Comparison of semantic and episodic memory BOLD fMRI activation in predicting cognitive decline in older adults.

PubMed

Hantke, Nathan; Nielson, Kristy A; Woodard, John L; Breting, Leslie M Guidotti; Butts, Alissa; Seidenberg, Michael; Carson Smith, J; Durgerian, Sally; Lancaster, Melissa; Matthews, Monica; Sugarman, Michael A; Rao, Stephen M

2013-01-01

Previous studies suggest that task-activated functional magnetic resonance imaging (fMRI) can predict future cognitive decline among healthy older adults. The present fMRI study examined the relative sensitivity of semantic memory (SM) versus episodic memory (EM) activation tasks for predicting cognitive decline. Seventy-eight cognitively intact elders underwent neuropsychological testing at entry and after an 18-month interval, with participants classified as cognitively "Stable" or "Declining" based on ≥ 1.0 SD decline in performance. Baseline fMRI scanning involved SM (famous name discrimination) and EM (name recognition) tasks. SM and EM fMRI activation, along with Apolipoprotein E (APOE) ε4 status, served as predictors of cognitive outcome using a logistic regression analysis. Twenty-seven (34.6%) participants were classified as Declining and 51 (65.4%) as Stable. APOE ε4 status alone significantly predicted cognitive decline (R(2) = .106; C index = .642). Addition of SM activation significantly improved prediction accuracy (R(2) = .285; C index = .787), whereas the addition of EM did not (R(2) = .212; C index = .711). In combination with APOE status, SM task activation predicts future cognitive decline better than EM activation. These results have implications for use of fMRI in prevention clinical trials involving the identification of persons at-risk for age-associated memory loss and Alzheimer's disease.

Effects of combined electromyostimulation and gymnastics training in prepubertal girls.

PubMed

Deley, Gaëlle; Cometti, Carole; Fatnassi, Anaïs; Paizis, Christos; Babault, Nicolas

2011-02-01

This study investigated the effects of a 6-week combined electromyostimulation (EMS) and gymnastic training program on muscle strength and vertical jump performance of prepubertal gymnasts. Sixteen young women gymnasts (age 12.4 ± 1.2 yrs) participated in this study, with 8 in the EMS group and the remaining 8 as controls. EMS was conducted on knee extensor muscles for 20 minutes 3 times a week during the first 3 weeks and once a week during the last 3 weeks. Gymnasts from both groups underwent similar gymnastics training 5-6 times a week. Isokinetic torque of the knee extensors was determined at different eccentric and concentric angular velocities ranging from -60 to +240° per second. Jumping ability was evaluated using squat jump (SJ), counter movement jump (CMJ), reactivity test, and 3 gymnastic-specific jumps. After the first 3 weeks of EMS, maximal voluntary torque was increased (+40.0 ± 10.0%, +35.3 ± 11.8%, and +50.6 ± 7.7% for -60, +60, and +240°s⁻¹, respectively; p < 0.05), as well as SJ, reactivity test and specific jump performances (+20.9 ± 8.3%, +20.4 ± 26.2% and +14.9 ± 17.2% respectively; p < 0.05). Six weeks of EMS were necessary to improve the CMJ (+10.1 ± 10.0%, p < 0.05). Improvements in jump ability were still maintained 1 month after the end of the EMS training program. To conclude, these results first demonstrate that in prepubertal gymnasts, a 6-week EMS program, combined with the daily gymnastic training, induced significant increases both in knee extensor muscle strength and nonspecific and some specific jump performances.

A modified oral sugar test for evaluation of insulin and glucose dynamics in horses.

PubMed

Lindåse, Sanna; Nostell, Katarina; Bröjer, Johan

2016-10-20

An oral sugar test (OST) using Karo ® Light Corn Syrup has been developed in the USA as a field test for the assessment of insulin dysregulation in horses but the syrup is not available in Scandinavian grocery stores. The aim of the study was to compare the results of a modified OST between horses with equine metabolic syndrome (EMS) and healthy horses using a Scandinavian commercially available glucose syrup (Dansukker glykossirap). In addition, the effect of breed and the repeatability of the test were evaluated. In the present study, clinically healthy horses (7 Shetland ponies, 8 Icelandic horses, 8 Standardbred horses) and 20 horses of various breeds with EMS underwent the modified OST test. The Icelandic horses and Shetland ponies underwent the OST twice. Insulin and glucose data from the OST were used to calculate peak insulin concentration (Peak INS ), time to peak insulin concentration (T-peak INS ), area under the curve for insulin (AUC INS ) and glucose (AUC GLU ) as well as whole body insulin sensitivity index (ISI COMP ). Compared to the healthy group, the EMS group had 6-7 times higher geometric mean for Peak INS and AUC INS and 8 times lower geometric mean for ISI COMP . The EMS group had a delayed T-peak INS compared to the healthy group. There was no effect of breed in the group of healthy horses on Peak INS , T-peak INS , AUC INS , AUC GLU and ISI COMP . Coefficient of variation for repeated tests was 19.8, 19.0 and 17.6 % for Peak INS , AUC INS and ISI COMP respectively. The results of the present study demonstrate that the modified OST appears to be a practical and useful diagnostic tool for assessment of insulin dysregulation in the horse. However, to make it possible to establish the most appropriate sampling interval and to evaluate the accuracy of the modified OST, further studies in horses with a variable degree of insulin resistance are needed, where results from the modified OST are compared with quantitative measurements for IS.

Mouse mutants from chemically mutagenized embryonic stem cells

PubMed Central

Munroe, Robert J.; Bergstrom, Rebecca A.; Zheng, Qing Yin; Libby, Brian; Smith, Richard; John, Simon W.M.; Schimenti, Kerry J.; Browning, Victoria L.; Schimenti, John C.

2010-01-01

The drive to characterize functions of human genes on a global scale has stimulated interest in large-scale generation of mouse mutants. Conventional germ-cell mutagenesis with N-ethyl-N-nitrosourea (ENU) is compromised by an inability to monitor mutation efficiency, strain1 and interlocus2 variation in mutation induction, and extensive husbandry requirements. To overcome these obstacles and develop new methods for generating mouse mutants, we devised protocols to generate germline chi-maeric mice from embryonic stem (ES) cells heavily mutagenized with ethylmethanesulphonate (EMS). Germline chimaeras were derived from cultures that underwent a mutation rate of up to 1 in 1,200 at the Hprt locus (encoding hypoxanthine guanine phosphoribosyl transferase). The spectrum of mutations induced by EMS and the frameshift mutagen ICR191 was consistent with that observed in other mammalian cells. Chimaeras derived from ES cells treated with EMS transmitted mutations affecting several processes, including limb development, hair growth, hearing and gametogenesis. This technology affords several advantages over traditional mutagenesis, including the ability to conduct shortened breeding schemes and to screen for mutant phenotypes directly in ES cells or their differentiated derivatives. PMID:10700192

Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

PubMed

Vieira, Ana Karine; Alvim, Cristina Gonçalves; Carneiro, Maria Cristina Marquez; Ibiapina, Cássio da Cunha

2016-01-01

To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter. Avaliar a função pulmonar e a capacidade funcional em crianças e adolescentes com doença falciforme. Estudo transversal com 70 crianças e adolescentes com doença falciforme (8-15 anos), submetidos a testes de função respiratória (espirometria) e de capacidade funcional (teste de caminhada de seis minutos). Os resultados da avaliação da função pulmonar foram comparados com variáveis relacionadas à gravidade da doença falciforme e à presença de história de asma e de síndrome torácica aguda. Dos 64 pacientes submetidos à espirometria, 15 (23,4%) apresentaram resultados alterados: distúrbio ventilatório restritivo, em 8; (12,5%) e distúrbio respiratório obstrutivo, em 7 (10,9%). Dos 69 pacientes submetidos ao teste de caminhada de seis minutos, 18 (26,1%) apresentaram resultados alterados na distância em % do previsto para a idade, e houve uma queda ≥ 3% na SpO2 em 36 (52,2%) dos pacientes. Não houve associações significativas entre função pulmonar alterada e as outras variáveis analisadas, exceto para hipoxemia e distúrbio ventilatório restritivo. Observou-se uma significativa prevalência de alterações na função pulmonar nesta amostra de crianças e adolescentes com doença falciforme. A elevada prevalência de distúrbios ventilatórios sugere a necessidade de um olhar mais atento à função pulmonar desde a infância nessa população.

Relationships (II) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with ventilatory functions indices for parenchymal abnormalities.

PubMed

Tamura, Taro; Suganuma, Narufumi; Hering, Kurt G; Vehmas, Tapio; Itoh, Harumi; Akira, Masanori; Takashima, Yoshihiro; Hirano, Harukazu; Kusaka, Yukinori

2015-01-01

The International Classification of High-Resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) is used to screen and diagnose respiratory illnesses. Using univariate and multivariate analysis, we investigated the relationship between subject characteristics and parenchymal abnormalities according to ICOERD, and the results of ventilatory function tests (VFT). Thirty-five patients with and 27 controls without mineral-dust exposure underwent VFT and HRCT. We recorded all subjects' occupational history for mineral dust exposure and smoking history. Experts independently assessed HRCT using the ICOERD parenchymal abnormalities (Items) grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). High-resolution computed tomography showed that 11 patients had RO; 15 patients, IR; and 19 patients, EM. According to the multiple regression model, age and height had significant associations with many indices ventilatory functions such as vital capacity, forced vital capacity, and forced expiratory volume in 1 s (FEV1). The EM summed grades on the upper, middle, and lower zones of the right and left lungs also had significant associations with FEV1 and the maximum mid-expiratory flow rate. The results suggest the ICOERD notation is adequate based on the good and significant multiple regression modeling of ventilatory function with the EM summed grades.

Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival.

PubMed

Strömsöe, Anneli; Svensson, Leif; Axelsson, Åsa B; Claesson, Andreas; Göransson, Katarina E; Nordberg, Per; Herlitz, Johan

2015-04-07

To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation. All cases of OHCA (n = 59,926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100,000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P < 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008-2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008-2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm. From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Phenytoin Induced Erythema Multiforme after Cranial Radiation Therapy

PubMed Central

Tekkök, İsmail Hakkı

2015-01-01

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM. PMID:26361537

Global Emergency Medicine: A review of the literature from 2017.

PubMed

Becker, Torben K; Trehan, Indi; Hayward, Alison Schroth; Hexom, Braden J; Kivlehan, Sean M; Lunney, Kevin M; Modi, Payal; Osei-Ampofo, Maxwell; Pousson, Amelia; Cho, Daniel K; Levine, Adam C

2018-05-23

The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 848 articles met our inclusion criteria and underwent full review. 63% were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as emergency medicine development. 21 articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's Kappa of 0.344. In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Incidence of Y-chromosome microdeletions in children whose fathers underwent vasectomy reversal or in vitro fertilization with epididymal sperm aspiration: a case-control study.

PubMed

Ghirelli-Filho, Milton; Marchi, Patricia Leme de; Mafra, Fernanda Abani; Cavalcanti, Viviane; Christofolini, Denise Maria; Barbosa, Caio Parente; Bianco, Bianca; Glina, Sidney

2016-01-01

To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions. Avaliar a incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados submetidos à reversão de vasectomia ou fertilização in vitro com recuperação de espermatozoides por aspiração do epidídimo (aspiração percutânea de espermatozoides do epidídimo). Estudo caso-controle que compreende crianças do sexo masculino de casais em que o homem havia sido previamente vasectomizado e escolheu reversão da vasectomia (n=31) ou fertilização in vitro com recuperação espermática por aspiração percutânea de espermatozoides do epidídimo (n=30) para obtenção de novos filhos, e um Grupo Controle de crianças do sexo masculino de homens férteis com vasectomia programada (n=60). A pesquisa de microdeleções do cromossomo Y foi realizada por reação em cadeia da polimerase nos pais e filhos, avaliando 20 regiões do cromossomo. O resultado não revelou microdeleções do cromossomo Y em qualquer indivíduo estudado. A incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados que sofreram reversão de vasectomia ou fertilização in vitro com espermatozoides recuperados pela aspiração percutânea de espermatozoides do epidídimo não diferiu entre os grupos, e não houve nenhuma diferença entre indivíduos controle nascidos de gestações naturais ou incidência populacional em homens férteis. Não foi encontrada nenhuma associação considerando microdeleções da região do fator de azoospermia no cromossomo Y e reprodução assistida. Não houve correlação entre microdeleções do cromossomo Y e vasectomia, o que sugere que as técnicas de reprodução assistida não aumentam a incidência de microdeleções do cromossomo Y.

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.

The Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Region, Mali).

PubMed

Ravit, Marion; Philibert, Aline; Tourigny, Caroline; Traore, Mamadou; Coulibaly, Aliou; Dumont, Alexandre; Fournier, Pierre

2015-08-01

The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. Household socioeconomic status was assessed using a wealth index constructed with a principal component analysis. The factors significantly associated with expenses were determined using multivariate linear regression analyses. Women in the Kayes region spent on average 77,017 FCFA (163 USD) for a caesarean episode in EmONC, of which 70 % was for treatment. Despite the caesarean fee exemption, 91 % of the women still paid for their treatment. The largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. Near-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. Although abolishing fees of EmONC in Mali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. There are still barriers to EmONC access for women of the lowest socio-economic group. These included direct expenses for drugs prescription, treatment and indirect expenses for transport and food.

Effect of extracorporeal magnetic energy stimulation on bothersome lower urinary tract symptoms and quality of life in female patients with stress urinary incontinence and overactive bladder.

