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A new image restoration algorithm is proposed to remove the effect of atmospheric turbulence on motion-compensated frame averaged data collected by a three dimensional FLASH Laser Radar (LADAR) imaging system. The algorithm simultaneously arrives at an enhanced image as well as Fried's seeing parameter through an Expectation Maximization (EM) technique. Unlike blind deconvolution algorithms that operate only on two dimensional images, this technique accounts for both the spatial and temporal mixing that is caused by the atmosphere through which the system is imaging. Additionally, due to the over-determined nature of this problem, the point-spread function parameterized by Fried's seeing parameter can be deduced without the requirement for additional assumptions or constraints. The utility of the approach lies in its application to laser illuminated imaging where processing time is important.

Iatrogenic diaphragmatic hernias are a rarely reported complication of abdominal surgery. We present a case of an iatrogenic diaphragmatic hernia diagnosed 2 years after an adrenalectomy. Corrective laparoscopic surgery was performed, and the postoperative course was uneventful. The patient remained asymptomatic 6 months after the repair. To our knowledge, this is the first such case to be reported.

In their 2005 study, Adamic and Glance coined the memorable phrase "divided they blog", referring to a trend of cyberbalkanization in the political blogosphere, with liberal and conservative blogs tending to link to other blogs with a similar political slant, and not to one another. As political discussion and activity increasingly moves online, the power of framing political discourses is shifting from mass media to social media. Continued examination of political interactions online is critical, and we extend this line of research by examining the activities of political users within the Wikipedia community. First, we examined how users in Wikipedia choose to display (or not to display) their political affiliation. Next, we more closely examined the patterns of cross-party interaction and community participation among those users proclaiming a political affiliation. In contrast to previous analyses of other social media, we did not find strong trends indicating a preference to interact with members of the same political party within the Wikipedia community. Our results indicate that users who proclaim their political affiliation within the community tend to proclaim their identity as a "Wikipedian" even more loudly. It seems that the shared identity of "being Wikipedian" may be strong enough to triumph over other potentially divisive facets of personal identity, such as political affiliation., Comment: 33 pages, 5 figures

The goal of this work is to develop an algorithm to enhance the utility of 3D FLASH laser radar sensors through accurate ranging to multiple surfaces per image pixel. Using this algorithm it will be possible to realize numerous enhancements over both traditional Gaussian mixture modeling and single surface range estimation. While traditional Gaussian mixture modeling can effectively model the received pulse, we know that the received pulse is likely corrupted due to optical aberrations from the imaging system and the medium through which it is imaging. Additionally, only identifying a single surface per pulse may result in the loss of valuable information about partially obscured surfaces. Ultimately, this algorithm in conjunction with other recent research may allow for techniques that enhance the spatial resolution of an image, improve image registration and enable the detection of obscured targets with a single pulse.

In urbanizing streams, the use of two-dimensional (2D) hydrodynamic models are essential for prediction of flow capacity channel stability, infrastructure protection, and physical habitat enhancement. River2D, a 2D hydrodynamic model has the capability to meet these needs for stream restoration assessment and design. As a restoration tool, depth-average and shear velocities for finite element cells within a mesh grid, which can be assessed for maximums spatially estimated throughout a design reach. Velocities can be estimated for current conditions and multiple design morphologies. Physical habitat quality can be assessed using species preferences for habitat suitability. Typically applied to fish species, weighted usable areas (WUAs) utilizing preferences for velocity, depth, and channel substrate are computed with River2D. Examples of model performance and their output’s use in the design process are presented for the: 1) Embarras River, Champaign County, Illinois; 2) West Prong of the Little Pigeon River, Sevier County, Tennessee; and 3) Beaver Creek, Knox County, Tennessee.

