Study objective Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from ...evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals. Methods We used a qualitative, interview-based method to identify medical surge strategies used at hospitals receiving patients from evacuated health care facilities during and after Hurricane Sandy. We identified 4 hospital systems that received the majority of evacuated patients and those departments most involved in managing patient surge. We invited key staff at those hospitals to participate in on-site group interviews. Results We interviewed 71 key individuals. Although all hospitals had emergency preparedness plans in place before Hurricane Sandy, we identified gaps. Insights gleaned included improvement opportunities in these areas: prolonged increased patient volume, an increase in the number of methadone and dialysis patients, ability to absorb displaced staff, the challenges associated with nursing homes that have evacuated and shelters that have already reached capacity, and reimbursements for transferred patients. Conclusion Our qualitative, event-based research identified key opportunities to improve disaster preparedness. The specific opportunities and this structured postevent approach can serve to guide future disaster planning and analyses.
Several laboratory studies suggested that induced hypothermia during hemorrhagic shock improves survival. Inhaled hydrogen sulfide (H2S) induced hypothermia and decreased metabolism in mice and rats ...but not in piglets. We tested the hypothesis that i.v. H2S will induce hypothermia, reduce oxygen consumption (VO2), and improve outcome in prolonged hemorrhagic shock in pigs. We also assessed markers of organ injury (alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, creatinine, and troponin) and level of protein thiols to monitor H2S metabolism. In a prospective randomized study, pigs were subjected to volume-controlled hemorrhagic shock with limited fluid resuscitation to maintain MAP 30 mmHg or greater. The study group received infusion of H2S at 5 mg·kg·h; the control group received vehicle (n = 8 per group). Dose was based on the highest tolerated dose in pilot studies. Full resuscitation was initiated after 3 h. There were no differences in survival at 24 h between groups (2/8 in H2S vs. 3/8 in control group). Heart rate increased similarly during hemorrhagic shock in both groups. Cardiac output was better preserved in the delayed phase of hemorrhagic shock in the control group. Temperature and VO2 were similar in both groups during hemorrhagic shock and resuscitation. Markers of organ injury and protein thiols markedly increased in both groups with no differences between groups. In conclusion, we were not able to demonstrate the hypothermia-inducing effect or a reduction in VO2 from H2S infusion in our model of hemorrhagic shock in pigs. Our data mirror those seen in piglets and provide additional evidence of difficulty in translating the hypothermia effect of H2S to large animals in a clinically relevant postinsult paradigm.
Flexible silicone membranes are key components for tunable optical lenses. The elastic operation of the membranes impedes the use of classical layer systems for an antireflective (AR) effect. To ...overcome this limitation, we equipped optical elastomer membranes with "moth-eye" structures directly in the flexible silicone substrate. The manufacturing of the AR structures in the flexible membrane includes a mastering process based on block copolymer micelle nanolithography followed by a replication method. We investigate the performance of the resulting AR structures under strain of up to 20% membrane expansion. A significant transmittance enhancement of up to 2.5% is achieved over the entire visible spectrum, which means that more than half of the surface reflection losses are compensated by the AR structures.
Antireflective subwavelength structures (ARS) resembling nanostructures found on the cornea of night-active insects reduce the reflection of light by providing a gradual change in the refractive ...index at the interface. These artificial ARS have mainly been fabricated by a combination of conventional lithography and reactive ion etching, which constrains their application to planar substrates. We report on the fabrication of ARS using three different techniques including bottom-up and top-down methods as well as their combination on microlens arrays (MLAs) made of fused silica. The optical performance of the resulting ARS on the MLAs is as good as ARS fabricated on planar substrates with increased transmission of up to 96% at certain wavelengths.
