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This chapter will begin by highlighting the important distinction between SARS-CoV-2 as a virus and COVID-19 as a pandemic. It will also highlight potential reasons why this particular virus and the associated pandemic are receiving unprecedented attention. I will then discuss the tenuous reasons why this pandemic might contain some silver linings, further unpack a small portion of the reasons why this pandemic is inarguably a bad thing, and explore some of the as-yet unknowns related to the pandemic as it exists today. The chapter will conclude with some thoughts as to potential future impacts and possible directions as to where we, as a global community, can go from here.

This chapter will examine the ways in which neoliberalism, nationalism, and neoconservative ideologies have all enjoyed a newfound resurgence, even while death tolls, unemployment numbers, and indicators of social and psychological distress have all surged to levels unknown in nearly a century. I will begin by discussing the ways in which this triple threat (a term I will use to collectively refer to the issues under discussion) are linked by a common theme of the construction of an “other” and a general promotion of inequality. I will then turn to a general discussion of each aspect - neoliberalism, nationalism, neoconservative ideologies - in turn, highlighting the ways in which each has benefited from the current global pandemic. I purposefully chose the term “blessing” because, as I will argue, each of these has received an unprecedented level of support during the current global pandemic. And where there might be minor crises experienced by the triple threat, such crisis will, I argue, only ultimately serve to make them stronger. I will conclude with some final reflections and a genuine hope that all of my arguments might be wrong. © 2021 selection and editorial matter, J. Michael Ryan;individual chapters, the contributors.

Cottage cheese was manufactured from milk powder reconstituted at solids levels ranging from 8.0 to 20%. The reconstituted cheese milk was held at 6°C for four time periods (0, 12, 24 and 36 h), followed by inoculation with 1 % bulk lactic starter. Values determined were yields expressed in three different ways and total solids. The study was first conducted in the laboratory using 3-L containers for each treatment effect. This was to be used as a screening technique with the optimal results then being tested under pilot plant conditions. The 0-hold resulted in a shorter setting time than any of the other hold periods. The four optimal solids levels obtained in the laboratory study were determined on the basis of moisture characteristics, yield, cost and setting time. Those solids levels evaluated in the pilot plant study were 10.5, 12, 13 and 15%. Two hold times were selected for the pilot plant study, with those being a 0-hold and a 12-h hold at 4.4°C. All results were compared to two controls, a non-fortified (9.0% total solids) and a fortified (10.5% total solids) skim milk. Cost comparisons at the various levels were made. Over all conditions of this study, cottage cheese made from 10.5% reconstituted non-fat-dry milk with a 0-hold appeared to be best as measured by moisture control, set time, cost, adjusted yield and appearance of curd at varying stages. In the pilot plant study, there was no significant (P

We used acid digestion and glycogen depletion to determine fascicle organization, fiber morphology, and physiological and anatomical features of individual motor units of an in-series muscle, the pectoralis (pars thoracicus) of the pigeon (Columba livia). Most fascicles are attached at one end to connective tissue. Average fiber length in the four regions examined range from 42% to 66% of average fascicle length. More than 65% of fibers are blunt at one end of a fascicle and taper intrafascicularly. Fibers with blunt-blunt endings range from 13% to 31% of the population in different regions; taper-taper fibers range from 2% to 17%. Pigeon pectoralis fibers are distinguished histochemically into fast-twitch glycolytic (FG) and fast-twitch oxidative-glycolytic (FOG) populations. Three units composed of FG fibers (FG units) contract more quickly than three units composed of FOG fibers (FOG units) (range 31-37 vs 47-62 msec), produce more tetanic force (0.11-0.32 vs 0.02-0.05 N) and are more fatigable (18% initial force vs50% after repeated stimulation). Most motor units are confined to one of the four muscle regions. Territory of two FOG units is30% of parent fascicle length. Territories of other units spanned parent fascicles; most fibers in these units do not extend the full fascicle length. Compared to FG units, FOG units have lower maximum innervation ratios and density indices (ratio of depleted/total FOG fibers in territory 8-14% vs 58-76% for FG units). These differences support the hypothesis that FG units are organized to produce substantial force and power for takeoff, landing and other ballistic movements whereas FOG units are suited for sustained flight when power requirements are reduced. Implications of findings for understanding the control of in-series muscles and the use of connective tissue elastic elements during wing movements are discussed. J.Morphol. 236:179-208, 1998. © 1998 Wiley-Liss, Inc.