Acid deposition has impacted stream chemistry in the Great Smoky Mountains National Park (GRSM), however, basin-scale factors governing local chemical processes affect stream acidification response differently in distinct basins. The primary objective of this research was to examine the effects of elevation, basin area, and geology on episodic stream acidification. A secondary objective was to investigate the influence of physical and chemical soil properties and dominant vegetation on stream chemistry. Considering basin area, site elevation, and presence of Anakeesta geology, eight study sites were selected; baseflow and stormflow chemistries were monitored at these sites. Study basins were characterized using ArcGIS considering topographical, geological, pedological, and vegetative factors. Multiple statistical analyses were employed to relate baseflow and stormflow chemistry to basin factors. Following precipitation events, stream water pH was significantly reduced and aluminum concentrations increased in seven of the eight study sites (p

Ph.D. Candidate, University of Tennessee, Department of Civil and Environmental Engineering, 223 Perkins Hall, Knoxville, TN 37996 kneff1@utk.edu Associate Professor, University of Tennessee, Department of Civil and Environmental Engineering, 223 Perkins Hall, Knoxville, TN 37996 jschwart@utk.edu Stormwater Engineer Intern, Knox County Stormwater Management, 205 West Baxter Avenue, Knoxville, TN 37917 andrew.dodson@knoxcounty.org GIS/Stormwater Analyst, Knox County Stormwater Management, 205 West Baxter Avenue, Knoxville, TN 37917 michael.hamrick@knoxcounty.org

Oscillations in unidirectionally coupled overdamped bistable systems are, now, known to occur when a control parameter is swept through a critical value. Here, we use a protype device—the Coupled Core Fluxgate Magnetometer (CCFM)‐ as an example system and demonstrate how its response, quantified by a suitably defined non‐spectral figure of merit, can be quantified in the presence of a noise floor.

Fine needle aspiration specimens from 29 patients with bone and soft tissue neoplasms were analyzed by flow cytometry for DNA index and cell cycle analysis to determine whether such studies were helpful in cytologic diagnosis. Of 15 cases initially cytologically diagnosed as benign, 14 had a DNA index of 1.0, indicating a diploid population. The remaining case diagnosed as cytologically benign had a DNA index of 1.3. Further tissue from this tumor revealed an osteogenic sarcoma. Of the 14 cases initially diagnosed as malignant, 12 were hyperdiploid. Cell cycle analysis showed that malignant tumors had a higher proportion of cells in S phase (15.2% +/- 8.7%) than benign tumors (6.9% +/- 1.6%). Furthermore, high-grade malignancies had a significantly greater number of cells in S phase (18.5% +/- 1.5%) than low-grade tumors (9.9% +/- 6.3%).

Though the need for human-subjects review is readily apparent to investigators when conducting a randomized clinical trial, that same requirement is often less obvious when considering activities such as chart reviews, observational studies, or even case reports. In some cases all that is needed is notification of the institutional review board, which might then exempt the research. In other cases, waiver of consent and Health Insurance Portability and Accountability Act authorization may be granted, whereas in some situations risk to privacy may be considered too great and approval denied. In all cases, including case reviews, quality-improvement projects, and chart reviews, the most cautious approach for the investigator is to discuss regulatory requirements with the institutional review board official to ensure compliance. I will review what constitutes human-subjects research and how investigators may access protected health information, and consider some examples of observational research.

Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons, but the incidence and association of CMV reactivation with adverse outcomes in critically ill persons lacking evidence of immunosuppression have not been well defined.To determine the association of CMV reactivation with intensive care unit (ICU) and hospital length of stay in critically ill immunocompetent persons.We prospectively assessed CMV plasma DNAemia by thrice-weekly real-time polymerase chain reaction (PCR) and clinical outcomes in a cohort of 120 CMV-seropositive, immunocompetent adults admitted to 1 of 6 ICUs at 2 separate hospitals at a large US tertiary care academic medical center between 2004 and 2006. Clinical measurements were assessed by personnel blinded to CMV PCR results. Risk factors for CMV reactivation and association with hospital and ICU length of stay were assessed by multivariable logistic regression and proportional odds models.Association of CMV reactivation with prolonged hospital length of stay or death.The primary composite end point of continued hospitalization (n = 35) or death (n = 10) by 30 days occurred in 45 (35%) of the 120 patients. Cytomegalovirus viremia at any level occurred in 33% (39/120; 95% confidence interval [CI], 24%-41%) at a median of 12 days (range, 3-57 days) and CMV viremia greater than 1000 copies/mL occurred in 20% (24/120; 95% CI, 13%-28%) at a median of 26 days (range, 9-56 days). By logistic regression, CMV infection at any level (adjusted odds ratio [OR], 4.3; 95% CI, 1.6-11.9; P = .005) and at greater than 1000 copies/mL (adjusted OR, 13.9; 95% CI, 3.2-60; P.001) and the average CMV area under the curve (AUC) in log(10) copies per milliliter (adjusted OR, 2.1; 95% CI, 1.3-3.2; P.001) were independently associated with hospitalization or death by 30 days. In multivariable partial proportional odds models, both CMV 7-day moving average (OR, 5.1; 95% CI, 2.9-9.1; P.001) and CMV AUC (OR, 3.2; 95% CI, 2.1-4.7; P.001) were independently associated with a hospital length of stay of at least 14 days.These preliminary findings suggest that reactivation of CMV occurs frequently in critically ill immunocompetent patients and is associated with prolonged hospitalization or death. A controlled trial of CMV prophylaxis in this setting is warranted.

