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Background: The focused abdominal sonography in trauma (FAST) examination is a routine component of the initial work-up of trauma patients. However, it does not identify patients with retroperitoneal hemorrhage associated with significant pelvic trauma. A wide pubic symphysis (PS) is indicative of an open book pelvic fracture and a high risk of retroperitoneal bleeding. Study Objectives: We hypothesized that an ultrasound image of the PS as part of the FAST examination (FAST-PS) would be an accurate method to determine if pubic symphysis diastasis was present. Methods: This is a comparative study of a diagnostic test on a convenience sample of 23 trauma patients at a Level 1 Trauma Center. The PS was measured sonographically in the Emergency Department (ED) and post-mortem (PM) at the State Medical Examiner. The ultrasound (US) measurements were then compared with PS width on anterior-posterior pelvis radiograph. Results: Twenty-three trauma patients were evaluated with both plain radiographs and US (11 PM, 12 ED). Four patients had radiographic PS widening (3 PM, 1 ED) and 19 patients had radiographically normal PS width; all were correctly identified with US. US measurements were compared with plain X-ray study by Bland-Altman plot. With one exception, US measurements were within 2 standard deviations of the radiographic measurements and, therefore, have excellent agreement. The only exception was a patient with pubic symphysis wider than the US probe. Conclusion: Bedside ultrasound examination may be able to identify pubic symphysis widening in trauma patients. This potentially could lead to faster application of a pelvic binder and tamponade of bleeding.

Background: Video assisted pulmonary lobectomy is 25 years old. Despite the recent advancement of minimally invasive surgery, this procedure is still related to a considerable amount of post-operative pain. We describe the results with ‘Microlobectomy’: an innovative technique which eliminated the utility port. Methods: Microlobectomy has been offered at James Cook University Hospital, UK, for the last 4 years. This manuscript represents a single centre, single surgeon consecutive series of cases from January 2014 until December 2016. The technique was recently described in a multi-center study. Its key principles are: no intercostal incisions larger than 5 mm, no utility incision, a 12 mm subxiphoid port (used for specimen retrieval and chest drainage), CO2 insufflation of the surgical field throughout the procedure, 5 mm diameter instruments and 5 mm optic are adopted. We offered this procedure to all the patients awaiting pulmonary lobectomy for different conditions, while relative contraindications were severe obesity and left ventricular hypertrophy for left sided procedure. Results: Data from 82 cases where recorded. Mean age was 66 years (range, 27–82 years). Sixty-nine operations (84.1%) were performed for pulmonary malignancy (stages from Ia to IIIb). Fifty-three patients underwent a right sided procedure and 29 a left sided, namely the procedures were: 30 right upper lobectomies, 9 right middle, 13 right lower, 15 left upper, 7 left lower, 4 trisegmentectomy, 2 lingulectomy, 1 right and 1 left pneumonectomy. Conversion rate was 3.7% (3 patients). The mean operative time was 189 minutes (range, 126–315 minutes). The 30 days mortality was 1.2% (1 patient deceased of sepsis). Morbidity was post-operative infection in 12 individuals (14.6%), atrial fibrillation in 3 (3.7%) and prolonged air leakage, over 5 days, in 9 (11%). Seventeen patients (20.7%) went home on the day after surgery, 31 (37.8%) went home on post-operative day 2. Sixty-three patients (76.8%) went home within the first week from the procedure. The median length of stay was 3 days (range, 1–34 days). Conclusions: We are enthusiast about these preliminary results and we will continue to offer this procedure in order to report on a wider cohort and also to have long term oncological follow up data.