BACKGROUNDd: ACC-001 is an investigational therapeutic vaccine designed to elicit antibodies against the N-terminal peptide 1-7 of the amyloid-beta peptide, believed to be important in the pathogenesis of Alzheimer’s disease. OBJECTIVES: To evaluate safety, immunogenicity, impact on brain amyloid, and other exploratory endpoints in participants receiving ACC-001. DESIGN: Randomized, phase 2, interventional study. Trial registration: Clinicaltrials.gov ID NCT01227564. PARTICIPANTS: Individuals with early Alzheimer’s disease (Mini-Mental State Examination scores ≥25, a global Clinical Dementia Rating of 0.5, and evidence of elevated baseline brain amyloid burden). Intervention: Participants were randomized to ACC-001 3 µg or 10 µg with QS-21 adjuvant (50 µg), or placebo. MEASUREMENTS: The primary endpoint was change in brain amyloid burden by 18F-florbetapir positron emission tomography in composite cortical standard uptake value ratio. RESULTS: A total of 63 participants were randomized and 51 completed the study. At week 104, no significant differences were observed in 18F-florbetapir positron emission tomography composite cortical standard uptake value ratio between either ACC-001 dose compared with placebo. In both ACC-001 + QS-21 treatment groups, following the initial immunization, the anti-amyloid-beta geometric mean titers increased after each subsequent vaccination and then declined, with less apparent decline after the later compared with earlier immunizations. The majority of treatment-emergent adverse events in the ACC-001 + QS-21 groups were injection site reactions, which occurred at a greater rate in active treatment groups than in the placebo group. No amyloid-related imaging abnormalities of edema or effusion were reported. CONCLUSION: No statistically significant differences were observed between groups in the change from baseline brain amyloid burden despite apparently robust systemically measured anti-amyloid-beta antibody response at both dose levels. Insufficient antibody titers, poor quality immune response, short duration of treatment, or small sample size may have resulted in these findings. The safety and tolerability profile was acceptable.

Background: In animals, insulin-like growth factor-1 (IGF-1) increases clearance of β-amyloid, a pathologic hallmark of Alzheimer disease (AD), from the CNS. Serum IGF-1 level decreases with age, and shows a further decrease in AD. We examined whether the growth hormone secretagogue MK-677 (ibutamoren mesylate), a potent inducer of IGF-1 secretion, slows the rate of progression of symptoms in patients with AD. Methods: A double-blind, multicenter study was conducted in which 563 patients with mild to moderate AD were randomized to receive MK-677 25 mg or placebo daily for 12 months. Efficacy measures were mean change from baseline at month 12 on the Clinician9s Interview Based Impression of Change with caregiver input (CIBIC-plus), the cognitive subscale of the Alzheimer9s Disease Assessment Scale (ADAS-Cog), Alzheimer9s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), and the Clinical Dementia Rating-sum of boxes (CDR-sob). Results: A total of 416 patients completed treatment and assessments at 12 months. Administration of MK-677 25 mg resulted in a 60.1% increase in serum IGF-1 levels at 6 weeks and a 72.9% increase at 12 months. In mixed-effects models that included treatment, time (month), randomization strata (baseline MMSE score ≤20 vs >20), and interaction of treatment-by-time, there were no significant differences between the treatment groups on the CIBIC-plus or the mean change from baseline scores on the ADAS-Cog, ADCS-ADL, or CDR-sob scores over 12 months. Conclusion: Despite evidence of target engagement as indicated by an increase in serum insulin-like growth factor-1, the human growth hormone secretagogue MK-677 25 mg was ineffective at slowing the rate of progression of Alzheimer disease.

