Design study of RL10 derivatives. Volume 3, part 2: Operational and flight support plan

Transportation requirements are considered during the engine design layout reviews and maintenance engineering analyses. Where designs cannot be influenced to avoid transportation problems, the transportation representative is advised of the problems permitting remedies early in the program. The transportation representative will monitor and be involved in the shipment of development engine and GSE hardware between FRDC and vehicle manufacturing plant and thereby will be provided an early evaluation of the transportation plans, methods and procedures to be used in the space tug support program. Unanticipated problems discovered in the shipment of development hardware will be known early enough to permit changes in packaging designs and transportation plans before the start of production hardware and engine shipments. All conventional transport media can be used for the movement of space tug engines. However, truck transport is recommended for ready availability, variety of routes, short transit time, and low cost

Heat bounds and the blowtorch theorem

We study driven systems with possible population inversion and we give optimal bounds on the relative occupations in terms of released heat. A precise meaning to Landauer's blowtorch theorem (1975) is obtained stating that nonequilibrium occupations are essentially modified by kinetic effects. Towards very low temperatures we apply a Freidlin-Wentzel type analysis for continuous time Markov jump processes. It leads to a definition of dominant states in terms of both heat and escape rates.Comment: 11 pages; v2: minor changes, 1 reference adde

Estudio del aprovechamiento de agua de riego disponible por unidad de producción agropecuaria, con base en el requerimiento hídrico de cultivos y el área regada, en dos localidades de la Sierra ecuatoriana

Approximately 70% of all fresh water, one of the most important resources of the planet is used for agricultural activities, and the proportion is very similar in Ecuador. This is enough justification to any research or strategy in order to optimize the available irrigation water utilization. The research goal was to determine the efficiency of available irrigation water utilization per Agricultural Production Unit (UPA), in function of the irrigated area and the crop water requirements, in two locations of the Ecuadorian Range Area. The “Porotog” rural Irrigation Board, in Cangagua rural parish, at canton Cayambe, and “San Ramon” community, in Mulaló rural parish, at canton Latacunga. The field work included nine typical production systems, at the research locations. The results showed in Cangagua near of 95% of the UPA do not have enough irrigation water to supply the crop water requirements at the irrigated area. It means that these growers are underusing the irrigation water, because they irrigate more area than it can be irrigated with the available water. On the contrary, in Mulaló, the 85% of producers are overusing the irrigation water, because they have water in excess for the irrigated area.  The main conclusion of the investigation refers: both the deficit and the excess of irrigation water in the UPA, that produce inefficiency in the consumption of this scarce resource, would be the result of equitable distribution of the water in the communities, which does not depend of technical factors like agricultural land available for irrigation, in order to assign the correct amounts of irrigation water.El agua que se destina a riego agrícola bordea el 70% de la disponibilidad de agua dulce del planeta, y en Ecuador el porcentaje es muy parecido. Esto justifica cualquier esfuerzo de investigación o estrategia para optimizar el aprovechamiento del agua de riego. El objetivo de la investigación fue: Determinar la eficiencia del aprovechamiento del agua de riego disponible por Unidad de Producción Agropecuaria, UPA, en función del área regada y del requerimiento de los cultivos en dos localidades de la Sierra ecuatoriana; la Junta de Riego Porotog, parroquia Cangagua, cantón Cayambe y Comuna, San Ramón, parroquia Mulaló, cantón Latacunga. Se trabajó con nueve sistemas de producción típicos de las zonas en estudio. Se encontró que, en Cangagua, el 95% de los agricultores estudiados no cuentan con la disponibilidad de agua necesaria para satisfacer los requerimientos de los cultivos y sistemas de producción para el área regada en sus UPA; es decir, están subutilizando el agua al regar superficies superiores a las que deben regarse con el agua disponible. En cambio, en Mulaló se encontró que el 83% de productores están sobre utilizando el agua de riego al disponer de excesos de agua sobre los requeridos por lo cultivos y por área regada. La conclusión principal de la investigación fue: tanto el déficit como el exceso de agua de riego en las UPA, que provocan ineficiencias en el aprovechamiento de este recurso escaso, estarían propiciadas entre otros factores por la modalidad del reparto equitativo de agua en las comunidades, que no obedece a factores técnicos como la disponibilidad de tierra regable para adjudicar los caudales o volúmenes de agua requeridos

