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Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake.

The feasibility of refinement of Al–Zn–Mg–Si hot dip coatings by diode laser resurfacing has been demonstrated. The microstructure of the laser resurfaced coatings was characterised mainly by transmission electron microscopy and also by scanning electron microscopy. The variance of heat input results in different cooling rates and varying degrees of refinement; that is, the higher the power density, the lower the cooling rate and the larger the secondary dendrite arm spacing of a-Al dendrites. In addition, the inherent variation of chemical composition in coatings also affects the microstructure as well as phase distribution. This laser resurfacing technique has not only reduced the secondary dendrite arm spacing/a-Al dendrites but also changed the solidification path and produce different phases and microstructure in the interdendritic areas.

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Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) have been increasingly used to diagnose acute coagulopathy and guide blood transfusion. The tests are routinely performed using different triggering activators such as tissue factor and kaolin, which activate different pathways yielding different results. To optimize the global blood coagulation assays using ROTEM and TEG, we conducted a comparative study on the activation methods employing tissue factor and kaolin at different concentrations as well as standard reagents as recommended by the manufacturer of each device. Key parameter values were obtained at various assay conditions to evaluate and compare coagulation and fibrinolysis profiles of citrated whole blood collected from healthy volunteers. It was found that tissue factor reduced ROTEM clotting time and TEG R, and increased ROTEM clot formation time and TEG K in a concentration-dependent manner. In addition, tissue factor affected ROTEM alpha angle, and maximum clot firmness, especially in the absence of kaolin activation, whereas both ROTEM and TEG clot lysis (LI30, CL30, and LY30) remained unaffected. Moreover, kaolin reduced ROTEM clotting time and TEG R and K, but to a lesser extent than tissue factor, in-tem and ex-tem. Correlations in all corresponding parameters between ROTEM and TEG were observed, when the same activators were used in the assays compared with lesser correlations between standard kaolin TEG and ROTEM (INTEM/EXTEM). The two types of viscoelastic point-of-care devices provide different results, depending on the triggering reagent used to perform the assay. Optimal assay condition was obtained to reduce assay time and improve assay accuracy.

The leading causes of death for trauma patients in civilian and combat settings are traumatic brain injury and uncontrolled hemorrhage, respectively. This study examines the hemostatic activity of an ideal amphipathic peptide (IAP) attached to a biocompatible surface.

In this study of 41 patients, we used proteomic, Western blot and immunohistochemical analyses to show that several reactive oxygen species scavenging enzymes are expressed differentially in patients with primary osteoarthritis and those with non-loosening and aseptic loosening after total hip replacement (THR). The patients were grouped as A (n = 16, primary THR), B (n = 10, fixed THR but requiring revision for polyethylene wear) and C (n = 15, requiring revision due to aseptic loosening) to verify the involvement of the identified targets in aseptic loosening. When compared with Groups A and B, Group C patients exhibited significant up-regulation of transthyretin and superoxide dismutase 3, but down-regulation of glutathione peroxidase 2 in their hip synovial fluids. Also, higher levels of superoxide dismutase 2 and peroxiredoxin 2, but not superoxide dismutase 1, catalase and glutathione perioxidase 1, were consistently detected in the hip capsules of Group C patients.We propose that dysregulated reactive oxygen species-related enzymes may play an important role in the pathogenesis and progression of aseptic loosening after THR.

We conducted a retrospective study to investigate the effect of femoral bowing on the placement of components in total knee replacement (TKR), with regard to its effect on reestablishing the correct mechanical axis, as we hypothesised that computer-assisted total knee replacement (CAS-TKR) would produce more accurate alignment than conventional TKR. Between January 2006 and December 2009, 212 patients (306 knees) underwent TKR. The conventional TKR was compared with CAS-TKR for accuracy of placement of the components and post-operative alignment, as determined by five radiological measurements. There were significant differences in the reconstructed mechanical axes between the bowed and the non-bowed group after conventional TKR (176.2° (sd3.4) vs179.3° (sd2.1), p < 0.001).For patients with significant femoral bowing, the reconstructed mechanical axes were significantly closer to normal in the CAS group than in the conventional group (179.2° (sd1.9) vs176.2° (sd3.4), p < 0.001). Femoral bowing resulted in inaccuracy when a conventional technique was used. CAS-TKR provides an effective method of restoring the mechanical axis in the presence of significant femoral bowing.