PubMed

Lo, Tsia-Shu; Tseng, Ling-Hong; Lin, Yi-Hao; Liang, Ching-Chung; Lu, Ching-Yi; Pue, Leng Boi

2013-11-01

The aim of this study was to investigate the efficacy of extracorporeal magnetic stimulation (EMS) for the treatment of bothersome and severe symptoms of stress urinary incontinence (SUI) and overactive bladder syndrome (OAB) in female patients. A retrospective review was conducted on patients with SUI and OAB who were referred to EMS therapy. Successful treatment for the bothersome symptoms of OAB and SUI was defined as score ≤1 for questions 2 and 3 on the Urodynamic Distress Inventory-6. The objective cure of SUI and OAB was defined as no urinary leakage during the cough stress test and any urgency, urge incontinence and voiding frequency of less than eight times per 24 h based on the 3-day bladder diary, after the 9 weeks of treatment, respectively. Ninety-three patients with SUI or OAB underwent a 9-week course of EMS at 20 min twice weekly. Seventy-two (77%) patients completed EMS treatment. Geographical factor and poor economic status were two main factors for dropout. A total of 94.1% (32 of 34) and 86.8% (33 of 38) of subjects had successful treatment for the bothersome symptoms of OAB and SUI, respectively. In contrast, the cure rate for OAB and SUI was only 61.7% and 42.1%, respectively. There was also a significant improvement in both Urogenital Distress Inventory Short Form (bothersome on lower urinary tract symptoms) and the Incontinence Impact Questionnaire Short Form (quality of life) total score in both groups after EMS. EMS is a safe and effective alternative method for treating SUI and OAB. Further studies are needed to evaluate the long-term efficacy. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

PREVALENCE OF HELICOBACTER PYLORI TEN YEARS AGO COMPARED TO THE CURRENT PREVALENCE IN PATIENTS UNDERGOING UPPER ENDOSCOPY.

PubMed

Frugis, Sandra; Czeczko, Nicolau Gregori; Malafaia, Osvaldo; Parada, Artur Adolfo; Poletti, Paula Bechara; Secchi, Thiago Festa; Degiovani, Matheus; Rampanazzo-Neto, Alécio; D Agostino, Mariza D

2016-01-01

Helicobacter pylori has been extensively studied since 1982 it is estimated that 50% of the world population is affected. The literature lacks studies that show the change of its prevalence in the same population over time. To compare the prevalence of H. pylori in 10 years interval in a population that was submitted to upper endoscopy in the same endoscopy service. Observational, retrospective and cross-sectional study comparing the prevalence of H. pylori in two samples with 10 years apart (2004 and 2014) who underwent endoscopy with biopsy and urease. Patients were studied in three consecutive months of 2004, compared to three consecutive months of 2014. The total number of patients was 2536, and 1406 in 2004 and 1130 in 2014. There were positive for H. pylori in 17 % of the sample as a whole. There was a significant decrease in the prevalence from 19.3% in 2004 to 14.1% in 2014 (p<0.005). There was a 5.2% reduction in the prevalence of H. pylori comparing two periods of three consecutive months with 10 years apart in two equivalent population samples. Helicobacter pylori vem sendo amplamente estudado desde 1982 estimando-se que 50% da população mundial esteja afetada. A literatura carece de estudos que mostrem a mudança de sua prevalência em uma mesma população ao longo do tempo. Comparar a prevalência do H.pylori no intervalo de 10 anos em população que realizou endoscopia digestiva alta no mesmo serviço de endoscopia. Estudo observacional, retrospectivo e transversal, comparando a prevalência de H. pylori em duas amostras com intervalo de 10 anos (2004 e 2014) que realizaram endoscopia digestiva alta com biópsias e teste da urease para a pesquisa de H. pylori. Foram estudados pacientes em três meses consecutivos de 2004, comparados aos de três meses consecutivos de 2014. O número total de pacientes avaliados foi 2536, sendo 1406 em 2004 e 1130 em 2014. Constatou-se resultado positivo para H.pylori em 17% da amostra como um todo. Houve queda significativa da prevalência de H.pylori de 19,3% em 2004 para 14,1% em 2014 (p<0.005). Houve redução de 5,2% da prevalência de H. pylori comparando-se dois períodos de três meses consecutivos com intervalo de 10 anos em duas amostras populacionais equivalentes.

8p11 myeloproliferative syndrome: diagnostic challenges and pitfalls.

PubMed

Antic, Darko A; Vukovic, Vojin M; Milosevic Feenstra, Jelena D; Kralovics, Robert; Bogdanovic, Andrija D; Dencic Fekete, Marija S; Mihaljevic, Biljana S

2016-01-01

8p11 myeloproliferative syndrome (EMS) is a very rare clinicopathological entity which is characterized by the appearance of a myeloproliferative neoplasm in the bone marrow, peripheral lymphadenopathy, usually caused by T or B lymphoblastic lymphoma/leukemia, and a reciprocal translocation involving chromosome 8p11. Herein we describe a 22-year-old male patient with unusual clinical presentation of EMS. Namely, he initially presented with prolonged epistaxis. Complete blood count showed elevated hemoglobin (17.7g/dl), thrombocytopenia (98x109/l) and leukocytosis (57x109/l). Bone marrow aspirate and biopsy findings corresponded with the presence of a myeloproliferative neoplasm while cytogenetic analysis revealed t(8;13)(p11q12). After that ZMYM2-FGFR1 in-frame fusion was confirmed at the molecular level. Immediately after establishing the diagnosis of a myeloproliferative neoplasm (MPN) generalized lymphadenopathy was developed. Histopathologic examination of lymph node sample confirmed the diagnosis of a T cell lymphoblastic lymphoma without bone marrow involvement. Four cycles of Hyper CVAD chemotherapy were administered with complete morphological and cytogenetic remission. Four weeks after evaluation, patient developed peripheral blood monocytosis and eosinophilia without bone marrow criteria for acute leukemia. Cytogenetic analysis showed t(8;13) accompanied by complex numerical and structural aberrations. The patient underwent allogeneic stem cell transplantation (allo-SCT) from HLA matched sister and he subsequently achieved complete remission. In conclusion, patients with MPN and translocations involving chromosome 8 need to be carefully evaluated for EMS. However, having in mind the very aggressive clinical course of EMS allo-SCT is the only potential curative option.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

PubMed

Işıl, Rıza Gürhan; Yazıcı, Pınar; Demir, Uygar; Kaya, Cemal; Bostancı, Özgür; İdiz, Ufuk Oğuz; Işıl, Canan Tülay; Demircioğlu, Mahmut Kaan; Mihmanlı, Mehmet

2017-03-01

Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

Trapped as a Group, Escape as a Team: Applying Gamification to Incorporate Team-building Skills Through an ‘Escape Room’ Experience

PubMed Central

Lee, Hyunjoo; Rodriguez, Carlos; Rudner, Joshua; Chan, Teresa M; Papanagnou, Dimitrios

2018-01-01

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational ‘Escape Rooms’ have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively ‘escape the room’ in the time allotted. In this regard, escape rooms share many parallels with the multitasking and teamwork that is essential for a successful emergency department (ED) shift. A pilot group of nine emergency medicine (EM) residents and one senior EM faculty member underwent a commercial escape room as part of a team-building exercise in January 2018. The escape room required participants to practice teamwork, communication, task delegation, and critical thinking to tackle waves of increasingly complex puzzles, ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), and symbol matching. Activities required members to recognize and utilize the collective experiences, skills, knowledge base, and physical abilities of the group. After the game, players underwent a structured ‘game-master’ debriefing facilitated by an employee of the commercial escape room; this was followed by a post-event survey facilitated by a faculty member, which focused on participants’ feelings, experiences, and problem-solving techniques. Escape rooms afford learners the opportunity to engage in an activity that rewards teamwork and effective leadership through experiences that directly link to specific ACGME milestones and educational learning theories. EM participants were engaged in the activity and felt that the escape room reproduced an environment analogous to the ED. The debriefing that followed the activity provided a satisfactory conclusion to the experience; but learners preferred a more organized debriefing format that provided them with constructive and specific feedback on their performance. PMID:29725559

Trapped as a Group, Escape as a Team: Applying Gamification to Incorporate Team-building Skills Through an 'Escape Room' Experience.

PubMed

Zhang, Xiao Chi; Lee, Hyunjoo; Rodriguez, Carlos; Rudner, Joshua; Chan, Teresa M; Papanagnou, Dimitrios

2018-03-02

Teamwork, a skill critical for quality patient care, is recognized as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). To date, there is no consensus on how to effectively teach these skills in a forum that engages learners, immerses members in life-like activities, and builds both trust and rapport. Recreational 'Escape Rooms' have gained popularity in creating a life-like environment that rewards players for working together, solving puzzles, and completing successions of mind-bending tasks in order to effectively 'escape the room' in the time allotted. In this regard, escape rooms share many parallels with the multitasking and teamwork that is essential for a successful emergency department (ED) shift. A pilot group of nine emergency medicine (EM) residents and one senior EM faculty member underwent a commercial escape room as part of a team-building exercise in January 2018. The escape room required participants to practice teamwork, communication, task delegation, and critical thinking to tackle waves of increasingly complex puzzles, ranging from hidden objects, physical object assembly (i.e., jigsaw puzzles), and symbol matching. Activities required members to recognize and utilize the collective experiences, skills, knowledge base, and physical abilities of the group. After the game, players underwent a structured 'game-master' debriefing facilitated by an employee of the commercial escape room; this was followed by a post-event survey facilitated by a faculty member, which focused on participants' feelings, experiences, and problem-solving techniques. Escape rooms afford learners the opportunity to engage in an activity that rewards teamwork and effective leadership through experiences that directly link to specific ACGME milestones and educational learning theories. EM participants were engaged in the activity and felt that the escape room reproduced an environment analogous to the ED. The debriefing that followed the activity provided a satisfactory conclusion to the experience; but learners preferred a more organized debriefing format that provided them with constructive and specific feedback on their performance.

Transection of the hepatic parenchyma associated or not with the contralateral portal vein branch ligature and its effect in liver regeneration.

PubMed

Wiederkehr, Henrique de Aguiar; Wiederkehr, Julio Cesar; Collaço, Luiz Martins; Sousa, Eros Luiz de; Salvalaggio, Paolo; Carvalho, Caroline Aragão de; Wiederkehr, Barbara de Aguiar; Marques, Camila Aparecida Moraes; Rosa, Francielle França da; Nanni, Felipe de Negreiros; Fuchs, Taíse

2017-01-01

To analyze the influence of portal vein ligation in hepatic regeneration by immunohistochemical criteria. Ten pigs divided into two groups of five animals underwent hepatectomy in two stages, and the groups were differentiated by ligation or not of the left portal vein tributary, which is responsible for vascularization of the left lateral and medial lobes of the pig liver. Five days after the procedure, the animals underwent liver biopsies for further analysis of histological and immunohistochemical with marker Ki67. The group submitted to hepatectomy with vascular ligation showed an increase of approximately 4% of hepatocytes in regeneration status, as well as a greater presence of Kupffer and inflammatory cells as compared to control. As a result of positive cell replication observed through the Ki67 marker, we can suspect that the ligation of a tributary of the portal vein associated with liver resection promoted a greater stimulus of liver regeneration when compared to liver resection alone. Analisar a influência da ligadura da tributária da veia porta no estímulo regenerativo hepático por meio de critérios imuno-histoquímicos. Dez suínos, divididos em dois grupos de cinco animais, foram submetidos à hepatectomia em dois estágios, sendo que os grupos foram diferenciados pela ligadura ou não da tributária da veia porta, responsável pela vascularização dos lobos lateral e medial esquerdos do fígado do suíno. Cinco dias após o procedimento, os animais foram reabordados para retirada de amostras hepáticas para posterior análise de histológica e imunoistoquímica com o marcador Ki67. O grupo submetido à hepatectomia com ligadura vascular apresentou incremento de 4% aproximadamente de hepatócitos em processo de regeneração, bem como grande número de células de Kupffer e células inflamatórias, quando comparado ao controle. Em virtude da análise positiva da replicação celular observada por meio do marcador Ki67, pode-se observar que a ligadura de uma tributária da veia porta promoveu um maior estímulo de regeneração hepática, efeito observado com menor intensidade no grupo submetido apenas à ressecção hepática.

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study.

PubMed

Trimmel, Helmut; Beywinkler, Christoph; Hornung, Sonja; Kreutziger, Janett; Voelckel, Wolfgang G

2017-04-26

Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer's qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5-42.5) vs. 19.0 (15.0-27.0) during initial training; 62.0 (41.8-86.5) vs. 33.5 (18.0-54.5) during the first, and 64.0 (34.5-93.8) vs. 27 (12.5-56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0-14.8) TIs vs. 0.0 (0.0-0.0) SGA cases during the first, and 9.0 (7.0-13.8) TIs vs. 0.0 (0.0-0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency. CONCLUSIONS: In-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities.

Effects of various freezing containers for vitrification freezing on mouse oogenesis.

PubMed

Kim, Ji Chul; Kim, Jae Myeoung; Seo, Byoung Boo

2016-01-01

In the present study, various freezing containers were tested for mouse embryos of respective developmental stages; embryos were vitrified and then their survival rate and developmental rate were monitored. Mouse two cell, 8 cell, and blastula stage embryos underwent vitrification freezing-thawing and then their recovery rate, survival rate, development rate, and hatching rate were investigated. EM-grid, OPS, and cryo-loop were utilized for vitrification freezing-thawing of mouse embryos. It was found that recovery rate and survival rate were higher in the group of cryo-loop compared to those of EM-grid (p < 0.05). Embryonic development rate, two cell embryos to blastocyst, as well as hatching rate were higher in the control group compared to the EM-grid group and OPS group (p < 0.05), yet no difference was noted between the control group and cryo-loop group. Development rate and hatching rate of eight cell morulae and blastocysts were all lower in the treatment groups than the control group whilst hatching rate of blastocysts was higher in the control group compared to the groups of EM-grid and OPS (p < 0.05); although the cryo-loop group was shown to be slightly higher than other groups, it was not statistically significant. In the study, we investigate effects of freezing containers on vitrified embryos of respective developmental stages; it was demonstrated that higher developmental rate was shown in more progressed (or developed) embryos with more blastomeres. There was however, no difference in embryonic development rate was shown amongst containers. Taken together, further additional studies are warranted with regards to 1) manipulation techniques of embryos for various vitrification freezing containers and 2) preventive measures against contamination via liquid nitrogen.

