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Jigar Shah, the director of the U.S. Department of Energy's Loan Programs Office, is dedicated to promoting clean energy and unlocking entrepreneurial opportunities in this field. He oversees more than $200 billion in government loans for energy innovation, which could lead to a green and clean era of prosperity and job creation. Shah's career began with the launch of SunEdison in 2003, which brought significant investment to the solar market, and he has since been involved in successful ventures like Generate Capital. He also served as the first CEO of the Carbon War Room, an initiative focused on market-based models for climate action. Shah is recognized as one of the key architects of the world's clean-energy revolution. [Extracted from the article]

Diagnostic testing is fundamental to medicine. However, studies of diagnostic testing in respiratory medicine vary significantly in terms of their methodology, definitions, and reporting of results. This has led to often conflicting or ambiguous results. To address this issue, a group of 20 respiratory journal editors worked to develop reporting standards for studies of diagnostic testing based on a rigorous methodology to guide authors, peer reviewers, and researchers when conducting studies of diagnostic testing in respiratory medicine. Four key areas are covered, including defining the reference standard of truth, measures of dichotomous test performance when used for dichotomous outcomes, measures of multichotomous test performance for dichotomous outcomes, and what constitutes a useful definition of diagnostic yield. The importance of using contingency tables for reporting results is addressed with examples from the literature. A practical checklist is provided as well for reporting studies of diagnostic testing.

This document summarizes the work of the COPD Technical Expert Panel working group. For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation) and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Critical evidence supports changes to current policies, including randomized controlled trial evidence suggesting a mortality benefit from bilevel positive airway pressure with backup rate and updated clinical practice guidelines from the American Thoracic Society as well as the European Respiratory Society. To achieve optimal access to noninvasive ventilation for patients with COPD, we make the following key recommendations: (1) removal of the need for overnight oximetry testing; (2) the ability to initiate therapy using bilevel devices with backup rate capability; and (3) increased duration of time to meet adherence criteria (ie, a second 90-day trial period) in those patients actively engaged in their care. Clear guidelines based on medical necessity are also included for patients who require initiation of or switch to a home mechanical ventilator. Adoption of these proposed recommendations would result in the right device, for the right type of patient with COPD, at the right time. Finally, we emphasize the need for adequate clinical support during initiation and maintenance of home noninvasive ventilation in such patients.

Introduction Continuous process improvement has become the primary means for addressing the myriad of constraints that Airmen face. The idea of doing more with less has slowly given way to [...]

AbstractThe purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.11.007 Byline: Richard D. Branson, Kenneth Davis, Karyn L. Butler Keywords: Clinical research; Ethics; African-American Abstract: Ethical and scientifically sound research requires that any sample population represent the population as a whole. African-Americans suffer disproportionately from cancer, hypertension, and heart failure compared with whites, but they are commonly underrepresented in clinical trials of these diseases. Failure to include African-American subjects in clinical trials prevents generalizability of the results to this population. African-Americans are often underrepresented in clinical research for numerous historic, societal, educational, and economic reasons. Efforts to improve enrollment of African-American subjects requires recognition of the problem, planning, educational efforts, and investigator training. The incidence of heart disease and prostrate cancer in African-Americans dictates that these patients be targeted for clinical trials of surgical research. The research team must appreciate the importance of community involvement and support in recruiting African-Americans participants. Additionally, the continued effort to recruit and train African-American investigators must be a priority Author Affiliation: Department of Surgery, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, Cincinnati, OH 45267-0558, USA Article History: Received 7 February 2005; Revised 14 November 2005

This section offers news briefs related to the economy as of December 2016. Topics covered include the purpose of the TIME/Fortune Global Forum for chief executives and church leaders, the role of the private sector in dealing with the problem of food waste and the concern over the impact of globalization and technology on jobs. Also mentioned is the optimization of the world's energy system, as well as the support of businesses to those whose jobs are impacted by technology.