Episodic stream acidification from atmospheric deposition is suspected to detrimentally impact native southern brook trout (Salvelinus fontinalis) in Great Smoky Mountains National Park (GRSM) headwater streams. To test the hypothesis that episodes of stream acidification cause physiological distress to native trout, caged fish at three sites were exposed to acid episodes during in situ bioassays conducted in June 2006 and March 2007. Stream pH decreased (0.7 pH units) and total dissolved aluminum (Al(TD)) increased (175 microg/L) at all three sites during acid episodes in both bioassays. Whole-body sodium concentrations were significantly reduced (10-20%) following the acid episodes, when preceding 24-h mean pH values of 4.88, 5.09, and 4.87 and corresponding 24-h time-weighted average Al(TD) concentrations of 210, 202, and 202 microg/L were observed. Lower whole-body sodium concentrations were correlated with elevated H+ and Al(TD) concentrations. Loss of sodium ions in native southern brook trout was consistent with physiological distress resulting from acid exposure reported in salmonids in other investigations. Further research is necessary to conclude whether acid episodes are responsible for extirpation of brook trout from headwater streams in the GRSM.

In 2006, 67-km of 12 streams in the Great Smoky Mountains National Park (GRSM) were listed on the 303d list as impaired due to low pH from atmospheric deposition and unknown sources, requiring a TMDL to be developed. The GRSM receives some of the highest rates of atmospheric acid deposition in the U.S. in the form of sulfur and nitrogen oxides, which can cause stream pH to drop below 5.0 (minimum of 4.0) for 2-days or longer. Acids enter poorly buffered streams through wet deposition and from naturally occurring organic acids and accumulated dry deposition flushed from watersheds, temporarily reducing pH and ANC in streams. Stream acidification has been shown to have damaging effects on the health of aquatic ecosystems and biota, and is suspected to be a primary cause of the extirpation of native brook trout ( Salvelinus fontinalis ) in six headwater streams in the GRSM. To develop appropriate TMDLs, it is imperative to understand the environmental processes associated with stream acidification, determine system responses to atmospheric deposition, and evaluate impacts to biota. The objectives of the current research are to 1) characterize the chemical constituents in stream water during baseflow and stormflow in three forested watersheds in the GRSM, 2) identify potential mechanisms responsible for episodic acidification, and 3) evaluate physiological distress in native brook trout during episodes of stream acidification. Conductivity, pH, turbidity, stage height and temperature were monitored continuously (15-minute intervals) at three study sites using multi-parameter data sondes. Baseflow grab samples and precipitation samples were collected; automatic water samplers captured stormflow samples. Stormflow, baseflow, and precipitation samples were analyzed for pH, ANC, trace metals, and major cations and anions. To provide evidence that native brook trout are impacted by stream acidification, in situ bioassay experiments were conducted. Changes in native brook trout physiology were determined during two acid runoff episodes. Brook trout were put in cages at the three sites and fish were sampled before and after stream acidification events. To assess physiological stress in brook trout as a response to acid conditions, whole-body sodium concentrations of individual fish were evaluated. ANC and pH depressions were observed during all stormflows at the three study sites. Sulfate, nitrate, and organic acid concentrations increased during runoff episodes. Base cation concentrations generally increased during stormflow at two stream sites, but diluted occasionally at the third site. The relative changes in ion concentrations were used to determine which ions (acids) were most responsible for ANC depression. ANC contribution analysis indicates acid deposition may be the primary cause of episodic stream acidification, but it appears organic acids and cation dilution may also contribute. Results of the in situ bioassay demonstrate that stream acidification can negatively affect native southern brook trout physiology in the GRSM under actual field conditions. Trout lose the ability to regulate critical blood ions, as exemplified by a loss of whole-body sodium, when stream pH dropped below 5.1.