An increased number of thalassaemia patients treated with effective chelation therapy protocols are achieving body iron levels similar to those of normal individuals. Iron chelation therapy has also been recently used in a number of other categories of patients with no excess body iron load such as neurodegenerative, renal and infectious diseases. Chelation therapy in the absence of iron overload in the latter conditions raises many safety issues including chelator overdose toxicity and toxicity related to iron and other essential metal deficiencies. Preliminary preclinical and clinical toxicity evidence suggest that deferoxamine and deferasirox can only be safely used for these non-iron loaded conditions for short-term treatments of a few weeks, whereas deferiprone can be used for longer term treatments of many months. The selection of the chelating drug and appropriate dose protocols for targeting specific organs and conditions is critical for the safety of patients with normal iron stores. Chelation therapy is likely to play a major role as adjuvant, alternative or main therapy in many non-iron loading conditions in the forthcoming years.

This paper presents flyback converter combined with single-capacitor turn-off snubber for auto-tuning fan speed system. The proposed system can automatically adjust rotational speed of fan, depending on the temperature in the chassis of the equipment. Its control algorithm is realised by a PWM IC which, by taking into account the converter output voltage and chassis temperature, will regulate the output voltage of the converter. With this approach, the wear and tear of the bearing of fan can be reduced and the circuit structure, compared with the conventional two stage driving circuit, can be simplified. Therefore, the proposed system can raise conversion efficiency, reduce component count, weight and size. Moreover, in order to further increase conversion efficiency of the proposed system, a single-capacitor turn-off snubber is adopted to reduce switching loss at turn off transition, Finally, a prototype under output voltage varied from 5 V-12 V and maximum output power of 200 W has been implemented to prove the feasibility of the proposed auto-tuning fan speed system.

Background: Nesiritide, a synthetic B-type natriuretic peptide, is used for the treatment of patients with acutely decompensated heart failure. Although nesiritide has been reported to worsen renal function, as reflected by significant elevations in serum creatinine (SCr), the impact of infusion duration on renal function has not been evaluated.Objective: To investigate the effect of nesiritide infusion duration (<24 h vs ≥24 h) on worsening renal function in patients with acutely decompensated heart failure.Methods: Medical records of hospitalized patients receiving nesiritide were retrospectively reviewed, and 84 consecutive charts of patients with acute decompensated heart failure and available renal function tests were identified for the study. SCr and blood urea nitrogen (BUN) were documented at baseline and during infusion. Worsening renal function was defined as an increase in SCr of 0.5 mg/dL or more or BUN 10 mg/dL or more from baseline.Results: Univariate analysis showed a significant association between nesiritide infusion duration of 24 hours or more (26.1% vs 2.6%; p = 0.003), high diuretic doses (61.5% vs 32.4%; p = 0.045), and baseline SCr (2.0 ± 0.8 vs 1.5 ± 0.7 mg/dL; p = 0.04) with increases in SCr of 0.5 mg/dL or more. However, only infusion duration of 24 hours or more was statistically significant on multivariate analysis, after adjusting for baseline SCr (OR 10.46; 95% CI 1.26 to 86.72; p = 0.03). Longer duration of infusion was also a consistent variable in both univariate and multivariate analysis when elevated BUN was evaluated (34.8 vs 2.6%; p < 0.001 and OR 19.73; 95% CI 2.47 to 157.46; p = 0.005, respectively).Conclusions: Nesiritide infusion of 24 hours or more appears to be significantly associated with elevated markers of worsening renal function in patients with acutely decompensated heart failure compared with infusion of less than 24 hours; however, prospective studies are needed to corroborate this finding.

[Thiocarbonyl-¹⁴C] Dithizone was prepared and characterized spectroscopically. Copyright © 2003 John Wiley & Sons, Ltd.