In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns.

Using dilatometric techniques, detailed investigations have been made of the crystallization and melting behavior of high molecular weight poly(tetramethylene oxide), low molecular weight poly(tetramethylene oxide) glycol, and a high molecular weight copolymer prepared by the chain extension of the glycol. The degree of crys-tallinity is expressed as a function of time and temperature. Using fast melting rates, the apparent melting point of the bulk polymers has been found to depend on both the temperature of crystallization and the level of crystallization allowed to develop before melting. Extrapolation gave an estimated equilibrium melting point for high molecular weight homopolymer of about 51°C. The highest experimentally observed melting point was 43°C. Visual observations have been made on crystallization of these materials from dilute solution (⪕3%) in toluene. Under some experimental conditions crystallization was accompanied by gel formation while under other conditions two distinct and separable phases were formed. Measurements were made on the dissolution temperatures of solutions crystallized under different experimental conditions.

A search for steady TeV point sources anywhere in the northern sky has been made with data from the Milagrito air-shower-particle detector. Over 3 x 10**9 events collected from 1997 February to 1998 May have been used in this study. No statistically significant excess above the background from the isotropic flux of cosmic rays was found for any direction of the sky with declination between -5 degrees and 71.7 degrees. Upper limits are derived for the photon flux above 1 TeV from any steady point source in the northern sky., 2 Figures

Brighton and Hove has one of the highest rates of drug-related deaths in the UK. The deceased commonly have had contact with a number of organizations isolated from each other. The aim of this study was to explore aspects of drug addiction in Brighton as the first stage in the creation of a local Drug addiction Intervention Network (DIN) and to make recommendations about improving the effectiveness of medical contacts so that modifiable risk factors could be addressed appropriately and consistently. The coroner's records of the drug-related deaths in 1998 for Brighton and Hove were cross-referenced with computerized records of the Accident & Emergency department of the local hospital and the police station. Of the 36 drug misusers who died during the year, most were male, mean age 34 years. Alcohol was a common comorbid finding. Seventy-eight per cent were known to the A&E department and 62% had been arrested locally during 1997 or 1998. Such retrospective data can only give limited information. We, therefore, performed a prospective survey. It was carried out by the forensic medical examiner (FME) in 1997-1998, interviewing 41 arrestees to give a profile of the criminally involved drug misusers. With the information obtained, the A&E doctors and FMEs were able to review the medical advice given and establish a protocol for the transfer of severely intoxicated arrestees.

The Milagrito water Cherenkov detector near Los Alamos, New Mexico, operated as a sky monitor at energies of a few TeV between February 1997 and May 1998 including the period of the strong, long-lasting 1997 flare of Markarian 501. Milagrito served as a test run for the full Milagro detector. An event excess with a significance of 3.7 sigma from Markarian 501 was observed, in agreement with expectations.

Over the years, various hypotheses have implicated the role of structural instabilities in the expansion of intracranial saccular aneurysms. Recent nonlinear analyses suggest, however, that particular subclasses of aneurysms are structurally stable (in the mechanics sense) and that we must consider different hypotheses. Indeed, based on an ever-increasing database, it appears that aneurysms may well expand via the remodeling of their constituents. Although more data and a kinetics-based formulation of remodeling are needed to examine this hypothesis, we present results from quasistatic finite element analyses of 12 subclasses of lesions that support the remodeling hypothesis. Briefly, we identify regional variations in material symmetry, for a class of noncomplicated axisymmetric lesions subjected to a uniform distension pressure, that minimize local maxima in multiaxial stress and tend to homogenize the stress field. Such symmetries are termed preferred. It is shown that the numerical predictions are consistent with the teleological concept that some intracranial saccular aneurysms will seek to become spherical, since the sphere is an optimal geometry for resisting a distension pressure. To achieve this, however, different subclasses must develop differently. Lesions having an initially large neck:height ratio must increase in height and therefore may seek to become increasingly stiffer circumferentially from the fundus to the neck. Conversely, lesions having an initially small neck:height ratio must increase in breadth and therefore may seek to become increasingly stiffer meridionally from the fundus to the neck. We submit that these results demonstrate the need for a detailed histological examination of regional variations in collagen organization in human lesions, for it is upon data that an analysis of remodeling must be founded.

