At Ocean Drilling Program Site 981, the Reunion Subchron is recorded from the Marine Isotopic Stage (MIS) 81/82 boundary to MIS 79 as a single normal polarity zone spanning the 2.115-2.153-Ma ...interval. According to the age model, produced by matching the Site 981 delta super(18)O record to an orbitally-tuned reference record, the duration of the Reunion Subchron (38 kyr) is almost four times that assumed in current geomagnetic polarity timescales. High interval sedimentation rates (18 cm/kyr) during MIS 81 at Site 981 have resulted in an unusually detailed record of the Subchron. Virtual geomagnetic poles during the onset and demise of the Reunion Subchron trace a series of mainly anticlockwise loops over eastern Asia.
Emergency Medical Treatment and Active Labor Act, an unfunded mandate for emergency hospital physician coverage, combined with falling reimbursement and escalating medico-legal risk, has resulted in ...declining enthusiasm for specialty coverage to emergency rooms. In a South West Florida community of 150,000, limited hand surgeons necessitated modification of acute on-call duties for hand trauma, whereby the hospital emergency room personnel performed evaluation and wound management with telephonic consultation followed by referral and definitive care in the outpatient setting by the hand surgeon. The policy for hand care, triage, management, and transfer is reviewed, as well as the first year experience with this highly efficient management methodology for urgent and emergent hand problems. In establishing a county-wide standard of care, emergency rooms and hand surgeons are coordinated to deliver excellent care by treatment protocol.
Results from a unique experimental system that quantifies combustion products from a single diesel combustion event are presented and the implications of these results are discussed. Data presented ...in this paper are the emission levels for carbon monoxide and nitric oxide, normalized by carbon dioxide produced, as a function of fuel quantity injected. Carbon monoxide is notably present in very short duration (or small mass) injection burns where the spray event concludes before the beginning of the major heat release. However, the trend for NO emission levels appears to be influenced by the interaction of combustion with injection. For events with an overlap between injection and the combustion event, reduced NO emission levels are observed. Examination of data from engines indicates a similar trend in NO emission behavior; residence time effects and/or entrainment of post combustion gases into the fuel jet are hypothesized as the physical mechanisms that explain the overall emission behavior.
To increase system capacity of underwater optical communications, we employ the spatial domain to simultaneously transmit multiple orthogonal spatial beams, each carrying an independent data channel. ...In this paper, we show up to a 40-Gbit/s link by multiplexing and transmitting four green orbital angular momentum (OAM) beams through a single aperture. Moreover, we investigate the degrading effects of scattering/turbidity, water current, and thermal gradient-induced turbulence, and we find that thermal gradients cause the most distortions and turbidity causes the most loss. We show systems results using two different data generation techniques, one at 1064 nm for 10-Gbit/s/beam and one at 520 nm for 1-Gbit/s/beam; we use both techniques since present data-modulation technologies are faster for infrared (IR) than for green. For the 40-Gbit/s link, data is modulated in the IR, and OAM imprinting is performed in the green using a specially-designed metasurface phase mask. For the 4-Gbit/s link, a green laser diode is directly modulated. Finally, we show that inter-channel crosstalk induced by thermal gradients can be mitigated using multi-channel equalisation processing.
Indian pharmaceutical industry (IPI) has traversed through many phases and it is in emerging phase now (2019). IPI is looking for innovation, creativity, newness in patient connect to perform ...different activities to achieve their stated goals. According to a recent World Health Organization report, approximately 50% of the people with chronic illness do not take their medication as prescribed 1. Medication Non-Adherence is a huge problem across the world. Pharmaceutical companies across the world manufacture medicines with set of standard operating procedures, guidelines, quality execution systems, inspection and verification from quality control and quality assurance activities. The very intention of producing medicines is to sell them to the patients who are in need. The last thing Pharmaceutical companies expects from Health Care Professional (HCP) is to write the prescription and patient carrying it to Pharmacy to buy the medicine. The medicines for chronic illness are expensive in general. Despite having the prescriptions for medicines, there are plethora of reasons for Patient not to buy them. One of the most remarkable reason is – ‘the medicine costs are exorbitant’. If the medicines are not taken in case of the chronic illness, the patient’s quality of life degrades over a period of time, eventually resulting to fatality. This is a known concern to Pharmaceutical companies and new methods are invented to address the need for supporting the Patient at difficult times. This paper made an attempt to introduce predictive analytics based financial assistance model for chronic care patients in India.