AIM: To compare the efficacy and safety of an indomethacin treatment strategy based on serial echocardiographic measurement of patent ductus arteriosus (PDA) flow pattern with a standard protocol. METHODS: Neonates weighing less than 1500 g at birth, who required respiratory support, and who had developed symptomatic PDA, were studied. PDA was confirmed in all infants using colour Doppler echocardiography, and serial observations of the ductal flow pattern were made. Infants randomly assigned to receive conventional indomethacin treatment (protocol group) were given an initial dose of 0.2 mg/kg, followed by 0.1 or 0.2 mg/kg, depending on age, 12 hourly for two further doses, and were eligible for a second course. Those randomly assigned to the ductal flow pattern assessment (ECHO group) received further doses of indomethacin after 24 hours, only if their flow pattern was "pulsatile" or "growing." RESULTS: There was no significant difference in the primary outcome measures between the two groups. The closure rate was 89.1% and 87.2%, respectively, in the protocol and ECHO groups. The mean (SD) doses of indomethacin were significantly higher in the protocol group: 3.2 (1.4) doses compared with 1.6 (0.9) doses. There was a significantly higher incidence of hypoglycaemia, impaired urine output, and gastrointestinal bleeding in the protocol group. CONCLUSIONS: An indomethacin treatment strategy for PDA based on measurement of the ductal flow pattern is associated with a reduction in the total doses of indomethacin administered, and a reduced rate of complications, compared with a conventional protocol. There is no difference in closure rate.

Abstract:  We analyzed the seven mutations which are responsible for the deficiency of the secretor type α(1,2)-fucosyltransferase gene product, Se enzyme, in the Philippine population. One hundred and one unrelated Filipinos in Taiwan were studied. A new mutation, a 3-base pair deletion from nt 688 through 690, was found in two (0.1%) of 202 chromosomes. The frequencies of six other mutated alleles were as follows: 71/202 (35.2%) were cDNA 385 A→T missensed mutation (se2), 28/202 (13.9%) were C571T nonsense mutation (se3), 16/202 (7.9%) were G849A nonsense mutation (se4), 4/202 (1.9%) were G428A nonsense mutation (se1), and 81/202 (40.1%) were wild-type allele (Se). No C628T nonsense mutations (se5) or fusion genes of pseudogene and FUT2 gene (se 6) were found in this population. For the molecular basis of phenotype Le(a+ b–): eight cases had se2/se2, six cases had se2/se3, two cases had se3/se4, one case was homozygous of se4, one case was se3/se1, and two cases were se2/se7. For the Le(a+ b+) phenotype: four cases had se2/se2, two cases had se2/se3, one case was se3/se3, and one case was se2/se4. For the Le(a– b+) phenotype: 16 cases were Se/Se, 21 cases were Se/se2, six cases were Se/se3, five cases were Se/se4, and two cases had Se/se1. Our results suggest that the genotypes of the α(1,2)-fucosyltransferase gene in phenotypes Le(a+ b+) and Le(a+ b–) are the same. Other factors that play important roles may cause the differences between these two phenotypes. Several hotspot mutations in the α(1,2)-fucosyltransferase gene are responsible for the nonsecretor phenotype.

An 8.5-month-old male infant with Kawasaki disease (KD) received high-dose intravenous immunoglobulin (IVIG) therapy on the fifth day after fever onset. However, multiple peripheral limb ischemias occurred 2 days later. Accordingly, heparin followed by dipyridamole was administered. Aside from a small amputation at the tip of the right middle finger, all other digital ischemias resolved. This presentation demonstrates that early recognition and management of peripheral gangrene in KD may keep its sequela to a minimum.

It is the pervading law of all things organic and inorganic, of all things physical and metaphysical, of all things human and all things superhuman, of all true manifestations of the head, of the heart, of the soul, that the life is recognizable in its expression, that form ever follows function, this is the law.1

An exact formulation is presented for the boundary-value problem of a class of doubly periodic structures, each of which is composed of a uniform dielectric layer sandwiched between two gratings with two different periods. The general dispersion properties of doubly periodic structures as waveguides are rigorously established and both global and local behaviors of the Brillouin diagram are analyzed to illustrate the guiding characteristics of doubly periodic structures, regardless of the grating profiles. The effects of the commensurability of the two grating periods are carefully studied; in particular, it is shown that the commensurate case will still support purely bounded waves, but the noncommensurate case will not. Furthermore, it is shown that, in a doubly periodic structure, strong couplings may involve two or more space harmonics that may come from more than one mode. Numerical results are given for the special case of a dielectric layer with rectangular corrugations of different periods on its two boundary surfaces. The stop-band behaviors are examined in detail for various cases involving one, two, and three modes.