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First-Morning Micturition and in the Afternoon

PubMed Central

de Almeida, Antonio Eduardo Monteiro; Stein, Ricardo; Gus, Miguel; Nascimento, João Agnaldo; Belli, Karlyse Claudino; Arévalo, Jorge Rene Garcia; Fuchs, Flávio Dani

2014-01-01

Background The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers. Methods After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU). Result Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers. PMID:25352508

Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist.

PubMed

Taylor, Hugh S; Giudice, Linda C; Lessey, Bruce A; Abrao, Mauricio S; Kotarski, Jan; Archer, David F; Diamond, Michael P; Surrey, Eric; Johnson, Neil P; Watts, Nelson B; Gallagher, J Chris; Simon, James A; Carr, Bruce R; Dmowski, W Paul; Leyland, Nicholas; Rowan, Jean P; Duan, W Rachel; Ng, Juki; Schwefel, Brittany; Thomas, James W; Jain, Rita I; Chwalisz, Kristof

2017-07-06

Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to nearly full estrogen suppression in previous studies. We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II [EM-I and EM-II]) to evaluate the effects of two doses of elagolix - 150 mg once daily (lower-dose group) and 200 mg twice daily (higher-dose group) - as compared with placebo in women with surgically diagnosed endometriosis and moderate or severe endometriosis-associated pain. The two primary efficacy end points were the proportion of women who had a clinical response with respect to dysmenorrhea and the proportion who had a clinical response with respect to nonmenstrual pelvic pain at 3 months. Each of these end points was measured as a clinically meaningful reduction in the pain score and a decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary. A total of 872 women underwent randomization in Elaris EM-I and 817 in Elaris EM-II; of these women, 653 (74.9%) and 632 (77.4%), respectively, completed the intervention. At 3 months, a significantly greater proportion of women who received each elagolix dose met the clinical response criteria for the two primary end points than did those who received placebo. In Elaris EM-I, the percentage of women who had a clinical response with respect to dysmenorrhea was 46.4% in the lower-dose elagolix group and 75.8% in the higher-dose elagolix group, as compared with 19.6% in the placebo group; in Elaris EM-II, the corresponding percentages were 43.4% and 72.4%, as compared with 22.7% (P<0.001 for all comparisons). In Elaris EM-I, the percentage of women who had a clinical response with respect to nonmenstrual pelvic pain was 50.4% in the lower-dose elagolix group and 54.5% in the higher-dose elagolix group, as compared with 36.5% in the placebo group (P<0.001 for all comparisons); in Elaris EM-II, the corresponding percentages were 49.8% and 57.8%, as compared with 36.5% (P=0.003 and P<0.001, respectively). The responses with respect to dysmenorrhea and nonmenstrual pelvic pain were sustained at 6 months. Women who received elagolix had higher rates of hot flushes (mostly mild or moderate), higher levels of serum lipids, and greater decreases from baseline in bone mineral density than did those who received placebo; there were no adverse endometrial findings. Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II ClinicalTrials.gov numbers, NCT01620528 and NCT01931670 .).

The viability of transplanting organs from donors who underwent cardiopulmonary resuscitation: A systematic review.

PubMed

West, Stephen; Soar, Jasmeet; Callaway, Clifton W

2016-11-01

To identify reports of patients who underwent cardiopulmonary resuscitation (CPR) prior to solid organ donation and compare recipient and organ function outcomes to those that did not undergo CPR. Donation after restoration of circulation then progressing to death and those donating with on-going CPR who would have otherwise have termination of efforts were both included. Systematic review. Clinical studies comparing the outcome of patients and organs retrieved from donors who underwent CPR with those that did not require CPR. Full-text articles were searched on EmBASE, MEDLINE, Cochrane Database of Systematic Reviews and the Cochrane Register of Controlled Trials. Twenty-two observational studies were included. There were 12,206 adult and 2552 paediatric organ transplantation identified. Comparing donation after restoration of circulation there was no difference in immediate, one year, and five-year graft function. Donation with on-going CPR was associated with reduced immediate graft function for both renal and hepatic transplantation, however long term function was not different. CPR does not appear to adversely affect graft function. Patients who have restored circulation after resuscitation and subsequently progress to death should be evaluated for organ donation. Those with on-going CPR should be considered for hepatic and renal transplantation but there may be worse initial graft function. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Improved Outcomes After Autologous Hematopoietic Cell Transplantation for Light Chain Amyloidosis: A Center for International Blood and Marrow Transplant Research Study

PubMed Central

D'Souza, Anita; Dispenzieri, Angela; Wirk, Baldeep; Zhang, Mei-Jie; Huang, Jiaxing; Gertz, Morie A.; Kyle, Robert A.; Kumar, Shaji; Comenzo, Raymond L.; Peter Gale, Robert; Lazarus, Hillard M.; Savani, Bipin N.; Cornell, Robert F.; Weiss, Brendan M.; Vogl, Dan T.; Freytes, César O.; Scott, Emma C.; Landau, Heather J.; Moreb, Jan S.; Costa, Luciano J.; Ramanathan, Muthalagu; Callander, Natalie S.; Kamble, Rammurti T.; Olsson, Richard F.; Ganguly, Siddhartha; Nishihori, Taiga; Kindwall-Keller, Tamila L.; Wood, William A.; Mark, Tomer M.; Hari, Parameswaran

2015-01-01

Purpose Autologous hematopoietic cell transplantation, or autotransplantation, is effective in light-chain amyloidosis (AL), but it is associated with a high risk of early mortality (EM). In a multicenter randomized comparison against oral chemotherapy, autotransplantation was associated with 24% EM. We analyzed trends in outcomes after autologous hematopoietic cell transplantation for AL in North America. Patients and Methods Between 1995 and 2012, 1,536 patients with AL who underwent autotransplantation at 134 centers were identified in the Center for International Blood and Marrow Transplant Research database. EM and overall survival (OS) were analyzed in three time cohorts: 1995 to 2000 (n = 140), 2001 to 2006 (n = 596), and 2007 to 2012 (n = 800). Hematologic and renal responses and factors associated with EM, relapse and/or progression, progression-free survival and OS were analyzed in more recent subgroups from 2001 to 2006 (n = 197) and from 2007 to 2012 (n = 157). Results Mortality at 30 and 100 days progressively declined over successive time periods from 11% and 20%, respectively, in 1995 to 2000 to 5% and 11%, respectively, in 2001 to 2006, and to 3% and 5%, respectively, in 2007 to 2012. Correspondingly, 5-year OS improved from 55% in 1995 to 2000 to 61% in 2001 to 2006 and to 77% in 2007 to 2012. Hematologic response to transplantation improved in the latest cohort. Renal response rate was 32%. Centers performing more than four AL transplantations per year had superior survival outcomes. In the multivariable analysis, cardiac AL was associated with high EM and inferior progression-free survival and OS. Autotransplantation in 2007 to 2012 and use of higher dosages of melphalan were associated with a lowered relapse risk. A Karnofsky score less than 80 and creatinine levels 2 mg/m2 or greater were associated with worsened OS. Conclusion Post-transplantation survival in AL has improved, with a dramatic reduction in early post-transplantation mortality and excellent 5-year survival. The risk-benefit ratio for autotransplantation has changed, and randomized comparison with nontransplantation approaches is again warranted. PMID:26371138

Endoscopic intracranial surgery enhanced by electromagnetic-guided neuronavigation in children.

PubMed

Hermann, Elvis J; Esmaeilzadeh, Majid; Ertl, Philipp; Polemikos, Manolis; Raab, Peter; Krauss, Joachim K

2015-08-01

Navigated intracranial endoscopy with conventional technique usually requires sharp head fixation. In children, especially in those younger than 1 year of age and in older children with thin skulls due to chronic hydrocephalus, sharp head fixation is not possible. Here, we studied the feasibility, safety, and accuracy of electromagnetic (EM)-navigated endoscopy in a series of children, obviating the need of sharp head fixation. Seventeen children (ten boys, seven girls) between 12 days and 16.8 years (mean age 4.3 years; median 14 months) underwent EM-navigated intracranial endoscopic surgery based on 3D MR imaging of the head. Inclusion criteria for the study were intraventricular cysts, arachnoid cysts, aqueduct stenosis for endoscopic third ventriculostomy (ETV) with distorted ventricular anatomy, the need of biopsy in intraventricular tumors, and multiloculated hydrocephalus. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface rendering in the supine position. After confirming accuracy, they were repositioned for endoscopic surgery with the head fixed slightly on a horseshoe headholder. EM navigation was performed using a flexible stylet introduced into the working channel of a rigid endoscope. Neuronavigation accuracy was checked for deviations measured in millimeters on screenshots after the referencing procedure and during surgery in the coronal (z = vertical), axial (x = mediolateral), and sagittal (y = anteroposterior) planes. EM-navigated endoscopy was feasible and safe. In all 17 patients, the aim of endoscopic surgery was achieved, except in one case in which a hemorrhage occurred, blurring visibility, and we proceeded with open surgery without complications for the patient. Navigation accuracy for extracranial markers such as the tragus, bregma, and nasion ranged between 1 and 2.5 mm. Accuracy for fixed anatomical structures like the optic nerve or the carotid artery varied between 2 and 4 mm, while there was a broader variance of accuracy at the target point of the cyst itself ranging between 2 and 9 mm. EM-navigated endoscopy in children is a safe and useful technique enhancing endoscopic intracranial surgery and obviating the need of sharp head fixation. It is a good alternative to the common opto-electric navigation system in this age group.

Hard metal lung disease: a case series.

PubMed

Mizutani, Rafael Futoshi; Terra-Filho, Mário; Lima, Evelise; Freitas, Carolina Salim Gonçalves; Chate, Rodrigo Caruso; Kairalla, Ronaldo Adib; Carvalho-Oliveira, Regiani; Santos, Ubiratan Paula

2016-01-01

To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis. Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.

ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

PubMed

Passos, Márcio Alexandre Terra; Portari-Filho, Pedro Eder

2016-01-01

Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis. Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection. A colecistectomia laparoscópica eletiva apresenta risco muito baixo para complicações infecciosas, com média de infecção entre 0,4% a 1,1%. Muitos cirurgiões ainda utilizam de rotina profilaxia antibiótica. Avaliar a real necessidade de profilaxia antibiótica em colecistectomias laparoscópicas eletivas em pacientes de baixo risco para infecção do sítio cirúrgico. Estudo prospectivo, randomizado e duplo-cego, em pacientes submetidos à colecistectomia laparoscópica eletiva, envolvendo 100 pacientes em dois grupos: A (n=50), que receberam profilaxia com cefazolina 2 g intravenoso na indução anestésica; B (n=50), não foi utilizado antibiótico. O desfecho avaliado foi presença de complicações infecciosas de sítio cirúrgico. Os pacientes foram revisados em sete e 30 dias no pós-operatório. As taxas de complicações infecciosas foi de 2% no grupo A e de também 2% no grupo B. Não houve diferença estatisticamente significativa (p>0,05) entre os grupos que foram homogêneos e comparáveis. A antibioticoprofilaxia na colecistectomia laparoscópica em pacientes de baixo risco não apresenta nenhum benefício significativo na redução da incidência de infecção do sítio cirúrgico.

Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis.

PubMed

Hillenbrand, Andreas; Beck, Annika; Kratzer, Wolfgang; Graeter, Tilmann; Barth, Thomas F E; Schmidberger, Julian; Möller, Peter; Henne-Bruns, Doris; Gruener, Beate

2018-06-16

Alveolar echinococcosis (AE) is a life-threatening helminthic disease. In humans, AE mostly affects the liver; the regional hepatic lymph nodes may be involved, indicating dissemination of AE from the liver. To achieve complete removal of the disease, enlarged hepatic lymph nodes may be resected during surgical treatment. We evaluated the frequency of affected lymph nodes by conventional microscopic and immunohistochemical analyses including detection of small particles of Echinococcus multilocularis (spem). Furthermore, we analyzed the association of resection of enlarged and affected lymph nodes with long-term outcome after surgical therapy of patients who underwent surgery with curative intent. We identified 43 patients who underwent hepatic surgery with curative intent with lymph node resection for AE. We analyzed the cohort for the manifestation of the parasite in the resected lymph nodes by conventional histology and by immunohistochemistry and compared these data with the further course of AE. Microscopically infected lymph nodes (laminar layer visible) were found in 7 out of these 43 patients (16%). In more than three quarters (25/32) of all specimens investigated, lymph nodes showed spems when stained with antibody against Em2G11, a monoclonal antibody specific for the Em2 antigen of the Echinococcus multilocularis metacestode. Most frequently, lymph nodes were resected due to enlargement. The median size of microscopically affected lymph nodes was 2 cm (range, 1.2 to 2.5 cm), the median size of immunohistochemically and non-affected lymph nodes was 1.3 cm each (range, "small" to 2.3 or 2.5 cm, respectively). Median follow-up was 8 years for all patients, 5 years for patients with lymph node resection, and 4 years for patients with infested lymph nodes. Overall, recurrent disease was seen in ten patients (10/109; 9%) after a median period of 1.5 years (range, 4 months to 4 years). None of the seven patients with conventionally microscopically affected lymph nodes suffered from recurrent disease. One patient with negative resected nodes and one patient with spems showed recurrent disease after 4 and 35 months, respectively. Lymph node involvement in AE is frequent, particularly when evaluated by immunohistochemical examination of lymph nodes with the monoclonal antibody Em2G11. Affected lymph nodes tend to be larger in size. Lymph node involvement is not associated with recurrent disease and therefore warrants further analysis of the biological significance of lymph node involvement.

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.

Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial.