Temozolomide is an oral alkylating agent used in the treatment of metastatic melanoma. Commonly reported adverse effects of the drug include nausea and vomiting, constipation, headache, and fatigue, as well as myelosuppression, which may be dose limiting. Few reports have described dermatologic adverse effects such as rash and pruritus, and, to our knowledge, none have discussed the seriousness or extensiveness of the rash. We describe a 37-year-old woman who was receiving temozolomide for treatment of metastatic melanoma. After 6 weeks of therapy, the patient developed an unexplained fever. The drug was discontinued, and the fever resolved within 2 days. Temozolomide was restarted 2 months later; the patient again developed a fever. This time the fever was accompanied by a diffuse erythematous skin rash that progressed to an extensive, full-body, desquamative skin rash. The rash was treated with moisturizing cream along with intravenous and topical corticosteroids and antibiotics. Due to the severity of the rash, temozolomide was permanently discontinued. Even after its discontinuation, the patient experienced the rash on a long-term basis, with periodic exacerbations. However, none were as severe as the first rash. The patient's metastatic disease remained stable for the next 2 years. According to the Naranjo adverse drug reaction probability scale, the likelihood that temozolomide was responsible for the adverse drug reaction of fever was probable (score of 6). Clinicians should be aware that an erythematous and exfoliative rash may be induced by temozolomide, and be familiar with the pharmacologic and supportive measures necessary for its treatment.

Background The leading cause of late mortality after trauma is multiple organ failure syndrome, due to a dysfunctional inflammatory response early after injury. Preclinical studies demonstrate that hypertonicity alters the activation of inflammatory cells, leading to reduction in organ injury. The purpose of this study was to evaluate the effect of hypertonicity on organ injury after blunt trauma. Design Double-blind, randomized controlled trial from October 1, 2003, to August 31, 2005. Setting Prehospital enrollment at a single level I trauma center. Patients Patients older than 17 years with blunt trauma and prehospital hypotension (systolic blood pressure, ≤ 90 mm Hg). Interventions Treatment with 250 mL of 7.5% hypertonic saline and 6% dextran 70 (HSD) vs lactated Ringer solution (LRS). Main Outcome Measures The primary end point was survival without acute respiratory distress syndrome (ARDS) at 28 days. Cox proportional hazards regression was used to adjust for confounding factors. A preplanned subset analysis was performed for patients requiring 10 U or more of packed red blood cells in the first 24 hours. Results A total of 209 patients were enrolled (110 in the HSD group and 99 in the LRS group). The study was stopped for futility after the second interim analysis. Intent-to-treat analysis demonstrated no significant difference in ARDS-free survival (hazard ratio, 1.01; 95% confidence interval, 0.63-1.60). There was improved ARDS-free survival in the subset (19% of the population) requiring 10 U or more of packed red blood cells (hazard ratio, 2.18; 95% confidence interval, 1.09-4.36). Conclusions Although no significant difference in ARDS-free survival was demonstrated overall, there was benefit in the subgroup of patients requiring 10 U or more of packed red blood cells in the first 24 hours. Massive transfusion may be a better predictor of ARDS than prehospital hypotension. The use of HSD may offer maximum benefit in patients at highest risk of ARDS. Trial Registration clinicaltrials.gov Identifier:NCT00113685

Accurate momentum mapping of bulk and surface electronic states by angle-resolved two-photon photoemission is demonstrated on Cu(111) and one of its vicinal surfaces, Cu(443), using laser light of $3.08\phantom{\rule{0.3em}{0ex}}\mathrm{eV}$ photon energy for excitation. The surface state dispersion found agrees well with that expected from the periodic arrangement of terraces and monatomic steps on Cu(443). Polarization dependent data suggest that the state consists of out-of-plane ${p}_{z}$ orbitals like on the flat (111) copper surface, mixed with in-plane orbitals at the step edges. Maps of the Fermi surface taken from the vicinal surface are found to be in excellent agreement with conventional photoemission data and density-functional calculations. This proves that multiphoton photoemission can be used like direct one-photon photoemission as initial state spectroscopy with high energy and momentum resolution provided that no real intermediate states are involved in the excitation process.