A domestic-scale prototype experimental solar cooling system has been developed based on a LiBr/H2O absorption system and tested during the 2007 summer and autumn months in Cardiff University, UK. The system consisted of a 12 m2 vacuum tube solar collector, a 4.5 kW LiBr/H2O absorption chiller, a 1000 l cold storage tank and a 6 kW fan coil. The system performance, as well as the performances of the individual components in the system, were evaluated based on the physical measurements of the daily solar radiation, ambient temperature, inlet and outlet fluid temperatures, mass flow rates and electrical consumption by component. The average coefficient of thermal performance (COP) of the system was 0.58, based on the thermal cooling power output per unit of available thermal solar energy from the 12 m2 Thermomax DF100 vacuum tube collector on a hot sunny day with average peak insolation of 800 W/m2 (between 11 and 13.30 h) and ambient temperature of 24 °C. The system produced an electrical COP of 3.6. Experimental results prove the feasibility of the new concept of cold store at this scale, with chilled water temperatures as low as 7.4 °C, demonstrating its potential use in cooling domestic scale buildings.

A previous study by the authors concluded that the optimal indoor air temperature for satisfying the wide range of occupancy needs in Iranian hospitals falls in a range from 24 °C to 26 °C. Other measures are also needed to achieve thermal comfort at this temperature for all occupants. This study examines, through modelling, a range of passive building fabric techniques in two monitored case study hospitals to examine how we might best achieve this range of indoor air temperatures, and reduce reliance on the heating and cooling systems. Both case study buildings are simulated using HTB2 in their original and modified states. Modifications are limited to changing the fabric of the buildings in the simulated models. The simulations show that it is theoretically possible to reduce the average heating demand in the two buildings to 9% of the original demand by area. Similarly the cooling demand can be reduced in both buildings to 73% of the original demand by area.

Revelation has always presented major challenges for study, interpretation and application. Over the last twenty years there have been some significant developments in a number of areas, including greater understanding of Revelation's first-century setting, some settling of debate about the nature of its language, engagement with questions of the complexity of its structure, and a growing awareness of the impact of its rhetoric, both in its original contexts and in the history of interpretation. Yet there still remains a substantial gap between much scholarly insight and its appropriation at a more popular level.

This study explores the interaction between perceived and calculated thermal comfort in Iranian office buildings. To achieve this, a questionnaire survey in six office buildings in Tehran (Iran) is conducted in conjunction with physical measurements. The study results reveal that there is a good agreement between perceived thermal sensation and calculated predicted mean vote (PMV) from the measurements for the majority of the offices (four out of six). This finding implies that the calculation of PMV is valid for the Iranian cultural situation in air conditioned and HVAC office buildings. The results also show that more than half of the studied offices are not in good compliance with the comfort levels suggested in ASHRAE Standard 55 and ISO Standard 7730.

This article is a revision of the previous edition article by L.S. Zegans, volume 1, pp. 344–350, © 2001, Elsevier Ltd.

With the EU Energy Performance in Buildings Directive imminent in 2006, attention is focusing on how to reduce carbon emissions from buildings in practice. This research was undertaken to try to establish some ‘real’ buildingbased figures for the energy performance of air-conditioning systems in UK office buildings. One of the major questions to be answered is whether chilled beam and ceiling systems really are more efficient than traditional air-conditioning systems when used in the real world.1,2 This paper presents findings of a two-year field monitoring study investigating the energy performance of airconditioning (AC) systems in UK office buildings. The findings shown in this paper include: 1) the cooling power demand for the various air-conditioning systems monitored; 2) comparison of national energy consumption and carbon emissions bench-marks to the monitored systems; 3) comparison of the energy consumption and carbon emissions of reverse-cycle AC systems with traditional heating-only systems. The results show that chilled ceiling systems typically consume significantly less energy than the other generic AC types in the heating and cooling of office buildings. However, all the generic AC system types studied appeared capable of meeting current ‘good practice’ standards for energy use in the UK. Practical application: The work provides an insight into the energy performance achieved by real AC systems as operated in UK Offices. When the EC Energy Performance in Buildings Directive becomes law in January 2006 the practically achievable energy and emissions performance of building services will fall more sharply into focus for designers. It is hoped that this paper will provide information useful to both designers and operators of AC systems in the UK as they attempt to reduce the impact of AC systems on the environment.

