Mass casualty events: what to do as the dust settles?

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs

Naval submarine base Kings Bay and Bangor soil evaluations.

This report provides soil evaluation and characterization testing for the submarine bases at Kings Bay, Georgia, and Bangor, Washington, using triaxial testing at high confining pressures with different moisture contents. In general, the samples from the Bangor and Kings Bay sites appeared to be stronger than a previously used reference soil. Assuming the samples of the material were representative of the material found at the sites, they should be adequate for use in the planned construction. Since soils can vary greatly over even a small site, a soil specification for the construction contractor would be needed to insure that soil variations found at the site would meet or exceed the requirements. A suggested specification for the Bangor and Kings Bay soils was presented based on information gathered from references plus data obtained from this study, which could be used as a basis for design by the construction contractor

Geomechanics of penetration : experimental and computational approaches : final report for LDRD project 38718.

The purpose of the present work is to increase our understanding of which properties of geomaterials most influence the penetration process with a goal of improving our predictive ability. Two primary approaches were followed: development of a realistic, constitutive model for geomaterials and designing an experimental approach to study penetration from the target's point of view. A realistic constitutive model, with parameters based on measurable properties, can be used for sensitivity analysis to determine the properties that are most important in influencing the penetration process. An immense literature exists that is devoted to the problem of predicting penetration into geomaterials or similar man-made materials such as concrete. Various formulations have been developed that use an analytic or more commonly, numerical, solution for the spherical or cylindrical cavity expansion as a sort of Green's function to establish the forces acting on a penetrator. This approach has had considerable success in modeling the behavior of penetrators, both as to path and depth of penetration. However the approach is not well adapted to the problem of understanding what is happening to the material being penetrated. Without a picture of the stress and strain state imposed on the highly deformed target material, it is not easy to determine what properties of the target are important in influencing the penetration process. We developed an experimental arrangement that allows greater control of the deformation than is possible in actual penetrator tests, yet approximates the deformation processes imposed by a penetrator. Using explosive line charges placed in a central borehole, we loaded cylindrical specimens in a manner equivalent to an increment of penetration, allowing the measurement of the associated strains and accelerations and the retrieval of specimens from the more-or-less intact cylinder. Results show clearly that the deformation zone is highly concentrated near the borehole, with almost no damage occurring beyond 1/2 a borehole diameter. This implies penetration is not strongly influenced by anything but the material within a diameter or so of the penetration. For penetrator tests, target size should not matter strongly once target diameters exceed some small multiple of the penetrator diameter. Penetration into jointed rock should not be much affected unless a discontinuity is within a similar range. Accelerations measured at several points along a radius from the borehole are consistent with highly-concentrated damage and energy absorption; At the borehole wall, accelerations were an order of magnitude higher than at 1/2 a diameter, but at the outer surface, 8 diameters away, accelerations were as expected for propagation through an elastic medium. Accelerations measured at the outer surface of the cylinders increased significantly with cure time for the concrete. As strength increased, less damage was observed near the explosively-driven borehole wall consistent with the lower energy absorption expected and observed for stronger concrete. As it is the energy absorbing properties of a target that ultimately stop a penetrator, we believe this may point the way to a more readily determined equivalent of the S number

Advanced modeling and simulation to design and manufacture high performance and reliable advanced microelectronics and microsystems.

An interdisciplinary team of scientists and engineers having broad expertise in materials processing and properties, materials characterization, and computational mechanics was assembled to develop science-based modeling/simulation technology to design and reproducibly manufacture high performance and reliable, complex microelectronics and microsystems. The team's efforts focused on defining and developing a science-based infrastructure to enable predictive compaction, sintering, stress, and thermomechanical modeling in ''real systems'', including: (1) developing techniques to and determining materials properties and constitutive behavior required for modeling; (2) developing new, improved/updated models and modeling capabilities, (3) ensuring that models are representative of the physical phenomena being simulated; and (4) assessing existing modeling capabilities to identify advances necessary to facilitate the practical application of Sandia's predictive modeling technology

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations: Translation Into Practice