Adsorbed on the nickel 111 surface, hexagonal boron nitride h-BN forms a commensurate monolayer, which retains much of the band structure of layered bulk h-BN, specifically the wide band gap. This article explores its unoccupied band structure with femtosecond time-resolved two-photon photoelectron spectroscopy in a two-color setup, and presents spectra, dispersion, and cross-correlation measurements. Two distinct, dispersive intermediate states are observed at the origin of the surface Brillouin zone : a -related interface state at 1.51 eV above the Fermi level, which forms the conduction band, and an image-potential state at 0.65 eV below the vacuum level. With 260 fs for the image state and 110 fs for the interface state the lifetimes of the two unoccupied states are remarkably high due to the very small overlap of the corresponding wave functions with the nickel bulk states.

Temperature and radiation tolerant electronics, as well as long life survivability are key capabilities required for future NASA missions. Current approaches to electronics for extreme environments focus on component level robustness and hardening. Compensation techniques such as bias cancellation circuitry have also been employed. However, current technology can only ensure very limited lifetime in extreme environments. Previous work presented a novel approach, based on evolvable hardware technology, which allows adaptive in-situ circuit redesign/reconfiguration during operation in extreme environments. This technology would complement material/device advancements and increase the mission capability to survive harsh environments. This work describes a new reconfigurable analog chip developed by JPL and SPA WAR that is targeted for extreme temperature and evolutionary hardware experiments. Being based on Gm-C technology, this chip can have its functionality tuned and adapted to extreme temperatures through voltage bias adjustment. This tuning process will be controlled by evolutionary algorithms. This paper presents details of the reconfigurable analog chip as well as a system level overview. Some early experiments are also described.

Medication errors are at the forefront of discussion for government officials, health care professionals, and consumers. An analysis of these errors has led health care organizations to conclude that many of these problems occur within the medication-use process.[1][1] In 2004, the Joint Commission

For years the concept of ‘‘evidence-based critical care’’ was largely theore-tical because of a lack of high-grade clinical trial evidence demonstrating a survival benefit for any specific therapy for acute lung injury (ALI) andsevere sepsis. The last decade has produced a number of clinical trials incritical care demonstrating significant effects on important clinical out-comes (lung-protective ventilation for ALI, activated protein C for severesepsis, and protocolized ventilator weaning) and other trials raising ques-tions about the benefit of treatments thought to be effective (human growthhormone for chronic critical illness, pulmonary artery catheterization, andcolloid resuscitation). A natural assumption would be that this evidence would be followed by the rapid integration of these results into clinical prac-tice. Experience tells us otherwise. Whether trying to change practice inbusiness or medicine, change is a slow process. Entire industries are devel-oped to improve systems and processes to incorporate change into theindustry. Critical care medicine is new to this phenomenon and also tothe situation of having evidence-based medicine with which to guide clinicalpractice. Until recently, the problem was not knowing the answer; now the problem is figuring out how to apply the answers.

This paper describes a new reconfigurable analog array (RAA) architecture and integrated circuit (IC) used to map analog circuits that can adapt to extreme temperatures under programmable control. Algorithm-driven adaptation takes place on the RAA IC. The algorithms are implemented in a separate field programmable gate array (FPGA) IC, co-located with the RAA in the extreme temperature environment. The experiments demonstrate circuit adaptation over a wide temperature range, from extremely low temperature of -180degC to high 120deg

ContextOn January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a bioterrorism event.ObjectiveTo describe results from the comprehensive DHHS smallpox vaccine safety monitoring and response system.Design, Setting, and ParticipantsDescriptive study of adverse event reports from the DHHS smallpox vaccine safety monitoring and response system received between January 24 and October 31, 2003, through the Vaccine Adverse Event Reporting System (VAERS) and the Centers for Disease Control and Prevention. A total of 37 901 volunteers in 55 jurisdictions received at least 1 dose of smallpox vaccine.Main Outcome MeasuresNumber of vaccinations administered and description of adverse events and reporting rates.ResultsA total of 38 885 smallpox vaccinations were administered, with a take rate of 92%. VAERS received 822 reports of adverse events following smallpox vaccination (overall reporting rate, 217 per 10 000 vaccinees). A total of 590 adverse events (72%) were reported within 14 days of vaccination. Nonserious adverse events (n = 722) included multiple signs and symptoms of mild and self-limited local reactions. One hundred adverse events (12%) were designated as serious, resulting in 85 hospitalizations, 2 permanent disabilities, 10 life-threatening illnesses, and 3 deaths. Among the serious adverse events, 21 cases were classified as myocarditis and/or pericarditis and 10 as ischemic cardiac events that were not anticipated based on historical data. Two cases of generalized vaccinia and 1 case of postvaccinial encephalitis were detected. No preventable life-threatening adverse reactions, contact transmissions, or adverse reactions that required treatment with vaccinia immune globulin were identified. Serious adverse events were more common among older revaccinees than younger first-time vaccinees.ConclusionsRigorous smallpox vaccine safety screening, educational programs, and older vaccinees may have contributed to low rates of preventable life-threatening adverse reactions. Other rare, clinically significant, or unexpected cardiac adverse events were detected by timely review of VAERS data and intensive clinical case investigation.

