulsante AI Vel (V = 6,6) e da variável cataclísmica FO Aqr (V = 13,5), e do monitoramento do trânsito da lua de Júpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras estão concordantes com as da literatura, assim como os respectivos períodos encontrados (1h20min e 4h48min). No caso do FO Aqr, ficou evidente, também, a modulação decorrente da rotação da anã branca receptora (21min). O erro estimado é de 0,01 magnitude. Propomos uma maior utilização de telescópios de pequeno porte, como suporte ao ensino (médio e superior) em cidades com poluição luminosa. Escolas e Planetários seriam ambientes propícios para a localização do telescópio. Os critérios adotados na escolha dos objetos e o método observacional empregado são também apresentados.

2005 Tri-Service Infrastructure Systems Conference and Exhibition. Volume 10, Track 12

DTIC Science & Technology

2005-08-04

Schmidt Track 12 Greenup L&D Miter Gate Repair and...j uv en ile fi sh p as sa ge o n ty pi ca l d es ig n cr ite ria R ob er t B uc hh ol z H yd ra ul ic d es ig n of ju ve ni le fis h pa ss...C hi ca go se w er sy st em s E rn es to G o T R A C K 1 8 C iv il M e ch a n ic a l S e ss io n 1 8 D N ew c oa tin g pr od uc ts fo

Annual Systems Engineering Conference (9th): Focusing on Improving Performance of Defense Systems Programs. Volume 3. Wednesday

DTIC Science & Technology

2006-10-26

tte r M r. D ea n C ar ic o TR AC K 1 Sy st em s En gi ne er in g Ef fe ct iv en es s M r. Al B ro...FS S) T oo ls - PG M M Ca se S tu dy M r. D ou gl as S to rs ve d Pa tte rn L ib ra ry fo r Us e in W ea po ns S ys te m E ng in ee...Sensors Sensors Sensors Sensors Air, Land or Sea Undersea or from the Sea (C3) (C2)( ) Sensors Sensors

Special Inspector General for Iraq Reconstruction. Quarterly Report to the United States Congress

DTIC Science & Technology

2007-10-30

InSPeCtoR GeneRaL FoR IRaQ ReConStRUCtIon Fu nd in g M ec ha ni sm Co ns o li da te d Ap pr o pr ia ti o ns Re so lu ti o n, 2 00 3 Em er ge nc y W...8/25/2006) $30M (10/16/2006) $30M QRF (8/25/2006) $3.007B (7/13/2006) $30M FAD FAD RAD FADFAD OA FY 2006 P.L. 109-234 (6/15/2006) $3.007B ISFF...FAD Funding Authorization Document M Million OA Obligation Authority RAD Resource Allocation Document SF 132 Apportionment and Reapportionment

Influence of Class V preparation on in vivo temperature rise in anesthetized human pulp during exposure to a Polywave® LED light curing unit.

PubMed

Zarpellon, Driellen Christine; Runnacles, Patrício; Maucoski, Cristiane; Gross, Dayane Jaqueline; Coelho, Ulisses; Rueggeberg, Frederick Allen; Arrais, Cesar Augusto Galvão

2018-06-01

This in vivo study evaluated pulp temperature (PT) rise in human premolars having deep Class V preparations during exposure to a light curing unit (LCU) using selected exposure modes (EMs). After local Ethics Committee approval, intact first premolars (n=8) requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia and were isolated using rubber dam. A minute pulp exposure was attained and sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted into the coronal pulp chamber to continuously monitor PT (°C). A deep buccal Class V preparation was prepared using a high speed diamond bur under air-water spray cooling. The surface was exposed to a Polywave ® LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs, allowing 7-min span between each exposure: 10-s in low (10-s/L), 10-s (10-s/H), 30-s (30-s/H), or 60-s (60-s/H) in high mode; and 5-s-Turbo (5-s/T). Peak PT values and PT increases over physiologic baseline levels (ΔT) were subjected to 1-way, repeated measures ANOVAs, and Bonferroni's post-hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. All EMs produced higher peak PT than the baseline temperature (p<0.001). Only 60-s/H mode generated an average ΔT of 5.5°C (p<0.001). A significant, positive relationship was noted between applied radiant exposure and ΔT (r 2 =0.8962; p<0.001). In vivo exposure of deep Class V preparation to Polywave ® LED LCU increases PT to values considered safe for the pulp, for most EMs. Only the longest evaluated EM caused higher PT increase than the critical ΔT, thought to be associated with pulpal necrosis. Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies.

PubMed

Goudouris, Ekaterini Simões; Rego Silva, Almerinda Maria do; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Silva Segundo, Gesmar Rodrigues; Barreto, Irma Cecília; Dorna, Mayra de Barros; Barros, Myrthes Anna; Forte, Wilma Carvalho Neves

2017-01-01

In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. RESUMO Nos últimos anos, novas imunodeficiências primárias e defeitos genéticos têm sido descritos. Recentemente, produtos de imunoglobulina, com aprimoramento em sua composição e para uso por via subcutânea, tornaram-se disponíveis em nosso meio. Com o objetivo de orientar o médico no uso da imunoglobulina humana para o tratamento das imunodeficiências primárias, os membros do Grupo de Assessoria em Imunodeficiências da Associação Brasileira de Alergia e Imunologia produziram um documento que teve por base uma revisão narrativa da literatura e sua experiência profissional, atualizando o I Consenso Brasileiro publicado em 2010. Apresentam-se novos conhecimentos sobre indicações e eficácia do tratamento com imunoglobulina nas imunodeficiências primárias, aspectos relevantes sobre a produção, forma de utilização (vias de administração, farmacocinética, doses e intervalos), efeitos adversos (principais efeitos, prevenção, tratamento e notificação), monitorização do paciente, apresentações disponíveis e forma de obtenção deste recurso terapêutico em nosso meio.

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.

PubMed

Duong, David K; O'Sullivan, Patricia S; Satre, Derek D; Soskin, Philippa; Satterfield, Jason

2016-01-01

Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.

In vivo temperature rise in anesthetized human pulp during exposure to a polywave LED light curing unit.

PubMed

Runnacles, Patrício; Arrais, Cesar Augusto Galvão; Pochapski, Marcia Thais; Dos Santos, Fábio André; Coelho, Ulisses; Gomes, João Carlos; De Goes, Mário Fernando; Gomes, Osnara Maria Mongruel; Rueggeberg, Frederick Allen

2015-05-01

This in vivo study evaluated pulp temperature (PT) rise in human premolars during exposure to a light curing unit (LCU) using selected exposure modes (EMs). After local Ethics Committee approval, intact first upper premolars, requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia. The teeth (n=15) were isolated using rubber dam and a minute pulp exposure was attained. A sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted directly into the coronal pulp chamber, and real time PT (°C) was continuously monitored while the buccal surface was exposed to polywave light from a LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs allowing a 7-min span between each exposure: 10-s either in low (10-s/L) or high (10-s/H); 5-s-turbo (5-s/T); and 60-s-high (60-s/H) intensities. Peak PT values and PT increases from baseline (ΔT) after exposure were subjected to one-way, repeated measures ANOVAs, and Bonferroni's post hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. All EMs produced higher peak PT than the baseline temperature (p<0.001). The 60-s/H mode generated the highest peak PT and ΔT (p<0.001), with some teeth exhibiting ΔT higher than 5.5°C. A significant, positive relationship between applied radiant exposure and ΔT (r(2)=0.916; p<0.001) was noted. Exposing intact, in vivo anesthetized human upper premolars to a polywave LED LCU increases PT, and depending on EM and the tooth, PT increase can be higher than the critical ΔT, thought to be associated with pulpal necrosis. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Evaluation of Change in Knowledge and Attitude of Emergency Medicine Residents after Introduction of a Rotation in Emergency Medical Services and Disaster Medicine

PubMed Central

Aljerian, Nawfal; Omair, Aamir; Yousif, Sami A.; Alqahtani, Abdulrahman S.; Alhusain, Faisal A.; Alotaibi, Bader; Alshehri, Mohammad F.; Aljuhani, Majed; Albaiz, Saad; Alaska, Yasser; Alanazi, Abdullah F.

2018-01-01

Background: Saudi Board of Emergency Medicine (SBEM) graduates are involved in a 1-month rotation in emergency medical services (EMSs) and disaster medicine. The purpose of this study was to evaluate change in knowledge and attitude of EM residents after the introduction of the EMS and disaster medicine rotation. Materials and Methods: The study included 32 3rd-year SBEM residents. A pretest/posttest design and a five-point Likert scale were used. The data included a response to a questionnaire developed by EMS and disaster experts. The questionnaire was distributed on the 1st day of the rotation and 45 days after. Satisfaction questionnaires were distributed after the rotation. The data were analyzed using SPSS 20. Results: Twenty-five residents responded to the satisfaction survey (75%). The overall satisfaction with the course modules was high; the course content showed the highest level of satisfaction (96%), and the lowest satisfaction was for the air ambulance ride outs (56%). The results of the pre-/post-test questionnaire showed an increase of 18.5% in the residents mean score (P < 0.001). In the open-ended section, the residents requested that the schedule is distributed before the course start date, to have more field and hands-on experience, and to present actual disaster incidents as discussion cases. The residents were impressed with the organization and diversity of the lectures, and to a lesser extent for the ambulance ride outs and the mass casualty incident drill l. Seventy-one percent indicated that they would recommend this course to other residents. Conclusion/Recommendation: This study showed that a structured course in EMS and disaster medicine had improved knowledge and had an overall high level of satisfaction among the residents of the SBEM. Although overall satisfaction and improvement in knowledge were significant, there are many areas in need of better organization. PMID:29628668

Final Environmental Assessment Test Operations at Arnold Engineering Development Center. Volumes 1 & 2

DTIC Science & Technology

2008-06-01

ir Fo rc e B as e, T en ne ss ee Fi gu re 1 -2 A er od yn am ic s A er op ro pu ls io n S pa ce & M is si le In fr as...lin es /te xt - fa ci lit ie s in s ta nd by o r m ot hb al le d st at us H ea lth , S af et y an d E nv ir on m en ta l M an ag em en t S ys...yp er so ni c C A er ot he rm al C A FC L La b H E AT -H 2 C C O S

The interaction with the lower ionosphere of electromagnetic pulses from lightning: Excitation of optical emissions

NASA Technical Reports Server (NTRS)

Taranenko, Y. N.; Inan, U. S.; Bell, T. F.

1993-01-01

A self consistent and fully kinetic simulation of the interaction of lightning radiated electromagnetic (EM) pulses with the nighttime lower ionosphere indicates that optical emissions observable with conventional instruments would be excited. For example, emissions of the 1st and 2nd positive bands of N2 occur at rates reaching 7 x 10(exp 7) and 10(exp 7) cu cm/s respectively at 92 km altitude for a lightning discharge with an electric field E(sub 100) = 20 V/m (normalized to a 100 km distance). The maximum height integrated intensities of these emissions are 4 x 10(exp 7) and 6 x 10(exp 6) R respectively, lasting for approx. 50 micrometers.

Phototoxicity in Human Retinal Pigment Epithelial Cells Promoted by Hypericin, a Component of St. John’s Wort†

PubMed Central

Wielgus, Albert R.; Chignell, Colin F.; Miller, David S.; Van Houten, Ben; Meyer, Joel; Hu, Dan-Ning; Roberts, Joan E.

2007-01-01

St. John’s Wort (SJW), an over-the-counter antidepressant, contains hypericin, which absorbs light in the UV and visible ranges. In vivo studies have determined that hypericin is phototoxic to skin and our previous in vitro studies with lens tissues have determined that it is potentially phototoxic to the human lens. To determine if hypericin might also be phototoxic to the human retina, we exposed human retinal pigment epithelial cells to 10−7 to 10−5 M hypericin. Fluorescence emission detected from the cells (λexc = 488 nm; λem = 505 nm) confirmed hypericin uptake by human RPE. Neither hypericin exposure alone nor visible light exposure alone reduced cell viability. However when irradiated with 0.7 J/cm2 of visible light (λ> 400 nm) there was loss of cell viability as measured by MTS and LDH assays. The presence of hypericin in irradiated hRPE cells significantly changed the redox equilibrium of glutathione and a decrease in the activity of glutathione reductase. Increased lipid peroxidation as measured by the TBARS assay correlated to hypericin concentration in hRPE cells and visible light radiation. Thus, ingested SJW is potentially phototoxic to retina and could contribute to retinal or early macular degeneration. PMID:17576381

Using the Bologna Score to assess normal delivery healthcare.

