Pearl Harbor Collection - Accession 1313

The Pearl Harbor Collection consists of 39 bound volumes of the transcripts of the hearings before the Joint Committee on the Investigation of the Pearl Harbor Attack on December 7, 1941 and contains marks and notes produced by the Kimmel family. One volume is a transcript of the Report of the Joint Committee and one is of the Minority Views of the committee. The Hearings Before The Joint Committee span from Part I to Part XXXIX, however Part XX and XXII are missing. There are also 8 volumes of books on Pearl Harbor that were collected by the Kimmel family.https://digitalcommons.winthrop.edu/manuscriptcollection_findingaids/2126/thumbnail.jp

Emergency Physician Treatment of Acute Stroke with Recombinant Tissue Plasminogen Activator: A Retrospective Analysis

Stroke teams are advocated for the rapid treatment of patients who have acute ischemic stroke (AIS) with recombinant tissue plasminogen activator (rt-PA). An alternate model uses existing ED resources with specialist consultation as needed. Objectives: To evaluate the treatment of AIS with rt-PA in this alternate ED model. Methods: A retrospective observational review was performed of consecutive patients with AIS treated with rt-PA at four hospitals affiliated with an emergency medicine residency. Emergency physicians (EPs) were directly responsible for the treatment of all patients according to predefined guidelines. Records were evaluated from the implementation of the guidelines through December 15, 1997. Results: 37 patients with AIS received rt-PA. Mean age ± SD was 63 ± 16 years (range 22-87), with 25 (68%) male. Patients presented 67 ± 29 minutes after stroke onset. After ED arrival, they were seen by the EP in 14 ± 13 minutes, had CT in 46 ± 22 minutes, and were treated in 97 ± 35 minutes. Neurologist consultation occurred in the department for nine patients (24.3%), and by telephone for 14 (37.8%). Symptomatic intracerebral hemorrhage (ICH) occurred in four (10.8%, 95% CI = 0.8% to 20.8%). There were two deaths, neither associated with ICH. Neurologic outcome at discharge compared with presentation in survivors was normal for four patients (11.4%), improved for 16 (45.7%), unchanged for ten (28.6%), and worse for five (14.3%). Conclusions: In this analysis, EPs, with specialty consultation as required, successfully identified patients with AIS and delivered rt-PA with satisfactory outcomes. Important elements of this model include early patient identification, preestablished protocols, and rapid access to CT scanning and interpretation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71596/1/j.1553-2712.1999.tb00416.x.pd

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

Background: Acute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department (ED) visit and hospitalization. Appropriate care is fundamental, considering both the high prevalence of asthma in children, and its life-threatening risks. Italian Society of Pediatrics recently issued a guideline on the management of acute asthma attack in children over age 2, in ambulatory and emergency department settings. Methods: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was adopted. A literature search was performed using the Cochrane Library and Medline/PubMed databases, retrieving studies in English or Italian and including children over age 2 year. Results: Inhaled f2 agonists are the first line drugs for acute asthma attack in children. Ipratropium bromide should be added in moderate/severe attacks. Early use of systemic steroids is associated with reduced risk of ED visits and hospitalization. High doses of inhaled steroids should not replace systemic steroids. Aminophylline use should be avoided in mild/moderate attacks. Weak evidence supports its use in life-threatening attacks. Epinephrine should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to \u3b22 agonists. Intravenous magnesium solphate could be used in children with severe attacks and/or forced expiratory volume1 (FEV1) lower than 60% predicted, unresponsive to initial inhaled therapy. Heliox could be administered in life-threatening attacks. Leukotriene receptor antagonists are not recommended. Conclusions: This Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2

Do New Drugs Increase Life Expectancy? A Critique of a Manhattan Institute Paper

A recent study published by the Manhattan Institute “Why Has Longevity Increased More in Some States than in Others? The Role of Medical Innovation and Other Factors,” purported to show that the more rapid adoption of new drugs has substantial benefits in the form of increased life expectancy, higher productivity and lower non-drug health care expenditures. This study has been cited as evidence supporting the more rapid acceptance of new drugs in Medicaid, Medicare, and other public programs and has helped to shape public debate on the value of new drugs. This analysis questions the key conclusions of the study. It points out that the key statistical regressions appear to be misspecified, since they show anomalies such as a negative correlation between income growth and life expectancy and find no relationship between education and productivity growth. Methodological flaws addressed include lack of adjustment for infant mortality rates; inadequate proxy measures of health status; lack of adjustment for ages of individuals and other sociodemographic factors; inherent problems with the definition of drug age, or ‘vintage;’ and the failure to consider reverse causation as an obvious explanation for several findings. The Manhattan Institute study does not provide reliable evidence for favoring adoption of newer drugs in either public or private health care programs