The existing coverage criteria for home noninvasive ventilation (NIV) do not recognize the diversity of hypoventilation syndromes and advances in technologies. This document summarizes the work of the hypoventilation syndromes Technical Expert Panel working group. The most pressing current coverage barriers identified were: (1) overreliance on arterial blood gases (particularly during sleep); (2) need to perform testing on prescribed oxygen; (3) requiring a sleep study to rule out OSA as the cause of sustained hypoxemia; (4) need for spirometry; (5) need to show bilevel positive airway pressure (BPAP) without a backup rate failure to qualify for BPAP spontaneous/timed; and (6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies includes randomized controlled trial evidence and clinical practice guidelines. To decrease morbidity and mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: (1) given the significant technological advances, we advise acceptance of surrogate noninvasive end-tidal and transcutaneous Pco2and venous blood gases in lieu of arterial blood gases; (2) not requiring Pco2measures while on prescribed oxygen; (3) not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; (4) remove spirometry as a requirement; and (5) not requiring BPAP without a backup rate failure to approve BPAP spontaneous/timed. The overarching goal of the Technical Expert Panel is to establish pathways that improve clinicians’ management capability to provide Medicare beneficiaries access to appropriate home NIV therapy. Adoption of these proposed suggestions would result in the right device, for the right type of patient with hypoventilation syndromes, at the right time.

This document summarizes the work of the CPAP and bilevel PAP therapy for OSA Technical Expert Panel working group. For positive airway pressure (PAP) therapy, the most pressing current coverage barriers identified were: an insufficient symptom list describing all potential symptoms in patients with mild OSA; the 4 h per night of PAP usage requirement to keep the device; the additional sleep studies requirement to re-qualify for PAP or supplemental oxygen; and the inability to use telehealth visits for follow-up visits. Critical evidence supports changes to current policies and includes: symptom list inadequate to cover all scenarios based on updated clinical practice guidelines; published evidence that 2 h per night of PAP use can result in benefit to quality of life and other metrics; the costs of another sleep study not justified for all nonadherent patients or for supplemental oxygen due to other types of assessment currently available; and the remarkable success and acceptance of telehealth visits. To achieve optimal access for patients on PAP therapy, we make the following key suggestions: removing symptom criteria for mild OSA; reduce continued coverage criteria to > 2 h per night; eliminate the need for a sleep study to re-qualify if nonadherent or for new Centers for Medicare & Medicaid Services beneficiaries already on and adherent to PAP therapy; allow telehealth visits for documenting benefit and adherence; and allow PAP reports and domiciliary oximetry to qualify for supplemental oxygen with PAP if needed. This paper shares our best vision for bringing the right device to the right patient at the right time.

'I would be lying if I didn't admit sadness that our wonderful airline is merging with another' --Virgin America founder Richard Branson on the company's merger with Alaska [...]

Study objective: Compare the inspiratory work of breathing ([WOB.sub.I]) during pressure triggering PT), and flow triggering (FT) using two microprocessor ventilators. Design: A randomized, crossover comparison of triggering strategies and [...]

Study objective: Determine the utility of a proposed algorithm in allowing safe, efficient humidification in mechanically ventilated patients using both a hygroscopic condenser humidifier (HCH) and heated humidifier (HH). Design: A prospective study using an algorithm to chose humidification devices based on physical examination and sputum characteristics. Setting: All patients admitted to the surgical ICU. Patients: One hundred twenty consecutive patients requiring mechanical ventilation (MV) were studied. Interventions: Patients were examined by the attending respiratory care practitioner and given either an HCH or HH. If patients demonstrated any of the following--thick or tenacious secretions, core temperature, During mechanical ventilation (MV), following endotracheal (ET) intubation, heating and humidifying inspired gases is essential to assure integrity of the airway and proper mucociliary function.[1-5] While the optimum level of [...]