PubMed

Carvalho, Isaiane da Silva; Brito, Rosineide Santana de

2016-01-01

Describing the obstetric care provided in public maternity hospitals during normal labour using the Bologna Score in the city of Natal, Northeastern Brazil. A quantitative cross-sectional study conducted with 314 puerperal women. Data collection was carried out consecutively during the months of March to July 2014. Prenatal care was provided to 95.9% of the mothers, beginning around the 1st trimester of pregnancy (72.3%) and having seven or more consultations (51%). Spontaneous vaginal delivery was planned for 88.2% women. All laboring women were assisted by a health professional, mostly by a physician (80.6%), and none of them obtained 5 points on the Bologna Score due to the small percentage of births in non-supine position (0.3%) and absence of a partogram (2.2%). A higher number of episiotomies were observed among primiparous women (75.5%). The score obtained using the Bologna Index was low. Thus, it is necessary to improve and readjust the existing obstetrical model. Descrever a assistência obstétrica prestada em maternidades públicas municipais durante o parto normal na cidade de Natal, Nordeste do Brasil, com uso do Índice de Bologna. Estudo transversal com abordagem quantitativa, desenvolvido com 314 puérperas. A coleta de dados processou-se de forma consecutiva durante os meses de março a julho de 2014. A assistência pré-natal foi prestada a 95,9% das puérperas, com início em torno do 1º trimestre de gestação (72,3%) e realização de sete ou mais consultas (51%). O parto vaginal espontâneo foi planejado para 88,2% mulheres. Todas as parturientes foram assistidas por um profissional de saúde, especialmente pelo médico (80,6%) e nenhuma obteve 5 pontos no Índice de Bologna em virtude dos baixos percentuais de partos em posição não supina (0,3%) e ausência do partograma (2,2%). Houve maior número de episiotomias em primíparas (75,5%). A pontuação obtida por meio do Índice de Bologna foi baixa. Desse modo, é preciso melhorar e readequar o modelo obstétrico vigente.

Implementation of Pit Crew Approach and Cardiopulmonary Resuscitation Metrics for Out-of-Hospital Cardiac Arrest Improves Patient Survival and Neurological Outcome.

PubMed

Hopkins, Christy L; Burk, Chris; Moser, Shane; Meersman, Jack; Baldwin, Clair; Youngquist, Scott T

2016-01-11

Survival from out-of-hospital cardiac arrest (OHCA) varies by community and emergency medical services (EMS) system. We hypothesized that the adoption of multiple best practices to focus EMS crews on high-quality, minimally interrupted cardiopulmonary resuscitation (CPR) would improve survival of OHCA patients in Salt Lake City. In September 2011, Salt Lake City Fire Department EMS providers underwent a systemwide restructuring of care for OHCA patients that focused on the adoption of high-quality CPR with minimal interruptions and offline medical review of defibrillator data and feedback on CPR metrics. Victims were directed to ST-elevation myocardial infarction receiving centers. Prospectively collected data on patient survival and neurological outcome for all OHCAs were compared. In the postintervention period, there were 407 cardiac arrests with 65 neurologically intact survivors (16%), compared with 330 cardiac arrests with 25 neurologically intact survivors (8%) in the preintervention period. Among patients who survived to hospital admission, a higher proportion in the postintervention period survived to hospital discharge (71/141 [50%] versus 36/98 [37%], P=0.037) and had a favorable neurological outcome (65 [46%] versus 25 [26%], P=0.0005) compared with patients treated before the protocol changes. The univariate odds ratio or the association between neurologically intact survival (cerebral performance category 1 and 2) and protocol implementation was 2.3 (95% CI 1.4 to 3.7, P=0.001). Among discharged patients, the distribution of cerebral performance category scores was more favorable in the postintervention period (P<0.0001). A multifaceted protocol, including several American Heart Assocation best practices for the resuscitation of patients with OHCA, was associated with improved survival and neurological outcome. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Schema Therapy for Emotional Dysregulation: Theoretical Implication and Clinical Applications

PubMed Central

Dadomo, Harold; Grecucci, Alessandro; Giardini, Irene; Ugolini, Erika; Carmelita, Alessandro; Panzeri, Marta

2016-01-01

The term emotional dysregulation refers to an impaired ability to regulate unwanted emotional states. Scientific evidence supports the idea that emotional dysregulation underlies several psychological disorders as, for example: personality disorders, bipolar disorder type II, interpersonal trauma, anxiety disorders, mood disorders and post-traumatic stress disorder. Emotional dysregulation may derive from early interpersonal traumas in childhood. These early traumatic events create a persistent sensitization of the central nervous system in relation to early life stressing events. For this reason, some authors suggest a common endophenotypical origin across psychopathologies. In the last 20 years, cognitive behavioral therapy has increasingly adopted an interactive-ontogenetic view to explain the development of disorders associated to emotional dysregulation. Unfortunately, standard Cognitive Behavior Therapy (CBT) methods are not useful in treating emotional dysregulation. A CBT-derived new approach called Schema Therapy (ST), that integrates theory and techniques from psychodynamic and emotion focused therapy, holds the promise to fill this gap in cognitive literature. In this model, psychopathology is viewed as the interaction between the innate temperament of the child and the early experiences of deprivation or frustration of the subject’s basic needs. This deprivation may lead to develop early maladaptive schemas (EMS), and maladaptive Modes. In the present paper we point out that EMSs and Modes are associated with either dysregulated emotions or with dysregulatory strategies that produce and maintain problematic emotional responses. Thanks to a special focus on the therapeutic relationship and emotion focused-experiential techniques, this approach successfully treats severe emotional dysregulation. In this paper, we make several comparisons between the main ideas of ST and the science of emotion regulation, and we present how to conceptualize pathological phenomena in terms of failed regulation and some of the ST strategies and techniques to foster successful regulation in patients. PMID:28066304

Community cooperatives combat sexual assault and domestic violence.

PubMed

Greenwood, Marc D

2003-02-01

The effectiveness of the SANE program is borne out by the following testimonies: "The emotional support required by these victims is best rendered by a SANE. This frees the ED nurse to care for other patients, while sexual assault victims receive a high level of care," says Nancy Donel, RN manager at St. Thomas Hospital ED. "The DOVE program benefits not only the emergency physician, but the EMS system as well. It gives us a resource and a specifically identified program with well-trained, qualified providers. Through their training and knowledge, SANEs not only help victims, but also increase the number of legal convictions that take assailants off the streets. This improves the health and safety of the communities in which we live and serve," says Michael Mackan, MD, of the Summa Health System.

Retrospective analysis of a case series of patients with traumatic injuries to the craniocervical junction.

PubMed

Esteves, Luiz Adriano; Joaquim, Andrei Fernandes; Tedeschi, Helder

2016-01-01

To evaluate the correlation between the treatment, the characteristics of the lesions and the clinical outcome of patients with traumatic injuries to the craniocervical junction. This was a retrospective study of patients treated conservatively or surgically between 2010 and 2013 with complete data sets. We analyzed 37 patients, 73% were men with mean age of 41.7 years. Of these, 32% were submitted to initial surgical treatment and 68% received conservative treatment. Seven (29%) underwent surgery subsequently. In the surgical group, there were seven cases of odontoid type II fractures, two cases of fracture of posterior elements of the axis, one case of C1-C2 dislocation with associated fractured C2, one case of occipitocervical dislocation, and one case of combined C1 and C2 fractures, and facet dislocation. Only one patient had neurological déficit that improved after treatment. Two surgical complications were seen: a liquoric fistula and one surgical wound infection (reaproached). In the group treated conservatively, odontoid fractures (eight cases) and fractures of the posterior elements of C2 (five cases) were more frequent. In two cases, in addition to the injuries of the craniocervical junction, there were fractures in other segments of the spine. None of the patients who underwent conservative treatment presented neurological deterioration. Although injuries of craniocervical junction are relatively rare, they usually involve fractures of the odontoid and the posterior elements of the axis. Our results recommend early surgical treatment for type II odontoid fractures and ligament injuries, the conservative treatment for other injuries. Avaliar a correlação entre o tratamento, as características das lesões e o resultado clínico em pacientes com lesões traumáticas na junção craniocervical. Estudo retrospectivo de pacientes maiores de 18 anos tratados de forma conservadora ou cirúrgica, entre 2010 e 2013. Foram analisados 37 pacientes, 73% eram do sexo masculino e a média de idade foi de 41,7 anos. Inicialmente 32% dos pacientes foram submetidos a tratamento cirúrgico, e 68% foram submetidos a tratamento conservador. Sete pacientes (29%) do grupo conservador foram submetidos posteriormente à cirurgia. No grupo cirúrgico, houve sete casos de fratura de odontóide tipo II, dois casos de fratura de elementos posteriores do áxis, um caso de luxação C1-C2, um caso de deslocamento occipito-cervical e um caso de fraturas de C1 e C2 e luxação facetária. Um paciente apresentava déficit neurológico, melhorando após o tratamento. Houve duas complicações pós-cirúrgicas, uma fístula liquórica e uma infecção de ferida operatória (reabordada). No grupo conservador, predominaram as fraturas do odontóide (oito) e dos elementos posteriores de C2 (cinco). Em dois casos, havia também fraturas em outros segmentos da coluna. Nenhum dos pacientes deste grupo apresentou deterioração neurológica. As lesões da junção craniocervical são raras, sendo mais frequentes as fraturas do odontóide e dos elementos posteriores do áxis. Nossos resultados recomendam o tratamento cirúrgico precoce para os pacientes com fraturas do odontóide tipo II e lesões ligamentares, e tratamento conservador para os demais pacientes.

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

Wassom, John S.; Malling, Heinrich V.; Sankaranarayanan, K.

This article traces the development of the field of mutagenesis and its metamorphosis into the research area we now call genetic toxicology. In 1969 this transitional event led to the founding of the Environmental Mutagen Society (EMS). The charter of this new Society was to encourage interest in and study of mutagens in the human environment, particularly as these may be of concern to public health. As the mutagenesis field unfolded and expanded, the lexicon changed and new wording appeared to better describe this evolving area of research. The term genetic toxicology was coined and became an important subspecialty ofmore » the broad area of toxicology. Genetic toxicology is now set for a thorough reappraisal of its methods, goals, and priorities to meet the challenges of the 21st Century. To better understand these challenges, we have revisited the primary goal that the EMS founders had in mind for the Society s main mission and objective, namely, the quantitative assessment of genetic (hereditary) risks to human populations exposed to environmental agents. We also have reflected upon some of the seminal events over the last 40 years that have influenced the advancement of the genetic toxicology discipline and the extent to which the Society s major goal and allied objectives have been achieved. Additionally, we have provided suggestions on how EMS can further advance the science of genetic toxicology in the postgenome era. Chronicling all events and publications that influenced the development of the mutagenesis and genetic toxicology research area for this article was not possible, but some key happenings that contributed to the field s development have been reviewed. Events that led to the origin of EMS are also presented in celebration of the Society s 40th anniversary. Any historical accounting will have perceived deficiencies. Key people, publications, or events that some readers may feel have had significant impact on development of the subject under review may have been overlooked and left out. We are sure that such will be the case with the appraisal given in this article. However, any oversight or failure to make proper acknowledgment of individuals, events, or the citation of relevant references is unintentional.« less

Integrating volcanic hazard data in a systematic approach to develop volcanic hazard maps in the Lesser Antilles

NASA Astrophysics Data System (ADS)

Lindsay, Jan M.; Robertson, Richard E. A.