An Effective Community–Academic Partnership to Extend the Reach of Screenings for Fall Risk

Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community–academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and older adults. With administrative support from the regional fall prevention coalition and technical support from academia, community providers screened 161 older adults from a broad geographic area. Twenty-one community providers completed the training. Knowledge and confidence surveys demonstrated improvements before and after training (P < .001). Skills assessments demonstrated mastery of most skills, but some providers required additional training. Provider feedback indicated screening procedures were complex. Future projects will examine this model using simplified screening procedures

The utility of chest ultrasound-guided fine-needle biopsy in the diagnosis of plasmacytoma

Background. Plasmacytoma is a plasma cell dyscrasia originating from a single clone of plasma cells of B-lymphocyte lineage and produces a monoclonal immunoglobulin. Transthoracic fine-needle aspiration (TTNA) under ultrasound (US) guidance is a well-validated technique for the diagnosis of many neoplasms and has been shown to be safe and cost effective, with diagnostic yields comparable to more invasive techniques. However, the role of TTNA in the diagnosis of thoracic plasmacytoma is not well established. Objective. The aim of this study was to assess the utility of TTNA and cytology in confirming a diagnosis of plasmacytoma. Methods. All cases of plasmacytoma diagnosed from January 2006 to December 2017 by the Division of Pulmonology, Tygerberg Hospital, were retrospectively identified. All patients who underwent an US-guided TTNA and of whose clinical records could be retrieved were included in this cohort. The International Myeloma Working Group’s definition of a plasmacytoma was used as the gold standard. Results. A total of 12 cases of plasmacytoma were identified and 11 patients included (one patient was excluded owing to missing medical records). Six of the 11 patients (mean age 59.5 ± 8.5 years) were male. Radiologically, most had multiple lesions (n=7), most commonly bony (n=6) with vertebral body involvement (n=5) and pleural-based lesions (n=2). Rapid onsite evaluation (ROSE) was performed and documented in 6 of the 11 cases, and a provisional diagnosis of plasmacytoma was suggested in 5 of the 6 patients (83.3%). The final laboratory cytological diagnoses of all 11 cases were compatible with plasmacytoma which was further confirmed via a bone marrow biopsy (n=4) and by serum electrophoresis (n=7). Conclusion. US-guided fine-needle aspiration is feasible and is useful to confirm a diagnosis of plasmacytoma. Its minimally invasive nature may be the ideal investigation of choice in suspected cases

Comparison of balance assessment modalities in emergency department elders: a pilot cross-sectional observational study

<p>Abstract</p> <p>Background</p> <p>More than one-third of US adults 65 and over fall every year. These falls may cause serious injury including substantial long-term morbidity (due declines in activities of daily living) and death. The emergency department (ED) visit represents an opportunity for identifying high risk elders and potentially instituting falls-related interventions. The unique characteristic of the ED environment and patient population necessitate that risk-assessment modalities be validated in this specific setting. In order to better identify elders at risk of falls, we examined the relationship between patient-provided history of falling and two testing modalities (a balance plate system and the timed up-and-go [TUG] test) in elder emergency department (ED) patients.</p> <p>Methods</p> <p>We conducted a cross-sectional observational study of patients ≥ 60 years old being discharged from the ED. Patient history of falls in the past week, month, 6 months, and year was obtained. Balance plate center of pressure excursion (COP) measurements and TUG testing times were recorded. COP was recorded under four conditions: normal stability eyes open (NSEO) and closed (NSEC), and perturbed stability eyes open and closed. Correlation between TUG and COP scores was measured. Univariate logistic regression was used to identify the relationship between patient-provided falls history and the two testing modalities. Proportions, likelihood ratios, and receiver-operating-characteristic (ROC) curves for prediction of previous falls were reported.</p> <p>Results</p> <p>Fifty-three subjects were enrolled, 11% had fallen in the previous week and 42% in the previous year. There was no correlation between TUG and any balance plate measurements. In logistic regression, neither testing modality was associated with prior history of falls (<it>p </it>> 0.05 for all time periods). Balance plate NSEO and NSEC testing cutoffs could be identified which were 83% sensitive and had a negative likelihood ratio (LR-) of 0.3 for falls in the past week. TUG testing was not useful for falls in the past week, but performed best for more distant falls in the past month, 6 months, or year. TUG cutoffs with sensitivity over 80% and LR(-) of 0.17-0.32 could be identified for these time periods.</p> <p>Conclusion</p> <p>Over 40% of community-dwelling elder ED patients report a fall within the past year. Balance plate and TUG testing were feasibly conducted in an ED setting. There is no relationship between scores on balance plate and TUG testing in these patients. In regression analysis, neither modality was significantly associated with patient provided history of falls. These modalities should not be adopted for screening purposes in elders in the ED setting without validation in future studies or as part of multi-factorial risk assessment.</p