We describe our protocol for performing decompression radiologic gastrostomy and gastrojejunostomy in patients with ascites and small-bowel obstruction. We also assess the technical success rate, the complications, and the morbidity and mortality in 45 patients who underwent radiologic gastrostomy.Forty-five consecutive patients with ascites associated with metastatic ovarian cancer underwent a radiologic gastrostomy or gastrojejunostomy with gastropexy. Six patients underwent gastrostomy, and 39 patients underwent gastrojejunostomy. Locking catheters were placed using the Seldinger technique after gastropexy in all patients. Paracentesis was performed before gastrostomy or gastrojejunostomy. Additional serial paracenteses were performed after the procedure when reaccumulation of ascites close to the site of gastropexy was detected on follow-up sonography.Forty-five procedures were attempted. The technical success rate was 97.8%. The complication rate was 15.6%. Three major complications (6.7%) and four minor complications (8.9%) occurred. One procedure-related death (2.2%) occurred 16 days after gastrojejunostomy.Radiologic gastrostomy and gastrojejunostomy can be performed safely in patients with ascites if the patients undergo paracentesis first and if the reaccumulation of ascites is prevented after tube placement. In patients with ascites, gastropexy plays an important role in preventing pericatheter leakage. Ascites and peritoneal carcinomatosis should not be considered contraindications for radiologic gastrostomy or gastrojejunostomy.

To assess the rates of technical success and complications associated with radiologic gastrostomy or gastrojejunostomy performed with T-fastener gastropexy.In 316 consecutive patients, radiologic gastrostomy or gastrojejunostomy with T-fastener gastropexy was performed over a 10-year period. Results of the procedures were reviewed. Results of follow-up were available for all patients.Of 316 procedures, 314 were successful (technical success rate, 99.4%). Six (1.9%) major complications occurred; 50% occurred in patients with peritoneal involvement from ovarian carcinoma. Ten (3.2%) minor complications occurred. Four minor complications occurred in patients with ovarian cancer and ascites. The 30-day mortality rate was 3.8% (12 patients) with one procedure-related death (0.3%).A T-fastener gastropexy may have a protective role in prevention of leakage of gastric contents into the peritoneum in patients with ascites. Ascites need no longer be considered a contraindication for radiologic gastrostomy. A gastropexy enables routine use of larger gastrostomy tubes and ready replacement of a displaced tube even before the development of a mature tract.

A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source. Altogether 498 children, aged from 3 months to 3 years, with a fever > or = 39.5 degrees C were identified over this period, of whom 291 were admitted to hospital because of evidence of sepsis or identified focal infection and 207 children without focal infection were observed in the short stay annexe of the emergency department. Fifty children, considered at high risk of bacteraemia because of a total white cell count > or = 20 x 10(9)/1 received empiric antibiotic treatment with ceftriaxone, of whom 19 subsequently had proved bacteraemia and another 10 had focal infection identified during observation in the short stay annexe. Bacteraemia was due to Streptococcus pneumoniae in 16 cases and Haemophilus influenzae type b in three. No adverse events occurred at follow up. Use of a management protocol and selection on higher white cell count criterion than previously recommended by US centres resulted in restriction of empiric antibiotic treatment to a small proportion of young febrile children presenting to a busy emergency department of whom 38% were bacteraemic.