PubMed

Odaka, Takeo; Yamato, Shigeru; Yokosuka, Osamu

2017-01-01

Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment. To clarify the characteristics of esophageal motility in patients with PPI-refractory NERD, we evaluated esophageal function using combined multichannel intraluminal impedance and esophageal manometry (MII-EM). In addition, we evaluated the efficacy of rikkunshito (RKT), which is a gastrointestinal prokinetic agent. Thirty patients with NERD were enrolled and underwent MII-EM. After 8 weeks of RKT (7.5 g/d) treatment, MII-EM was repeated on patients with PPI-refractory NERD. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale. In patients with PPI-refractory NERD, measures of complete bolus transit, peristaltic contractions, and residual pressure of the lower esophageal sphincter during swallowing deviated from the standard values and esophageal clearance was found to be deteriorated. RKT significantly improved the peristaltic contractions ( P < 0.05), the complete bolus transit ( P < 0.01), and the residual pressure of lower esophageal sphincter ( P < 0.05) in these patients. The overall score ( P < 0.01) and the subscale scores of acid reflux syndrome ( P < 0.05), abdominal pain ( P < 0.05), and indigestion syndrome ( P < 0.01) in the Gastrointestinal Symptom Rating Scale were significantly improved by the 8-week RKT treatment. In the pilot study, patients with PPI-refractory NERD had disorders of esophageal and lower esophageal sphincter motility that were improved by RKT. Further studies examining esophageal motor activity of RKT in PPI-refractory NERD are required. University hospital Medical Information Network (UMIN) Clinical Trial Registry identifier: UMIN000003092.

An observational study of Venlafaxine and CYP2D6 in clinical practice.

PubMed

Rolla, R; Gramaglia, Carla; Dalò, Valentina; Ressico, Francesca; Prosperini, Pierluigi; Vidali, Matteo; Meola, Silvia; Pollarolo, Paola; Bellomo, Giorgio; Torre, Eugenio; Zeppegno, Patrizia

2014-01-01

Venlafaxine (V) is a serotonin-norepinephrine selective reuptake inhibitor, mainly metabolized by cytochrome P4502D6 (CYP2D6). CYP2D6 polymorphisms result in a variety of phenotypes: poor (PMs), intermediate (IMs), extensive (EMs), and ultrarapid metabolizers (UMs). PMs usually show poor tolerance to drugs metabolized by CYP2D6, while UMs need greater doses. The aim of this study was to evaluate the impact of CYP2D6 genotype on V dosage, therapeutic response, and side effects in a clinical outpatient setting. 47 patients with Major Depressive Disorder, treated with V 75 - 300 mg/day, underwent CYP2D6 genotyping using the INFINITI-CYP2D6 assay. Duration of treatment and clinical outcome (Clinical Global Impression [CGI] effectiveness index) were assessed. CGI assessment was performed after 6 weeks, 6 months, and 1 year of treatment with a V median dose of 150 mg/day. CYP2D6 genotyping resulted in 1 PM, 3 IMs, 42 EMs, and 1 UM. The UM took the greatest V dose (375 mg) without side effects; IMs/PMs took moderate/high doses of V (150 - 300 mg) without adverse effects; EMs displayed high response variability. PM/IM patients responded to V differently than expected according to genotype. However, the UM patient responded to a dosage higher than the usual therapeutic range and without developing side effects, suggesting an association between CYP2D6 gene duplication and the therapeutic efficacy of venlafaxine. The CYP2D6 genotyping may thus provide clinicians with a potential explanation for those patients requiring greater doses of CYP2D6 substrates in order to obtain the same therapeutic efficacy.

Global Emergency Medicine: A Review of the Literature From 2015.

PubMed

Becker, Torben K; Hansoti, Bhakti; Bartels, Susan; Bisanzo, Mark; Jacquet, Gabrielle A; Lunney, Kevin; Marsh, Regan; Osei-Ampofo, Maxwell; Trehan, Indi; Lam, Christopher; Levine, Adam C

2016-10-01

The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year 12,435 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 723 articles were deemed appropriate by at least one reviewer and approved by their editor for formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 723 articles met our predetermined inclusion criteria and underwent full review. Sixty percent were categorized as emergency care in resource-limited settings (ECRLS), 17% as EM development (EMD), and 23% as disaster and humanitarian response (DHR). Twenty-four articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability between reviewers gave an intraclass correlation coefficient of 0.71 (95% confidence interval = 0.66 to 0.75). Studies and reviews with a focus on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. In 2015, there were almost twice as many articles found by our search compared to the 2014 review. The number of EMD articles increased, while the number ECRLS articles decreased. The number of DHR articles remained stable. As in prior years, the majority of articles focused on infectious diseases. © 2016 by the Society for Academic Emergency Medicine.

Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals.

PubMed

Cohanzad, Shahryar

2016-02-01

To introduce the operative technique of "extensive metoidioplasty" (EM) in female transsexual surgery, for achieving an effective reconstruction of a male-appearing, normally functioning, fully sensate and erectile external genitalia. Ten female transsexuals (46 xx karyotype) between the ages of 20 and 40 years underwent EM as their sex reassignment surgical procedure with the mean operative time of 171 min (45-211, SD 19.55 min) between 2007 and 2014 in a general hospital in Tehran, Iran. Subjects were closely followed for the mean time of 68.4 months. All participants were thoroughly rehearsed about the nature of their surgical procedure and an informed written consent was obtained before surgery. We extensively detached the native clitoris to the point of a nearly complete detachment from its attachments to the pubic arch and approximated the originally divergent corporal bodies to each other. We were also able to increase the penile size by the application of PEP, a procedure which is in practice at our clinic. Postoperatively all ten patients achieved a mean penile length of 8.7 (6-12) cm and 7/10 (70 %) were capable of obtaining erection, rigid enough for intromission. We did not observe any significant postoperative complications. EM in association with the application of PEP could result in a natural-looking, erotically fully sensate and functional penis in majority of female transsexuals undergoing this procedure. This operative technique should be given serious considerations in well-informed female transsexual. Larger studies may be needed to validate this technique further. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Impaired pulmonary function after treatment for tuberculosis: the end of the disease?

PubMed

Chushkin, Mikhail Ivanovich; Ots, Oleg Nikolayevich

2017-01-01

To evaluate the prevalence of pulmonary function abnormalities and to investigate the factors affecting lung function in patients treated for pulmonary tuberculosis. A total of 214 consecutive patients (132 men and 82 women; 20-82 years of age), treated for pulmonary tuberculosis and followed at a local dispensary, underwent spirometry and plethysmography at least one year after treatment. Pulmonary impairment was present in 102 (47.7%) of the 214 patients evaluated. The most common functional alteration was obstructive lung disease (seen in 34.6%). Of the 214 patients, 60 (28.0%) showed reduced pulmonary function (FEV1 below the lower limit of normal). Risk factors for reduced pulmonary function were having had culture-positive pulmonary tuberculosis in the past, being over 50 years of age, having recurrent tuberculosis, and having a lower level of education. Nearly half of all tuberculosis patients evolve to impaired pulmonary function. That underscores the need for pulmonary function testing after the end of treatment. Avaliar a prevalência de alterações da função pulmonar e investigar os fatores que afetam a função pulmonar em pacientes tratados para tuberculose pulmonar. Um total de 214 pacientes consecutivos (132 homens e 82 mulheres; 20-82 anos de idade), tratados para tuberculose pulmonar e acompanhados em um dispensário local, foi submetido a espirometria e pletismografia pelo menos um ano após o tratamento. O comprometimento pulmonar estava presente em 102 (47,7%) dos 214 pacientes avaliados. A alteração funcional mais comum foi o distúrbio ventilatório obstrutivo (observado em 34,6%). Dos 214 pacientes, 60 (28,0%) apresentaram função pulmonar reduzida (VEF1 abaixo do limite inferior de normalidade). Os fatores de risco para função pulmonar reduzida foram tuberculose pulmonar com cultura positiva no passado, idade acima de 50 anos, recidiva de tuberculose e menor nível de escolaridade. Quase metade de todos os pacientes com tuberculose evolui com comprometimento da função pulmonar. Isso reforça a necessidade de testes de função pulmonar após o término do tratamento.

Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion.

PubMed

Araujo, Pedro Henrique Xavier Nabuco de; Terra, Ricardo Mingarini; Santos, Thiago da Silva; Chate, Rodrigo Caruso; Paiva, Antonio Fernando Lins de; Pêgo-Fernandes, Paulo Manuel

2017-01-01

To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: -225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE. Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de coorte maior com pacientes com DPMR recrutados em um hospital-escola universitário terciário entre junho de 2009 e setembro de 2014. Os pacientes foram submetidos a inserção de cateter pleural e, em seguida, pleurodese à beira do leito. A TC de tórax foi realizada duas vezes: imediatamente antes da pleurodese (TCi) e 30 dias após a pleurodese (TC30). Com base na TCi, a posição do cateter foi classificada em posterolateral, anterior, fissural e subpulmonar. Usamos o volume pleural na TCi para estimar a expansão pulmonar precoce e a diferença entre os volumes pleurais na TC30 e na TCi a fim de avaliar o sucesso radiológico da pleurodese. Considerou-se que a pleurodese teve êxito clínico quando não foi necessário realizar nenhum outro procedimento pleural. Dos 131 pacientes elegíveis do estudo original, 85 foram incluídos neste estudo aninhado (64 mulheres; média de idade: 60,74 anos). A posição da ponta do cateter foi subpulmonar em 35 pacientes (41%), anterior em 23 (27%), posterolateral em 17 (20%) e fissural em 10 (12%). Não houve diferenças significativas entre os grupos quanto à expansão pulmonar precoce (mediana da cavidade pleural residual = 377 ml; intervalo interquartil: 171-722 ml; p = 0,645), sucesso radiológico da pleurodese (mediana do volume = 33 ml; intervalo interquartil: -225 a 257 ml; p = 0,923) e sucesso clínico da pleurodese (85,8%; p = 0,676). Nossos resultados sugerem que a posição da ponta do cateter pleural não influencia nem a expansão pulmonar precoce nem o sucesso da pleurodese à beira do leito em pacientes com DPMR.

Mantle transition zone-derived EM1 component beneath NE China: Geochemical evidence from Cenozoic potassic basalts

NASA Astrophysics Data System (ADS)

Wang, Xiao-Jun; Chen, Li-Hui; Hofmann, Albrecht W.; Mao, Fu-Gen; Liu, Jian-Qiang; Zhong, Yuan; Xie, Lie-Wen; Yang, Yue-Heng

2017-05-01

The isotopic characteristics of the sub-oceanic mantle are well established, but in continental regions these properties are usually obscured, and therefore controversial, because of the potential effects of crustal contamination together with lithospheric mantle metasomatism and melting. The so-called EM1 (Enriched Mantle-1) signature, characterized by low 206Pb/204Pb and 143Nd/144Nd ratios, is particularly problematic in this respect because EM1-type OIB sources are commonly attributed to recycled crust and/or lithospheric mantle. In this paper we show that a suite of Cenozoic potassic basalts from NE China displays many previously unrecognized correlations between chemical and isotopic parameters, which tightly constrain the isotopic characteristics of an extreme EM1-type mantle source located in the asthenosphere. Its radiogenic isotopes are similar to, but even more extreme than, those of the oceanic endmember composition represented by the Pitcairn hotspot, namely 206Pb/204Pb ≤ 16.5, 143Nd/144Nd ≤ 0.5123 (or εNd ≤ - 6.4), 176Hf/177Hf ≤ 0.2825 (or εHf ≤ - 10.1). These characteristics require a source of recycled crustal material of Precambrian age (∼2.2 Ga). An important new constraint is the Mg isotopic composition of δ26 Mg (≤ - 0.6 ‰), which is lower than normal mantle (δ26 Mg = - 0.25 ± 0.07 ‰) and lower crustal values (δ26 Mg = - 0.29 ± 0.15 ‰), but consistent with sedimentary carbonate (δ26 Mg = - 5.57 ‰ to - 0.38 ‰). The endmember EM1 source produced high-SiO2 melts with low MgO, CaO/Al2O3 and δ26 Mg values, exceptionally high K/U ≅ 50,000, Ba/Th ≅ 400, low U/Pb ≅ 0.06, and positive Zr and Hf anomalies. The chemical and isotopic parameters of this potassic basalt suite form binary mixing arrays, one end point of which is the inferred asthenospheric EM1 reservoir, whereas the other is a more ordinary, depleted mantle component, which is also sampled by local lithospheric mantle xenoliths. These binary arrays include well-developed correlations between Sr, Nd, Hf, Pb and Mg isotopes, negative correlations of 206Pb/204Pb with K2 O, K/U, Hf/Hf*, positive correlations of δ26 Mg with MgO, and 143Nd/144Nd with Fe2OT3 and U/Pb. We propose that the EM1 reservoir contains recycled ancient carbonate-bearing sediments, subducted into the mantle transition zone, where K, Rb, Ba and Pb are sequestered by K-hollandite as suggested by Murphy et al. (2002) for the Gaussberg lamproites. Loss of small amounts of carbonate melt extracted Th, U and some of the LREE, while retaining K, Rb, Ba, Pb, Zr and Hf in the residue, thereby generating the observed trace element anomalies. In Cenozoic time, this deep EM1 reservoir ascended into the shallow asthenosphere and underwent low-degree partial melting, at pressures below the stability field of K-hollandite, thereby releasing K, Rb and Ba into the melt. The partial melts ascended through subcontinental lithosphere and were progressively modified by interaction with the lithospheric mantle, thus accounting for the linear chemical and isotopic trends noted above. This interaction imposed a progressively more depleted character on the erupted melt, both in terms of isotopic composition and trace element enrichment.

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.

Climate Prediction Center - Stratosphere: Stratosphere-Troposphere

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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

Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities.

