Enhancing Cooperative Education Programs for Indian Valley Conference High Schools

The purpose of the study is to examine the alternatives by which small rural schools in the Indian Valley Conference could offer a broader education base for their students through cooperative education programs. Data was collected by personal interviews from the principals of the thirteen Indian Valley Conference high schools. The study focused on four areas, a) the factors necessary for effective cooperative education programs, b) the advantages of cooperative education programs, c) the disadvantages of cooperative education programs,d) and the desire for increased participation in cooperative education programs. The survey results, relative to the cooperative education program needs of the schools of the Indian Valley Conference, are analyzed qualitatively for type of response and quantitatively by frequency. The research reviewed revealed that the factors for effective cooperative education programs include district and community involvement, program accessibility, and academic need. Financial need played a very small role as a factor for effective cooperative education programs. The primary advantage is academic, with economic and district advantages as minor factors. The major disadvantages are travel and scheduling. Ten of the thirteen schools indicated a desire to increase participation in cooperative education programs. The study concludes with recommendations to successfully increase cooperative education programs to help solve academic limitations of the Indian Valley Conference districts. One recommendation is that cooperative education programs be organized in clusters to minimize the travel disadvantages. Another recommendation is that the programs be organized in two-period exchanges at the beginning and end of the day to minimize scheduling and travel problems. A third recommendation is that districts increase participation in satellite education. A final recommendation is that districts provide inservice (to present the facts as to the need for and advantages of cooperative education programs) to increase commitment from the school board, administrators, faculty, students, and community

New Concepts in Pacemaker Syndrome

After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome. Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V) synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing. Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR) pacing as compared to ventricular-based (VVI) pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V) dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode. Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome. Studies are currently ongoing to address these questions

Cardiac Resynchronization Therapy in Mild Heart Failure/ REVERSE, MADIT-CRT & RAFT studies & Meta-analyses / Expanding CRT-D Indications to Lower Risk Patients

Cardiac resynchronization therapy (CRT), effected via biventricular pacing, has been shown to improve symptoms and left ventricular (LV) systolic function and to reduce mortality and hospitalizations among patients with moderate to severe heart failure symptoms (class III and IV), reduced LV ejection fraction (EF), and a wide QRS complex on electrocardiogram, usually in the form of left bundle branch block. Recent evidence from randomized clinical trials and meta-analyses demonstrate that the beneficial effects of CRT on LV remodeling, heart failure symptoms, hospitalizations, and mortality also extend to patients with milder heart failure symptoms (class II). These data support the expansion of indications for CRT to less symptomatic patients with heart failure who have LVEF <0.35 and wide QRS duration in sinus rhythm. Accordingly the guidelines for CRT therapy by the European Society of Cardiology (ESC) and the American heart Association (AHA) have been updated to expand CRT indications to patients with milder heart failure symptoms

The Clinical Challenge of Predicting and Preventing Sudden Cardiac Death Immediately after Myocardial Infarction

Despite many advances in treatment of myocardial infarction (MI) with percutaneous coronary intervention (PCI) and pharmacologic therapies, mortality immediately after MI remains high in patients with impaired left ventricular function. One of the greatest challenges facing the contemporary cardiologist is predicting and preventing sudden cardiac death (SCD) immediately after MI. Unfortunately, the trials assessing the role of the implantable cardioverter defibrillator (ICD) in patients at high risk for SCD immediately post MI have failed to show survival benefit. Current clinical guidelines restrict ICD implants to patients at least 40 days after MI with continued left ventricular dysfunction while on optimal medical therapy. It is evident that additional research is needed to identify strategies to prevent SCD and improve survival immediately after MI. In the meantime, clinicians should optimize and individualize therapy in the immediate post MI patient while carefully considering the risk of SCD and the competing risk of mortality from other causes

Commotio Cordis

Sudden arrhythmic death as a result of a blunt chest wall blow has been termed Commotio Cordis (CC). CC is being reported with increasing frequency with more than 180 cases now described in the United States Commotio Cordis Registry. The clinical spectrum is diverse; however young athletes tend to be most at risk, with victims commonly being struck by projectiles regarded as standard implements of the sport. Sudden death is instantaneous and victims are most often found in ventricular fibrillation (VF). Chest blows are not of sufficient magnitude to cause any significant damage to overlying thoracic structures and autopsy is notable for the absence of any structural cardiac injury. Development of an experimental model has allowed for substantial insights into the underlying mechanisms of sudden death. In anesthetized juvenile swine, induction of VF is instantaneous following chest impacts that occur during a vulnerable window before the T wave peak. Other critical variables, including the impact velocity and location, and the hardness of the impact object have also been identified. Rapid left ventricular pressure rise following chest impact likely results in activation of ion channels via mechano-electric coupling. The generation of inward current through mechano-sensitive ion channels results in augmentation of repolarization and non-uniform myocardial activation, and is the cause of premature ventricular depolarizations that are triggers of VF in CC. Currently available chest protectors commonly used in sport are not adequately designed to prevent CC. The development of more effective chest protectors and the widespread availability of automated external defibrillators at youth sporting events could improve the safety of young athletes

The Application of Remotely Sensed Data and Models to Benefit Conservation and Restoration Along the Northern Gulf of Mexico Coast