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%).

Carbon enhanced vapor etching (CEVE) is an alternative approach for fine pattern delineation in silicon dioxide, especially for nanolithographic processes. Exposures by a scanning electron microscope have achieved etch rates of about with etch selectivity ratios of 30 or greater for exposed to unexposed areas. Scanning tunneling microscope resolution studies have shown that trench widths on the order of 3 - 5 nm are possible. Pattern transfer to silicon has been achieved using reactive ion etching.

C ase History A 52-year-old woman presented to the emergency department with an acute onset of severe abdominal cramps, feculent vomiting. and a fever of 103#{176}F (39#{176}C). Her medical history was significant: an appendectomy, a cholecystectomy, and an oophorectomy. A clinical diagnosis of small-bowel obstruction was made. A radiograph of the abdomen revealed dilated, fluid-filled smallbowel loops that confirmed the diagnosis. A chest radiograph revealed lung consolidation and a moderate-sized right pleural effusion (Fig. 1A). The emergency department resident performed a diagnostic thoracentesis without image guidance. Cloudy fluid was obtained. Laboratory analysis of the pleural fluid identifled 3500 WBC/pJ with a differential of 73% polymorphonuclear leukocytes. a pH of 7.15, and a glucose level of 31 mg/dl. An immediate Gram’s stain revealed no organisms. The patient was begun on IV antibiotics empirically that included 400 mg of clindamycin every 8 hr, 240 mg of gentamicin every 24 hr. and 1 g of eiythromycin every 6 hr. Subsequent cultures revealed no bacterial growth. A clinical diagnosis of empyema was made. What criteria are used to make this diagnosis, and do these criteria assist in selecting the appropriate treatment? Dr. Mueller. We employ the widely used criteria defined by Light [ I ] in differentiating patients with simple parapneumonic effusions from those with empyemas. The diagnosis of empyema by Light’s criteria requires one of the following features to be present: gross pus. organisms on Gram’s stain, a pH below 7.0, or a glucose level below 40 mg/dl [2]. Light went on to describe three stages in the evolution of empyema. The first is the exudative stage, which occurs when a focus of infection con

Electron beam lithography is generally accepted to have the highest practical resolution capability. In this paper the state of the art in terms of resolution is reviewed. This covers conventional resists such as PMMA, contamination resist, inorganic resists and damage processes. Some insights into the resolution limiting factors are given although the precise limitations still remain unclear. Consideration is also given as to the best measure of resolution and it is suggested that the minimum line spacing is a more appropriate and less subjective measure than minimum achievable feature size.

The defect engineering in metalorganic vapor phase epitaxy InxGa1-xAs and InP by controlled oxygen doping using diethyl aluminum ethoxide (DEALO) was developed in this study. DEALO doping has led to the incorporation of Al and O, and the compensation of shallow Si donors in InxGa1−xAs: Si with 0 ≤ x ≤ 0.25. With the same DEALO mole fraction during growth, the incorporation of Al and O was found to be independent of x, but the compensation of Si donors decreases with increasing In content. Deep level transient spectroscopy analysis on a series of InxGa1-xAs: Si. samples with 0 ≤ x ≤ 0.18 revealed that oxygen incorporation led to a set of deep levels, similar to those found in DEALO doped GaAs. As the In composition was increased, one or more of these deep levels became resonant with the conduction band and led to a high electron concentration in oxygen doped In0.53Ga0.47As. Low temperature photoluminescence emission measurements at 12K on the same set of samples revealed the quenching of the near-band edge peak, and the appearance of new oxygen-induced emission features. DEALO doping in InP has also led to the incorporation of Al and O, and the compensation of Si donors due to oxygen-induced multiple deep levels.