This paper presents figures for the small power equipment loads encountered by the Welsh School of Architecture in UK offices while undertaking a programme of research and monitoring into the energy efficiency of air-conditioning systems in use. The findings are based on surveys undertaken in 30 air-conditioned offices between April 2000 and October 2002. Peak small power equipment loads were calculated using the CIBSE nameplate-ratio method. The results show that the small power loads averaged 17.5 W/m2 with a range between 6 and 34 W/m2 of treated floor area. When normalised for occupancy the calculated peak small power equipment loads averaged 158 W per person, with a range between 124 and 229 W per person. Current industry guidance could lead to the overestimation of small power equipment loads by as much as 650%, ultimately resulting in increased capital and running costs of air-conditioning plant and reduced thermal comfort. A more accurate method of estimating peak small power equipment loads in UK office buildings is suggested based on occupant density.

We present the case of a 7-month-old female infant who was found crying and limp. She was transported to a hospital where a possible subarachnoid hemorrhage was diagnosed radiologically. Before further studies could be pursued, her condition worsened and she died. The autopsy demonstrated diffuse subarachnoid hemorrhage of the brain and along the spinal cord. The brain, spinal cord, and eyes were retained and examined postfixation. An aneurysm of the middle cerebral artery was identified. Examination of the eyes demonstrated bilateral optic nerve sheath hemorrhage and extensive retinal hemorrhages extending to the ora serrata. A rapid increase in intracranial pressure secondary to subarachnoid hemorrhage following rupture of an aneurysm can result in sequelae similar to those found in inflicted traumatic brain injury. In this case, the rise in intracranial pressure resulted in marked hemorrhage within the optic nerve sheaths as well as intra- and preretinal hemorrhages. Patients with subarachnoid hemorrhage, or other causes of rapidly increased intracranial pressure, may develop ocular hemorrhage (Terson syndrome). This case illustrates the importance of ruling out natural disease before attributing the autopsy findings to trauma, as well as the importance of postmortem fixation of pediatric brains and eyes prior to examination.

Lung cancer, is the most common cause of cancer death in men and second only to breast cancer in women. Currently, the first line therapy of choice is platinum-based combination chemotherapy. A therapeutic plateau has been reached with the prognosis for patients with advanced non-small cell lung cancer (NSCLC) remaining poor. New biomarkers of prognosis as well as new therapies focusing on molecular targets are emerging helping to identify patients who are likely to benefit from therapy. Despite this, drug resistance remains the major cause for treatment failure. In this article we review the role of apoptosis in mediating drug resistance in NSCLC. Better understanding of this fundamental biological process may provide a rationale for overcoming the current therapeutic plateau.

In 1991 the UK Audit Commission produced energy performance indicators for hospitals based on the type of care provided. However, an analysis of over 100 hospitals throughout the United Kingdom has found the type of care provided to have relatively little effect on the energy performance of hospitals. Although other factors influenced energy use to some degree, the major factor affecting performance was found to be the plan of the hospital, as this influenced the amount of mechanical ventilation required. Modem mechanically ventilated hospitals were found to typically use 40% of their total electricity consumption in fan power, equating to 80 kWh m-2 purely due to fans. This paper presents a suggested set of new performance indicators based on the percentage of floor area which is ventilated mechanically.

The results of a series of measurements into the electrical energy savings achieved by PIR and photocell control of individual fluorescent luminaires are presented. Two versions of the PIR/photocell control system (referred to as ‘intelligent’ luminaires from here on) were tested. The results are compared with estimates of the performance of switchstart and ‘standard’ high frequency fluorescent luminaires. The results show that the original ‘intelligent’ control system installed achieved electrical savings of around 10% when compared to ‘standard’ high frequency fittings. An improved version of the ‘intelligent’ system achieved energy savings averaging around 80% when compared to ‘standard’ high frequency fittings. This latter result is in line with the savings predicted by BRE Digest 272 (1) for photoelectric dimming control. The study also showed that these fittings need proper commissioning to return their full potential savings.