PubMed

Tamura, Taro; Suganuma, Narufumi; Hering, Kurt G; Vehmas, Tapio; Itoh, Harumi; Akira, Masanori; Takashima, Yoshihiro; Hirano, Harukazu; Kusaka, Yukinori

2015-01-01

The International Classification of High-resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for the screening, diagnosis, and epidemiological reporting of respiratory diseases caused by occupational hazards. This study aimed to establish a correlation between readings of HRCT (according to the ICOERD) and those of chest radiography (CXR) pneumoconiotic parenchymal opacities (according to the International Labor Organization Classification/International Classification of Radiographs of Pneumoconioses [ILO/ICRP]). Forty-six patients with and 28 controls without mineral dust exposure underwent posterior-anterior CXR and HRCT. We recorded all subjects' exposure and smoking history. Experts independently read CXRs (using ILO/ICRP). Experts independently assessed HRCT using the ICOERD parenchymal abnormalities grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). The correlation between the ICOERD summed grades and ILO/ICRP profusions was evaluated using Spearman's rank-order correlation. Twenty-three patients had small opacities on CXR. HRCT showed that 21 patients had RO; 20 patients, IR opacities; and 23 patients, EM. The correlation between ILO/ICRP profusions and the ICOERD grades was 0.844 for rounded opacities (p<0.01). ICOERD readings from HRCT scans correlated well with previously validated ILO/ICRP criteria. The ICOERD adequately detects pneumoconiotic micronodules and can be used for the interpretation of pneumoconiosis.

Seroprevalence of coeliac disease in at-risk subjects at the main tertiary hospital, southwest of Saudi Arabia.

PubMed

Al-Hakami, Ahmed M

2016-03-01

Coeliac disease (CD) is a gluten-induced autoimmune inflammation of small bowel villi, leading to atrophy and malabsorption. The current study aims to assess the prevalence of CD in high-risk subjects in the Aseer region, southwest of Saudi Arabia and to investigate the associated presentations. This is a retrospective case-finding study of the laboratory records for a 3-year period (2009-2012) at the main tertiary hospital (Aseer Central Hospital). Serum anti-tissue transglutaminase (atTG) and endomysial antibody (EmA) levels were determined along with small intestinal histopathological examination. The proportion of cases that tested positive for at least one coeliac antibody marker was 18.4% (58/315). Forty cases underwent endoscopic examination during the analysis, among which 22 were confirmed to have CD. The individual antibody positivity for atTG and EmA was 17.5% and 15.6%, respectively. The most common clinical condition (47%) associated with these markers was type 1 diabetes mellitus (T1DM). Interestingly, gastrointestinal presentations constituted only 11.5%. The rate of CD among hospital requests, including non-gastrointestinal symptomatic patients, at the Aseer main tertiary hospital seems to be high. Determining the prevalence of CD and also investigating the high-risk group commonly affected by CD warrant more screening studies. Copyright © 2016 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.

CFSv2 Seasonal Climate Forecasts

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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

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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

Long-Term Follow-Up of Patients after Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffold.

PubMed

Meneguz-Moreno, Rafael Alexandre; Costa, José de Ribamar; Moscoso, Freddy Antônio Britto; Staico, Rodolfo; Tanajura, Luiz Fernando Leite; Centemero, Marinella Patrizia; Chaves, Auréa Jacob; Abizaid, Andrea Claudia Leão de Sousa; Sousa, Amanda Guerra de Moraes Rego E; Abizaid, Alexandre Antonio Cunha

2017-02-01

Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos. A média de idade foi 56,8 ± 7,6 anos, sendo 71,4% da população estudada do sexo masculino e 26,5% composta por diabéticos. Considerando a apresentação clínica, a grande maioria (94%) tinha angina estável ou isquemia silenciosa. Obteve-se sucesso do dispositivo em 100% dos casos e do procedimento, em 96%. A taxa de eventos cardiovasculares maiores foi de 4% aos 30 dias, de 8,2% em 1 ano, e de 12,2% em 2 anos, sem mais eventos até 4,6 anos. Houve 2 casos de trombose (1 subaguda e 1 tardia) até o último seguimento. Nesta análise preliminar, o uso do SVB Absorb® mostrou-se seguro e eficaz no seguimento bastante tardio. Faz-se necessário estabelecer o perfil de eficácia e segurança destes dispositivos em cenários de maior complexidade.

Berkeley Lab - Materials Sciences Division

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2018 [PDF] October 2017 [PDF] July 2017 [PDF] April 2017 [PDF] January 2017 [PDF] October 2016 [PDF ] July 2016 [PDF] April 2016 [PDF] January 2016 [PDF] October 2015 [PDF] March 2015 [PDF] December 2014 [PDF] April 2014 [PDF] February 2014 [PDF] September 2013 [PDF] March 2013 [PDF] October, 2012 [PDF

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ACHP | Case Digest - Protecting Historic Properties: Section 106 in Action

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Digest index. Previous issues: Summer 2012 (PDF) Spring 2012 (PDF) Winter 2012 (PDF) Fall 2011 (PDF ) Summer 2011 (PDF) Spring 2011 (PDF) Winter 2011 (PDF) Fall 2010 (PDF) Summer 2010 (PDF) Winter 2010 (PDF ) Fall 2009 (PDF) Summer 2009 (PDF) Spring 2009 (PDF) Winter 2009 (PDF) Fall 2008 (PDF) Summer 2008 (PDF

NOAA Weather Radio

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recepción confiable en algunas localidades debido a bloqueos de las señales y/o distancia excesiva de la mensajes NOTA: Servicio de NWR para un condado depende de recepción confiable la señal, la cual cobertura de NWR, o cobertura parcial, serán indicados. Algunos condados o partes de condados

Periodic Table of Elements: Los Alamos National Laboratory

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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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mapping of the Upper Jurassic Naknek Formation in a footwall syncline associated with the Bruin Bay fault Ivishak Formation in the northeastern Brooks Range, Alaska: University of Alaska Fairbanks, M.S. thesis Triassic Ivishak Formation in the Sadlerochit Mountains, northeastern Alaska: Alaska Division of Geological

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Fermilab Today Related Content Subscribe | Contact Fermilab Today | Archive | Classifieds Search Experiment Profiles Current Archive Current Fermilab Today Archive of 2015 Archive of 2014 Archive of 2013 Archive of 2012 Archive of 2011 Archive of 2010 Archive of 2009 Archive of 2008 Archive of 2007 Archive of

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Conversion Factors Periodic Table of the Elements Chart of the Nuclides Map of the Nuclides Computer Index of (Atominstitut der Österreichischen Universitäten) Neutron Activation Table of Elements Neutron Scattering at neutronsources.org. The information contained here in the Neutron Scattering Web has been

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service at the U.S. Army Corps of Engineers, DeLisa L. Kviz currently works as chief ... Profile photo of of service with the Department of the Navy, including over 11 years ... Profile photo of Ivan E is a technical information specialist in the Analysis and ... Profile photo of Chad A. Molenhour

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Owen Barwell - Chief Financial Officer Owen Barwell - Chief Financial Officer A photo of Owen , analysis, and management. He previously served as the Acting Chief Financial Officer and Deputy Chief Financial Officer of the U.S. Department of Energy (DOE), where he was directly responsible for DOE's

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. ___________________________________________________________________________________ What do the different colors on the map of the CMB represent? Although the temperature of the CMB is The most conclusive and carefully examined evidence for The Big Bang is the existence of an isotropic radiation bath that permeates the entirety of the universe known as the cosmic microwave

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X-RAY DATA BOOKLET Center for X-ray Optics and Advanced Light Source Lawrence Berkeley National Laboratory Introduction X-Ray Properties of Elements Electron Binding Energies X-Ray Energy Emission Energies Table of X-Ray Properties Synchrotron Radiation Characteristics of Synchrotron Radiation History of X

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Pesticides and Human Health Pesticide Incidents What Happens to Pesticides Released into the Environment Pesticides and Human Health Pesticide Incidents What Happens to Pesticides Released into the Environment ; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife

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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

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Mineral Resources | Alaska Division of Geological & Geophysical Surveys

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and geophysical framework of Alaska as it pertains to the mineral resources of the state. Summary maps and reports illustrate the geology of the state's prospective mineral terranes and provide data on the location, type, and potential of the state's mineral resources. These data aid in the state's management of

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a.m. a 12:00 p.m. PT, de lunes a viernes A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Índice acuerdo de cooperación entre la Universidad Estatal de Oregón y la Agencia de Protección Ambiental de los Estados Unidos (acuerdo de cooperación # X8-83560101). La información contenida en esta

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investigations of the diatom stratigraphy of Borehole TA8, Portage Alaska: Alaska Division of Geological & Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of Geological & Geophysical DGGS GMC 395 Publication Details Title: Preliminary investigations of the diatom stratigraphy of

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modeled solar data to study the operational impacts of solar on the electric power grid. Solar Power Data need to estimate power production from hypothetical solar power plants. Solar Integration National Dataset (SIND) Toolkit The next generation of modeled solar data with higher temporal and spatial

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³mica (CNEA), a través de la Sección de... EL RA-6, RENOVADO EN EL AÑO DE SU 35º ANIVERSARIO EL RA-6 DIRIGIDAS A DOCENTES REALIZAN EN EL CAB CAPACITACIONES DIRIGIDAS A... La Comisión Nacional de Energía Atà ... RECONOCIMIENTO PARA LA SECCIÓN DE DIVULGACIÓN CIENTÍFICA Y TECNOLÓGICA DEL CAB RECONOCIMIENTO PARA LA SECCIÃ

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Defense.gov - Special Report - Travels With Gates

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. If you wish to see the latest content, please visit the current version of the site. For persons with look at production of the newest all-terrain vehicles slated for Afghanistan, and praised the modern You have reached a collection of archived material. The content available is no longer being

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investigations in the Brooks Range Foothills and North Slope, Alaska: Alaska Division of Geological & interpretations of the Nanushuk Formation exposed along the Colville River near the confluences with the Awuna and Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska

Periodic Table of Elements: Los Alamos National Laboratory

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, Communication Specialist talks about the Periodic Table of Elements 7/17/17 Back to Elements List Seaborgium is Phone Periodic Table of Elements: LANL Chemistry Division » Periodic Table of Elements Chemistry the Elements Chemical Properties Elements List Periodic Table Download News LANL Biofuels Work

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colaboración entre el gobierno y la industria patrocinada por el Programa de Tecnologías de Vehículos del enchufables Recursos en la web Use estas recursos para obtener información sobre: Economía de combustible y huella de carbono de su vehículo Cómo aumentar la economía de combustible Importancia de la economía

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¡tico de programación de la Radio del Tiempo de NOAA la capacidad de transmitir en español. Cualquier Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Search For Go NWS All NOAA Las Políticas de Programación en Español Se le añadió al sistema automÃ

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different penetration levels. This chart here shows the left column is the actual penetration of the renewables in all of the different scenarios. The higher base load and the higher VG before curtailment are to a lot of results. This next slide shows the generation by the different types of both renewable

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atomic layer deposition for applications. He also manages the majority of X-ray characterization equipment at NREL, specifically X-ray diffraction and X-ray fluorescence instrumentation. Additionally, he for EERE's Hydrogen Storage program. He is also an expert in X-ray diffraction and X-ray fluorescence

Energy Analysis Publications | Energy Analysis | NREL

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Systems Impact Analysis We perform impact analysis to evaluate and understand the impact of markets publications. Featured Publications Complex Systems Analysis Complex systems analysis integrates all aspects of , policies, and financing on technology uptake and the impact of new technologies on markets and policy

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NREL's Advanced Atomic Layer Deposition Enables Lithium-Ion Battery

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Battery Technology News Release: NREL's Advanced Atomic Layer Deposition Enables Lithium-Ion Battery increasingly demanding needs of any battery application. These lithium-ion batteries feature a hybrid solid further customized lithium-ion battery materials for high performance devices by utilizing our patented

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degradation in silicon nanowires for lithium ion battery," ACS Nano, 2015, 9(5), pp 5559-5566, DOI molecular layer deposited coating on silicon nanoparticles for lithium ion battery anodes," ACS Nano lithium-ion batteries, lithium-air batteries, organic radical batteries, and magnesium-ion batteries. The

Transportation Research News | Transportation News | Transportation

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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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Information Management, Microsoft Platform Management, Identity & Access Management, Endpoint Systems /2016-24054/category-management). OMB released this IT Success Story for "Information Sharing Management of Common Information Technology: Mobile Devices and Services 7/1/2016 Category Management Policy

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automatizado apoyará la difusión en español. Idioma español de voz sintetizada será proporcionado para algunas oficinas donde el personal permite y los dictados de la población, la radiodifusión española Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing

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para un condado depende de recepción de la seña fiable, que típicamente se extiende en un radio de 40 millas del transmisor, asumiendo terreno plano. Condados sin la cobertura de NWR o cobertura obstáculos de la seña y/o la distancia excesiva del transmisor. Usted puede referirse directamente a

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, and updates the energy prediction algorithms to be in line with the actual performance of modern the latest update." In this webinar, one of the tool's developers explains how the new version of ® Wednesday, July 9, 2014 As part of a Do-It-Yourself Solar Market Analysis summer series, NREL's Solar

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Carlo, F. De Carlo, Francesco De Graef, Marc de Jalon, Garcia De La Rosa, K. de Leon, P.A. Ignacio- de . Degenkolb, E. DeJongh, M. DeLisi, M. Delmont, T. O. DeLuca, C. Demas, N. Demchenko, Y. Demeshko, I. Demiguel , N. Kyrpides, Nikos La Joie, C. Labarta, J. LaBissoniere, D. Lacinski, L. Lacour, S. Laguna, I. Lai

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who have a lot of experience in this area may handle the process on their own while others may decide greatest number of respondents and give the agency the greatest number of options. Solar RFP Elements As to the selection criteria. Sources Solar Powering Your Community: Key Elements of Solar Requests for

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] View Images Details ID: SIL32-035-02 Enlarge Image View Images Details ID: SIL32-038-02 Enlarge Image View Images Details ID: SIL-2004_CT_6_1 Enlarge Image View Images Details ID: SIL32-010-01 Enlarge Image View Images Details ID: SIL32-013-05 Enlarge Image View Images Details ID: SIL32-014-02 Enlarge

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appreciation of this invaluable natural resource. My image My image My image My image My image Discover: - over difference in IRL water quality Check Out: - the IRL Photo Gallery - the IRL Species Image Collection Downloads: - Species Database - IRL Species Bibliography My image My image My image My image My image EOL