Parenteral nutrition (PN) serves as an important therapeutic modality that is used in adults, children, and infants for a variety of indications. The appropriate use of this complex therapy aims to maximize clinical benefit while minimizing the potential risk for adverse events. Despite being classified and acknowledged as a high-alert medication,1 only 58% of organizations have precautions in place to prevent errors and patient harm associated with PN.2 Complications can occur as a result of the therapy and as the result of the PN process. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Parenteral Nutrition Safety Consensus Recommendations are based on practices that are generally accepted to minimize errors with PN therapy. However, the broad range of healthcare settings in which PN administration occurs—from critical care to home care—raises the potential for disparities to exist in the knowledge and skills of the healthcare professionals responsible for PN prescribing, review, preparation (including compounding, labeling, and dispensing), and administration. Regardless of the setting or the number of patients treated in a given facility, the classification of PN as a high-alert medication requires all healthcare organizations to develop evidence-based policies and procedures related to PN. With these concepts in mind, the A.S.P.E.N. Parenteral Nutrition Safety Task Force developed the A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations, available online in the Journal of Parenteral and Enteral Nutrition (JPEN) in late 2013 and published in March

The TESS-Keck Survey. XVI. Mass Measurements for 12 Planets in Eight Systems

With JWST's successful deployment and unexpectedly high fuel reserves, measuring the masses of sub-Neptunes transiting bright, nearby stars will soon become the bottleneck for characterizing the atmospheres of small exoplanets via transmission spectroscopy. Using a carefully curated target list and more than two years' worth of APF-Levy and Keck-HIRES Doppler monitoring, the TESS-Keck Survey is working toward alleviating this pressure. Here we present mass measurements for 11 transiting planets in eight systems that are particularly suited to atmospheric follow-up with JWST. We also report the discovery and confirmation of a temperate super-Jovian-mass planet on a moderately eccentric orbit. The sample of eight host stars, which includes one subgiant, spans early-K to late-F spectral types ($T_\mathrm{eff} =$ 5200--6200 K). We homogeneously derive planet parameters using a joint photometry and radial velocity modeling framework, discuss the planets' possible bulk compositions, and comment on their prospects for atmospheric characterization.Comment: Accepted for publication in The Astronomical Journal on 2023-Jun-22. 60 pages, 17 Tables, 28 Figure

The TESS-Keck Survey. XXII. A Sub-Neptune Orbiting TOI-1437

Exoplanet discoveries have revealed a dramatic diversity of planet sizes across a vast array of orbital architectures. Sub-Neptunes are of particular interest; due to their absence in our own solar system, we rely on demographics of exoplanets to better understand their bulk composition and formation scenarios. Here, we present the discovery and characterization of TOI-1437 b, a sub-Neptune with a 18.84 day orbit around a near-solar analog (M⋆ = 1.10 ± 0.10 M☉, R⋆=1.17 ± 0.12 R☉). The planet was detected using photometric data from the Transiting Exoplanet Survey Satellite (TESS) mission and radial velocity (RV) follow-up observations were carried out as a part of the TESS-Keck Survey using both the HIRES instrument at Keck Observatory and the Levy Spectrograph on the Automated Planet Finder telescope. A combined analysis of these data reveal a planet radius of Rp = 2.24 ± 0.23 R⊕ and a mass measurement of Mp = 9.6 ± 3.9 M⊕). TOI-1437 b is one of few (∼50) known transiting sub-Neptunes orbiting a solar-mass star that has a RV mass measurement. As the formation pathway of these worlds remains an unanswered question, the precise mass characterization of TOI-1437 b may provide further insight into this class of planet

Defects in Mitochondrial Dynamics and Metabolomic Signatures of Evolving Energetic Stress in Mouse Models of Familial Alzheimer's Disease

The identification of early mechanisms underlying Alzheimer's Disease (AD) and associated biomarkers could advance development of new therapies and improve monitoring and predicting of AD progression. Mitochondrial dysfunction has been suggested to underlie AD pathophysiology, however, no comprehensive study exists that evaluates the effect of different familial AD (FAD) mutations on mitochondrial function, dynamics, and brain energetics.We characterized early mitochondrial dysfunction and metabolomic signatures of energetic stress in three commonly used transgenic mouse models of FAD. Assessment of mitochondrial motility, distribution, dynamics, morphology, and metabolomic profiling revealed the specific effect of each FAD mutation on the development of mitochondrial stress and dysfunction. Inhibition of mitochondrial trafficking was characteristic for embryonic neurons from mice expressing mutant human presenilin 1, PS1(M146L) and the double mutation of human amyloid precursor protein APP(Tg2576) and PS1(M146L) contributing to the increased susceptibility of neurons to excitotoxic cell death. Significant changes in mitochondrial morphology were detected in APP and APP/PS1 mice. All three FAD models demonstrated a loss of the integrity of synaptic mitochondria and energy production. Metabolomic profiling revealed mutation-specific changes in the levels of metabolites reflecting altered energy metabolism and mitochondrial dysfunction in brains of FAD mice. Metabolic biomarkers adequately reflected gender differences similar to that reported for AD patients and correlated well with the biomarkers currently used for diagnosis in humans.Mutation-specific alterations in mitochondrial dynamics, morphology and function in FAD mice occurred prior to the onset of memory and neurological phenotype and before the formation of amyloid deposits. Metabolomic signatures of mitochondrial stress and altered energy metabolism indicated alterations in nucleotide, Krebs cycle, energy transfer, carbohydrate, neurotransmitter, and amino acid metabolic pathways. Mitochondrial dysfunction, therefore, is an underlying event in AD progression, and FAD mouse models provide valuable tools to study early molecular mechanisms implicated in AD