2018-04-01

We report on the process of generating the first suite of integrated volcanic hazard zonation maps for the islands of Dominica, Grenada (including Kick 'em Jenny and Ronde/Caille), Nevis, Saba, St. Eustatius, St. Kitts, Saint Lucia and St Vincent in the Lesser Antilles. We developed a systematic approach that accommodated the range in prior knowledge of the volcanoes in the region. A first-order hazard assessment for each island was used to develop one or more scenario(s) of likely future activity, for which scenario-based hazard maps were generated. For the most-likely scenario on each island we also produced a poster-sized integrated volcanic hazard zonation map, which combined the individual hazardous phenomena depicted in the scenario-based hazard maps into integrated hazard zones. We document the philosophy behind the generation of this suite of maps, and the method by which hazard information was combined to create integrated hazard zonation maps, and illustrate our approach through a case study of St. Vincent. We also outline some of the challenges we faced using this approach, and the lessons we have learned by observing how stakeholders have interacted with the maps over the past 10 years. Based on our experience, we recommend that future map makers involve stakeholders in the entire map generation process, especially when making design choices such as type of base map, use of colour and gradational boundaries, and indeed what to depict on the map. We also recommend careful consideration of how to evaluate and depict offshore hazard of island volcanoes, and recommend computer-assisted modelling of all phenomena to generate more realistic hazard footprints. Finally, although our systematic approach to integrating individual hazard data into zones generally worked well, we suggest that a better approach might be to treat the integration of hazards on a case-by-case basis to ensure the final product meets map users' needs. We hope that the documentation of our experience might be useful for other map makers to take into account when creating new or updating existing maps.

5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.

PubMed

Morris, Niall; Body, Rick

2017-12-01

This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. This is a secondary analysis of a prospective, multi-centre, observational cohort at 14 centres: the Bedside Evaluation of Sensitive Troponin study. All fourteen Emergency Departments were based in the United Kingdom. Emergency physicians' assessments of the ECG were collected using a standardised form. Clinicians were asked to judge whether the ECG demonstrated ischaemia, the presence of ST depression (STD) and if there was abnormal T wave inversion (ATWI). Patients provided written informed consent and underwent serial high sensitivity troponin testing. 30 day follow-up was performed by research nurses using a standardised form via telephone. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, any cause of death and coronary revascularisation. In total, 756 patients were included in the analysis. Clinicians' ECG diagnosis of ischaemia for 30-day MACE: ECG ischaemia produces a sensitivity (Sn) of 19.54% (95% CI:11.81% to 29.43%), specificity (Sp) of 93.27% (95% CI:91.10% to 95.05%), positive predictive value (PPV) of 27.42% (95% CI:18.47% to 38.65%) and negative predictive value (NPV) of 89.91% (95%CI 88.92% to 90.83%). ECG ST depression produces Sn of 16.09% (9.09% to 25.52%), Sp of 89.69% (87.13% to 91.89%), PPV 16.87 (10.68% to 25.62%), and NPV 89.15% (88.19% to 90.04%). ECG ATWI produces Sn of 4.60% (1.27% to 11.36%), Sp of 91.63% (89.27% to 93.62%), PPV of 6.67% (2.59% to 16.12%) and NPV of 88.07% (87.52% to 88.6). This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules. In this study a clinician's overall judgement of ischaemia has a better diagnostic performance compared to simple STD and ATWI. This may be due to an appreciation of morphology and the amount of deviation; future work should explore the effect of measuring deviation and analysing morphology. © 2017, 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.

On the cosmic ray spectrum from type II supernovae expanding in their red giant presupernova wind

NASA Astrophysics Data System (ADS)

Cardillo, Martina; Amato, Elena; Blasi, Pasquale

2015-09-01

While from the energetic point of view supernova remnants are viable sources of Galactic cosmic rays (CRs), the issue of whether they can accelerate protons up to a few PeV remains unsolved. Here we discuss particle acceleration at the forward shock of supernovae, and discuss the possibility that the current of escaping particles may excite a non-resonant instability that in turn leads to the formation of resonant modes that confine particles close to the shock, thereby increasing the maximum energy. This mechanism is at work throughout the expansion of the supernova explosion, from the ejecta dominated (ED) phase to the Sedov-Taylor (ST) phase. The transition from one stage to the other reflects in a break in the spectrum of injected particles. Because of their higher explosion rate, we focus our work on type II SNe expanding in the slow, dense wind, produced by the red super-giant progenitor stars. When the explosion occurs in such winds, the transition between the ED and the ST phase is likely to take place within a few tens of years. The highest energies are reached at even earlier times, when, however, a small fraction of the mass of ejecta has been processed. As a result, the spectrum of accelerated particles shows a break in the slope, at an energy that is the maximum energy (EM) achieved at the beginning of the ST phase. Above this characteristic energy, the spectrum becomes steeper but remains a power law rather than developing an exponential cutoff. An exponential cut is eventually present at much higher energies but it does not have a phenomenological relevance. We show that for parameters typical of type II supernovae, EM for protons can easily reach values in the PeV range, confirming that type II SNRs are the best candidate sources for CRs at the knee. From the point of view of implications of this scenario on the measured particle spectra, we have tried to fit KASCADE-Grande, ARGO -YBJ and YAC1-Tibet Array data with our model but we could not find any combination of the parameters that could explain all data sets. Indeed the recent measurement of the proton and helium spectra in the knee region, with the ARGO-YBJ and YAC1-Tibet Array, has made the situation very confused. These measurements suggest that the knee in the light component is at ∼ 650 TeV, appreciably below the knee in the overall spectrum. On one hand this finding would resolve the problem of reaching very high energies in supernovae, but on the other it would open a critical issue in the transition region between Galactic and extragalactic CRs.

A Comprehensive Study of the Tocks Island Lake Project and Alternatives. Part A. Chapters IV, V, VI. Analysis of Service Areas and Resource Needs.

DTIC Science & Technology

1975-06-01

3431 378 * 9 0S go9 391" I0*9 Is 3179 701 463 S09 831 736 *0" M1 Art 14M, *1 3us 1914 £00 St309 G17 494 so? AV ? A9l 1*7 64 13 * a£ oil 93 1969 100...AD-AO83 999 URS/MADIGAN-PRAEGER INC NEW YORK FIG 13 / 13 COMPREHENSIVE STUDY OF THE TOCKS ISLAND LAKE PROJECT AND ALTE--ETC(U) JUN 75 DACWSI75-C-0026... REPORT NUMBER 2S A RC1 11m a TR C OReu 4f** NUMS.em : 319a~ab boc mb The PROseIN OfGNZTO thi E stuDisDES to help decision maesdtrieftrA rsource n ege

Echinococcus multilocularis in Svalbard, Norway: microsatellite genotyping to investigate the origin of a highly focal contamination.

PubMed

Knapp, J; Staebler, S; Bart, J M; Stien, A; Yoccoz, N G; Drögemüller, C; Gottstein, B; Deplazes, P

2012-08-01

Echinococcus multilocularis is a threatening cestode involved in the human alveolar echinococcosis. The parasite, mainly described in temperate regions of the Northern hemisphere was described for the first time in 1999 in the High Arctic Svalbard archipelago, Norway. The origin of this contamination could be due to an anthropogenic introduction from mainland Europe by domestic dogs or with the introduction of the sibling vole, perhaps from mainland Russia (St. Petersburg area), or with roaming Arctic foxes, known as the main definitive host of the parasite in Arctic regions. The genetic diversity of E. multilocularis in Svalbard was investigated here for the first time by genotyping using EmsB microsatellite and compared to other genotyped populations in the main worldwide endemic areas. We found low polymorphism amongst the 27 metacestode isolates from sibling voles trapped in the core of the distribution area of the vole on Svalbard. E. mutilocularis Arctic populations, using the Arctic fox as the definitive host, were genetically separated from European temperate populations that use the red fox, but closely related to St. Lawrence Island samples from Alaska. The result is inconsistent with the hypothesis of an anthropogenic introduction from mainland Europe, but can be seen as consistent with the hypothesis that Arctic foxes introduced E. multilocularis to Svalbard. Copyright © 2012 Elsevier B.V. All rights reserved.

Fotometria diferencial de estrelas T Tauri

NASA Astrophysics Data System (ADS)

Pereira, P. C. R.; Santos-Júnior, J. M.; Cruz, W. S.

2003-08-01

Neste trabalho apresentamos os resultados preliminares de um monitoramento de estrelas jovens, que pretende ser de longa duração. As estrelas estão em sua maioria localizadas no complexo Lupus-Scorpius. Nosso objetivo principal é o estudo da variabilidade em escalas de tempo de minutos até vários dias para estrelas cujos períodos não estão determinados ou apresentam discrepâncias entre diferentes publicações. A técnica utilizada foi a fotometria diferencial, com exposições de 60s e 90s, com as câmaras CCD SBIG ST7E e ST8E acopladas aos telescópios Schmidt-Cassegrain LX200 (10 e 12 polegadas), instalados na Fundação Planetário da Cidade do Rio de Janeiro. Os primeiros resultados indicam que a técnica é bastante sólida com relação à instabilidade na transparência do céu, mesmo com o uso de telescópios de pequeno porte. Objetos de magnitude 14, no telescópio de 10 polegadas, apresentam dispersões na diferença de magnitudes das comparações, em torno de 0,008mag nas exposições de 60s. Note-se, ainda, que a dispersão pode ser melhorada utilizando-se a técnica de soma de imagens. Destacamos AK Sco, GW Lup, GQ Lup e TW Hya. AK Sco é uma binária que, apesar de ter a sua órbita e período cobertos espectroscopicamente (13,6dias), nunca teve seus eclipses estudados por meio de fotometria. GW Lup não tem período determinado na literatura. Temos acompanhado este objeto há alguns anos, e sugestões de períodos entre 5 e 6 dias têm sido encontradas. O objeto que mereceu maior atenção foi TW Hya por apresentar vários trabalhos fotométricos e espectroscópicos com resultados discrepantes quanto ao período rotacional, que varia de 1,8 a 4,4 dias (Rucinsky & Krautter 1983, A&A 121, 217; Herbst & Koret 1988, AJ 96, 1949; Mekkaden 1988, A&A 340, 135; Batalha et al. 2002, ApJ 580, 343). Dedicamos 13 noites para essa estrela, totalizando cerca de 2.000 pontos na curva de luz. Nossos dados indicam a presença de uma modulação com dois períodos possíveis: 2,2 ou 3,8 dias, além de variações irregulares superpostas. Foram observados, também, dois eventos súbitos, espaçados de uma hora, com amplitudes de 0,05mag e duração de aproximadamente 30 minutos. Admitindo-se que tal modulação seja originada por acréscimo sobre a superfície estelar, dois cenários são possíveis. No caso do menor período, apenas uma mancha quente seria visível. No outro caso, duas manchas seriam necessárias, explicando assim a presença de dois picos ao se colocar os pontos em fase.

Mantle Sulfur Cycle: A Case for Non-Steady State ?

NASA Astrophysics Data System (ADS)

Cartigny, Pierre; Labidi, Jabrane

2016-04-01

Data published over the last 5 years show that the early inference that mantle is isotopically homogeneous is no more valid. Instead, new generation data on lavas range over a significant 34S/32S variability of up to 5‰ with δ 34S values often correlated to Sr- and Nd-isotope compositions. This new set of data also reveals the Earth's mantle to have a sub-chondritic 34S/32S ratio, by about ˜ 1‰. We will present at the conference our published and unpublished data on samples characterizing the different mantle components (i.e. EM1, EM2, HIMU and LOMU). All illustrate 34S-enrichments compared to MORB with Δ 33S and Δ 36S values indistinguishable from CDT or chondrites at the 0.03‰ level. These data are consistent with the recycling of subducted components carrying sulfur with Δ 33S and Δ 36S-values close to zero. Archean rocks commonly display Δ 33S and Δ 36S values deviating from zero by 1 to 10 ‰. The lack of variations for Δ 33S and Δ 36S values in present day lava argue against the sampling of any subducted protolith of Archean age in their mantle source. Instead, our data are consistent with the occurrence of Proterozoic subducted sulfur in the source of the EM1, EM2, LOMU and HIMU endmember at the St-Helena island. This is in agreement with the age of those components early derived through the use of the Pb isotope systematic. Currently, the negative δ 34S-values of the depleted mantle seem to be associated with mostly positive values of enriched components. This would be inconsistent with the concept a steady state of sulfur. Assuming that the overall observations of recycled sulfur are not biased, the origin of such a non-steady state remains unclear. It could be related to the relatively compatible behavior of sulfur during partial melting, as the residue of present-day melting can be shown to always contain significant amounts of sulfide (50{%} of what is observed in a fertile source). This typical behavior likely prevents an efficient extraction of mantle S over time, hence inhibiting quantitative mixing between surface and mantle S. This also allows the preservation of any primitive signature of the deep sulfur cycle to be potentially recorded.