The purpose of this study was to determine if sigh breaths delivered during pressure support ventilation (PSV) were beneficial in maintaining arterial oxygenation ([PaO.sub.2]) and pulmonary mechanics. Ten patients being [...]

Positive end-expiratory pressure (PEEP) improves oxygenation but, at moderate levels, limits portal blood flow (PBF) and may cause relative splanchnic ischemic. Under these conditions, methods of supporting gut physiology may prevent the sequelae of gut ischemic damage. Enternal feeding is known to cause splanehnic hyperemia in uninjured animals. In order to study the effects of continuous enteral feeding on gut hemodynamics in a flow-limited environment, six dogs underwent the insertion of arterial, pulmonary artery, and portal and hepatic vein catheters. Splenectomy and duodenostomy were performed, and the hepatic artery and portal vein were encircled with flow probes. Lung injury (LI) was undertaken with intravenons oleic acid (0.08 mL/kg), followed by incremental additions of PEEP totaling 10 cm[H.sub.2.O]to correct shunt. Continuons elemental feeding (1 keal/mL, 3 mL/kg/hr ) was started through the duodenostomy. Cardiac index (CI), PBF, and gut oxygen delivery and consumption [GO.sub.D], [GO.sub.2.C]) were measured at baseline (TO), 1 hour after LI and PEEP (T1), and 1 hour after drip feeding was begun (T2). Lung injury and PEEP significantly decreased CI, PBF, and[GO.sub.D]without changing[GO.sub.C]. Feeding returned PBF and[GO.sub.D]to baseline levels without changing CI.[GO.sub.C] increased significantly compared with baseline levels. Binreed on prior studies, these changes do not represent recovery of the injured model. Continuous enteral feeding, therefore, redistributed CI to the portal circulation. The improved gut hemodynamics documented in this model may preserve splanchnic integrity and prevent gut-derived complications.

The article presents profiles on several nominees for "Time" magazine's annual list of 100 influential people. Topics include a graph demonstrating the influence the nominees in this section; why each nominee is influential; and each nominees' professional field. Nominees include reality star Kim Kardashian, executive Tim Cook, restaurateur Danny Meyer, executive Bob Iger, and investor Reid Hoffman.

It's extremely important that the chief information security officers have a direct line to the board--being able to communicate status, your opinion of the risk of the organization and being [...]