Phylogenetic reconstruction of dengue virus type 2 in Colombia

Background: Dengue fever is perhaps the most important viral re-emergent disease especially in tropical and subtropical countries, affecting about 50 million people around the world yearly. In Colombia, dengue virus was first detected in 1971 and still remains as a major public health issue. Although four viral serotypes have been recurrently identified, dengue virus type 2 (DENV-2) has been involved in the most important outbreaks during the last 20 years, including 2010 when the fatality rate highly increased. As there are no major studies reviewing virus origin and genotype distribution in this country, the present study attempts to reconstruct the phylogenetic history of DENV-2 using a sequence analysis from a 224 bp PCR-amplified product corresponding to the carboxyl terminus of the envelope (E) gene from 48 Colombian isolates. Results: As expected, the oldest isolates belonged to the American genotype (subtype V), but the strains collected since 1990 represent the American/Asian genotype (subtype IIIb) as previously reported in different American countries. Interestingly, the introduction of this genotype coincides with the first report of dengue hemorrhagic fever in Colombia at the end of 1989 and the increase of cases during the next years. Conclusion: After replacement of the American genotype, several lineages of American/Asian subtype have rapidly spread all over the country evolving in new clades. Nevertheless, the direct association of these new variants in the raise of lethality rate observed during the last outbreak has to be demonstrated

Global report on preterm birth and stillbirth (2 of 7): discovery science

<p>Abstract</p> <p>Background</p> <p>Normal and abnormal processes of pregnancy and childbirth are poorly understood. This second article in a global report explains what is known about the etiologies of preterm births and stillbirths and identifies critical gaps in knowledge. Two important concepts emerge: the continuum of pregnancy, beginning at implantation and ending with uterine involution following birth; and the multifactorial etiologies of preterm birth and stillbirth. Improved tools and data will enable discovery scientists to identify causal pathways and cost-effective interventions.</p> <p>Pregnancy and parturition continuum</p> <p>The biological process of pregnancy and childbirth begins with implantation and, after birth, ends with the return of the uterus to its previous state. The majority of pregnancy is characterized by rapid uterine and fetal growth without contractions. Yet most research has addressed only uterine stimulation (labor) that accounts for <0.5% of pregnancy.</p> <p>Etiologies</p> <p>The etiologies of preterm birth and stillbirth differ by gestational age, genetics, and environmental factors. Approximately 30% of all preterm births are indicated for either maternal or fetal complications, such as maternal illness or fetal growth restriction. Commonly recognized pathways leading to preterm birth occur most often during the gestational ages indicated: (1) inflammation caused by infection (22-32 weeks); (2) decidual hemorrhage caused by uteroplacental thrombosis (early or late preterm birth); (3) stress (32-36 weeks); and (4) uterine overdistention, often caused by multiple fetuses (32-36 weeks). Other contributors include cervical insufficiency, smoking, and systemic infections. Many stillbirths have similar causes and mechanisms. About two-thirds of late fetal deaths occur during the antepartum period; the other third occur during childbirth. Intrapartum asphyxia is a leading cause of stillbirths in low- and middle-income countries.</p> <p>Recommendations</p> <p>Utilizing new systems biology tools, opportunities now exist for researchers to investigate various pathways important to normal and abnormal pregnancies. Improved access to quality data and biological specimens are critical to advancing discovery science. Phenotypes, standardized definitions, and uniform criteria for assessing preterm birth and stillbirth outcomes are other immediate research needs.</p> <p>Conclusion</p> <p>Preterm birth and stillbirth have multifactorial etiologies. More resources must be directed toward accelerating our understanding of these complex processes, and identifying upstream and cost-effective solutions that will improve these pregnancy outcomes.</p

Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals

Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take pre-existing patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for five obstetric outcomes and assess hospital performance across these outcomes