A novel means of pattern generation and transfer combining electron beam lithography of scanning tunneling. microscopy (STM) patterning with HF vapor etching is reported. HF vapor etch rates in silicon dioxide are found to be markedly enhanced by the presence of adsorbed hydrocarbon species that have been positionally fixed in either the electron beam tool or using the STM. Etch selectivities of at least 100 have been shown to be achievable in electron beam experiments for pattern generation. The relationships that exist between electron beam parameters and the observed etch rates are discussed in terms of possible chemical mechanism extent on the surface during and after electron beam exposure. Feature generation in silicon dioxide using electron beam approaches is reported for

The Cygnus region is a very bright and complex portion of the TeV sky, host to unidentified sources and a diffuse excess with respect to conventional cosmic-ray propagation models. Two of the brightest TeV sources, MGRO J2019+37 and MGRO J2031+41, are analyzed using Milagro data with a new technique, and their emission is tested under two different spectral assumptions: a power law and a power law with an exponential cutoff. The new analysis technique is based on an energy estimator that uses the fraction of photomultiplier tubes in the observatory that detect the extensive air shower. The photon spectrum is measured in the range 1 to 200 TeV using the last 3 years of Milagro data (2005-2008), with the detector in its final configuration. MGRO J2019+37 is detected with a significance of 12.3 standard deviations ($\sigma$), and is better fit by a power law with an exponential cutoff than by a simple power law, with a probability $>98$% (F-test). The best-fitting parameters for the power law with exponential cutoff model are a normalization at 10 TeV of $7^{+5}_{-2}\times10^{-10}$ $\mathrm{s^{-1}\: m^{-2}\: TeV^{-1}}$, a spectral index of $2.0^{+0.5}_{-1.0}$ and a cutoff energy of $29^{+50}_{-16}$ TeV. MGRO J2031+41 is detected with a significance of 7.3$\sigma$, with no evidence of a cutoff. The best-fitting parameters for a power law are a normalization of $2.4^{+0.6}_{-0.5}\times10^{-10}$ $\mathrm{s^{-1}\: m^{-2}\: TeV^{-1}}$ and a spectral index of $3.08^{+0.19}_{-0.17}$. The overall flux is subject to an $\sim$30% systematic uncertainty. The systematic uncertainty on the power law indices is $\sim$0.1. A comparison with previous results from TeV J2032+4130, MGRO J2031+41 and MGRO J2019+37 is also presented., Comment: 11 pages, 10 figures

Thrombus formation is a recognised complication of IVC filter placement, however IVC and bilateral renal vein occlusion secondary to thrombus is much less common. We present a case of infrahepatic caval and bilateral renal vein occlusion secondary to thrombosis of a suprarenal IVC filter. With progressive clinical deterioration and failure of conservative medical management the patient underwent successful mechanical disruption and catheter directed thrombolysis.

We have made non-local measurements of a two-dimensional electron gas (2DEG) formed at the interface of a GaAs/GaxAl1-xAs heterojunction. The magnetoresistance was measured on a standard Hall bar that had a gate placed between the current and voltage probes. We observed non-local resistance peaks at the location of the Shubnikov-de Haas oscillation maxima. The magnitude of these peaks depends on the gate voltage applied to the semiconductor between the current and voltage probes. We also observe 'Aharanov-Bohm'-like oscillations, presumably due to a localized impurity near the gate.

The enzyme responsible for the metalloproteinase activity which cleaves the Glu143-Leu144 bond of (pro)urokinase has been isolated from the conditioned medium of cultured normal human kidney cells. Using S-Sepharose and Cibacron Blue-agarose chromatography, then C-4 reversed phase high pressure liquid chromatography, a protein of about 20,000 Da was isolated. Through an identical amino-terminal sequence, the protein was shown to be the matrix metalloproteinase previously referred to in the literature as "pump-1" (putative metalloproteinase). When aprotinin was added during the course of the purification, the major species isolated was the zymogen form (28,000 Da) of pump-1. Pump-1 has been shown to efficiently cleave the susceptible bond of both pro-urokinase (single-chain) and active (two-chain) urokinase and thereby produce the corresponding low molecular weight forms. The amino-terminal sequences of the A and B chains of low molecular weight urokinase prepared by action of pump-1 on recombinant high molecular weight urokinase are identical to those of the low molecular weight urokinase isolated from human kidney cell culture. Since the reaction of urokinase with this metalloproteinase results in separation of its serine proteinase region from the domain which mediates binding to the urokinase receptor, it may be of importance in the regulation of the functional activity of the plasminogen activator in cellular processes.