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has the ability to view various parts of a frog from many different angles, and with the different here - the Virtual Dissection Kit - has been accessed by 50,000 different sites, in over 50 different form document that is a translation of the user interface into a different language (the Virtual Frog

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An edition of: WaterAtlas.orgPresented By: USF Water Institute Choose a Water Atlas Charlotte Harbor NEP Water Atlas Hillsborough County Water Atlas Lake County Water Atlas Manatee County Water Atlas Orange County Water Atlas Pinellas County Water Atlas Polk County Water Atlas Sarasota County Water Atlas

Publications - GMC 430 | Alaska Division of Geological & Geophysical

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: Formation hardness of Hemlock Formation cores after immersion in water and oil based fracturing fluids; and mechanics: Formation hardness of Hemlock Formation cores after immersion in water and oil based fracturing Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska

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- nssl0057 Early stage of tornado formation. Photo #1 of a series of classic photographs of this tornado 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

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2010 Basin: North Atlantic Eastern North Pacific Central North Pacific Western North Pacific North ALBERTO01L North Atlantic: (1) active ALBERTO01L Eastern North Pacific: (0) active Central North Pacific: (0 ) active Western North Pacific: (0) active North Indian Ocean: (0) active Southern Hemisphere: (0) active Â

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Turbine Control Systems Wind Turbine Control Systems Advanced wind turbine controls can reduce the loads on wind turbine components while capturing more wind energy and converting it into electricity turbines. A photo of a wind turbine against blue sky with white blades on their sides in the foreground

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Wind Energy Modeling and Simulation Wind Turbine Modeling and Simulation Wind turbines are unique wind turbines. It enables the analysis of a range of wind turbine configurations, including: Two- or (SOWFA) employs computational fluid dynamics to allow users to investigate wind turbine and wind power

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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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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

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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

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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

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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

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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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Alamos National Laboratory Delivering science and technology to protect our nation and promote world stability Science & Innovation Collaboration Careers Community Environment Science & Innovation Facilities Science Pillars Research Library Science Briefs Science News Science Highlights Lab Organizations

Home Energy Saver

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. Environmental Protection Agency logo PIER logo Touchstome Energy Cooperatives logo California Air Resouces Board logo Infosys logo Berkeley Lab logo Created for the US Department of Energy by the Energy Technologies Energy logo

The policy of the Laboratory is to provide a safe and healthy workplace for

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group within the Collider Accelerator (C-A) Department. The Advanced Accelerator Group, a group within ://www.tvdg.bnl.gov/index.html that also has links to the C-A and other BNL information. We hope your stay at policies are outlined in the Employees' Handbook, the BNL ES&H Standards the C-A Operations Procedure

NOAA Weather Radio

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Programación Español Listado de estación Explicacion de SAME Coverage Station Listing County Listing Search For Go NWS All NOAA Lista de Emisora y Cobertura Seleccione aquí para radiofrecuencias (La lista Transmitter Outages FAQ NWR - Special Needs ESPAÑOL Español Condado de cobertura Listado de estación Lista

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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-2018 17:38 - cmce.20180527/ 27-May-2018 05:39 - fens.20180526/ 26-May-2018 17:50 - fens.20180527/ 27 -May-2018 06:20 - gefs.20180520/ 20-May-2018 22:41 - gefs.20180521/ 21-May-2018 22:43 - gefs.20180522 / 22-May-2018 22:43 - gefs.20180523/ 23-May-2018 22:42 - gefs.20180524/ 24-May-2018 22:43 - gefs

Index of /data/nccf/com/gfs/prod

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-2018 08:00 - enkf.20180527/ 27-May-2018 06:37 - gdas.20180518/ 21-May-2018 01:00 - gdas.20180519/ 22 -May-2018 01:00 - gdas.20180520/ 23-May-2018 02:00 - gdas.20180521/ 24-May-2018 01:00 - gdas.20180522 / 25-May-2018 02:00 - gdas.20180523/ 26-May-2018 02:00 - gdas.20180524/ 27-May-2018 02:00 - gdas

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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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

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

Publications - SR 52 | 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

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

Solar Photovoltaic Technology Basics | NREL

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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

Alaska Department of Natural Resources

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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

Pesticide Ingredients

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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 Fact Sheets Types of Pesticides Pest Control Information Pesticide Health and Safety Information

International Pesticide Regulations

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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 - World Health Organization (WHO) International Agencies: International Websites on Pesticides - OECD

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

Ramin Faramarzi | NREL

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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

Home Energy Saver Pro

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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

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

Publications - PDF 97-29I | Alaska Division of Geological & Geophysical

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igneous rocks of the Tanana B-1 Quadrangle and vicinity Authors: Newberry, R.J., and Haug, S.A , and Sr isotopic data for igneous rocks of the Tanana B-1 Quadrangle and vicinity: Alaska Division of ; Isotopes; Plutonic; STATEMAP Project; Trace Elements; Volcanic Top of Page Department of Natural Resources

NOAA Photo Library

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NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes you to the Contacts page. Takes you to the HELP page. Takes you to the Credits page. Takes you to the Collections page. Takes you to the search page. Takes you to the Links page. NOAA Photo Library Image

NOAA Photo Library - Search

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NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes you to the Contacts page. Takes you to the HELP page. Takes you to the Credits page. Takes you to the Collections page. Takes you to the search page. Takes you to the Links page. search banner butterfly fish

Inventory of File gfs.t06z.smartguam15.tm00.grib2

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hour fcst Visibility [m] 014 planetary boundary layer WDIR 15 hour fcst Wind Direction (from which blowing) [degtrue] 015 planetary boundary layer WIND 15 hour fcst Wind Speed [m/s] 016 planetary boundary layer RH 15 hour fcst Relative Humidity [%] 017 planetary boundary layer DIST 15 hour fcst Geometric

Inventory of File nam.t00z.smartpr00.tm00.grib2

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layer WDIR analysis Wind Direction (from which blowing) [degtrue] 016 planetary boundary layer WIND analysis Wind Speed [m/s] 017 planetary boundary layer RH analysis Relative Humidity [%] 018 planetary boundary layer DIST analysis Geometric Height [m] 019 surface 4LFTX analysis Best (4 layer) Lifted Index [K

Inventory of File nam.t00z.smartak00.tm00.grib2

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layer WDIR analysis Wind Direction (from which blowing) [degtrue] 016 planetary boundary layer WIND analysis Wind Speed [m/s] 017 planetary boundary layer RH analysis Relative Humidity [%] 018 planetary boundary layer DIST analysis Geometric Height [m] 019 surface 4LFTX analysis Best (4 layer) Lifted Index [K

Inventory of File nam.t00z.smarthi00.tm00.grib2

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layer WDIR analysis Wind Direction (from which blowing) [degtrue] 016 planetary boundary layer WIND analysis Wind Speed [m/s] 017 planetary boundary layer RH analysis Relative Humidity [%] 018 planetary boundary layer DIST analysis Geometric Height [m] 019 surface 4LFTX analysis Best (4 layer) Lifted Index [K

Assistant Secretary of Defense for Legislative Affairs

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Links Mission Congressional Links Secretary of Defense James Mattis
James Mattis" title=" Secretary of Defense James Mattis" /> The

Energy Education | NREL

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Energy Education Energy Education Learn how NREL's Workforce Development and Education Programs lectures at NREL's Education Center. Energy Education for Students 4th-12th Grades Energy Education

Publications - AR 2010 | Alaska Division of Geological & Geophysical

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Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of Geological & Geophysical DGGS AR 2010 Publication Details Title: Alaska Division of Geological & Geophysical Surveys Annual Report Authors: DGGS Staff Publication Date: Jan 2011 Publisher: Alaska Division of Geological &

Center for Adaptive Optics | News

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* Methane Clouds Observed Near Titan's Equator May Explain Presence of Riverbeds on the Surface * 'Dark Center for Adaptive Optics A University of California Science and Technology Center home AO of Cosmic Time * Celebration of Science and Technology Centers Class of 2000 AO Headlines 2009

Alaska State Legislature

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The Alaska State Legislature search menu Home Senate Current Members Past Members By Session search Home Get Started About the Legislative Branch Legislative Branch The Legislative Branch is responsible for enacting the laws of the State of Alaska and appropriating the money necessary to operate the

NOAA Office of Exploration and Research > Home

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2014 Funding Opportunities Contact Us Program Review Review Panel Final Report Review Team Documents Review Review Panel Final Report Review Team Documents Presentations Supporting Documents Guiding the NOAA Science Advisory Board, a thirteen-member Review Panel conducted the first-ever formal

Building Awards | NREL

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Mountain campus is designed to meet the Gold or Platinum standards of the U.S. Green Building Council's Research Facility. South Site Entrance Building South Site Entrance Building 2013 U.S. Green Buildings Building Awards Building Awards NREL's high-performance buildings are sustainability models for the

Wind | NREL

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Facilities Support Innovation and Collaboration Take a Tour of a Wind Turbine Featured Publications 2017 Recommended Practices Lidar-Enhanced Wind Turbine Control: Past, Present, and Future Development of a 5 MW wind turbine science and lowering the cost of wind-generated electricity alongside our partners. We

NREL: Renewable Resource Data Center - Geothermal Resource Related Links

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from the following sources: U.S. Department of Energy Geothermal Technologies Office. National Geothermal Resource Related Links Comprehensive geothermal resource information is also available Geothermal Data System A portal to geothermal data. Southern Methodist University Geothermal Laboratory The

Energized Learning

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Energized Learning Students Lessons Bullet Getting Started Bullet Bringing It Home Bullet Unit activities with keys to subject matter standards. As students work through one or more of the standards-based Why Use the Energized Learning Site? How will teachers and Students Use the Energized Learning Site

K-12 Education

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reached out to elementary and high school students to expose them to earthquakes in a hands-on products laboratories publications nisee b.i.p. members education FAQs links education Education Program Internships K-12 Education Contact the PEER Education Program PEER's Educational Affiliates Student Design

Alternative Fuels Data Center

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three consecutive minutes, except under the following conditions: 1) to operate power takeoff equipment including, but not limited to, cement mixers, refrigeration systems, and delivery vehicles; 2) to operate private passenger vehicles; or 3) to operate heating equipment for five minutes when the ambient

Navy Directory

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Training Command EDIT Region Legal Service Office Japan Facebook EDIT Region Legal Service Office Mid Navy.mil Home Page Navy.mil Home Page Subscribe to Navy News Service Search Navy.mil Navy.mil Training and Readiness Center Facebook EDIT Afloat Training Group Mayport Facebook EDIT Afloat Training

Safe Use Practices for Pesticides

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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 Safe Use Practices for Pesticides Related Topics

Minimizing Exposure at Work

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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 (chronic) exposure to certain pesticides may increase your risk of chronic health effects. Therefore, it is

Energy Analysis Research | Energy Analysis | NREL

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innovation through integration. Illustration of NREL energy analysis research, including impact systems analysis integrates all aspects of our capability set to develop future energy system scenarios evaluate and understand the impact of markets, policies, and financing on technology uptake and the impact

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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 Gallery Links and Events About Us SMS Home Roseate Spoonbill Search by Word or Phrase Go to Species

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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 [ TOP ] © Copyright Smithsonian Institution Privacy SMS Home Contact Us Search NMNH Home DCSIMG

Climate Prediction Center - Monitoring and Data - Regional Climate Maps:

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; Precipitation & Temperature > Regional Climate Maps: USA Menu Weekly 1-Month 3-Month 12-Month Weekly Total Precipitation Average Temperature Extreme Maximum Temperature Extreme Minimum Temperature Departure of Average Temperature from Normal Extreme Apparent Temperature Minimum Wind Chill Temperature

CFS Forecast Verification

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history of Nino3.4 SST anomalies of individual forecasts Forecast anomalies Target season Nino SST Global SST Global Prec Global T2m US Prec US T2m US SM z200 NDJ 2004/2005 Nino SST Global SST Global Prec Global T2m US Prec US T2m US SM z200 DJF 2005 Nino SST Global SST Global Prec Global T2m US Prec US T2m

Inventory of File sref.t03z.pgrb197.prob_ds_3hrly.grib

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ground WIND 3 hour fcst Wind Speed [prob] prob >12.89 005 10 m above ground WIND 3 hour fcst Wind Speed [prob] prob >17.5 006 10 m above ground WIND 3 hour fcst Wind Speed [prob] prob >25.78 007 2 ;0.015 010 10 m above ground WIND 6 hour fcst Wind Speed [prob] prob >12.89 011 10 m above ground WIND

U.S. High Seas Marine Text Forecasts by Area

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Flooding Tsunamis 406 EPIRB's U.S. High Seas Marine Text Forecasts by Area OPC N.Atlantic High Seas Forecast NHC N.Atlantic High Seas Forecast OPC N.Pacific High Seas Forecast HFO N.Pacific High Seas Forecast NHC N.Pacific High Seas Forecast HFO S.Pacific High Seas Forecast U.S. High Seas Marine Text

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NOAA Photo Library - NOAA In Space Collection/Satellite

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Systems/Geostationary Satellites NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes you to the Contacts page. Takes you to the HELP page. Takes you to the Credits page. Takes you to the Collections page. Takes you to the search page. Takes you to the

NOAA Photo Library - National Severe Storms Laboratory Collection -

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Tornadoes NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes you to the Contacts page. Takes you to the HELP page. Takes you to the Credits page. Takes you to the Collections page. Takes you to the search page. Takes you to the Links page. Tornadoes

NOAA Photo Library - National Estuarine Research Reserve System

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NOAA Photo Library Banner Takes you to the Top Page Takes you to the About this Site page. Takes you to the Contacts page. Takes you to the HELP page. Takes you to the Credits page. Takes you to the Collections page. Takes you to the search page. Takes you to the Links page. National Estuarine Research

Inventory of File gfs.t06z.smartguam24.tm00.grib2

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boundary layer WDIR 24 hour fcst Wind Direction (from which blowing) [degtrue] 016 planetary boundary layer WIND 24 hour fcst Wind Speed [m/s] 017 planetary boundary layer RH 24 hour fcst Relative Humidity [%] 018 planetary boundary layer DIST 24 hour fcst Geometric Height [m] 019 surface 4LFTX 24 hour fcst

Myosin-binding Protein C Compound Heterozygous Variant Effect on the Phenotypic Expression of Hypertrophic Cardiomyopathy.