Medical examiners are often first to recognize unusual occurrences of fatal infectious diseases. Recognition of these deaths allows public health officials to institute appropriate public health measures. Therefore, we developed a simple method of identifying and tracking infectious disease deaths in a statewide medical examiner's office. One-page infectious disease forms were completed for 1566/1949 autopsies (80%) performed at the New Mexico Office of the Medical Investigator in 2004. In 241 cases one infectious disease was identified at autopsy and 58 cases had two infectious diseases. Fourteen of the infectious-diseases caused deaths involved diseases that are notifiable conditions in New Mexico. Pneumonia was the most commonly reported infectious process (47 deaths) followed by sepsis (25 deaths). Tracking infectious disease deaths highlighted the importance of recognizing these deaths, although hand-written entries were unstandardized. Preferably, a tracking system would be built into electronic databases at medical examiner and coroner's offices, expediting the identification of these diseases and contact of public health agencies.

This study has been undertaken to gain a better understanding of how to allow for energy storage in the design of a future built environment where renewable energy systems will play a significant role.\ud \ud Electricity storage solutions are a key element in achieving high renewable energy penetration in the built environment. This paper presents an overview of electricity storage technologies and their distinct characteristics. The currently available technologies have been classified according to the means by which each can be used in supplying energy to buildings.\ud \ud As the storage market is evolving rapidly, the analysis provides an up-to-date evaluation of different storage options with regard to scale, reliability and site-specificity among others.\ud \ud It is concluded that Li-ion batteries, which today have a limited use in the built environment, and Zn–air batteries that will be commercialised in 2013/14 are amongst the most promising technologies for buildings due to their exceptionally high energy density. They are expected to play an important role in reliable, economical and energy efficient building design in the future. NaNiCl batteries, which are currently used in vehicles, are also considered an important technology for buildings, because of their high cycle lifetime and their high peak power capability.

The market for combined heat and power (CHP) in the UK is being significantly restricted by the lack of a reliable sizing procedure for CHP in new buildings. This paper describes the approach taken to produce such a procedure for new build hospitals. The procedure is based around energy use profiles for existing hospital buildings and a requirement to minimise the input necessary to obtain a reliable sizing estimate. A computer program has been written which automates the procedure, and means that an initial sizing estimate can usually be reached within 20 minutes. The only aspect of the work not yet fully completed is an analysis of the error limits associated with the new technique. These are currently being assessed. Initial findings suggest that the procedure is at least as accurate as sizing techniques used for the installation of CHP in existing hospital buildings.

Synopsis The significant breaks proposed by previous researchers in the Cambro-Ordovician succession of north-western Scotland to explain the absence of Mid- and Late Cambrian faunas cannot be justified by field evidence. Moreover, comparison with the once contiguous succession of western Newfoundland suggests that the Scottish succession contains both Middle and Upper Cambrian strata. Age-diagnostic faunas from the Early Cambrian Bonnia–Olenellus Zone in both sequences allow the upper Forteau Formation and the lower Hawke Bay Formation of western Newfoundland to be biostratigraphically correlated with the lithologically similar Fucoid Beds and Salterella Grit, and with the basal dolostones of the Ghrudaidh Formation, in north-western Scotland. Similarly, Early Canadian cephalopods and matching lithostratigraphy allow the correlation of the Scottish Lower Ordovician Sailmhor Formation with the Watts Bight Formation in western Newfoundland. These benchmarks, together with the close similarities of lithostratigraphy, facies, faunal trends and patterns of cyclicity, allow the Eilean Dubh Formation of north-western Scotland to be correlated with the dolostones of the Upper Cambrian Petit Jardin and Berry Head formations of the interior shelf of western Newfoundland. The middle and upper Ghrudaidh Formation can also be correlated with the Middle Cambrian Bridge Cove Member of the upper part of the Hawke Bay Formation and the overlying Upper Middle Cambrian March Point Formation, suggesting that the Cambrian succession in north-western Scotland is largely continuous.

A 20-month old energy monitoring scheme has achieved a 14% reduction in gas energy consumption and costs at Cardiff University. This paper reviews the implementation of the energy monitoring scheme, briefly noting the main details including the data gathering techniques used and the main obstacles encountered. It also notes the total energy and cost benefits achieved to date along with measures proposed to maintain and improve the savings achieved.