First a rigorous formulation is presented for the scattering of a uniform plane wave by an infinite dielectric grating waveguide, under the most general condition of oblique incidence. The results are then applied to the analysis of the guidance of waves by the dielectric grating waveguide. By using a simple coordinate rotation, the TE and TM Floquet mode functions determined previously for the special case of principal-plane incidence are combined to treat the general case of oblique incidence. In terms of the coupling between the known Floquet mode functions of both polarizations, the general case of oblique incidence is formulated in an exact fashion, as a three-dimensional boundary-value problem, so that the hybrid nature of waves supported by the structure can be investigated rigorously.

In a previous paper, a constitutive equation of relaxation behaviour of time-dependent chemically unstable materials has been developed by employing the irreversible thermodynamics of internal variables and Eyring's absolute reaction theory. In that paper, a theoretical expression for the effect of chemical crosslink density,v, on the relaxation rate has been developed. In this paper the creep behaviour of a network polymer undergoing a scission process has been developed. The temperature effect using the WLF equation on the coupled chemomechanical behaviour has also been incorporated into the equation.

The reflection characteristics of the planar surface wave antennas with different tapering profiles are analyzed by a method which transforms the radiation problem into the transmission problem of the eigen mode in the partially dielectric filled planar waveguide to avoid the difficulty of the field source problem which is met in the traditional analysis. As a result, the analysis procedure is tremendously simplified. The effect of the tapering profile on the reflection property is carefully investigated and extensive numerical results are given to establish useful guidelines for the design of the planar surface wave antennas.

The coupling between two parallel dielectric waveguides with a finite coupling length is investigated. The ends of the waveguides are tapered in order to reduce the scattering losses. It is shown that the taper sections can be utilized to achieve an effective coupling which is insensitive to the coupling length, thus, providing a much greater tolerance for the design and manufacturing of coupling devices.

The design of a bigrating for use as a beam splitter is presented. It is based on a rigorous formulation of plane-wave scattering by a bigrating that is composed of two individual gratings oriented in different directions. Numerical results are carried out to optimize the design of a bigrating to perform 1 × 4 beam splitting in two dimensions and to examine its fabrication and operation tolerances. It is found that a bigrating can be designed to perform two functions: beam splitting and polarization purification.

We present a theoretical and experimental study on the diffraction characteristics of gratings, with particular attention focused on the effects of polarization. The goal of our study is to develop multifunctional devices for use in a pickup head for optical storage systems. Experiments and numerical calculations are carried out systematically to determine the effects of the grating parameters of depth, period, and duty cycle and also the effects of the incident-wave parameters of incident angle, wavelength, and polarization. It is shown that, theoretically, the diffraction efficiency can reach 100% for both TE and TM polarizations that are incident at the Bragg angle. The simple dispersion characteristics of the Floquet modes are invoked to explain the different diffraction behaviors between the two polarizations. We conclude that a suitably designed grating may split an incident light beam of mixed polarizations into two beams of the opposite polarizations, each propagating in a different direction. Based on the numerical results, simple criteria are suggested for the design of the grating structures for both polarizing and nonpolarizing beam splitters.

Summary An experimental investigation of the behavior of a polymer specimen for a constant stretch history has been conducted for both strip biaxial extensional flow and simple extensional flow. It had been shown previously that the stress functional of a non-Newtonian fluid under motion with constant stretch history reduces to a function of the threeRivlin-Ericksen tensors. Here it is shown that the second order approximation of a simple fluid is not capable of describing the steady-state viscosity in both types of flow under very slow motion. By considering higher orders, however, one may obtain the material constants necessary to describe steady-state non-Newtonian viscosity for both strip biaxial extensional flow and simple extension flow.

Summary The specific Helmholtz free energy of nonlinear viscoelastic isotropic polymer solids is assumed to be a separable, symmetric function along three orthogonal principal strain directions, i.e.?=?(?1,qn(1))+?(?2,qn(2))+?(?3,qn(3)), where the?r (r=1, 2, 3) are three principal stretch ratios and theqn(r) are a set of internal state variables. It is shown that, by using this postulated form of the free energy function, one can readily characterize the mechanical response of viscoelastic polymer solids.