We have developed a design for a hard X‐ray polarimeter operating in the energy range from 50 to 500 keV. This modular design, known as GRAPE (Gamma‐Ray Polarimeter Experiment), was successfully demonstrated with partially polarized gamma‐ray sources in the lab and fully polarized photon beams at Argonne National Laboratory. In June of 2007, a GRAPE engineering model flew on a high altitude balloon flight which demonstrated the design and collected background data. A much larger payload is currently under development that will provide a significant level of sensitivity for gamma‐ray bursts on a long‐duration balloon flight. The first balloon flight of the full GRAPE instrument is currently scheduled to take place in the Fall of 2011 from Ft. Sumner, NM.

POET (Polarimeters for Energetic Transients) represents a concept for a Small Explorer (SMEX) satellite mission, whose principal scientific goal is to understand the structure of GRB sources through sensitive X‐ray and γ‐ray polarization measurements. The payload consists of two wide field‐of‐view (FoV) instruments: a Low Energy Polarimeter (LEP) capable of polarization measurements in the energy range from 2–15 keV and a high energy polarimeter (Gamma‐Ray Polarimeter Experiment or GRAPE) that would measure polarization in the 60–500 keV energy range. The POET spacecraft provides a zenith‐pointed platform for maximizing the exposure to deep space. Spacecraft rotation provides a means of effectively dealing with any residual systematic effects in the polarization response. POET provides sufficient sensitivity and sky coverage to measure statistically significant polarization (for polarization levels in excess of 20%) for ∼80 GRBs in a two‐year mission. High energy polarization data would also be obtained f...

There are limited data available on the management of massive pulmonary embolism in pregnancy. The use of systemic thrombolysis has been reported, but there are few documented cases on the use of mechanical fragmentation or catheter-directed thrombolysis. Systemic thrombolysis in pregnancy increases the risk of major hemorrhage and there are reports of massive subchorionic hematomas following its use. We describe the use of mechanical fragmentation and optional retrievable inferior vena cava (IVC) filter insertion in a 38-week pregnant woman followed by delayed pharmacological catheter-directed thrombolysis during the early postpartum period to successfully treat a massive pulmonary embolism.

Two years have passed since the worst firearms incident in recent British civil history. Most of the casualties were managed at a local district general hospital; this experience was reported soon afterwards. Two casualties were managed at Princess Alexandra's Hospital, RAF Wroughton; both are still under review. This paper describes their injuries, investigations and treatment. Current thoughts on optimal management are discussed; areas of particular controversy are highlighted. Language: en

It is apparent from review of published papers and books that misunderstanding and confusion exists in the minds of many authors describing the interaction of penetrating missiles with tissues. These misapprehensions may influence the management of wounds by suggesting didactic approaches based upon a preconceived notion of the nature and severity of the wound for different types of projectiles. This review considers the biophysics of penetrating missile wounds, highlights some of the more common misconceptions and seeks to reconcile the conflicting and confusing management doctrines that are promulgated in the literature - differences that arise not only from two scenarios, peace and war, but also from misapprehensions of the wounding process. Wounds of war and of peacetime differ both in the nature of the wound and in the propensity for wound infection. Additionally, the limitations imposed by war dictate the type of management that may be practised and result in procedures that would be considered inappropriate by some in civilian clinical practice. Many of the procedures described in civilian peacetime settings, such as reliance on antibiotics alone for the control of infection in penetrating wounds, or minimal excision and debridement, can yield good results but would herald disaster if transposed to a war setting.