PubMed

Rafael, Julianny Freitas; Cruz, Fernando Eugênio Dos Santos; Carvalho, Antônio Carlos Campos de; Gottlieb, Ilan; Cazelli, José Guilherme; Siciliano, Ana Paula; Dias, Glauber Monteiro

2017-04-01

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant genetic disease caused by mutations in genes encoding sarcomere proteins. It is the major cause of sudden cardiac death in young high-level athletes. Studies have demonstrated a poorer prognosis when associated with specific mutations. The association between HCM genotype and phenotype has been the subject of several studies since the discovery of the genetic nature of the disease. This study shows the effect of a MYBPC3 compound variant on the phenotypic HCM expression. A family in which a young man had a clinical diagnosis of HCM underwent clinical and genetic investigations. The coding regions of the MYH7, MYBPC3 and TNNT2 genes were sequenced and analyzed. The proband present a malignant manifestation of the disease, and is the only one to express HCM in his family. The genetic analysis through direct sequencing of the three main genes related to this disease identified a compound heterozygous variant (p.E542Q and p.D610H) in MYBPC3. A family analysis indicated that the p.E542Q and p.D610H alleles have paternal and maternal origin, respectively. No family member carrier of one of the variant alleles manifested clinical signs of HCM. We suggest that the MYBPC3-biallelic heterozygous expression of p.E542Q and p.D610H may cause the severe disease phenotype seen in the proband. Resumo A cardiomiopatia hipertrófica (CMH) é uma doença autossômica dominante causada por mutações em genes que codificam as proteínas dos sarcômeros. É a principal causa de morte súbita cardíaca em atletas jovens de alto nível. Estudos têm demonstrado um pior prognóstico associado a mutações específicas. A associação entre genótipo e fenótipo em CMH tem sido objeto de diversos estudos desde a descoberta da origem genética dessa doença. Este trabalho apresenta o efeito de uma mutação composta em MYBPC3 na expressão fenotípica da CMH. Uma família na qual um jovem tem o diagnóstico clínico de CMH foi submetida à investigação clínica e genética. As regiões codificadoras dos genes MYH7, MYBPC3 e TNNT2 foram sequenciadas e analisadas. O probando apresenta uma manifestação maligna da doença e é o único em sua família a desenvolver CMH. A análise genética pelo sequenciamento direto dos três principais genes relacionados à essa doença identificou uma variante em heterozigose composta (p.E542Q e p.D610H) em MYBPC3. A análise da família mostrou que os alelos p.E542Q e p.D610H tem origem paterna e materna, respectivamente. Nenhum familiar portador de um dos alelos variantes manifestou sinais clínicos de CMH. Sugerimos que a expressão heterozigótica bialélica de p.E542Q e p.D610H pode ser responsável pelo fenótipo severo da doença encontrada no probando.

Effects of emissions from sugar cane burning on the trachea and lungs of Wistar rats.

PubMed

Matos, Verena Sampaio Barbosa; Gomes, Felipe da Silva; Oliveira, Tarcio Macena; Schulz, Renata da Silva; Ribeiro, Lídia Cristina Villela; Gonzales, Astria Dias Ferrão; Lima, Januário Mourão; Guerreiro, Marcos Lázaro da Silva

2017-01-01

To evaluate the effects of exposure to emissions from sugar cane burning on inflammatory mechanisms in tissues of the trachea and lung parenchyma in Wistar rats after different periods of exposure. This was an experimental open randomized study. The animals were divided into four groups: a control group (CG) underwent standard laboratory conditions, and three experimental groups were exposed to emissions from sugar cane burning over different periods of time, in days-1 (EG1), 7 (EG7), and 21 (EG21). After euthanasia with 200 mg/kg of ketamine/xylazine, fragments of trachea and lung were collected and fixed in 10% formalin. Histological analyses were performed with H&E and picrosirius red staining. No inflammatory infiltrates were found in the tissues of CG rats. The histological examination of tissues of the trachea and lung parenchyma revealed that the inflammatory process was significantly more intense in EG7 than in the CG (p < 0.05 and p < 0.01, respectively). In comparison with the CG and EG1, angiogenesis in the lung parenchyma and collagen deposition in tracheal tissues were significantly greater only in EG21 (p < 0.001 and p < 0.01, respectively). In this sample, emissions from sugar cane burning induced acute focal and diffuse inflammation in the lamina propria of tracheal tissues, with no loss of ciliated epithelial tissue. In the lung parenchyma of the animals in the experimental groups, there was interstitial and alveolar edema, together with polymorphonuclear cell infiltrates. Avaliar os efeitos da exposição à fumaça da queima da cana-de-açúcar sobre mecanismos inflamatórios em tecidos de traqueia e de parênquima pulmonar de ratos Wistar após diferentes períodos de exposição. Estudo experimental, randomizado, não cego. Os animais foram divididos em quatro grupos: controle (GC), sob condições padrão de laboratório e os demais expostos à fumaça da queima da cana-de-açúcar por diferentes períodos: em 1 (GE1), 7 (GE7) e 21 (GE21) dias. Após a eutanásia com 200 mg/kg de ketamina/xilazina, foram coletados fragmentos de traqueia e pulmão e fixadas em formol 10%. Análises histológicas foram realizadas com coloração com H&E e picrosírius. Não houve infiltrado inflamatório nos tecidos no GC. O processo inflamatório na análise histológica de tecidos de traqueia e de parênquima pulmonar foi significativamente mais intenso no GE7 quando comparado ao GC (p < 0,05 e p < 0,01, respectivamente). Em comparação com os grupos GC e GE1, apenas no GE21 foi observada angiogênese significativa no parênquima pulmonar e aumento significativo de depósitos de colágeno em tecido de traqueia (p < 0,001 e p < 0,01, respectivamente). Nesta amostra, a fumaça da queima de cana-de-açúcar induziu processo inflamatório focal, difuso e agudo em tecidos de traqueia na lâmina própria, sem perda do tecido epitelial ciliado. Houve presença de edemas intersticiais e alveolares e infiltrados de células polimorfonucleares no parênquima pulmonar nos animais dos grupos experimentais.

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Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of Geological & Geophysical 2002 Publisher: Alaska Division of Geological & Geophysical Surveys Ordering Info: Download below Reference DGGS Staff, and Werdon, M.B., 2002, Alaska GeoSurvey News - Geologic Investigations in the Salcha

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applicability of artificial intelligence to search for cybersecurity gaps in our existing SKATA networks. Second primarily renewable that all back each other up; that are all highly intelligent, artificial intelligence we have in cyber security, digital technologies, artificial intelligence. We think that that would

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analysis to expand the midscale solar market. The midscale market for solar photovoltaics (PV), loosely than other PV market segments in recent years. Featured Analysis Midmarket Solar Policies in the United Midscale Commercial Solar Market Midscale Commercial Solar Market NREL experts are providing

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authorized by section 3709.05 of the Revised Code. (C) "Circulation system" means an arrangement of transferred and does not mean the person who formerly operated or maintained the public swimming pool. (J ://catalog.asme.org/. ASME documents are also generally available at the state library of Ohio. (c) American national

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and x-ray spectroscopy pioneer, Farrel W. Lytle, and include precious metals such as gold, silver structure of matter called x-ray absorption spectroscopy. The foils were donated by entrepreneur, scientist activities on x-ray fluorescence imaging in ancient materials like fossils and the Archimedes Palimpsest

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Technical Potential Renewable Energy Technical Potential The renewable energy technical potential level from Resource to Technical to Economic to Market. The benefit of assessing technical potential is potential-resource, technical, economic, and market-as shown in the graphic with key assumptions. Technical

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UFR Process was established on July 29, 2014, by the execution of the Memorandum of Understanding Process is being led by a Steering Group consisting of the Council on Environmental Quality, the Review was established on July 29, 2014, through an interagency Memorandum of Understanding by eleven

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hierarchical control architecture that enables a hybrid control approach, where centralized control systems will be complemented by distributed control algorithms for solar inverters and autonomous control of ), involves developing a novel control scheme that provides system-wide monitoring and control using a small

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Ahmad Pesaran Honored with DOE Assistant Secretary's 2017 EERE Outstanding

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Anatomic pulmonary resection via video-assisted thoracic surgery: analysis of 117 cases at a referral center in Brazil.

PubMed

Soder, Stephan Adamour; Barth, Frederico; Perin, Fabiola Adelia; Felicetti, José Carlos; Camargo, José de Jesus Peixoto; Camargo, Spencer Marcantônio

2017-01-01

To describe our experience with video-assisted thoracic surgery (VATS) for anatomic pulmonary resection at a referral center for thoracic surgery in Brazil. All patients who underwent anatomic pulmonary resection by VATS between 2010 and 2015 were included. Clinical and pathological data, as well as postoperative complications, were analyzed. A total of 117 pulmonary resections by VATS were performed, of which 98 were lobectomies and 19 were anatomic segmentectomies. The mean age of the patients was 63.6 years (range, 15-86 years). Females predominated (n = 69; 59%). The mean time to chest tube removal was 2.47 days, and the mean length of ICU stay was 1.88 days. The mean length of hospital stay was 4.48 days. Bleeding ≥ 400 mL occurred in 15 patients. Conversion to thoracotomy was required in 4 patients. Our results are similar to those published in major international studies, indicating that VATS is an important strategy for pulmonary resection. They also show that VATS can be safely performed with adequate training. This technique should be used more often for the treatment of lung diseases in Brazil. Relatar a experiência com cirurgia torácica videoassistida (CTVA) para ressecções pulmonares anatômicas em um centro nacional de referência de cirurgia torácica no Brasil. Foram incluídos todos os pacientes tratados com ressecções pulmonares anatômicas por CTVA entre 2010 e 2015 e analisados dados clínicos e patológicos, assim como complicações pós-operatórias. Foram realizadas 117 ressecções pulmonares por CTVA, sendo 98 lobectomias e 19 segmentectomias anatômicas. A média de idade foi de 63,6 anos (variação, 15-86 anos), sendo a maioria mulheres (n = 69; 59%). A média de tempo de permanência com dreno foi de 2,47 dias e a de estada em UTI foi de 1,88 dias. A média de tempo de internação foi de 4,48 dias. Sangramento ≥ 400 ml ocorreu em 15 pacientes. Houve conversão para toracotomia em 4 pacientes. Nossos resultados vão ao encontro de publicações em grandes séries internacionais, corroborando que a CTVA é uma importante via de execução de ressecções pulmonares e que pode ser realizada com segurança quando há treinamento adequado, devendo ser mais utilizada no Brasil para o tratamento das doenças pulmonares.

BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?

PubMed

Rodrigues, Marcus Vinicius Rozo; Tercioti-Junior, Valdir; Lopes, Luiz Roberto; Coelho-Neto, João de Souza; Andreollo, Nelson Adami

2016-01-01

Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion. A neoplasia de mama é o tumor maligno mais comum na população feminina tendo o trato gastrointestinal, e mais especificamente o estômago, como local incomum para metástases. Analisar uma série de casos com esse tumor e propor medidas que possam diagnosticá-lo com maior precocidade. Foram analisados retrospectivamente 12 pacientes com diagnóstico de neoplasia gástrica secundária a câncer de mama, confirmado por biópsia e imunoistoquímica. Foram analisados idade do diagnóstico, tipo histológico do tumor primário, intervalo de tempo entre o diagnóstico do tumor e a metástase, tratamento e sobrevida. A idade média foi de 71,3 anos (40-86 anos). Em média, o diagnóstico da metástase gástrica foi de sete anos após o diagnóstico da lesão primaria (0-13 anos). Nove casos tiveram metástases em outros órgãos, sendo os ossos os locais mais acometidos. Evidenciou-se positividade de anticorpo CK7 em 90,9% casos, receptor de estrógeno em 91,67%, receptor de progesterona em 66,67% e BRST2 em 41,67%. A ausência de CK20 foi de 88,89%. Oito casos foram tratados com quimioterapia associada ou não ao bloqueio hormonal e em quatro foi indicada ressecção cirúrgica sendo em três gastrectomia total e em um caso gastrectomia subtotal. A sobrevida média foi de 14,58 meses. Em doentes com história prévia de câncer de mama apresentando diagnóstico endoscópico de neoplasia gástrica, é necessário considerar a possibilidade de metástase. A confirmação é feita por estudo imunoistoquímico e a gastrectomia deve ser orientada diante da ausência de outros locais de acometimento secundário e controle da lesão primária.