The surface of a Ti-48 at. Pct Al alloy was examined by Auger electron microscopy to study oxidation at room temperature. On exposure to air at room temperature, both Al and Ti oxides were observed together with an abundance of C. The amount of C was always larger in the two-phase α2+ γregion compared to the single-phase γ region. The Ti oxides formed on the surface of theygrains were primarily Ti2O3rather than TiO2. On depth profiling with Ar+ion sputtering, lower oxide states of Ti were found. This was attributed to either the Ar+ion sputtering or the fact that the inner layers of oxide represented oxides of Ti in their lower valence states. The A12O3was stable and did not exhibit any transient oxidation states. The dominant oxidation product on the surface of sputtered single-phase γ grains after an 84-hour exposure in the ultrahigh vacuum Auger chamber at room temperature is A12O3. A depletion of C and O occurred beneath the oxide surface in some γ grains. The chemical shift between the Al L2,3MM and A12O3L2,3(A1)M(O)M(O)peaks in the Auger spectrum of A12O3formed on the γ phase in TiAl was found to be 11 eV.

In this paper we study concept representation by factor spaces and fuzzy sets theory. Fuzzy sets are used to represent the membership grade of objects to a concept, and factor spaces are used to capture the characteristics of a concept. Based on this method, some problems, such as decomposability of complex concepts and combination of concepts, are investigated.

ANESTHESIA for laryngoscopy differs somewhat from anesthesia for bronchoscopy. In the latter procedure, ventilation can be achieved by the use of a ventilating bronchoscope, or by inserting a small endotracheal tube prior to and during the bronchoscopy, or insufflating oxygen by the side-arm on the bronchoscope. In direct laryngoscopy the above methods are not applicable because the tube may interfere with visualization of the field or may interfere with the surgeon.The most common method of anesthesia for laryngoscopy is the use of topical analgesia with heavy sedation. This is an excellent method in skilled hands, but it may be unsuccessful with uncooperative patients or young children. There are many anesthetic techniques for laryngoscopy reported in the current literature, namely, the use of the recovery phase of deep ether anesthesia; the use of methoxyflurane in a similar manner; the use of topical analgesia with general anesthesia; the use of intravenous

The new method for immunochemical assay of extractable insulin from the pancreas described in this report is based on the change in binding of insulin-I131to insulin antibodies in the presence of varying quantities of unlabeled insulin. The method was used to study changes in extractable pancreatic insulin after administration of tolbutamide to normal mice. Although tolbutamide caused a sharp decline in blood sugar within 2 hours of administration, a consistent decrease of insulin in the pancreas was not observed.

Perrin's equation for solute quenching is redefined. Multicomponent concentration quenching curves are obtained by plotting log (I/c) vs. c. Addition of quencher to the solvent-solute system and use of inefficient solvent cause the quenching curves to become linear. Based on the shift of maximum activating wavelength during photo-activation, formation of excimers or molecular aggregates of similar nature is postulated to explain the observed phenomenon.

Apomorphine, Hydergine, deslanoside, copper sulfate, and protoveratrine A were tested for their emetic action in monkeys. Apomorphine or Hydergine, even in doses as high as 0.3 mg/kg, i.v., could not provoke vomiting in monkeys. 0.1 mg/kg i.v., of deslanoside induced vomiting lasting several hours and with a long latency in 94.5% of the monkeys. After trigger zone ablation, most of the monkeys did not vomit to deslanoside and only a few vomited to high doses of this agent.Oral copper sulfate in a dose of 160 mg provoked vomiting in 63.6% of monkeys. After gut denervation these animals did not vomit even to 360 mg, except for one which vomited to this dose after a long latency. 83.3% of the monkeys vomited to IS μg/kg of intravenous protoveratrine A. Cardiac denervation or trigger zone ablation plus cardiac denervation influenced neither the threshold emetic dose nor the latency of this agent.

The influence of testosterone propionate upon the central sexual maturation of the male rat has been investigated. Male rats castrated on the day of birth and injected with testosterone propionate at 5, 10 or 20 days of age had immature ovarian tissue transplanted to the anterior chamber of one eye when 3 months old. Ovarian grafts in castrate males injected with testosterone at 5 or 10 days of age did not show cyclical activity. Grafts in non-injected castrates or hosts injected with testosterone at 20 days of age showed cyclical activity. The site of action of testosterone is discussed, and it is suggested that it may have an inductive influence upon the sexual maturation of the rat brain.