The injuries likely to occur during a future general war will differ in severity and number from those experienced during recent short campaigns, terrorist incidents and natural disasters. If general war should break out in Europe, casualty numbers will lean towards the First World War rather than the Second in scale. Medical assets can expect, at least temporarily, to be overwhelmed with casualties. To deal with this problem, casualty management will be staged through five echelons or lines of medical support. The principal problem that will face medical attendants at the forward lines will be the sorting of casualties by priority so that those unable to tolerate delay in treatment will be evacuated rapidly before the less severely injured. Sorting will be achieved by the application of a crude scoring system known as Military Triage. We examine this concept and discuss its likely effectiveness in a scenario characterised by limited medical resources and a high flow of casualties. With the widespread introduction of modern and complex injury severity scoring systems into civilian trauma practice it is timely to examine their potential role in augmenting or replacing the current Military Triage system. Language: en

In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators.Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3).Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis.Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit.We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.

The diffuse gamma radiation arising from the interaction of cosmic ray particles with matter and radiation in the Galaxy is one of the few probes available to study the origin of the cosmic rays. Milagro is a water Cherenkov detector that continuously views the entire overhead sky. The large field-of-view combined with the long observation time makes Milagro the most sensitive instrument available for the study of large, low surface brightness sources such as the diffuse gamma radiation arising from interactions of cosmic radiation with interstellar matter. In this paper we present spatial and flux measurements of TeV gamma-ray emission from the Cygnus Region. The TeV image shows at least one new source MGRO J2019+37 as well as correlations with the matter density in the region as would be expected from cosmic-ray proton interactions. However, the TeV gamma-ray flux as measured at ~12 TeV from the Cygnus region (after excluding MGRO J2019+37) exceeds that predicted from a conventional model of cosmic ray production and propagation. This observation indicates the existence of either hard-spectrum cosmic-ray sources and/or other sources of TeV gamma rays in the region., Comment: Submitted to Astrophysical Journal Letters

The effect of pressure on the luminescence of porous Si has been considered. We observe a blue shift in the luminescence peak position up to ≈ 25 kbar followed by a red shift above 25 kbar. We interpret our results in the context of a pressure-induced direct-indirect transition in porous Si.

Medical Support Troop Bravo (MST Bravo) provides third line medical support for the United Kingdom Battle Group currently deployed on operation Grapple 2 in Bosnia Herzegovina. Standing operating procedures for the initial assessment and resuscitation of all casualties are based on the protocols taught on Advanced Trauma Life Support (ATLS) and Battlefield Advanced Trauma Life Support (BATLS) courses. These protocols dictate a period of initial assessment and resuscitation with the casualty immobilised in the supine position. Recent experience in casualty management at MST Bravo has identified inadvertent spinal movement taking place during removal of Combat Body Armour Lightweight (CBA) which might have detrimental effects for casualties with occult spinal injury. This has led to an appraisal of CBA removal and the identification of a drill for rapid, safe and reliable means of undressing without jeopardy to the integrity of the spine. The method is described. Language: en

This issue brief explores existing and potential opportunities to further expand the availability of health coverage for the uninsured and the under insured, given the current economy and the resulting state budget shortfalls. It also considers the implications of the Health Insurance Flexibility and Accountability initiative recently announced by the Centers for Medicare and Medicaid Services and the legislative options for health care reform being debated in Washington, including tax-credit incentives and additional federal funding for public coverage expansions through Medicaid and the State Children's Health Insurance Program. The Forum session will explore state, federal, and academic perspectives on public coverage expansions and the variety of paths available to support such expansions. The meeting will also address the cost implications of the differing perspectives in the context of the shifting economy. This is expected to lead to a discussion among presenters and participants of the future of and priorities for public financing of health insurance coverage.