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Giant cell myocarditis is a rare, often rapidly progressive and potentially fatal, disease due to T-cell lymphocyte-mediated inflammation of the myocardium that typically affects young and middle-aged adults. Frequently, the disease course is marked by acute heart failure, cardiogenic shock, intractable ventricular arrhythmias, and/or heart block. Diagnosis is often difficult due to its varied clinical presentation and overlap with other cardiovascular conditions. Although cardiac biomarkers and multimodality imaging are often used as initial diagnostic tests, endomyocardial biopsy is required for definitive diagnosis. Combination immunosuppressive therapy, along with guideline-directed medical therapy, has led to a paradigm shift in the management of giant cell myocarditis resulting in an improvement in overall and transplant-free survival. Early diagnosis and prompt management can decrease the risk of transplantation or death, which remain common in patients who present with cardiogenic shock.

The use of range lights in nautical navigation involves the visual determination of the vertical alignment of two points of light, in order to indicate the centre of the channel. In two experiments it is shown that this vernier alignment task is more accurate if illuminated linear stimuli are used as range lights. Experiment 1 involved a laboratory simulation and experiment 2 involved a field test with full sized range lights. The average reduction of error through the use of linear stimuli over the standard point stimuli, for navigational alignments at a distance of one-half nautical mile from the range lights, was 69-4%. This suggests that a marked safety advantage might accrue from the use of linear range lights for nautical navigation purposes.

Carbon dioxide (CO2) removal technology development for portable life support systems (PLSS) has traditionally concentrated in the areas of solid and liquid chemical sorbents and semi-permeable membranes. Most of these systems are too heavy in gravity environments, require prohibitive amounts of consumables for operation on long term planetary missions, or are inoperable on the surface of Mars due to the presence of a CO2 atmosphere. This paper describes the effort performed to mature an innovative CO2 removal technology that meets NASA s planetary mission needs while adhering to the important guiding principles of simplicity, reliability, and operability. A breadboard cryogenic carbon dioxide scrubber (Cryo Scrubber) for a closed loop cryogenic PLSS was developed, designed, and tested, and a conceptual design suitable for a PLSS was developed based on the results of the breadboard testing. The Cryo Scrubber freezes CO2 and other trace contaminants out of expired vent loop gas using cooling available from a liquid oxygen (LOX) based PLSS. The device is continuously regenerable, with solid CO2 being removed from the cold freeze-out surfaces, sublimated, and vented overboard. Duration is limited only by the supply of LOX stored in the PLSS. Simplicity, reliability, and operability are universally important criteria for critical hardware on long duration Lunar or Mars missions. The Cryo Scrubber has no moving parts, requires no additional consumables, and uses no electrical power, contributing to its simplicity and reliability. It is easy to use; no operator action is required to prepare, use, or shut down the Cryo Scrubber, and it does not require charging or regeneration. The versatility of the concept allows for operation on earth, the moon, and Mars, and in microgravity.

THUNDER technology introduces a versatile new family of rugged, robust, reliable piezoelectric actuators and sensors. Because of their pre-stressed composite structure, these powerful yet lightweight devices exhibit unprecedented performance in a durable, solid state package. Both sensors and actuators can be manufactured in a variety of adaptable geometries - squares, rectangles and disks - from several millimeters to many centimeters in size. Wide bandwidth performance can be achieved and maintained even in harsh chemical and temperature environments. Based on an invention patented by NASA, THUNDER is an emerging, enabling technology that holds the promise of significant advancements in numerous 'smart' applications. Development of these applications for smart materials and structures requires extensive characterization of a variety of THUNDER devices in a range of configurations. This comprehensive characterization effort is especially challenging because of the extraordinary flexibility and range of motion demonstrated by THUNDER devices, even under significant load. This paper will discuss important new work in the ongoing program of THUNDER device characterization. The program includes not only development of the characterization process, but also design and manufacture of the test and measurement equipment necessary to conduct meaningful and reliable testing on these unique, high performance devices. Results will be presented on characterization of two configurations of THUNDER devices, including a circular and a rectangular model of different sizes constructed of varying materials. Data will be offered for a number of key performance characteristics, including displacement, block force, plus displacement vs. voltage and displacement vs. force.

THUNDER TM (thin-layer composite unimorph ferroelectric driver and sensor) represents a new class of piezoceramic- based actuators capable of generating significant displacements and forces in response to input voltages. The performance capabilities of THUNDER TM actuators are due to the component materials and process used in their construction. A typical THUNDER TM actuator is composed of metallic backing materials (e.g., aluminum or stainless steel), a piezoceramic wafer, and adhesive in spray or film form. The materials are bonded under high pressures and temperatures and then cooled to room temperature after the adhesive has solidified. Due to the prestresses which result from the differing thermal properties of the component materials under cooling, the actuator is highly durable with respect to mechanical impacts and voltage levels. As a result of this construction voltages in excess of 800 V can be applied to new actuator models without causing damage. This provides the actuators with significant displacement and force capabilities. In this paper, we discuss the development of evaluation criteria which are suitable for characterizing the actuator capabilities and provide a legitimate methodology for comparing THUNDER TM properties with those of other smart material actuators. For example, the concept of blocked force is often used to quantify the force capabilities of an actuator. However due to the inherent curvature and mode of operation, standard techniques for measuring blocked forces are inappropriate for THUNDER TM actuators. Furthermore, changing operating conditions, frequency, etc., often make blocked force measurements ambiguous. We will discuss techniques for evaluating THUNDER TM properties in a manner which limits such ambiguities when comparing with other smart materials. We note that the evaluation issues discussed here are germane to a variety of high performance smart material transducers.

Background The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.

Since 1989 the Government of Viet Nam has undertaken a series of fundamental economic reforms that have increased the use markets to set prices and enhanced the role of the non-state sector in the production and distribution of goods and services. During this time Viet Nam has opened up its economy to increase trade with the rest of the world in order to achieve the level of growth rates and development enjoyed by many other countries of the region. This policy of economic rehabilitation and the development of a market economy has required that a fundamental change be made in the way the government is financed. This paper contains an analysis of the tax system and provides a set of recommendation for the future evaluation of the system.

The system outline here is designed to make the maximum use of the great advances and cost savings arising in modern communication. Fax and electronic mail allow for almost instant communication at very low cost between Bolivia and almost every other country in the world. As a consequence, the information on price and quality is more readily available at the place of export than at the point of import; this information can be obtained quickly and inexpensively by Bolivia. The surveyor firms assisting in this system should have access to these new communication facilities.

A piezoelectric actuator and sensor which develops unusually high forces and displacements, and which is very rugged and durable, was invented by NASA at the Langley Research Center, Hampton, Virginia. Face International Corporation, under license from NASA Langley, has furthered the development of this actuator/sensor technology, and has successfully brought it to commercial production. Trade‐named THUNDER, the device derives its improved performance from two unique features. First, THUNDER is composed of a piezoelectric ceramic core which is enclosed in a sandwich having metal foil faces. The metal faces are bonded with a very strong hot‐melt adhesive which enables the actuator, operating as a unimorph, to develop large displacements and support heavy loads without failure. Second, through unique design features, the ceramic core of THUNDER is subjected to thermal expansion during manufacture. The thermal effects place the faces of the ceramic in compression so that it can undergo severe bending without cracking. The combination of the described design features of THUNDER permit its operation as a sensitive motion sensor and voltage generator as well as making it a superior solid state actuator.