NOAA Office of Exploration and Research > Science > Overview

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Summer teachers' teaching tool

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and nervous system of the frog. Skeleton System Organs Digestive System Nervous System Berkeley Lab students study anatomy of a frog in Biology class room. The pictures showed the skeleton, organs, digestive

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: approximately 2,580 megawatts (MW) of new residential solar photovoltaic (PV) capacity was brought online in home with rooftop solar Figure 1. Example of a residential solar PV system. NREL 00565 The existing Governments | NREL Solar Access: Issues and Policy Options Solar Access: Issues and Policy

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the same basic force and have frozen out to different forces in the cooler present Universe. We see Implications of the COBE DMR Map of the Early Universe What COBE DMR saw: The COBE DMR (Cosmic Background Explorer Differential Microwave Radiometer) mapped the microwave (wavelengths of 9, 5,6, and 3.3

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electron neutrino, muon neutrino, or tau neutrino. The three different neutrinos are complemented by anti of the neutrinos we detect will look different (have a different flavor) compared to the time they Big World of Small Neutrinos Neutrinos will find you! Fig 1: Hubble image of the deep field

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geometric primitives (points, lines, polygons, etc.) that accurately represent the shape of the surface constant value (color). This operation effectively defines the boundary between areas of different color about 10 seconds on a 56K baud modem. The controls can be set to send compressed images of 3 different

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1 At speeds above mid-range, both the engine and electric motor are used to propel the vehicle. The gasoline engine provides power to the drive-train directly and to the electric motor via the generator. Go , generator, power split device, and electric motor visible. The car is moving. There are blue arrows flowing

Solution for Data Security Challenges Faced by Smart Grid Evolution - Video

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the same utility - different business units that are dealing with generation, transmission, and smart grid, the consumers now also have access to information about zero utilization and the different alive to sense what's going on. And then there's certainly variety with the various different elements

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all the same. It appears that tornadoes arise in many different ways, and perhaps different process can be associated with the tornado at different times in its life cycle. Moreover, not all tornadoes , mesocyclone) be? Where do you propose to put the dividing lines between tornado-tornado cyclone-mesocyclone? c

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model has only one type of cloud cover represented by C. In the tropics the cloudiness is primarily due mainly through grid-scale condensation. The fractional cloud cover C is available at all model levels , 1996: Parameterizations for the absorption of solar radiation by water vapor and ozone. J. Atmos. Sci

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improve the quality of science, mathematics and technology education in Colorado schools, the U.S critical agents of change in working to improve science, mathematics and technology education in our Science and Technology Education Irene Hays. "This is NREL's way of helping the quality of teaching

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, Alluvial facies and paleosols in the Cretaceous Nanushuk formation, Kanayut River, North Slope, Alaska Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska content DGGS PIR 2003-1 Publication Details Title: Alluvial facies and paleosols in the Cretaceous

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of recent geologic field investigations in the Brooks Range Foothills and North Slope, Alaska: Alaska Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska ; Tectonics; Thermal History; Thrust; Toolik River; Torok Formation; Turbidites; Turonian; Valanginian Top of

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Research | NREL Electric and Plug-In Hybrid Electric Fleet Vehicle Evaluations Electric and Plug-In Hybrid Electric Fleet Vehicle Evaluations How Electric and Plug-In Hybrid Electric Vehicles Work EVs use batteries to store the electric energy that powers the motor. EV batteries are charged by

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cell was computed by combining these data sets with a composite turbine power curve. Wind power plants wind speed at the site. Adjustments were made for model biases, wake losses, wind gusts, turbine and conversion was also updated to better reflect future wind turbine technology. The 12-hour discontinuity was

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NREL Taps Young to Oversee Geothermal Energy Program | News | NREL

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Taps Young to Oversee Geothermal Energy Program News Release: NREL Taps Young to Oversee Geothermal (NREL) promoted Katherine Young to laboratory program manager for geothermal energy. Young has been with NREL since 2008, working as a senior geothermal analyst and engineer in the Strategic Energy Analysis

ERDDAP - RESTful Web Services

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, graphs, or information about datasets). A RESTful web service (external link) - a URL that computer to get the same information in a more computer-program-friendly format like JSON (external link .jsonlKVP, where column names are on every row): Each column has a column name and one type of information

NREL and Hawaiian Electric Navigate Uncharted Waters of Energy

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potential grid impact of adding customer-side storage to rooftop solar systems-a scenario that could soon Systems Integration Facility's (ESIF's) power hardware-in-the-loop capability. NREL's ESIF was one of the justify activation of a specific grid support function called "volt-var control" for all new

DRIVE: Drive-Cycle Rapid Investigation, Visualization, and Evaluation

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specialized statistical clustering methods. The duration of these representative drive cycles, which aim to , DRIVE can benefit a variety of users. For example: Fleet managers can use the tool to make educated investment decisions by determining, in advance, the payback period for a given technology. Vehicle

Publications - PDF 98-36A | Alaska Division of Geological & Geophysical

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Oxides; Rocks; STATEMAP Project; Trace Elements Top of Page Department of Natural Resources, Division of Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of Geological & Geophysical

Publications - GMC 370 | Alaska Division of Geological & Geophysical

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(249.0 K) Keywords Rare Earth Elements Top of Page Department of Natural Resources, Division of Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska Visiting Alaska State Employees DGGS State of Alaska search Alaska Division of Geological & Geophysical

Message from the Director | Galaxy of Images

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Search! Enter a search term and hit the search button to quickly find an image Go The above "Quick Search" box will find ANY words you type in. Use "*" to truncate a word (dog* will get more precise search, try the "Advanced Search" option below. More search options, including

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

Publications - GMC 350 | Alaska Division of Geological & Geophysical

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in the NPRA, Alaska as follows: Ikpikpuk #1 core, cuttings, and sidewall core; South Meade #1 cuttings; Brontosaurus #1 cuttings and core; Walakpa #1 core; and Walakpa #2 cuttings and core Authors follows: Ikpikpuk #1 core, cuttings, and sidewall core; South Meade #1 cuttings; Brontosaurus #1 cuttings

John Turner | NREL

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; International Journal of Energy Research 32 (5), 379-407. Ahn, K.S., Shet, S., Deutsch, T., Jiang, C.S., Yan, Y and Sustainable Energy, an AIP journal. Research Interests Dr. Turner has been recognized as a methods, definitions, and reporting protocols." Journal of Materials Research 25 (01), 3-16. Yin, W.J

NOAA's National Weather Service/Environmental Protection Agency - United

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Integration Image | Loop View | Daily View | Point Guidance | | Experimental Air Quality Guidance | Product Map To View Additional Guidance Graphic of Air Quality Forecast Guidance for the CONUS Mouse over or Image Alaska 1-Hr Average Ozone Concentration Image Hawaii 1-Hr Average Ozone Concentration Image 8-Hr

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

Inclusion & Diversity

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Engineering Institute Information Science & Technology Institute Center for Space and Earth Science Management System Environmental Outreach Feature Stories Individual Permit for Storm Water Public Reading Management (First-line and Mid-level) (Engineering Management, Research Management, Technical Management

Research | NREL

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manufacturing, buildings efficiency, concentrating solar power, geothermal energy, transportation, water power Integration Facility Geothermal Energy Grid Modernization Hydrogen & Fuel Cells Integrated Energy Research Research Researching energy systems and technologies-and the science behind them-for a

Homepage P. Fischer, LBNL, Berkeley CA | UC Santa Cruz CA

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mesoscale magnetic x-ray microscopy and spectroscopy (ultra-)fast spin dynamics soft x-ray tomography of condensed matter x-ray optics publications presentations invited talks conference contributions curriculum

Facilities | Argonne National Laboratory

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Skip to main content Argonne National Laboratory Toggle Navigation Toggle Search Research Facilities Advanced Powertrain Research Facility Center for Transportation Research Distributed Energy Research Center Engine Research Facility Heat Transfer Laboratory Materials Engineering Research Facility

Defense Advisory Committee on Women in the Services (DACOWITS)

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Reports & Meetings News Articles 2018 Weekly Articles 2017 Weekly Articles 2016 Weekly Articles 2015 Weekly Articles 2014 Weekly Articles Latest Updates: The Next Quarterly Business Meeting is June 19-20

Data and Tools | Energy Analysis | NREL

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and Tools Energy Analysis Data and Tools NREL develops energy analysis data and tools to assess collections. Data Products Technology and Performance Analysis Tools Energy Systems Analysis Tools Economic and Financial Analysis Tools

Inmetro - Instituto Nacional de Metrologia, Qualidade e Tecnologia

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Consumidor Laboratórios Legislação Comunicação Social Programa de Monitoramento BPL Produtos analisados de selos Indique! Sugestão para o Programa de Análise de Produtos Licitações Material de Portal do Governo Brasileiro mdic Carta de Serviços Inmetro nos Estados Acre Alagoas AmapÃ

National Centers for Environmental Prediction

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) soilm1 0-10cm soil moisture soilm2 10-40cm soil moisture soilm3 40-100cm soil moisture soilm4 100-200cm soil moisture soilt1 0-10cm soil temperature soilt2 10-40cm soil temperature soilt3 40-100cm soil temperature soilt4 100-200cm soil temperature thick700.ptype 850-700mb thickness precipitation type thick850

Ryan Davis | NREL

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design TEA LCA Biochemical conversion process pathways Algal biomass production and conversion pathways Production," Green Chemistry (2015) Process Design and Economics for the Conversion of Lignocellulosic Production," Applied Energy (2011) Process Design and Economics for Biochemical Conversion of

Treasury > Home

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Home Unclaimed Property Investments Cash Management Debt Management Admin Sign-In State of Alaska > provides cash management, investment and portfolio management, debt management and accounting services for investments, establishes and implements policies, and provides administrative and information technology

Employment Opportunities

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Conservation Education Timber Management Wildland Fire & Aviation Burn Permits Firewise Alaska Brochure (PDF) Fire Management Plans Fire Assignments Annual Fire Statistics Fire Terms Glossary Incident Business Management Grants Become an Alaska Firewise Community Community Wildland Fire Protection Plans

Forest Stewardship Committee

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Conservation Education Timber Management Wildland Fire & Aviation Burn Permits Firewise Alaska Brochure (PDF) Fire Management Plans Fire Assignments Annual Fire Statistics Fire Terms Glossary Incident Business Management Grants Become an Alaska Firewise Community Community Wildland Fire Protection Plans

Ag Data Commons Monthly Metrics | National Agricultural Library

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and Nutrition Service(84)","value":"Food and Nutrition Service(84)"," and Nutrition Service(84)","value":"Food and Nutrition Service(84)"," and Nutrition Service(84)","value":"Food and Nutrition Service(84)","

Taeho Yoon | NREL

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postdoctoral fellow. He developed his expertise in electrochemistry and lithium-ion batteries (failure for lithium-ion batteries. His current research focuses on developing: 1) a fundamental understanding electrochemical performance of lithium-ion batteries. Research Interests Fundamental understanding of

MATLAB Software Versions and Licenses for the Peregrine System |

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: Feature usage info: Users of MATLAB: (Total of 6 licenses issued; Total of ... licenses in use) Users of Compiler: (Total of 1 license issued; Total of ... licenses in use) Users of Distrib_Computing_Toolbox : (Total of 4 licenses issued; Total of ... licenses in use) Users of MATLAB_Distrib_Comp_Engine: (Total of

2014 NREL Photovoltaic Reliability Workshops | Photovoltaic Research | NREL

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Curves and Visual Inspection of PV Modules Deployed at TEP Solar Test Yard-Peter McNutt, NREL Data Determining PV System's Degradation Rate and the Impact of Data Filters-Wilson Zexu Zhang, REC Solar Pte. Ltd " Test in Qualifying Solar PV Inverters-Dutch Uselton, Lennox IND System Reliability for Utility PV

Energy Systems Integration Newsletter - January 2017 | Energy Systems

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) project with PV manufacturer First Solar and NREL, First Solar designed an advanced plant-level controller relatively long history of interconnecting solar photovoltaic (PV) systems to its electric grid, with state Photo of a solar array. Tests Show Large Solar Plants Can Balance a Low-Carbon Grid In recent years

Top Five Large-Scale Solar Myths | State, Local, and Tribal Governments |

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of large-scale photovoltaic (PV) facilities or solar farms tend to include a myriad of misperceptions technologies do use mirrors which can cause glare, most solar farms use PV modules to generate electricity. PV panels in order to convert solar energy into electricity. PV modules are generally less reflective than

NOVA - Official Website | Invisible Universe Revealed

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): They look like artworks in the heavens. Each one of them is different, like snowflakes. And these are coming to a focus at different points. And that is the classic problem called "spherical aberration chips of paint. They had thrown off the laser-guided measuring tool used to shape the mirror. JIM

Virtual Frog Dissection: Interactive 3D Graphics Via the Web

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Kit''. A student using this kit has the ability to view various parts of a frog from many different angles, and with the different anatomical structures visible or invisible. For example, the student can up to 60 kilobytes for high quality. Clicking on the image yields different results depending on how

ACHP | Section 106 Disaster Response Planning FAQ

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§ 800.1(c)). What happens once the "emergency" response phase to the disaster is over? The ACHP be shared and in what format. 36 CFR § 800.11(c) provides further information on how the Secretary Introduction In response to recent catastrophic events across the country, such as flooding, snow, ice

Module 4: Text Versions | State, Local, and Tribal Governments | NREL

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own or finance a system. We'll help you understand the different financing types available to local often specific to a particular segment of the market with different amounts of incentives, different system size caps, and different total funds or aggregate capacity. The customer can identify if solar PV

Publications - PIR 2008-1B | Alaska Division of Geological & Geophysical

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., Preliminary results of recent geologic field investigations in the Brooks Range Foothills and North Slope Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska content DGGS PIR 2008-1B Publication Details Title: Measured section and facies analysis of the Lower

Publications - PIR 2008-1G | Alaska Division of Geological & Geophysical

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Wartes, M.A., and Decker, P.L., eds., Preliminary results of recent geologic field investigations in the Surveys Skip to content State of Alaska myAlaska My Government Resident Business in Alaska content DGGS PIR 2008-1G Publication Details Title: Turonian-Campanian strata east of the Trans-Alaska

ACHP | Working Together to Build a More Inclusive Preservation Program

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Street is all about creating lasting memories. When people visit the Georgetown Square, whether it be a ," but that's when historic preservation gets truly tested. When you have to remind people that even helps raise awareness and gives more validity to what we are doing locally. I think when people hear

Wind Power Innovation Enables Shift to Utility-Scale - Continuum Magazine

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the 1930s, a farmer in South Dakota built a small wind turbine on his farm, generating enough enough electricity to power thousands of homes. Aerial photo of large wind turbine with mountains in the background. Aerial view of the Siemens utility-scale wind turbine at the National Wind Technology Center

Publications - GMC 86 | Alaska Division of Geological & Geophysical Surveys

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DGGS GMC 86 Publication Details Title: Compressibility test data for the following seven NPRA wells : Inigok Test Well #1; Ikpikpuk Test Well #1; South Barrow Test Well #1; South Barrow Test Well #2; South Barrow #3; Peard Test Well #1; Point Barrow Core Test #1 Authors: Unknown Publication Date: 1988