BACKGROUND Acute lung injury is a critical illness syndrome consisting of acute hypoxemic respiratory failure with bilateral pulmonary infiltrates that are not attributed to left atrial hypertension. Despite recent advances in our understanding of the mechanism and treatment of acute lung injury, its incidence and outcomes in the United States have been unclear. METHODS We conducted a prospective, population-based, cohort study in 21 hospitals in and around King County, Washington, from April 1999 through July 2000, using a validated screening protocol to identify patients who met the consensus criteria for acute lung injury. RESULTS A total of 1113 King County residents undergoing mechanical ventilation met the criteria for acute lung injury and were 15 years of age or older. On the basis of this figure, the crude incidence of acute lung injury was 78.9 per 100,000 person-years and the age-adjusted incidence was 86.2 per 100,000 person-years. The in-hospital mortality rate was 38.5 percent. The incidence of acute lung injury increased with age from 16 per 100,000 person-years for those 15 through 19 years of age to 306 per 100,000 person-years for those 75 through 84 years of age. Mortality increased with age from 24 percent for patients 15 through 19 years of age to 60 percent for patients 85 years of age or older (P

Objective: Low tidal volume ventilation is associated with reduced mortality in patients with acute lung injury, yet concerns exist about patient comfort and the levels of sedation and analgesia required during its use. We compared the doses and duration of sedatives and opioid analgesics in patients receiving low vs. traditional tidal volumes at our institution. Design: Secondary analysis of a randomized clinical trial. Setting: University-affiliated county hospital in Seattle, WA. Patients: Sixty-one patients with acute lung injury enrolled in the National Heart, Lung and Blood Institute’s ARDS Network tidal volume trial. Interventions: None. Measurements and Main Results: Thirty-three patients were randomized to the lower tidal volume arm (6 mL/kg of predicted body weight) and 28 patients were randomized to the higher tidal volume arm (12 mL/kg of predicted body weight). There were no significant differences in the percentage of study days patients received sedatives, opioids, or neuromuscular blockade. When specific study days were examined, there were no significant differences in the proportion of patients receiving benzodiazepines, propofol, haloperidol, and opioids on days 1, 2, 3, and 7 of mechanical ventilation, nor were there differences in the doses of benzodiazepines and opioids on those days. Conclusions: At our institution, low tidal volume ventilation was not associated with increased dose or duration of sedatives in patients with acute lung injury. Sedation administration should not be considered a barrier to implementing a lung-protective ventilation strategy.

A hierarchical XML database and related analysis tools are being developed by the New Millennium Program to provide guidance on the relative impact, to future NASA missions, of advanced technologies under consideration for developmental funding. An XML dictionary codifies a standardized taxonomy and, in effect, begins to define a set of ontological relationships for space missions, systems, subsystems, and technologies. The use of an XML dictionary and the associated XML database are central to the concept behind the analysis tools. The XML dictionary, and the taxonomies defined therein, may be submitted to NASA as a proposed guideline. The analysis tools are planned for use across a broad range of NASA projects and technology planning activities. In addition, if successful, the products developed under this task may also be submitted for use by the DOD. This work describes the motivation for the project, the technical approach, the reasoning behind the selection of XML based tools, the current state of the project, and future plans for this work.