Evasion of apoptosis contributes to both tumourigenesis and drug resistance in non-small cell lung carcinoma (NSCLC). The pro-apoptotic BCL-2 family proteins BAX and BAK are critical regulators of mitochondrial apoptosis. New strategies for targeting NSCLC in a mitochondria-independent manner should bypass this common mechanism of apoptosis block. BRCA1 mutation frequency in lung cancer is low; however, decreased BRCA1 mRNA and protein expression levels have been reported in a significant proportion of lung adenocarcinomas. BRCA1 mutation/deficiency confers a defect in homologous recombination DNA repair that has been exploited by synthetic lethality through inhibition of PARP (PARPi) in breast and ovarian cells; however, it is not known whether this same synthetic lethal mechanism exists in NSCLC cells. Additionally, it is unknown whether the mitochondrial apoptotic pathway is required for BRCA1/PARPi-mediated synthetic lethality. Here we demonstrate that silencing of BRCA1 expression by RNA interference sensitizes NSCLC cells to PARP inhibition. Importantly, this sensitivity was not attenuated in cells harbouring mitochondrial apoptosis block induced by co-depletion of BAX and BAK. Furthermore, we demonstrate that BRCA1 inhibition cannot override platinum resistance, which is often mediated by loss of mitochondrial apoptosis signalling, but can still sensitize to PARP inhibition. Finally we demonstrate the existence of a BRCA1-deficient subgroup (11-19%) of NSCLC patients by analysing BRCA1 protein levels using immunohistochemistry in two independent primary NSCLC cohorts. Taken together, the existence of BRCA1-immunodeficient NSCLC suggests that this molecular subgroup could be effectively targeted by PARP inhibitors in the clinic and that PARP inhibitors could be used for the treatment of BRCA1-immunodeficient, platinum-resistant tumours.

in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a "normal" temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself wors- ens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious ill- ness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are con- cerns that combined treatment may be more complicated and contrib- ute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing in- structions, and dosing devices. Pediatrics 2011;127:580-587

Through undertaking monitoring and measurement of the energy use in 42 AC systems and their components in 8 EU Member States, HARMONAC has been able to provide an evidence based report on the Energy Conservation Opportunities (ECOs) generally available in Air Conditioning systems. These in-depth Case Studies have then compared with ECOs found from Field Trials of HARMONAC AC system inspection procedures which are based on EN15240 - the CEN Standard for AC Inspection. This comparison has enabled conclusions to be reached about how many of the ECOs that are available would be able to be identified and implemented in EU Member States as a result of the EPBD Inspection process. The project has also produced tools for use in the Inspection process, and a Teaching Package to assist in the Training of Inspectors.

Thin films of ferroelectric lanthanum-modified lead zirconate titanate (PLZT) and lanthanum-modified lead titanate (PLT) have been prepared using a novel high-powered pulsed plasma deposition technique. This method uses a microwave-induced intense discharge in a low pressure gas containing organometallic precursors of each of the required metal atoms, together with carbon dioxide and argon. In the discharge, the precursors dissociate to produce atoms which then recombine on the substrate to form the oxide film. Results are presented on the composition and crystal form of the films as the deposition conditions are varied. By careful control of deposition temperature, it is shown that a microcrystalline perovskite phase may be grown on a wide variety of substrate materials.

Subacute combined degeneration (SCD) of the spinal cord is the most common neurologic manifestation of vitamin B12 (cobalamin) deficiency and is usually secondary to autoimmune gastritis, but may also be seen in malnutrition syndromes such as chronic alcoholism, strict vegetarianism, gastrectomy, and also in nitrous oxide abuse. Although traumatic spinal cord injury is routinely encountered in the medical examiner's office, medical causes of spinal cord abnormalities such as SCD should be considered in the appropriate clinical setting. We report a case of alcohol-associated SCD mimicking traumatic spinal cord injury.