Climate Prediction Center - Stratosphere: Stratosphere-Troposphere

Science.gov Websites

Wave 2 Wave 3 - NH EQ SH NH EQ SH NH EQ SH NH EQ SH NH SH NH SH NH SH NH SH Annual N E S N E S N E S N E S N S N S N S N S JFM N E S N E S N E S N E S N S N S N S N S AMJ N E S N E S N E S N E S N S N S N S N S JAS N E S N E S N E S N E S N S N S N S N S OND N E S N E S N E S N E S N S N S N S N S Past

CFSv2 Seasonal Climate Forecasts

Science.gov Websites

Nino3.4 Nino4 E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) E1 (data) E2 (data) E3 (data) Sea surface height and

Conacyt

Science.gov Websites

Organismos de Inspección Organismos de Certificación de personas Calidad Acreditación ¿Que es la : Estructuración de la Evaluación de la Conformidad 1.2: Fortalecimiento y articulación de las instituciones Componente 2: Fortalecimiento del Sistema Nacional de Innovación 6: Incorporación de la Innovación en la

Earlier reperfusion in patients with ST-elevation Myocardial infarction by use of helicopter

PubMed Central

2012-01-01

Background In patients with ST-elevation myocardial infarction (STEMI) reperfusion therapy should be initiated as soon as possible. This study evaluated whether use of a helicopter for transportation of patients is associated with earlier initiation of reperfusion therapy. Material and methods A prospective study was conducted, including patients with STEMI and symptom duration less than 12 hours, who had primary percutaneous coronary intervention (PPCI) performed at Aarhus University Hospital in Skejby. Patients with a health care system delay (time from emergency call to first coronary intervention) of more than 360 minutes were excluded. The study period ran from 1.1.2011 until 31.12.2011. A Western Denmark Helicopter Emergency Medical Service (HEMS) project was initiated 1.6.2011 for transportation of patients with time-critical illnesses, including STEMI. Results The study population comprised 398 patients, of whom 376 were transported by ambulance Emergency Medical Service (EMS) and 22 by HEMS. Field-triage directly to the PCI-center was used in 338 of patients. The median system delay was 94 minutes among those field-triaged, and 168 minutes among those initially admitted to a local hospital. Patients transported by EMS and field-triaged were stratified into four groups according to transport distance from the scene of event to the PCI-center: ≤25 km., 26–50 km., 51–75 km. and > 75 km. For these groups, the median system delay was 78, 89, 99, and 141 minutes. Among patients transported by HEMS and field-triaged the estimated median transport distance by ground transportation was 115 km, and the observed system delay was 107 minutes. Based on second order polynomial regression, it was estimated that patients with a transport distance of >60 km to the PCI-center may benefit from helicopter transportation, and that transportation by helicopter is associated with a system delay of less than 120 minutes even at a transport distance up to 150 km. Conclusion The present study indicates that use of a helicopter should be considered for field-triage of patients with STEMI to the PCI-center in case of long transportation. Such a strategy may ensure that patients living up to 150 km. from the PCI-center can be treated within 120 minutes of emergency call. PMID:23036101

Earlier reperfusion in patients with ST-elevation myocardial infarction by use of helicopter.

PubMed

Knudsen, Lars; Stengaard, Carsten; Hansen, Troels Martin; Lassen, Jens Flensted; Terkelsen, Christian Juhl

2012-10-04

In patients with ST-elevation myocardial infarction (STEMI) reperfusion therapy should be initiated as soon as possible. This study evaluated whether use of a helicopter for transportation of patients is associated with earlier initiation of reperfusion therapy. A prospective study was conducted, including patients with STEMI and symptom duration less than 12 hours, who had primary percutaneous coronary intervention (PPCI) performed at Aarhus University Hospital in Skejby. Patients with a health care system delay (time from emergency call to first coronary intervention) of more than 360 minutes were excluded. The study period ran from 1.1.2011 until 31.12.2011. A Western Denmark Helicopter Emergency Medical Service (HEMS) project was initiated 1.6.2011 for transportation of patients with time-critical illnesses, including STEMI. The study population comprised 398 patients, of whom 376 were transported by ambulance Emergency Medical Service (EMS) and 22 by HEMS. Field-triage directly to the PCI-center was used in 338 of patients. The median system delay was 94 minutes among those field-triaged, and 168 minutes among those initially admitted to a local hospital. Patients transported by EMS and field-triaged were stratified into four groups according to transport distance from the scene of event to the PCI-center: ≤25 km., 26-50 km., 51-75 km. and > 75 km. For these groups, the median system delay was 78, 89, 99, and 141 minutes. Among patients transported by HEMS and field-triaged the estimated median transport distance by ground transportation was 115 km, and the observed system delay was 107 minutes. Based on second order polynomial regression, it was estimated that patients with a transport distance of >60 km to the PCI-center may benefit from helicopter transportation, and that transportation by helicopter is associated with a system delay of less than 120 minutes even at a transport distance up to 150 km. The present study indicates that use of a helicopter should be considered for field-triage of patients with STEMI to the PCI-center in case of long transportation. Such a strategy may ensure that patients living up to 150 km. from the PCI-center can be treated within 120 minutes of emergency call.

Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain.

PubMed

Hermans, Maaike P J; Velders, Matthijs A; Smeekes, Martin; Drexhage, Olivier S; Hautvast, Raymond W M; Ytsma, Timon; Schalij, Martin J; Umans, Victor A W M

2017-08-04

Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients. Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays. Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.

Berkeley Lab - Materials Sciences Division

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, Communication Specialist talks about the Periodic Table of Elements 7/17/17 Back to Elements List Fermium is process, but the identification of Pu-244 raised the possibility that still more neutrons could have been discovery of the new elements, and the new data on neutron capture, was kept secret on the orders of the U.S

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sandstone interval in outcrop of the Tonnie Siltstone Member, Chinitna Formation, lower Cook Inlet, south Paveloff Siltstone Member of the Chinitna Formation: Exploring the potential role of facies variations in member of the Upper Jurassic Naknek Formation, northern Chinitna Bay, Alaska, in Wartes, M.A., ed

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AF family shares experience with child's autism > U.S. Air Force >

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all forces show that they are the same basic force, and have frozen out to different forces in the . What do the different colors on the map of the CMB represent? Although the temperature of the CMB is Implications of the COBE DMR Map of the Early Universe What COBE DMR saw: The COBE DMR (Cosmic

What about using pesticides if I am pregnant or have a baby?

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Defense.gov - Special Report - Travels With Gates

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Engineering has yielded new insights for lithium-ion (Li-ion) battery electrodes at the microstructural level -Phase Stochastics in Lithium-Ion Battery Electrodes" detailing the research and resulting revolutionizes the way lithium-ion (Li-ion) batteries are evaluated so designs can be improved before batteries

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Energy for Wind Systems Today Cost and Value of Wind Power-Implications of Wind Turbine Design, János Aaron Smith, PPI Session II: Uncertainty Impacts on Wind Turbine Design and Performance Mitigation of Wind Turbine Design Load Uncertainties, Anand Natarajan, DTU Wind Energy Uncertainty in the Wind

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DIFFERENT BETWEEN THE 12-KM NAM PARENT DOMAIN AND THE NAM CONUS NEST? (04 Nov 2011, updated 13 April 2017 . Back to Table of Contents WHY IS THE QPF DIFFERENT BETWEEN THE 12-KM NAM PARENT DOMAIN AND THE NAM different QPF fields between the 12km NAM parent and the NAM nests. 13 April 2017 update: In the 12 August

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Transmitter Outages FAQ NWR - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista de Emisora y Cobertura Acerca de NWR ESTACIONES NACIONAL Información General Información Para el

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Transmitter Outages FAQ NWR - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista de Emisora y Cobertura Acerca de NWR ESTACIONES NACIONAL Información General Información Para el

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Outages FAQ NWR - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista de Emisora y Cobertura Acerca de NWR ESTACIONES NACIONAL Información General Información Para el consumidor

NOAA Weather Radio - NWR Voices

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Transmitter Outages FAQ NWR - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista de Emisora y Cobertura Acerca de NWR ESTACIONES NACIONAL Información General Información Para el

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista de Emisora y Cobertura Acerca de NWR ESTACIONES NACIONAL Información General Información Para el consumidor receptor NWR

The Sky This Week, 2016 April 26 - May 3 - Naval Oceanography Portal

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the week coursing through the summer Milky Way, skirting the southern reaches of the ecliptic in the morning sky. Last Quarter occurs on the 29th at 11:29 pm Eastern Daylight Time. As Luna wanes through her begins on the 29th and lasts through May 8th. This month's target constellation is Leo, the Lion, which

The Evolving Search for the Nature of Dark Energy | Berkeley Lab

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percent of its contents is ordinary matter, 24 percent is dark matter, and all the rest is dark energy ordinary matter, 24 percent is dark matter, and all the rest is dark energy - unless there's a flaw in our Universe, and it's pushing all the rest - ordinary matter and dark matter - farther apart at an ever

Chief Information Officer > About DoD CIO > Organization > DCIO CS

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Skip to main content (Press Enter). Toggle navigation Chief Information Officer Search Search Chief Information Officer: Search Search Chief Information Officer: Search Chief Information Officer U.S. Department of Defense Chief Information Officer Home About DoD CIO Bios Organization DCIO C4&IIC DCIO IE

Defense.gov - Special Report - Progress Report: Department of Defense

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the need to re-shape and re-balance the direction of the Department and an increasingly challenging capabilities, requirements, risks and needs for the purpose of shifting the Department toward a different , the Landing Platform Dock ship and Mobile Landing Platform ship; and Completing production of the C-17

Publications - PIR 2015-5 | Alaska Division of Geological & Geophysical

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superposition of strike-slip and reverse-slip faults in the Bruin Bay fault system, Ursus Head, lower Cook Inlet , Preliminary investigation of fracture populations in Mesozoic strata of the Cook Inlet forearc basin: Iniskin observations: Continued facies analysis of the Lower Jurassic Talkeetna Formation, north Chinitna Bay, Alaska

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Bee Creek 1976 holes of Chignik C2 Quadrangle (B-1, 265'; B-2, 500'; B-3, 500'; B-4, 300' and B-5, 300 the Bee Creek 1976 holes of Chignik C2 Quadrangle (B-1, 265'; B-2, 500'; B-3, 500'; B-4, 300' and B-5

NOAA Weather Radio

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Search For Go NWS All NOAA NWR Recepción El área de la recepción nominal para un receptor de Radio cosas afectan la recepción de señas de la radio. Por ejemplo, las extensiones grandes de agua de sal de NWR. Siga leyendo si está dentro del área pero tiene dificultad con recepción. Su seña de la

Research | Photovoltaic Research | NREL

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-V cells Hybrid tandems Polycrystalline Thin-Film PV CdTe solar cells CIGS solar cells Perovskites and Organic PV Perovskite solar cells Organic PV solar cells Advanced Materials, Devices, and Science Interfacial and Surface Science Reliability and Engineering Real-Time PV and Solar Resource

Chioke Harris | NREL

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transfer and materials science to the development of high-performance building components. He is member of the Building Energy Science Group, his research focuses on the application of fundamental heat particularly interested in the development of novel opaque insulation and window frame materials using nano