New data, tools, and capabilities for decision making are significant needs in the northern Gulf of Mexico and other coastal areas. The goal of this project is to support NASA s Earth Science Mission Directorate and its Applied Science Program and the Gulf of Mexico Alliance by producing and providing NASA data and products that will benefit decision making by coastal resource managers and other end users in the Gulf region. Data and research products are being developed to assist coastal resource managers adapt and plan for changing conditions by evaluating how climate changes and urban expansion will impact land cover/land use (LCLU), hydrodynamics, water properties, and shallow water habitats; to identify priority areas for conservation and restoration; and to distribute datasets to end-users and facilitating user interaction with models. The proposed host sites for data products are NOAA s National Coastal Data Development Center Regional Ecosystem Data Management, and Mississippi-Alabama Habitat Database. Tools will be available on the Gulf of Mexico Regional Collaborative website with links to data portals to enable end users to employ models and datasets to develop and evaluate LCLU and climate scenarios of particular interest. These data will benefit the Mobile Bay National Estuary Program in ongoing efforts to protect and restore the Fish River watershed and around Weeks Bay National Estuarine Research Reserve. The usefulness of data products and tools will be demonstrated at an end-user workshop

Primary Prevention of Sudden Cardiac Death: Implications of Recent Trials

Based on the results of randomized multicenter studies, such as the MADIT I, MADIT II, DINAMIT, and SCD-HeFT and DEFINITE trials, patients can be identified who are at high risk for sudden cardiac death (SCD) who demonstrate a reduction in arrhythmic mortality and total mortality with the implantation of an implantable cardioverter defibrillator (ICD). These are patients with coronary artery disease, impaired left ventricular function, spontaneous nonsustained ventricular tachycardia and inducible ventricular tachycardia not suppressed by procainamide. Also patients with coronary artery disease and left ventricular ejection fraction < 30% benefit from ICD placement.  Based on the SCD-HeFT results, patients with ischemic or nonischemic cardiomyopathy and class II or III congestive heart failure also benefit from the ICD.  At the same time, based on the results of the DINAMIT study, it has become apparent that the ICD does not play a role in patients within 45 days of myocardial infarction. The implications of these trials are further analyzed in this overview

Sudden Death in the Athlete

Arrhythmias in the athlete can range from benign and asymptomatic to highly symptomatic and life-threatening.  There is risk of not diagnosing an important cardiovascular condition which may predispose to a serious or life threatening arrhythmia.  At the same time there is the risk of unnecessarily restricting the athlete with a more benign condition. Sudden cardiac death in the athlete, although relatively uncommon, remains a challenge as the screening techniques for identification of individuals at risk are insensitive. Many of the underlying cardiovascular diseases responsible for sudden death with exercise can be identified. These include hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Wolff-Parkinson-White syndrome, anomalous origin of the coronary artery, and the inherited long QT syndromes. To prevent fatalities and unnecessary restriction on athletic participation, the best available information has recently been updated with consensus recommendations and guidelines regarding eligibility. In this manuscript the cardiovascular conditions and cardiac arrhythmias that predispose to sudden cardiac death in the athlete are discussed

Prototype demonstration of radiation therapy planning code system

This is the final report of a one-year, Laboratory-Directed Research and Development project at the Los Alamos National Laboratory (LANL). Radiation therapy planning is the process by which a radiation oncologist plans a treatment protocol for a patient preparing to undergo radiation therapy. The objective is to develop a protocol that delivers sufficient radiation dose to the entire tumor volume, while minimizing dose to healthy tissue. Radiation therapy planning, as currently practiced in the field, suffers from inaccuracies made in modeling patient anatomy and radiation transport. This project investigated the ability to automatically model patient-specific, three-dimensional (3-D) geometries in advanced Los Alamos radiation transport codes (such as MCNP), and to efficiently generate accurate radiation dose profiles in these geometries via sophisticated physics modeling. Modem scientific visualization techniques were utilized. The long-term goal is that such a system could be used by a non-expert in a distributed computing environment to help plan the treatment protocol for any candidate radiation source. The improved accuracy offered by such a system promises increased efficacy and reduced costs for this important aspect of health care

Preparation and Integration of ALHAT Precision Landing Technology for Morpheus Flight Testing

The Autonomous precision Landing and Hazard Avoidance Technology (ALHAT) project has developed a suite of prototype sensors for enabling autonomous and safe precision land- ing of robotic or crewed vehicles on solid solar bodies under varying terrain lighting condi- tions. The sensors include a Lidar-based Hazard Detection System (HDS), a multipurpose Navigation Doppler Lidar (NDL), and a long-range Laser Altimeter (LAlt). Preparation for terrestrial ight testing of ALHAT onboard the Morpheus free- ying, rocket-propelled ight test vehicle has been in progress since 2012, with ight tests over a lunar-like ter- rain eld occurring in Spring 2014. Signi cant work e orts within both the ALHAT and Morpheus projects has been required in the preparation of the sensors, vehicle, and test facilities for interfacing, integrating and verifying overall system performance to ensure readiness for ight testing. The ALHAT sensors have undergone numerous stand-alone sensor tests, simulations, and calibrations, along with integrated-system tests in special- ized gantries, trucks, helicopters and xed-wing aircraft. A lunar-like terrain environment was constructed for ALHAT system testing during Morpheus ights, and vibration and thermal testing of the ALHAT sensors was performed based on Morpheus ights prior to ALHAT integration. High- delity simulations were implemented to gain insight into integrated ALHAT sensors and Morpheus GN&C system performance, and command and telemetry interfacing and functional testing was conducted once the ALHAT sensors and electronics were integrated onto Morpheus. This paper captures some of the details and lessons learned in the planning, preparation and integration of the individual ALHAT sen- sors, the vehicle, and the test environment that led up to the joint ight tests