A hierarchical XML (eXtensible Markup Language) database is being developed by the New Millennium Program to assist in technology return on investment (ROI) analysis and technology portfolio optimization. The database contains mission requirements and technology capabilities, which are related by use of an XML dictionary. The XML dictionary codifies a standardized taxonomy and, in effect, begins defining a set of ontological relationships for space missions, systems, subsystems and technologies. The XML dictionary, and the taxonomies defined therein, will be submitted to NASA, DOD and commercial standardization bodies as a proposed standard. In addition to being used for ROI analysis, the database is being examined for use in project planning, tracking and documenting. This paper describes the motivation for the database project, the technical approach, the reasoning behind the selection of an XML based approach, the current state of the project, and future plans for this work.

A hierarchical extensible markup language (XML) database called XCALIBR (XML capability analysis library) has been developed by the new millennium program to assist in technology return on investment (ROI) analysis and technology portfolio optimization. The database contains mission requirements and technology capabilities, which are related by use of an XML dictionary. The XML dictionary codifies a standardized taxonomy for space missions, systems, subsystems and technologies. In addition to being used for ROI analysis, the database is being examined for use in project planning, tracking and documentation. During the past year, the database has moved from development into alpha testing. This paper describes the lessons learned during construction and testing of the prototype database and the motivation for moving from an XML taxonomy to a standard XML-based ontology.

The NAMS recommends first considering lifestyle changes, alone or combined with a nonprescription remedy (such as dietary isoflavones, vitamin E, or black cohosh) for the relief of mild vasomotor symptoms. For moderate to severe menopause-related hot flashes, prescription systemic estrogen-containing products are still the therapeutic standard. For women with concerns or contraindications to estrogen-containing products, possible treatment options include prescription progestogens, venlafaxine, paroxetine, fluoxetine, or gabapentin.

Acute lung injury and ARDS have been clinically recognized syndromes for nearly 30 years. During that time, the understanding of the risks, pathophysiology, and outcomes has changed and improved. The definition for this disease has evolved in an attempt to identify more accurately and reliably a more homogeneous patient population that could be expected to have similar responses to the disease and therapies. The most widely accepted definition is that developed by the AECC in 1994 and now commonly used in epidemiologic studies and clinical trials. Estimates of the incidence of the disease and of mortality are significantly affected by variability in definitions used. Current estimates of the incidence of ALI, however, range from 3 to 75 cases/100,000 population/year. Mortality estimates range from 30% to 40%. Although mortality has improved from more than 60% 20 years ago, ALI survivors are still faced with an increased risk of death as well as significant decrements in physical function and quality of life through the first 12 months after hospital discharge. A great deal of progress has been made in the understanding and management of ALI patients. Now, as the search for new therapeutic options continues, equal attention must be focused on studying and improving qualitative outcomes for this group of patients.

Background A Healthy People 2010 objective includes increasing public awareness of the warning signs of stroke, yet few data exist about the level of awareness. Recognition of stroke symptoms and awareness of the need to call 911 for acute stroke events were examined among the general population. Methods Data are from 61,019 adults participating in the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Respondents indicated whether the following were symptoms of stroke: confusion/trouble speaking; numbness/weakness of face, arm, or leg; trouble seeing; chest pain (false symptom); trouble walking, dizziness, or loss of balance; and severe headache with no known cause. Persons also reported the first action they would take if they thought someone was having a stroke. Results Only 17.2% of respondents overall (5.9% to 21.7% by state) correctly classified all stroke symptoms and indicated that they would call 911 if they thought someone was having a stroke. Recognition of all symptoms and knowledge of when to call 911 were comparable by gender but lower among ethnic minorities, younger and older people, those with less education, and current smokers compared to whites, middle-aged people, those with more education, and nonsmokers, respectively. There were no substantive differences by history of hypertension, diabetes, heart disease, or stroke. Conclusions Public recognition of major stroke symptoms is low. Educational campaigns to increase awareness among the general population and targeted messages to those at high-risk persons and their families may help to improve time to treatment for adults suffering acute strokes.

We examined national trends in places where stroke deaths occurred.National vital statistics data (1990-1998) for stroke death (ICD-9 codes 430-438) were analyzed for place of death by selected socio-demographic characteristics and stroke subtype.Half of all stroke deaths in 1998 occurred in-hospital, 46.1% occurred pre-transport, 0.6% were dead on arrival, and 3.3% occurred in the emergency department. Pre-transport deaths accounted for 55.0% of ischemic strokes, 12.8% of intracerebral strokes, and 12.9% of subarachnoid hemorrhagic strokes. The proportions of stroke deaths occurring pre-transport increased from 1990 through 1998 by 22.9% for all strokes, by 25.3% for ischemic, and by 24.3% for hemorrhagic stroke deaths.Almost half of stroke deaths occur prior to hospital admission. Research must identify factors that promote more timely access to effective medical care. Further efforts are needed to increase public awareness about stroke symptoms in order to reduce both delays in seeking treatment, and untimely deaths from stroke.