Water Power Research | Water Power | NREL

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Water Power Research Water Power Research NREL conducts water power research; develops design tools Columbia River, Washington. Hydropower Research Hydropower technologies convert the energy of water moving ; and evaluates, validates, and supports the demonstration of innovative water power technologies. Photo

Mengjin Yang | NREL

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on the formation of higher efficiency formamidinium lead triiodide-based solar cells," Chem -0003-2019-4298 Dr. Mengjin Yang received his Ph.D. in Materials Science from the University of Pittsburgh, where he investigated nanomaterials for solar energy conversion under the supervision of Prof

Geothermal Energy | Climate Neutral Research Campuses | NREL

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Geothermal Energy Geothermal Energy Research campuses can take advantage of geothermal resources sections that describe how examining geothermal energy may fit into your climate action plans. Campus Options Considerations Sample Project Related Links Campus Geothermal Energy Options Campuses can use

Battery Control Algorithms | Transportation Research | NREL

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publications. Accounting for Lithium-Ion Battery Degradation in Electric Vehicle Charging Optimization Advanced Reformulation of Lithium-Ion Battery Models for Enabling Electric Transportation Fail-Safe Design for Large Capacity Lithium-Ion Battery Systems Contact Ying Shi Email | 303-275-4240

NREL: News - Winner of Solar Decathlon to be Announced

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Winner of Solar Decathlon to be Announced Friday, October 4, 2002 Washington, D.C.- The winner of National Gallery of Art Note: All houses competing in the Solar Decathlon will be open to the public from 9 the U.S. Department of Energy's first Solar Decathlon will be announced noon, Saturday, October 6 in

Site Description | CTIO

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Preserving the Dark Skies La Oficina de Protección de la Calidad del Cielo del Norte de Chile - OPCC Light view Cerro Pachón CTIO/AURA La Serena Facilities The "El Totoral" Reserve, Cerro Tololo and . back to top Sky Brightness over Cerro Pachón and Cerro Tololo Light pollution from nearby cities (La

AF Week in Photos > U.S. Air Force > Article Display

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Professors Senior Mentor Biographies Fact Sheets Commander's Call Topics CCT Archive CSAF Reading List 2017 CSAF Reading List 2016 CSAF Reading List 2015 CSAF Reading List 2014 CSAF Reading List 2013 CSAF Reading List 2012 CSAF Reading List 2011 CSAF Reading List 2010 CSAF Reading List 2009 CSAF Reading List

National Wind Technology Center | NREL

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. Wind Energy Research Wind turbine blade Wind energy research at the NWTC allows for validation and verification of large and small components and wind turbine systems. Photo by Dennis Schroeder / NREL 40935 Wind energy research at the NWTC has pioneered wind turbine components, systems, and modeling methods

Astronomical Information Center - Naval Oceanography Portal

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section Advanced Search... Sections Home Time Earth Orientation Astronomy Meteorology Oceanography Ice You the Moon Illuminated Time Universal Time and Greenwich Mean Time What is Terrestrial Time? Computing Greenwich Apparent Sidereal Time What are the U.S. Time Zones? World Time Zone Map When Does Daylight Time

Alternative Fuels Data Center: Data Downloads

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Data Downloads to someone by E-mail Share Alternative Fuels Data Center: Data Downloads on Facebook Tweet about Alternative Fuels Data Center: Data Downloads on Twitter Bookmark Alternative Fuels Data Center: Data Downloads on Google Bookmark Alternative Fuels Data Center: Data Downloads on Delicious Rank

Home Page, Alaska Department of Fish and Game

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Orders Media/Press Releases Hot Topics & Issues Board of Fisheries and Game: Actions & Activities Habitat Special Areas Fish Habitat Boards Board of Game Board of Fisheries The Joint Board Commissioner Maps & Area Information File Hunt Report Trapping Boards Board of Fisheries Board of Game

CAEBAT Model Featured on American Chemical Society Journal Tenth

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University's School of Mechanical Engineering has yielded new insights for lithium-ion (Li-ion) battery corresponding article, "Secondary-Phase Stochastics in Lithium-Ion Battery Electrodes" detailing the microstructural modifications can greatly improve overall Li-ion battery performance. The value of this work is

Energy Storage News | Transportation | Transportation Research | NREL

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NREL/Purdue team's corresponding article, "Secondary-Phase Stochastics in Lithium-Ion Battery by NREL and NASA, the Battery ISC Device revolutionizes the way lithium-ion (Li-ion) batteries are collaboration with Purdue University's School of Mechanical Engineering has yielded new insights for lithium-ion

News and Feature Stories | NREL

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insights for lithium-ion (Li-ion) battery electrodes at the microstructural level, that can lead to Lithium-Ion Battery Electrodes" detailing the research and resulting discoveries, is showcased inside 19th annual Middle School Electric Car Competition, where students raced solar and lithium-ion powered

Publications - GMC 73 | Alaska Division of Geological & Geophysical Surveys

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following seven NPRA wells: Fish Creek test well #1; Oumalik test well #1; Peard test well #1; Tunalik #1 ; Umiat test well #11; Wolf Creek test well #3; and Walapka test well #1 Authors: Unknown Publication Date wells: Fish Creek test well #1; Oumalik test well #1; Peard test well #1; Tunalik #1; Umiat test well

Nolan Wilson | NREL

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Nolan Wilson Nolan Wilson Postdoctoral Researcher-Chemical Engineering Nolan.Wilson@nrel.gov | 303 Ph.D., Chemical and Biomolecular Engineering, Clemson University, 2014 M.S., Chemical and Biomolecular Engineering, Clemson University, 2012 B.S., Chemical Engineering, Auburn University, 2007 Professional

GISD

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information on the ecology of the species, its impacts and management, a comprehensive bibliography and a list ) General Impact information Management information Distribution The Distribution page presents the global page collates management information from the profile narrative page plus location-specific management

Staff - Trent D. Hubbard | Alaska Division of Geological & Geophysical

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, R.P., Darrow, M.M., and Hubbard, T.D., 2015, Influence of catchment properties on stability of frozen : Evaluating geologic hazards and the distribution and character of geologic materials on Alaska's North Slope Professor, Department of Biology and Earth Sciences, University of Central Missouri, Warrensburg, MO 2003

Standard Terms and Conditions | NREL

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and Technical Services Subcontracts, Cost-Type (1) Cost Sharing (2) Cost Reimbursement (3) Cost Plus Than Foreign) (1) Cost Sharing (2) Cost Reimbursement (2) Cost Plus Fixed Fee. Appendix B-10 (12/15/16 /15/16) Standard Terms and Conditions for Travel Requirements (1) Cost Sharing (2) Cost Reimbursement

Publications - PIR 2015-5-8 | Alaska Division of Geological & Geophysical

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lower sandstone member of the Upper Jurassic Naknek Formation, northern Chinitna Bay, Alaska, in Wartes member of the Upper Jurassic Naknek Formation, northern Chinitna Bay, Alaska Authors: Wartes, M.A Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska

Publications - PIR 2015-5-4 | Alaska Division of Geological & Geophysical

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facies analysis of the Lower Jurassic Talkeetna Formation, north Chinitna Bay, Alaska, in Wartes, M.A of the Lower Jurassic Talkeetna Formation, north Chinitna Bay, Alaska Authors: Bull, K.F. Publication Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska

Presentations - Herriott, T.M. and others, 2011 | Alaska Division of

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Details Title: Detailed geologic mapping and overview of structural and stratigraphic studies in the east Resident Business in Alaska Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of in the east-central North Slope foothills, Alaska (poster): 3P Arctic, The Polar Petroleum Potential

Idaho Water Resources Research Institute

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Students Parents Alumni Faculty & Staff students walk on University of Idaho campus Visit U of I Learn Visit Students on Campus Title IX Helping to ensure U of I is a safe and engaging place for students to Diversity Athletics Events News Directory A - Z Prospective Students Current Students Parents Alumni Faculty

First International Workshop on Grid Simulator Testing of Wind Turbine

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of Wind Turbine Drivetrains First International Workshop on Grid Simulator Testing of Wind Turbine Wind Turbine Drivetrains June 13-14, 2013, at the National Wind Technology Center near Boulder apparatuses involved in grid compliance testing of utility-scale wind turbine generators. This includes both

Community Solar | State, Local, and Tribal Governments | NREL

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distributed generation owners for the power that their systems contribute to the grid. Community solar generation from an offsite solar system. Some form of VNM must exist for community solar to work properly so Electric Power Association. Community Solar: NREL's Working Group on Community Solar Gardens meeting

NREL Projects Awarded More Than $3 Million to Advance Novel Solar

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in Grid Operations," evaluating a research solution to better integrate solar power generation funding program, which advances state-of-the-art techniques for predicting solar power generation to Office to advance predictive modeling of solar power as part of its Solar Forecasting 2 funding program

Scanning Defect Mapping | Photovoltaic Research | NREL

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SDMS moves the treated wafer across a stationary laser beam and maps the defects for each location on the wafer. The amount of light reflected from an area is proportional to the dislocation density for that area and provides a direct statistical count of the number of dislocations. PV Research Other

Climate Prediction Center - Seasonal Outlook

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ACCOUNT FOR THE LATEST DYNAMICAL AND STATISTICAL GUIDANCE. LONG TERM TRENDS ACCOUNT FOR THE FAMILIAR U Time. Please consult the schedule of 30 & 90-day outlooks for exact release dates. Text Discussions COLLEGE PARK MD 830 AM EDT THU MAY 17 2018 SUMMARY OF THE OUTLOOK FOR NON-TECHNICAL USERS ENSO NEUTRAL

Project Development Model | Integrated Energy Solutions | NREL

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. The five elements of project fundamentals are: Baseline: Analyze the current situation for the site . The two-phase iterative model includes elements in project fundamentals and project development based State and Local Energy Data (SLED) tool, developed by NREL for the U.S. Department of Energy, to get

Rare Earth Elements | Alaska Division of Geological & Geophysical Surveys

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- Mineral Resources main content Rare Earth Elements Rare earth elements and the supply and demand of these deposits containing rare earth elements to meet the perceived future demand. High prices for rare earth earth element occurrences in the DGGS publications catalog. Department of Natural Resources, Division of

John B. Goodenough, Cathode Materials, and Rechargeable Lithium-ion

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cathode materials for the lithium-ion rechargeable battery that is ubiquitous in today’s portable conductors has enabled realization of the rechargeable lithium-ion battery used in cellular telephones and Goodenough, the rechargeable lithium ion battery, and related research is available in electronic documents

La Aventura de las Partículas

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ciertas formas fundamentales. Explore las siguientes rutas que le explicarán la materia del universo! La grande del logo de la Ruta SM) La ruta de las evidencias experimentales : aprenda como los físicos diseà explicación de los "por qué" de las interacciones físicas hay todavía muchos misterios por

NOAA Weather Radio - Información General

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logo La Radio de Canada NWR receiver logo recepción COVERAGE County Coverage Listings State Coverage Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Search For Go NWS All NOAA Información General NWR receiver logo Información de Fondo (incluyendo

Fermilab Today

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Search GO Special Result of the Week Toward a high-intensity muon source Impact of a single pulse of 12 x moment of impact (T=0); b) 9ms after impact; c) 15ms after impact. To solve the mysteries of nature 1012 protons at 14 GeV on a 1cm-wide jet of mercury flowing at 15m/s in a 10T solenoid field: a) at the

Xiaowen Chen | NREL

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Xiaowen Chen Photo of Xiaowen Chen Xiaowen Chen Researcher IV-Chemical Engineering Xiaowen.Chen Education Ph.D., Chemical Engineering, University of Maine, 2009 M.S., Chemical Engineering, University of Maine, 2005 B.S., Chemical Engineering in Polymer Science and Technology, Nanjing University of Science

Sandia National Laboratories: Research: R&D 100 Awards

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high radiation environments such as space. Watch the video. control system for active damping of inter first commercially available, high-voltage, high-frequency, high-current, high-temperature, single-chip Materials Science Nanodevices & Microsystems Radiation Effects & High Energy Density Science