Summary Emergency preservation and resuscitation (EPR) is a new approach for resuscitation of exsanguination cardiac arrest (CA) victims. EPR uses a cold aortic flush to induce deep hypothermic ...preservation during no-flow to buy time for transport and damage control surgery, followed by resuscitation with cardiopulmonary bypass (CPB). We reported previously that 20–60 min EPR in rats was associated with intact outcome, while 75 min EPR resulted in high mortality and neurological impairment in survivors. The delta opioid agonist DADLE ( d -Ala(2), d -Leu(5)-enkephalin) was shown previously to be protective against ischemia-reperfusion injury in multiple organs, including brain. We hypothesized that DADLE could augment neurological outcome after EPR in rats. After rapid lethal hemorrhage, EPR was initiated by perfusion with ice-cold crystalloid to induce hypothermia (15 °C). After 75 min EPR, resuscitation was attempted with CPB. After randomization, three groups were studied ( n = 10 per group): DADLE 0 mg/kg (D0), 4 mg/kg (D4) or 10 mg/kg (D10) added to the flush and during reperfusion. Survival, overall performance category (OPC; 1 = normal, 5 = death), neurological deficit score (NDS; 0–10% normal, 100% = max deficit), and histological damage score (HDS) were assessed in survivors on day 3. In D0 group, 2/10 rats survived, while in D4 and D10 groups, 4/10 and 5/10 rats survived, respectively ( p = NS). Survival time (h) was 26.7 ± 28.2 in D0, 36.3 ± 31.9 in D4 and 47.1 ± 30.3 in D10 groups, respectively ( p = 0.3). OPC, NDS and HDS were not significantly different between groups. In conclusion, DADLE failed to confer benefit on functional or histological outcome in our model of prolonged rat EPR.
AEgIS (Expérience sur l'Antimatière: Gravité, Interférométrie, Spectrométrie) est une expérience approuvée par le CERN qui vise une étude globale de la physique de l'anti-hydrogène. Dans AEgIS, ...l'anti-hydrogène sera produit par des réactions d'échange de charges d'anti-protons froids avec des atomes de positronium excités dans un état de Rydberg (n > 20). Dans la première phase de l'expérience, l'accélération est contrôlée par un gradient de champ électrique (effet Stark); une mesure subséquente en chute libre dans un déflectomètre de Moiré nous fournira un test du principe d'équivalence faible. Dans une deuxième phase, l'anti-hydrogène sera ralenti, confiné et refroidi par laser pour des études de CPT et de spectroscopie de précision. Après une description générale de l'expérience, nous passons ici en revue l'état d'avancement des travaux en accordant une attention particulière à la production et l'excitation des atomes de positronium.
The main scientific goal of the AEGIS experiment (
Antimatter
Experiment:
Gravity,
Interferometry,
Spectroscopy) is the direct measurement of the Earth's gravitational acceleration
g on a beam of ...cold antihydrogen (
H
¯
). The production of an antihydrogen beam is achieved by a charge exchange reaction between Rydberg positronium and cold antiprotons. The
H
¯
beam will be accelerated up to a velocity of a few 100 m/s and the gravitational acceleration will be obtained by measuring the small vertical deflection of the beam (a few tens
μm) using a Moire' deflectometer.
AEgIS (Antimatter experiment: gravity, interferometry, spectroscopy) is an experiment approved by CERN with the goal of studying antihydrogen physics. In AEgIS, antihydrogen will be produced by ...charge exchange reactions of cold antiprotons with positronium atoms excited in a Rydberg state (n > 20). In the first phase of the experiment, controlled acceleration by an electric field gradient (Stark effect) and subsequent measurement of free fall in a Moire deflectometer will allow a test of the weak equivalence principle. In a second phase, the antihydrogen will be slowed, confined, and laser-cooled to perform CPT studies and detailed spectroscopy. In the present work, after a general description of the experiment, the present status of advancement will be reviewed, with special attention to the production and excitation of positronium atoms.
The formation of the antihydrogen beam in the AEGIS experiment through the use of inhomogeneous electric fields is discussed and simulation results including the geometry of the apparatus and ...realistic hypothesis about the antihydrogen initial conditions are shown. The resulting velocity distribution matches the requirements of the gravity experiment. In particular it is shown that the inhomogeneous electric fields provide radial cooling of the beam during the acceleration.
AEgIS (Antimatter experiment: gravity, interferometry, spectroscopy) is an experiment approved by CERN with the goal of studying antihydrogen physics. In AEgIS, antihydrogen will be produced by ...charge exchange reactions of cold antiprotons with positronium atoms excited in a Rydberg state (n > 20). In the first phase of the experiment, controlled acceleration by an electric field gradient (Stark effect) and subsequent measurement of free fall in a Moiré deflectometer will allow a test of the weak equivalence principle. In a second phase, the antihydrogen will be slowed, confined, and laser-cooled to perform CPT studies and detailed spectroscopy. In the present work, after a general description of the experiment, the present status of advancement will be reviewed, with special attention to the production and excitation of positronium atoms.
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