The TESS-Keck Survey. XI. Mass Measurements for Four Transiting sub-Neptunes orbiting K dwarf TOI-1246

Multi-planet systems are valuable arenas for investigating exoplanet architectures and comparing planetary siblings. TOI-1246 is one such system, with a moderately bright K dwarf (V=11.6, K=9.9) and four transiting sub-Neptunes identified by TESS with orbital periods of 4.31 d, 5.90 d, 18.66 d, and 37.92 d. We collected 130 radial velocity observations with Keck/HIRES and TNG/HARPS-N to measure planet masses. We refit the 14 sectors of TESS photometry to refine planet radii (2.97±0.06 R⊕,2.47±0.08 R⊕,3.46±0.09 R⊕, 3.72±0.16 R⊕), and confirm the four planets. We find that TOI-1246 e is substantially more massive than the three inner planets (8.1±1.1M⊕, 8.8±1.2M⊕, 5.3±1.7M⊕, 14.8±2.3M⊕). The two outer planets, TOI-1246 d and TOI-1246 e, lie near to the 2:1 resonance (Pe/Pd=2.03) and exhibit transit timing variations. TOI-1246 is one of the brightest four-planet systems, making it amenable for continued observations. It is one of only six systems with measured masses and radii for all four transiting planets. The planet densities range from 0.70±0.24 to 3.21±0.44g/cm3, implying a range of bulk and atmospheric compositions. We also report a fifth planet candidate found in the RV data with a minimum mass of 25.6 ± 3.6 M⊕. This planet candidate is exterior to TOI-1246 e with a candidate period of 93.8 d, and we discuss the implications if it is confirmed to be planetary in nature

The TESS-Keck Survey. XI. Mass Measurements for Four Transiting Sub-Neptunes Orbiting K Dwarf TOI-1246

Multiplanet systems are valuable arenas for investigating exoplanet architectures and comparing planetary siblings. TOI-1246 is one such system, with a moderately bright K dwarf (V = 11.6, K = 9.9) and four transiting sub-Neptunes identified by TESS with orbital periods of 4.31, 5.90, 18.66, and 37.92 days. We collected 130 radial velocity observations with Keck/HIRES and TNG/HARPS-N to measure planet masses. We refit the 14 sectors of TESS photometry to refine planet radii (2.97 +/- 0.06 R (circle plus), 2.47 +/- 0.08 R (circle plus), 3.46 +/- 0.09 R (circle plus), and 3.72 +/- 0.16 R (circle plus)) and confirm the four planets. We find that TOI-1246 e is substantially more massive than the three inner planets (8.1 +/- 1.1 M (circle plus), 8.8 +/- 1.2 M (circle plus), 5.3 +/- 1.7 M (circle plus), and 14.8 +/- 2.3 M (circle plus)). The two outer planets, TOI-1246 d and TOI-1246 e, lie near to the 2:1 resonance (P (e)/P ( d ) = 2.03) and exhibit transit-timing variations. TOI-1246 is one of the brightest four-planet systems, making it amenable for continued observations. It is one of only five systems with measured masses and radii for all four transiting planets. The planet densities range from 0.70 +/- 0.24 to 3.21 +/- 0.44 g cm(-3), implying a range of bulk and atmospheric compositions. We also report a fifth planet candidate found in the RV data with a minimum mass of 25.6 +/- 3.6 M (circle plus). This planet candidate is exterior to TOI-1246 e, with a candidate period of 93.8 days, and we discuss the implications if it is confirmed to be planetary in nature