NOAA Photo Library -

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logo and clouds NSSL is one of the National Oceanic and Atmospheric Administration's internationally of tornado Tornadoes picture of vintage doppler radar Instruments picture of clouds Sky Scenes -known Environmental Research Laboratories, leading the way in investigations of all aspects of severe

Batavia Boy Scouts | News

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Financial Officer Finance Section Office of the Chief Operating Officer Facilities Engineering Services Accelerator Division Accelerator Physics Center Office of the Chief Safety Officer Environment, Safety, Health and Quality Section Office of the Chief Project Officer Office of Project Support Services Office of

Tuberculosis Reports - UDOH-EPI

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Tuberculosis Tuberculosis Reports Tuberculosis Reports Tuberculosis Utah Reports Tuberculosis in Utah - Five (IBIS-PH) Tuberculosis 2015 Monthy Reports January February March April May June Tuberculosis National Reports National TB Data and Statistics Tuberculosis Global Reports TB Incidence Map by country TB

Eric O'Shaughnessy | NREL

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of residential solar PV markets. Eric leads the lab's solar data partnerships program. Eric's current green power market research. Research Interests Economic analysis, econometrics, distributed solar PV . Ardani, R. Margolis. 2018. Solar plus: Optimization of distributed solar PV through battery storage and

Photovoltaics | Climate Neutral Research Campuses | NREL

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Photovoltaics Photovoltaics Solar photovoltaics (PV) is a mature, commercially available technology arrays. Campus Solar Energy Options A PV system requires periodic maintenance, but upkeep averages two to undertaking a solar energy assessment or PV installation. Solar Energy Resources Solar energy production

University of Maryland MRSEC - Education: Resources

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. University of Maryland Materials Research Science and Engineering Center Home About Us Leadership Moments in MSE The Materials Science and Engineering Career Resources Center Materials Research Society Central Super Science Fair Projects: Ideas, Topics, & Experiments All Science Fair Projects Science

Pesticide Information for Veterinarians

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; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure Home Page Pesticide Health and Safety Information Pesticides and Animal Health Pesticide Information

Pesticide Regulations

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costs and benefits of pesticides to society. They try to identify the potential risks on human health ; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure

A to Z Index of Topics

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; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure Health and Pesticides Animal Health Care Provider Information Animal Incident Reporting Annual Reports

Council on Tall Buildings and Urban Habitat

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Publications CTBUH Journal Awards Books Technical Guides Research Reports Other Books IJHRB Research Journal TBUH Chinese Journal Virtual Research Journal Conference Publications Posters Awards Global Awards Council on Tall Buildings and Urban Habitat About CTBUH Organization & People Membership

Home | Departamento de Salud de Puerto Rico

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Publicaciones Registros Suicidio Tuberculosis Centro de Aprendizaje Virtual sobre temas de Preparación en Salud Tuberculosis Centro de Aprendizaje Virtual sobre temas de Preparación en Salud Pública Informe de Casos de Departamento de Salud Search... Search It looks like your browser does not have JavaScript enabled

The Evolving Market Structure of the U.S. Residential Solar PV Installation

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Solar PV Installation Industry, 2000-2016 The Evolving Market Structure of the U.S. Residential Solar PV residential solar photovoltaic (PV) system and that the residential PV installation industry has become more concentrated over time. From 2000 to 2016, the U.S. residential solar photovoltaic (PV) installation industry

DefenseLink.mil - Pentagon Memorial Dedication

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Dept. photo by Army Staff Sgt. Michael J. Carden An entry stone at the Pentagon Memorial lists the their lives during the Sept. 11 terrorist attack on the Pentagon. Photo by Staff Sgt. Michael J. Carden Staff Sgt. Michael J. Carden A member of The United States Air Force Band practices before the start of

O, Canada: NREL Partnership Produces New Take on Alternative Fueling

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Fueling Station Locator. The tool, which is part of a significant investment by the Canadian government to to develop a modern, bilingual web tool that makes it easier for drivers of alternative fuel vehicles Locator Tool March 5, 2018 Word of the National Renewable Energy Laboratory's (NREL) deep transportation

Publications - PIR 2015-5-9 | Alaska Division of Geological & Geophysical

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content DGGS PIR 2015-5-9 Publication Details Title: Evidence of a submarine canyon in the Snug Harbor ., Decker, P.L., and Wartes, M.A., 2015, Evidence of a submarine canyon in the Snug Harbor Siltstone and Pomeroy Arkose Members, Naknek Formation, south-central Alaska: Implications for the distribution of

Visualization and Analytics Software Tools for Peregrine System |

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R is a language and environment for statistical computing and graphics. Go to the R web site for System Visualization and Analytics Software Tools for Peregrine System Learn about the available visualization for OpenGL-based applications. For more information, please go to the FastX page. ParaView An open

Inventory of File gfs.t06z.smartguam00.tm00.grib2

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boundary layer WDIR analysis Wind Direction (from which blowing) [degtrue] 013 planetary boundary layer WIND analysis Wind Speed [m/s] 014 planetary boundary layer RH analysis Relative Humidity [%] 015 planetary boundary layer DIST analysis Geometric Height [m] 016 surface 4LFTX analysis Best (4 layer) Lifted

John Lewis | NREL

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Lewis John Lewis John Lewis Researcher IV-Chemical Engineering John.Lewis@nrel.gov | 303-275-3021 Education Ph.D. Chemical Engineering, California Institute of Technology, Pasadena, CA, 1996 M.S. Chemical Engineering, California Institute of Technology, Pasadena, CA, 1993 B.S. Chemical Engineering, Texas A&M

Buy or sell used musical instruments | News

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Financial Officer Finance Section Office of the Chief Operating Officer Facilities Engineering Services Accelerator Division Accelerator Physics Center Office of the Chief Safety Officer Environment, Safety, Health and Quality Section Office of the Chief Project Officer Office of Project Support Services Office of

David Toback re-elected CDF co-spokesperson | News

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Financial Officer Finance Section Office of the Chief Operating Officer Facilities Engineering Services Accelerator Division Accelerator Physics Center Office of the Chief Safety Officer Environment, Safety, Health and Quality Section Office of the Chief Project Officer Office of Project Support Services Office of

MMAB Mission Statement

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services. Marine Modeling and Analysis Branch Logo Click here to go to the EMC/MMAB homepage MMAB Mission Statement The Marine Modeling and Analysis Branch is part of the Environmental Modeling Center, which is Environmental Prediction Environmental Modeling Center Marine Modeling and Analysis Branch 5830 University

Materials and Devices | Photovoltaic Research | NREL

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Polycrystalline Thin-Film PV Cadmium telluride (CdTe) solar cells Copper indium gallium diselenide (CIGS) solar cells Perovskite and Organic PV Perovskite solar cells Perovskite Patent Portfolio Organic PV (OPV ) solar cells Advanced Materials, Devices, and Concepts We explore new PV materials using high-throughput

Silicon Materials and Devices R&D | Photovoltaic Research | NREL

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" and "Si-based Tandem Solar Cells"), Next Generation Photovoltaics (NextGen PV III), and devices, especially for photovoltaic (PV) cell applications. PV Research Other Materials & Devices pages: High-Efficiency Crystalline PV Polycrystalline Thin-Film PV Perovskite and Organic PV Advanced PV

Water Resource Sustainability Conference 2015

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| Honolulu, Hawaii Presented By Water Resources Research Center (WRRC), Hawaii and American Samoa Water and Environmental Research Institute (WERI), Guam Puerto Rico Water Resources and Environmental Research Institute (PRWRERI), Puerto Rico The Virgin Islands Water Resources Research Institute (VI-WRRI), U. S. Virgin

NOAA Photo Library

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reached the mature stage of formation. Image ID: nssl0065, NOAA's National Severe Storms Laboratory (NSSL Available Publication of the U.S. Department of Commerce, National Oceanic & Atmospheric Adminstration NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes

NOAA Photo Library

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in its early stage of formation. Image ID: nssl0061, NOAA's National Severe Storms Laboratory (NSSL Available Publication of the U.S. Department of Commerce, National Oceanic & Atmospheric Adminstration NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes

NOAA Photo Library

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in its early stage of formation. Image ID: nssl0062, NOAA's National Severe Storms Laboratory (NSSL Available Publication of the U.S. Department of Commerce, National Oceanic & Atmospheric Adminstration NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes

NOAA Photo Library

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in its early stage of formation. Image ID: nssl0064, NOAA's National Severe Storms Laboratory (NSSL Available Publication of the U.S. Department of Commerce, National Oceanic & Atmospheric Adminstration NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes

Wind Maps | Geospatial Data Science | NREL

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Wind Maps Wind Maps Wind Prospector This GIS application supports resource assessment and data exploration for wind development. This collection of wind maps and assessments details the wind resource in Geospatial Data Science Team. National Wind Resource Assessment The national wind resource assessment was

Impacts | Wind | NREL

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in hard hats standing on top of a large wind turbine overlooking several other wind turbines in the Framework Transforms FAST Wind Turbine Modeling Tool NREL Assesses National Design Standards for Offshore Wind Resource NREL Identifies Investments for Wind Turbine Drivetrain Technologies Awards R&D 100

@NWTC Newsletter: Fall 2013 | Wind | NREL

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Assessment of the U.S. Wind Industry in 2012 NREL Identifies Investments for Wind Turbine Drivetrain , medium-speed, medium-voltage wind turbine drivetrain design. Tapping into unparalleled expertise, the The drivetrain of a wind turbine converts the power of the wind into electrical energy. Now

Geothermal Maps | Geospatial Data Science | NREL

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presented in these maps was aggregated from the Geothermal Energy Association 2014 Annual U.S. and Global Geothermal Maps Geothermal Maps Our geothermal map collection covers U.S. geothermal power plants , geothermal resource potential, and geothermal power generation. If you have difficulty accessing these maps

NREL: Renewable Resource Data Center - Geothermal Resource Information

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Energy's Office of Energy Efficiency and Renewable Energy Geothermal Technologies Program. Its collection , and thermal springs. View NREL's Geothermal resource maps as well as maps for other renewable energy Geothermal Resource Information Geothermal Prospector Start exploring U.S. geothermal resources

XHTML Vocabulary

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content of resource. contentinfo contains meta information about the content on the page or the page as a Applications Vocabulary alert A message with important, and usually time-sensitive, information. Also see : true, false, or mixed. columnheader A cell containing header information for a column. combobox A

Federal Pesticide Regulation

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pesticides, the EPA works to protect human health and the environment. The EPA works cooperatively with state ; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure

Before You Control Your Pest

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; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure activities. Public Health Departments Control pests that impact human health and that are a community concern

Alternative Fuels Data Center

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fueled for the fleet to be subject to the regulatory requirements. Under Standard Compliance, the AFVs that may be used toward compliance or banked once the fleet achieves compliance for investments in composition. For more information, visit the EPAct State and Alternative Fuel Provider Fleets website

R&D Nuggets

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Origin of the Chemical Elements and Their Discoveries [added 1/2007] National Laboratories and Other to the content of DOE R&D Accomplishments. Celebrating Einstein - series of articles about Albert Einstein and his work [added 3/2005] Compact Portable Electric Power Sources [added 1/2007] History of the

Fermilab | Science | Historic Results

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quark since the discovery of the bottom quark at Fermilab through fixed-target experiments in 1977. Both cosmic rays. Researchers previously had assumed that cosmic rays approach the Earth uniformly from random impact the Earth generally come from the direction of active galactic nuclei. Many large galaxies

ACHP | Defense Department Compliance with NHPA

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NHPA: Section 202(a)(6) Evaluation Report Defense Department Compliance with the National Historic )(6) Evaluation Report is a preliminary step in helping the Department of Defense marshall its Search skip specific nav links Home arrow Publications arrow Intro: Defense Department Compliance with

SIMES

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image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image Quick Energy@Stanford&SLAC LINAC Coherent Light Source (LCLS) Stanford Synchrotron Radiation Lightsource 29 30 31 1 2 3 Events (List View) No events See all events ©2012- Stanford University. All rights