Reynolds Number Effects at High Angles of Attack

Lessons learned from comparisons between ground-based tests and flight measurements for the high-angle-of-attack programs on the F-18 High Alpha Research Vehicle (HARV), the X-29 forward-swept wing aircraft, and the X-31 enhanced fighter maneuverability aircraft are presented. On all three vehicles, Reynolds number effects were evident on the forebodies at high angles of attack. The correlation between flight and wind tunnel forebody pressure distributions for the F-18 HARV were improved by using twin longitudinal grit strips on the forebody of the wind-tunnel model. Pressure distributions obtained on the X-29 wind-tunnel model at flight Reynolds numbers showed excellent correlation with the flight data up to alpha = 50 deg. Above (alpha = 50 deg. the pressure distributions for both flight and wind tunnel became asymmetric and showed poorer agreement, possibly because of the different surface finish of the model and aircraft. The detrimental effect of a very sharp nose apex was demonstrated on the X-31 aircraft. Grit strips on the forebody of the X-31 reduced the randomness but increased the magnitude of the asymmetry. Nose strakes were required to reduce the forebody yawing moment asymmetries and the grit strips on the flight test noseboom improved the aircraft handling qualities

CONSORT 2010 statement: extension to randomised pilot and feasibility trials [on behalf of the PAFS consensus group*]

The Consolidated Standards of Reporting Trials (CONSORT) statement is a guideline designed to improve the transparency and quality of the reporting of randomised controlled trials (RCTs). In this article we present an extension to that statement for randomised pilot and feasibility trials conducted in advance of a future definitive RCT. The checklist applies to any randomised study in which a future definitive RCT, or part of it, is conducted on a smaller scale, regardless of its design (eg, cluster, factorial, crossover) or the terms used by authors to describe the study (eg, pilot, feasibility, trial, study). The extension does not directly apply to internal pilot studies built into the design of a main trial, non-randomised pilot and feasibility studies, or phase II studies, but these studies all have some similarities to randomised pilot and feasibility studies and so many of the principles might also apply. The development of the extension was motivated by the growing number of studies described as feasibility or pilot studies and by research that has identified weaknesses in their reporting and conduct. We followed recommended good practice to develop the extension, including carrying out a Delphi survey, holding a consensus meeting and research team meetings, and piloting the checklist. The aims and objectives of pilot and feasibility randomised studies differ from those of other randomised trials. Consequently, although much of the information to be reported in these trials is similar to those in randomised controlled trials (RCTs) assessing effectiveness and efficacy, there are some key differences in the type of information and in the appropriate interpretation of standard CONSORT reporting items. We have retained some of the original CONSORT statement items, but most have been adapted, some removed, and new items added. The new items cover how participants were identified and consent obtained; if applicable, the prespecified criteria used to judge whether or how to proceed with a future definitive RCT; if relevant, other important unintended consequences; implications for progression from pilot to future definitive RCT, including any proposed amendments; and ethical approval or approval by a research review committee confirmed with a reference number. This article includes the 26 item checklist, a separate checklist for the abstract, a template for a CONSORT flowchart for these studies, and an explanation of the changes made and supporting examples. We believe that routine use of this proposed extension to the CONSORT statement will result in improvements in the reporting of pilot trials. Editor’s note: In order to encourage its wide dissemination this article is freely accessible on the BMJ and Pilot and Feasibility Studies journal websites

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

International Fragility Fracture Network Delphi consensus statement on the principles of anaesthesia for patients with hip fracture

Globally, the number of hip fractures is expected to double between 2017 and 2050, from ~2.2 million to ~4.5 million. For the purposes of analgesia and remobilisation, ~ 99% of hip fractures should be fixed surgically, requiring anaesthesia. Surgery for hip fracture has become increasingly standardised, but peri‐operative medical and anaesthetic care varies considerably. Peri‐operative morbidity and mortality remain high. Guidelines exist for the anaesthetic management of patients with hip fracture, but are specific to the healthcare systems of Western nations. This consensus statement (advises basic standards of anaesthetic care that hip fracture patients should expect to receive in any country, regardless of resources. On behalf of the Fragility Fracture Network (FFN), the Anaesthesia Working Group (SW) invited internationally recognised experts in hip fracture anaesthesia and national professional leaders to contribute to a Consensus Com-mittee

Big Data Analytics for Wireless and Wired Network Design: A Survey

Currently, the world is witnessing a mounting avalanche of data due to the increasing number of mobile network subscribers, Internet websites, and online services. This trend is continuing to develop in a quick and diverse manner in the form of big data. Big data analytics can process large amounts of raw data and extract useful, smaller-sized information, which can be used by different parties to make reliable decisions. In this paper, we conduct a survey on the role that big data analytics can play in the design of data communication networks. Integrating the latest advances that employ big data analytics with the networks’ control/traffic layers might be the best way to build robust data communication networks with refined performance and intelligent features. First, the survey starts with the introduction of the big data basic concepts, framework, and characteristics. Second, we illustrate the main network design cycle employing big data analytics. This cycle represents the umbrella concept that unifies the surveyed topics. Third, there is a detailed review of the current academic and industrial efforts toward network design using big data analytics. Forth, we identify the challenges confronting the utilization of big data analytics in network design. Finally, we highlight several future research directions. To the best of our knowledge, this is the first survey that addresses the use of big data analytics techniques for the design of a broad range of networks