Introduction: Intrathoracic pressure regulation (ITPR) can be utilized to enhance venous return and cardiac preload by inducing negative end expiratory pressure in mechanically ventilated patients. Previous preclinical studies have shown increased mean arterial pressure (MAP) and decreased intracranial pressure (ICP) with use of an ITPR device. The aim of this study was to evaluate the hemodynamic and respiratory effects of ITPR in a porcine polytrauma model of hemorrhagic shock and acute lung injury (ALI). Methods: Swine were anesthetized and underwent a combination of sham, hemorrhage, and/or lung injury. The experimental groups included: no injury with and without ITPR (ITPR, Sham), hemorrhage with and without ITPR (ITPR/Hem, Hem), and hemorrhage and ALI with and without ITPR (ITPR/Hem/ALI, Hem/ALI). The ITPR device was initiated at a setting of −3 cmH2O and incrementally decreased by 3 cmH2O after 30 minutes on each setting, with 15 minutes allowed for recovery between settings, to a nadir of −12 cmH2O. Histopathological analysis of the lungs was scored by blinded, independent reviewers. Of note, all animals were chemically paralyzed for the experiments to suppress gasping at ITPR pressures below −6 cmH2O. Results: Adequate shock was induced in the hemorrhage model, with the MAP being decreased in the Hem and ITPR/Hem group compared with Sham and ITPR/Sham, respectively, at all time points (Hem 54.2 ± 6.5 mmHg vs. 88.0 ± 13.9 mmHg, p< 0.01, −12 cmH2O; ITPR/Hem 59.5 ± 14.4 mmHg vs. 86.7 ± 12.1 mmHg, p< 0.01, −12 cmH2O). In addition, the PaO2/FIO2ratio was appropriately decreased in Hem/ALI compared with Sham and Hem groups (231.6 ± 152.5 vs. 502.0 ± 24.6 (Sham) p< 0.05 vs. 463.6 ± 10.2, (Hem) p< 0.01, −12 cmH2O). Heart rate was consistently higher in the ITPR/Hem/ALI group compared with the Hem/ALI group (255 ± 26 bpm vs. 150.6 ± 62.3 bpm, −12 cmH2O) and higher in the ITPR/Hem group compared with Hem. Respiratory rate (adjusted to maintain pH) was also higher in the ITPR/Hem/ALI group compared with Hem/ALI at −9 and − 12 cmH2O (32.8 ± 3.0 breaths per minute (bpm) vs. 26.8 ± 3.6 bpm, −12 cmH2O) and higher in the ITPR/Hem group compared with Hem at −6, −9, and − 12 cmH2O. Lung compliance and end expiratory lung volume (EELV) were both consistently decreased in all three ITPR groups compared with their controls. Histopathologic severity of lung injury was worse in the ITPR and ALI groups compared with their respective injured controls or Sham. Conclusion: In this swine polytrauma model, we demonstrated successful establishment of hemorrhage and combined hemorrhage/ALI models. While ITPR did not demonstrate a benefit for MAP or ICP, our data demonstrate that the ITPR device induced tachycardia with associated increase in cardiac output, as well as tachypnea with decreased lung compliance, EELV, PaO2/FIO2ratio, and worse histopathologic lung injury. Therefore, implementation of the ITPR device in the setting of polytrauma may compromise pulmonary function without significant hemodynamic improvement.

'I have known Lucian for 30 years, he is a great record man and has committed to revitalise Virgin Records which has been mismanaged in the last 10 years' Richard [...]

Global business icon Richard Branson has written many books, but none have been more popular than his first memoir, 1998's Losing My Virginity. Now he's finally publishing his second volume [...]

What is the best decision you've made in your career? Accepting an offer from Nick Redwood to join Gazeley in 2005.1 consider myself very lucky. I enjoy my job - [...]

Byline: Sir Richard Branson IN 1972, A YOUNG SCIENTIST NAMED LAMES LOVELOCK WAS DEveloping a hypothesis of how the planet worked called Gaia theory. Lovelock's theory, named for the Greek [...]

'To me, business isn't about wearing suits of pleasing stockholders. It's about being true to yourself, your ideas and focusing on the essentials.' Richard Branson, Chairman of Virgin and inspired [...]

The transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion.

Adequate oxygenation is one of the primary goals of mechanical ventilation. Maintenance of adequate oxygenation and prevention of hypoxemia are the primary goals for the battlefield casualty, but military operations have unique concerns. In military operations, oxygen is a limited resource. A portable oxygen concentrator has the advantage of operating solely from electrical power and theoretically is a never-exhausting supply of oxygen. Our previous bench work demonstrated that the pulsed dose setting of the concentrator can be used in concert with the ventilator to maximize oxygen delivery. We evaluated this ventilator/concentrator system with closed loop control of oxygen output in a porcine model.

The World in 1997 asked Richard Branson, chairman of the Virgin Group, how to make a name for oneself in the next century Brands such as BMW, Ford, McDonald's, Mitsubishi, [...]

AbstractThe state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.

Apollo's Fire: Igniting America's Clean Energy Economy by Jay Inslee and Bracken Hendricks Island Press, 387 pp. The debate over global warming has changed. Not so long ago, the point [...]

Profiles Juan Trippe. His way of managing Pan American Airways; Education and business background; Pacing of the airline's growth; Goal of allowing average people to fly; The route from New York to San Juan, Puerto Rico; Transformation brought about by the jet; First 707s; Trippe the co-creator of the 747 with Boeing; Pan Am's collapse. INSET: Giving Airlines Their Wings.