Navy.mil The Official Website of the United States Navy: Home Page

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of the Navy Chief Of Naval Operations Master Chief Petty Officer Of The Navy Chief Of Naval Personnel Pentagon Hall of Heroes On May 25, Medal of Honor recipient retired Master Chief Petty Officer (SEAL Of Naval Operations Master Chief Petty Officer Of The Navy Chief Of Naval Personnel Biographies SES

ACHP | News | President Bush Issues Executive Order on Preserve America

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requirements of subsections 3(a)-(c) of this order. To assist agencies, the Council, in consultation with the Preservation Officer in accordance with section 110(c) of the NHPA. The senior official shall ensure that the public benefit from, and access to, Federally owned historic properties. (c) The Council is directed to

Publications - GMC 9 | Alaska Division of Geological & Geophysical Surveys

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; Texaco West Kavik #1; Canning River B-1; ARCO Kavik #1; Forest Kemik #1; BP Kemik #2; Canning River A-1 ; Toolik Federal #1 Authors: Curiale, J.A. Publication Date: 1982 Publisher: Alaska Division of Geological eight North Slope wells: Mobil West Staines #2; Texaco West Kavik #1; Canning River B-1; ARCO Kavik #1

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Energy-Water Nexus and Energy Systems Integration | Energy Systems

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on a new area of research geared at finding ways to balance our water use for power systems. Photo of a body of water NREL's research explores the relationship between how much water is evaporated to spectrum. Learn more about NREL's energy-water nexus research. Team with us on water-energy nexus research

NREL to Lead Novel Field Demonstration of Wind Turbine Control at the Wind

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Power Plant Level | News | NREL to Lead Novel Field Demonstration of Wind Turbine Control at the Wind Power Plant Level NREL to Lead Novel Field Demonstration of Wind Turbine Control at the Wind to test wind turbine technology controls at the overall wind power plant level. This is a significant

Alternative Fuels Data Center: Maps and Data

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2014 2015 2016 Acura 1 2 1 Audi 6 6 7 7 Bentley Motors 3 3 4 4 3 BMW 1 3 1 3 6 6 5 Buick 1 1 1 3 4 5 1 3 2 Cadillac 2 2 4 4 6 4 2 1 Chevrolet 1 2 3 1 4 4 6 5 7 7 8 7 8 9 11 10 11 14 20 26 24 30 27 Chrysler 2 2 3 2 4 1 1 1 3 3 4 2 3 3 3 3 5 5 Coda Automotive 1 1 0 Dodge 2 2 3 7 5 1 4 4 6 6 6 2 4 5 5 5 6

Recycling

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Concentrating Solar Power Projects - Morón | Concentrating Solar Power |

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, 2018 Project Overview Project Name: Morón Country: Spain Location: Morón de la Frontera (Seville ? Background Technology: Parabolic trough Status: Operational Country: Spain City: Morón de la Frontera Region NREL Morón This page provides information on Morón, a concentrating solar power (CSP) project

Index of /data/nccf/com/gens/prod

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From Nigel Lockyer: Five things you should know | News

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Financial Officer Finance Section Office of the Chief Operating Officer Facilities Engineering Services Accelerator Division Accelerator Physics Center Office of the Chief Safety Officer Environment, Safety, Health and Quality Section Office of the Chief Project Officer Office of Project Support Services Office of

MicroBooNE project team recognized by Department of Energy | News

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DGIC Interconnection Insights | Distributed Generation Interconnection

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Power Association (SEPA), produced a webinar Utility Participation in the Roof Top Solar PV Market with ). These leaders are pioneering utility-owned rooftop solar programs to broaden the reach of solar PV utility hired solar PV developers who, representing CPS Energy, will install, own, and maintain solar

Solar Plus: A Holistic Approach to Distributed Solar PV | Solar Research |

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NREL Plus: A Holistic Approach to Distributed Solar PV Solar Plus: A Holistic Approach to Distributed Solar PV A new NREL report analyzes "solar plus," an emerging approach to distributed solar photovoltaic (PV) deployment that uses energy storage and controllable devices to optimize

2015 PV Solar Resource Workshop | Photovoltaic Research | NREL

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PV Solar Resource Workshop 2015 PV Solar Resource Workshop Friday, February 27, 2015 Chairs understand the solar resource available to PV plants and opportunities for the community to improve over the as Adobe Acrobat PDFs. Solar Resource Needs for Prediction and Monitoring of PV Performance

The New Jersey Water Resources Research Institute at Rutgers NJAES

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Rutgers New Jersey Agricultural Experiment Station [The New Jersey Water Resources Research wetland Program Areas The New Jersey Water Resources Research Institute (NJWRRI) is a federally-funded water in the state. Its mission is to: sponsor research on all aspects of water quality, water quantity

Energy Systems Integration Facility Insight Center | Energy Systems

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simulation data. Photo of researchers studying data on a 3-D power system profile depicting the interaction of renewable energy resources on the grid. Capabilities The Insight Center offers the following Integration Facility Insight Center Located adjacent to the Energy System Integration Facility's High

NREL Leads Wind Farm Modeling Research - Continuum Magazine | NREL

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ten 2-MW Bonus wind turbines. Photo provided by HC Sorensen, Middelgrunden Wind Turbine Cooperative ) has created complex computer modeling tools to improve wind turbine design and overall wind farm activity surrounding a multi-megawatt wind turbine. In addition to its work with Doppler LIDAR, the

@NWTC Newsletter: Summer 2014 | Wind | NREL

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, Developmental Role in Major Wind Journal Boosting Wind Plant Power Output by 4%-5% through Coordinated Turbine . Part 2: Wind Farm Wake Models New Framework Transforms FAST Wind Turbine Modeling Tool (Fact Sheet ) Sensitivity Analysis of Wind Plant Performance to Key Turbine Design Parameters: A Systems Engineering

Geothermal Energy Basics | NREL

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Geothermal Energy Basics Geothermal Energy Basics Many technologies have been developed to take advantage of geothermal energy-the heat from the earth. This heat can be drawn from several sources: hot hot spring. The Earth's heat-called geothermal energy-escapes as steam at a hot springs in Nevada

Nuclear and Particle Physics, Astrophysics and Cosmology : T-2 : LANL

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linked in Search T-2, Nuclear and Particle Physics, Astrophysics and Cosmology T-2 Home T Division Focus Areas Nuclear Information Service Nuclear Physics Particle Physics Astrophysics Cosmology CONTACTS Group energy security, heavy ion physics, nuclear astrophysics, physics beyond the standard model, neutrino

99aa/99ac data sets

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-redshifted), Observed Flux, Statistical Error (Based on the optimal extraction algorithm of the IRAF packages were acquired using different instrumental settings for the blue and red parts of the spectrum to avoid extracted for systematics checks of the wavelength calibration. Wavelength and flux calibration were applied

PEER Annual Meeting | Events

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window. 2018 PEER Annual Meeting, Jan 18-19, 2018 in Berkeley, CA 2016 PEER Annual Meeting, Jan 28-29 home about peer news events research products laboratories publications nisee b.i.p. members education FAQs links Events Calendar of PEER and Other Events PEER Events Archive PEER Annual Meeting 2009

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Nicholas Brunhart-Lupo | NREL

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. Education Ph.D., Computer Science, Colorado School of Mines M.S., Computer Science, University of Queensland B.S., Computer Science, Colorado School of Mines Brunhart-Lupo Nicholas Brunhart-Lupo Computational Science Nicholas.Brunhart-Lupo@nrel.gov

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Smithsonian Marine Station at Fort Pierce Website Search Box Search Field: SMS Website Search Search Submit: Submit Advanced Search IRLSI Home Search the Inventory The IRL Stewardship IRL Photo Institution Privacy SMS Home Contact Us Search NMNH Home DCSIMG

Index of /data/nccf/com/nam/prod

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WPC Maximum Heat Index Forecasts

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Forecasts for Western US CLICK ON MAPS FOR MAXIMUM HEAT INDEX AND PROBABILITY FORECASTS FROM SUN MAY 27 2018 02 CLICK to view SAT JUN 02 forecast SUN JUN 03 CLICK to view SUN JUN 03 forecast SUN JUN 03 CLICK to view SUN JUN 03 forecast SUN JUN 03 CLICK to view SUN JUN 03 forecast SUN JUN 03 CLICK to view SUN JUN

River Flow Advisory Commission: Snow Survey

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Survey River Watch Home → Snow Survey RFAC Information About Us Reports Maine Cooperative Snow Survey About the Snow Survey Snow Survey Map Compare Snow Survey Data Snow Survey Graphs River Watch MEMA Home USGS (Maine) Home Maine Cooperative Snow Survey This information is provided by a partnership with

Bobi A. Garrett - Deputy Laboratory Director and Chief Operating Officer

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| NREL Bobi A. Garrett - Deputy Laboratory Director and Chief Operating Officer Bobi A. Garrett - Deputy Laboratory Director and Chief Operating Officer A photo of Bobi A. Garrett, Deputy Laboratory Director and Chief Operating Officer In her role as deputy laboratory director/chief operating officer (COO

Sistema de Vigilancia de Influenza de Puerto Rico |

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Rico VIH Publicaciones sobre la Salud Otras Publicaciones Registros Suicidio Tuberculosis Centro de Suicidio Tuberculosis Recent Ávisos Públicos Reglamentación Informe de Casos del Síndrome de Guillain Departamento de Salud de Puerto Rico Departamento de Salud Search... Search It looks like your

ACHP | News

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§ 800.10(c) provides further direction for the ACHP to consider requesting the preparation of a Reports Background. Section 213 of the National Historic Preservation Act (NHPA) [16 U.S.C. § 470u ] directs the Secretary of the Interior (Secretary), if requested by the Chairman of the Advisory Council on

Supercell and tornado roles

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where C is the storm motion vector, and k is the unit vector in the vertical (Davies-Jones et al. 1990 mutually interacting perspectives, each addressing different aspects of the supercell storms most directly marked by low clouds, extending to the left. Photograph © 2005 C. Doswell 4. Developing a conceptual

Exploring Renewable Energy Integration in California - Text Version |

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look at different penetrations of solar and understand how the duck chart shape change and how much analyses and different scenario analyses to understand the key drivers behind these challenges. Today, we each of our different scenarios. We have three different renewable portfolios that we looked at. On the

Presentations - Herriott, T.M. and others, 2015 | Alaska Division of

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Details Title: Sequence stratigraphic framework of the Upper Jurassic Naknek Formation, Cook Inlet forearc Resident Business in Alaska Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of ., Wartes, M.A., and Decker, P.L., 2015, Sequence stratigraphic framework of the Upper Jurassic Naknek

Defenselink Special: Remembering September 11, 2001 - Six Years Later ...