The US Congress uses economic and budgetary projections, cost estimates for proposed legislation, and other analyses provided by the Congressional Budget Office (CBO) as part of its legislative ...process. CBO makes assessments based on an understanding of federal programs and revenue sources, reading the relevant research literature, analysis of data, and consultation with outside experts—and often relies on economic research. This article begins with a discussion of the role of the Congressional Budget Office and then discusses how economists could conduct research that would help inform the Congress by improving the quality of the analysis and parameter estimates that CBO uses. It gives overall context and specific examples in seven areas: credit and insurance, energy and the environment, health, labor, macroeconomics, national security, and taxes and transfers.
Aortic disease associated with pregnancy Williams, G M; Gott, V L; Brawley, R K ...
Journal of vascular surgery,
10/1988, Letnik:
8, Številka:
4
Journal Article
Recenzirano
Our experience with the management of two patients with life-threatening aortic disease during pregnancy is presented with a review of the literature. One of our patients had intimal disruption ...caused by trauma; the other had probable Ehlers-Danlos type IV syndrome, causing an acute dissection of the descending thoracic aorta and eventually requiring replacement of the aorta from the left subclavian artery to common iliac arteries. The challenge of treating both the pregnant woman and the fetus was managed successfully by an emergent cesarean section followed by Dacron graft replacement of the descending thoracic aorta. The literature reviewed disclosed that aneurysm expansion producing symptoms and dissection is most common during the third trimester and during labor and delivery in patients with or without Marfan's syndrome. Half of the aortic dissections in women less than 40 years of age occur in association with pregnancy. The available evidence indicates that patients with known valvular or aortic disease should have surgical repairs during the first or second trimester and thereafter have delivery by cesarean section. However, patients with acute aortic problems near term appear to be better managed by cesarean section followed promptly by treatment of the aortic disease.
Three-dimensional computed tomographic (3-D CT) reformations together with their corresponding conventional axial two-dimensional (2-D) CT images of 20 patients with facial fractures were compared ...with 2-D CT alone to define their usefulness in the determination of facial skeletal fracture patterns. Nine surgeons with three different levels of experience and training evaluated the presence and spatial arrangement of fractures in all 2-D CT and 3-D CT scans. Comparisons were made between their evaluations of 2-D CT alone and 2-D CT plus 3-D CT scans. Statistical analysis with Friedman's test were performed. The addition of 3-D CT did not alter the interpretation of 2-D CT in 75% of evaluations. The number and accuracy of the changes made with the aid of 3-D CT reflected the experience of the observers. Overall, there was no improvement in the accuracy of interpretations with the addition of 3-D CT.
We have evaluated the diagnostic role of computerized tomography in 42 patients suspected clinically of having a complication of acute diverticulitis (abscess, colovesical fistula, or both). ...Diverticular abscesses were confirmed at operation in 10 patients. All 10 patients were diagnosed preoperatively on computerized tomography by the triad of diverticula, a segmentally thickened colon, and extravisceral fluid collection with (6 patients) or without (4 patients) associated gas. Contrast enema study suggested the presence of a diverticular abscess in only two of eight patients studied. Colovesical fistulas were confirmed in 12 patients. Eleven of 12 were diagnosed preoperatively on computerized tomography by the triad of air in the bladder, thickened colon adjacent to an area of thickened bladder, and the presence of colonic diverticula. Contrast enema examinations demonstrated the fistula in only three of eight patients studied. The remaining 20 patients proved to have uncomplicated acute diverticulitis. Findings on computerized tomography included the presence of a segmentally thickened colon with diverticula but without the findings of an abscess or a colovesical fistula. Computerized tomography correctly visualized acute diverticular complications in 21 of 22 patients and it excluded an abscess or fistula in all 20 patients with uncomplicated acute diverticulitis who were suspected of having a diverticular complication. Computerized tomography is the most sensitive and specific test for diagnosing complications of acute diverticulitis. It should be an early consideration in patients with suspected diverticular abscesses or fistulas so that appropriate therapy is not delayed.
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