Perceptions of the environment and physical activity have been associated using survey methods, yet little is known about the validity of environmental surveys. In this study, perceptions of the environment at neighborhood and community levels were assessed (1) to determine validity by comparing respondent perceptions to objective measures and (2) to determine test-retest reliability of the survey.A telephone survey was administered to a stratified sample of Sumter County, South Carolina adults. Respondents' home addresses were mapped using a geographic information system (GIS) (n =1112). As an indicator of validity, kappa statistics were used to measure agreement between perceptions and objective measures identified at neighborhood and community levels using GIS. A second survey in an independent sample (n=408) assessed test-retest reliability.When assessing perceptions of environmental and physical activity in a defined geographic area, validity and reliability for neighborhood survey items were kappa= -0.02 to 0.37 and rho=0.42 to 0.74, and for community survey items were kappa= -0.07 to 0.25 and rho=0.28 to 0.56.Although causality between perception of access and safety and actual physical activity level cannot be assumed, those meeting national physical activity guidelines or reporting some physical activity demonstrated greatest agreement with access to recreation facilities, while those not meeting the guidelines demonstrated greater agreement with safety of recreation facilities. Factors such as distance and behavior may explain differences in perceptions at neighborhood and community levels. Using local environments with short distances in survey methods improves validity and reliability of results.

Multiple organ dysfunction syndrome (MODS) is the predominant cause of late death in patients requiring intensive care. Most consider it the pathologic sequela of an excessive host inflammatory response. The failure of current therapeutic interventions focused on the host’s immunoinflammatory response to affect the outcome of MODS stems, in part, from an incomplete understanding of the complex underlying pathophysiology and an inability to identify early the patients at greatest risk for development of MODS. 1 In the severely injured patient, our ability to predict many important outcomes is limited. Current scoring systems, such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, use population-based analyses and require the acquisition of many variables to compute a mathematical model to derive a numerical score indicative of outcome. 2–10 These scores define the net physiologic state of a heterogeneous population and, while valuable in estimating overall population mortality, correlate poorly with other important morbidity endpoints. Moreover, even a score associated with a high incidence of death frequently fails to identify the patient early enough so that potentially effective interventions may be implemented before the onset of an irreversible pathologic sequence. Regardless of the initiating sequence, an aberrant immunoinflammatory response is thought to underlie the pathophysiology of ischemia/reperfusion states, the systemic inflammatory response syndrome (SIRS), septic shock, and MODS. Identification of various components of these inflammatory states has generated a series of investigations to establish a potential association between the plasma concentrations of inflammatory products and patient outcome, specifically mortality. While the results are variable, several trials have demonstrated an association between the concentrations of certain inflammatory mediators and mortality. 1 Consequently, numerous clinical trials have been conducted employing selective anticytokine or antimediator compounds. While many of these agents have been proven effective in controlled animal models, they have failed to alter outcome when applied in the clinical arena. 1,11–18 Many of the implicated inflammatory mediators are regulated by intracellular signaling cascades involving the mitogen-activated protein kinases (MAPK). 19–24 One prominent member, p38, mediates the signal transduction induced by many environmental stresses, such as endotoxin and osmotic stress. While its activation is required for the production of such potent cytokines as tumor necrosis factor-alpha (TNF-α) and interleukin 8, p38 also participates in the reprogramming of inflammatory cells, including platelet-activating factor-induced “priming” of peripheral blood mononuclear cells. 19,24,25 Thus, the activation status of critical early signal transduction pathways, such as p38, might permit characterization of the host stress state, thereby enabling early identification of patients at risk for developing an aberrant host inflammatory response and subsequent MODS. Such a diagnostic tool would give clinicians the opportunity to institute and test potential therapeutic interventions. In this study we investigate the activation status of p38 in cells obtained by bronchoalveolar lavage from critically ill trauma patients in an attempt to identify the patients at greatest risk for progression of MODS.