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Sept. 11 Memorial observance, honoring the 184 people who perished when American Airline 77 crashed observance today honoring the 184 people who perished when American Airlines Flight 77 crashed into the , Irwin gets emotional quickly when talking about the day that 184 people died here. One-hundred twenty

Wind Data | Geospatial Data Science | NREL

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Class 3 or greater are suitable for most utility-scale wind turbine applications, whereas class 2 areas ) with adequate wind resource for wind turbine applications may exist in some Class 1 areas. The degree Wind Data Wind Data These datasets detail the wind resource available in the United States. 50-m

Publications | Wind | NREL

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-specific analysis can be used to assess the risk induced by loss of a wind turbine blade. The study used for different wind turbine configurations. The authors used assumptions specific to the National Wind ., failure rate for wind turbine rotors) are based on a 13-year-old report on wind turbines installed in

NREL: Renewable Resource Data Center - Wind Resource Information

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and Actual Wind Turbine Sites (September 1982) and a Wind Energy Resource Atlas of the United States Wind Resource Information Photo of five wind turbines at the Nine Canyon Wind Project. The Nine Canyon Wind Project in Benton County, Washington, includes 37 wind turbines and 48 MW of capacity

NREL Research Determines Integration of Plug-in Electric Vehicles Should

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transportation and energy systems engineer at NREL and author of the new Nature Energy paper, "Impact of Muratori, author of the new Nature Energy paper "Impact of Uncoordinated Plug-in Electric Vehicle Integration of Plug-in Electric Vehicles Should Play a Big Role in Future Electric System Planning News

Publications - SR 65 | Alaska Division of Geological & Geophysical Surveys

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; Geophysical Surveys Comments: Your help is crucial in the compilation of future Alaska Minerals Reports. The quality and completeness of the information in these annual reports is dependent on input from all members of the mineral industry. Please take time to fill out the current mining and mineral activity

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; Geophysical Surveys Comments: Your help is crucial in the compilation of future Alaska Minerals Reports. The quality and completeness of the information in these annual reports is dependent on input from all members of the mineral industry. Please take time to fill out the current mining and mineral activity

SuperCDMS - Home

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radiation and therefore it cannot be seen, which has earned it the title Dark Matter. Dark matter rest (approximately three quarters) of all the matter and energy in the universe is referred to as dark energy. Dark matter is most commonly hypothesized to be made up of exotic particles such as WIMPS (Weakly

Press Release | News | Page 2

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: Attend a Dark Matter Day event October 23, 2017 The world will soon be celebrating the hunt for the universe's most elusive matter in a series of Dark Matter Day events planned in over a dozen countries reveals most accurate measurement of dark matter structure in the universe August 3, 2017 Dark Energy

Press Release | News | Page 3

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, technology, engineering and math fields. New world-leading limit on dark matter search from PICO experiment February 27, 2017 The PICO-60 dark matter bubble chamber experiment has produced a new dark matter limit . Construction of world's most sensitive dark matter detector moves forward September 26, 2016 LUX-ZEPLIN (LZ), a

New Jersey | Midmarket Solar Policies in the United States | Solar Research

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| NRELA> Jersey New Jersey An arrow graphic shows that New Jersey's renewable portfolio standard property by a renewable system is exempt from property tax. Utility Incentive Programs The Board of Public incentive programs. Renewable Portfolio Standard New Jersey Board of Public Utilities: RPS Background New

Joint Center for Energy Storage Research

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singly charged lithium ions in the lithium-ion battery by new doubly or triple charged ions. Learn More Cells that Run on Air Scientists at UIC and Argonne Produce New Design of a True Lithium-air Battery phones from cumbersome bricks to sleek, powerful devices was possible because of the lithium-ion

SLAC Phone Directory: Search Form

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Facilities LCLS Hard X-Ray LCLS IT & Networking LCLS IT Photon Systems LCLS Instrumentation Dev LCLS Delivery Dept LCLS Science Research & DevDiv LCLS Soft X-Ray LCLS Technical Support LCLS User Beam Line Ops Sup SSRL MSD Hard X-rays SSRL MSD Soft X-rays SSRL MSDBeam Line Elec SSRL MSDBeam Line

Inventory of File nam.t00z.smartconus00.tm00.grib2

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(Eta model reduction) [Pa] 014 planetary boundary layer WDIR analysis Wind Direction (from which blowing) [degtrue] 015 planetary boundary layer WIND analysis Wind Speed [m/s] 016 planetary boundary layer RH analysis Relative Humidity [%] 017 planetary boundary layer DIST analysis Geometric Height [m

Richard T. (Rick) Elander | NREL

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T. (Rick) Elander Photo of Rick Elander Richard Elander Researcher VI-Chemical Engineering Chemicals and AIChE Annual Meeting, multiple years Education M.S., Chemical Engineering (Biochemical Engineering), Colorado State University B.S., Chemical Engineering, University of Pennsylvania Professional

Photovoltaic Lifetime Project | Photovoltaic Research | NREL

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PV & Solar Resource Testing Accelerated Testing & Analysis Systems Engineering Project Sandia National Laboratories' PV Performance Modeling Collaborative website. Jinko Solar. PV systems mounted on the ground. Jinko Solar PV Lifetime installation at NREL. need-alt Light-induced degradation

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For more information about solar photovoltaic energy, visit the following resources: Solar PV Photovoltaic Technology Basics Solar Photovoltaic Technology Basics Solar cells, also called photovoltaic (PV) cells by scientists, convert sunlight directly into electricity. PV gets its name from the

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Information Information Resource Management Information Resource Management (IRM) maintains the department's DNR's site DNR State of Alaska Toggle main menu visibility Home Contact Us Information Resource Management Recorder's Office/UCC Recorder's Office Recorder's Office Search Uniform Commercial Code (UCC) UCC

Publications | Geothermal Technologies | NREL

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Publications Publications NREL publishes a variety of publications related to geothermal energy geothermal energy research. Featured Publications Mexico's Geothermal Market Assessment Report NREL Technical investment in the country's geothermal energy sector. Since 2013, Mexico has enacted comprehensive reforms to

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Ella Zhou | NREL

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. 2015. Methods for Analyzing the Economic Value of Concentrating Solar Power with Thermal Energy in the United States, Potential Lessons for ChinaPDF. Golden, CO: National Renewable Energy . Renewable Electricity: Insights for the Coming DecadePDF. Golden, CO: National Renewable Energy Laboratory

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Ramin Faramarzi Photo of Ramin Faramarzi Ramin Faramarzi Researcher V-Mechanical Engineering Engineering, California State University B.S. Mechanical Engineering, North Carolina State University articles and is a registered mechanical engineer in the state of California. Education M.S. Mechanical

Environmental Stewardship

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. Protecting the present through resource management The Laboratory actively manages and protects resources on shared land. Through biological monitoring, the Laboratory strives to minimize operational impacts to plants and animals. Through collaboration with its stakeholders and local tribal governments, the

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welcome your suggestions and feedback. Environmental Protection Agency logo PIER logo Touchstome Energy Cooperatives logo California Air Resouces Board logo Infosys logo Berkeley Lab logo Created for the US the HES API for your projects Department of Energy logo

ESTIMATING BASAL ENERGY EXPENDITURE IN LIVER TRANSPLANT RECIPIENTS: THE VALUE OF THE HARRIS-BENEDICT EQUATION.

PubMed

Pinto, Andressa S; Chedid, Marcio F; Guerra, Léa T; Álvares-DA-Silva, Mario R; Araújo, Alexandre de; Guimarães, Luciano S; Leipnitz, Ian; Chedid, Aljamir D; Kruel, Cleber R P; Grezzana-Filho, Tomaz J M; Kruel, Cleber D P

2016-01-01

Reliable measurement of basal energy expenditure (BEE) in liver transplant (LT) recipients is necessary for adapting energy requirements, improving nutritional status and preventing weight gain. Indirect calorimetry (IC) is the gold standard for measuring BEE. However, BEE may be estimated through alternative methods, including electrical bioimpedance (BI), Harris-Benedict Equation (HBE), and Mifflin-St. Jeor Equation (MSJ) that carry easier applicability and lower cost. To determine which of the three alternative methods for BEE estimation (HBE, BI and MSJ) would provide most reliable BEE estimation in LT recipients. Prospective cross-sectional study including dyslipidemic LT recipients in follow-up at a 735-bed tertiary referral university hospital. Comparisons of BEE measured through IC to BEE estimated through each of the three alternative methods (HBE, BI and MSJ) were performed using Bland-Altman method and Wilcoxon Rank Sum test. Forty-five patients were included, aged 58±10 years. BEE measured using IC was 1664±319 kcal for males, and 1409±221 kcal for females. Average difference between BEE measured by IC (1534±300 kcal) and BI (1584±377 kcal) was +50 kcal (p=0.0384). Average difference between the BEE measured using IC (1534±300 kcal) and MSJ (1479.6±375 kcal) was -55 kcal (p=0.16). Average difference between BEE values measured by IC (1534±300 kcal) and HBE (1521±283 kcal) was -13 kcal (p=0.326). Difference between BEE estimated through IC and HBE was less than 100 kcal for 39 of all 43patients. Among the three alternative methods, HBE was the most reliable for estimating BEE in LT recipients. Estimativa confiável do metabolismo basal em pacientes transplantados de fígado é necessária para adaptar os requerimentos energéticos, melhorar o estado nutricional e prevenir ganho de peso. Calorimetria indireta (CI) é o padrão-ouro para a medição do metabolismo basal. No entanto, ele pode ser estimado utilizando-se métodos alternativos, incluindo a bioimpedância (BI), a Equação de Harris-Benedict (EHB), e também a Equação de Mifflin-St. Jeor (MSJ). Esses métodos alternativos possuem aplicabilidade mais fácil e custo inferior quando comparados à CI. Determinar qual dos três métodos alternativos para a estimativa do metabolismo basal (EHB, BI e MSJ) seria o mais confiável em pacientes transplantados de fígado. Foi realizado estudo transversal prospectivo incluindo pacientes transplantados de fígado com dislipidemia, em acompanhamento ambulatorial. Comparações dos valores calculados de metabolismo basal via CI aos valores estimados por cada um dos três métodos alternativos (EHB, BI e MSJ) foram realizadas utilizando o de Bland-Altman e o teste de Wilcoxon-Mann-Whitney. Quarenta e cinco pacientes foram incluídos com idade 58±10 anos. O metabolismo basal medido via CI foi 1664±319 kcal para pacientes do gênero masculino, e 1409±221 kcal para o feminino. A diferença média entre a taxa de metabolismo basal aferida por CI (1534±300 kcal) e estimada por BI (1584±377 kcal) foi +50 kcal (p=0.0384). A diferença média entre a taxa de metabolismo basal aferida via CI (1534±300 kcal) e estimada por MSJ (1479.6±375 kcal) foi -55 kcal (p=0.16). A diferença média entre os valores de taxa de metabolismo basal medidos via CI (1534±300 kcal) e estimados por EHB (1521±283 kcal) foi -13 kcal (p=0.326). Além disso, a diferença entre a taxa de metabolismo basal estimada via CI e a aferida por EHB foi menor que 100 kcal para 39 de todos os 43 pacientes avaliados. A EHB foi o mais confiável dos três métodos de estimativa da taxa de metabolismo basal em pacientes transplantados de fígado em acompanhamento ambulatorial.

Christopher Kinchin | NREL

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Kinchin Photo of Christopher Kinchin Christopher Kinchin Researcher III-Chemical Engineering . Education B.S., Chemical Engineering, Texas Tech University M.S., Chemical Engineering, University of North

Golden Rays - July 2017 | Solar Research | Solar Research | NREL

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Operator, First Solar, and NREL tested a 300-MW PV plant to demonstrate that, with proper controls, PV can technique to measure charge-carrier transport in PV materials. Solar Plus: A Holistic Approach to Distribution Solar PV By optimizing how PV interacts with other electricity loads at the household- and grid

EMC: Mesoscale Branch FAQ

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THE QPF DIFFERENT BETWEEN THE 12-KM NAM PARENT DOMAIN AND THE 4-KM NAM CONUS NEST? (04 Nov 2011) WHAT 28 MAR 2000? Eta Post Processor WHY IS THE SLP DIFFERENT BETWEEN AWIPS AND AFOS? (updated 6 Nov 98 IN THE BUFR OUTPUT DIFFERENT FROM WHAT IS OBSERVED? Eta Data Assimilation System (EDAS) COMMENTS ON

Western Wind Data Set | Grid Modernization | NREL

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replicates the stochastic nature of wind power plant output. NREL modeled hysteresis around wind turbine cut where wind speeds are often near wind turbine cut-out (~25 m/s), SCORE output does not replicate the Vestas V90). The hysteresis-corrected SCORE is an attempt to put the wind turbine hysteresis at cut-out

Wind Energy | Climate Neutral Research Campuses | NREL

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turbine or wind farm is one of the few technologies that supplies renewable energy at the scale required . Before determining whether a site is suitable for a wind turbine, read the Wind Energy Siting Handbook Community College has installed a wind turbine on site and now offers an Associate Degree in wind energy and

Glossary | Efficient Windows Collaborative

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double-hung windows as a means of counterbalancing the weight of the sash during opening and closing. Bay a fixed sash or a double-hung window. Also referred to as bead stop. Blackbody. The ideal, perfect member of the lower sash which meet at the middle of a double-hung window. Clerestory. A window in the