System analysis approach to deriving design criteria (loads) for Space Shuttle and its payloads. Volume 1: General statement of approach

Space shuttle, the most complex transportation system designed to date, illustrates the requirement for an analysis approach that considers all major disciplines simultaneously. Its unique cross coupling and high sensitivity to aerodynamic uncertainties and high performance requirements dictated a less conservative approach than those taken in programs. Analyses performed for the space shuttle and certain payloads, Space Telescope and Spacelab, are used a examples. These illustrate the requirements for system analysis approaches and criteria, including dynamic modeling requirements, test requirements control requirements and the resulting design verification approaches. A survey of the problem, potential approaches available as solutions, implications for future systems, and projected technology development areas are addressed

System analysis approach to deriving design criteria (Loads) for Space Shuttle and its payloads. Volume 2: Typical examples

The achievement of an optimized design from the system standpoint under the low cost, high risk constraints of the present day environment was analyzed. Space Shuttle illustrates the requirement for an analysis approach that considers all major disciplines (coupling between structures control, propulsion, thermal, aeroelastic, and performance), simultaneously. The Space Shuttle and certain payloads, Space Telescope and Spacelab, are examined. The requirements for system analysis approaches and criteria, including dynamic modeling requirements, test requirements, control requirements, and the resulting design verification approaches are illustrated. A survey of the problem, potential approaches available as solutions, implications for future systems, and projected technology development areas are addressed

Laryngeal tuberculosis presenting as a supraglottic carcinoma: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Laryngeal tuberculosis used to be a common complication in advanced pulmonary tuberculosis. However, it has become a rare occurrence in developed countries since the introduction of antituberculous agents. Moreover, the pattern of the disease has changed over the years. Nowadays, it more closely resembles a laryngeal carcinoma than any other laryngeal illness.</p> <p>Case presentation</p> <p>We describe the case of a 50-year-old Caucasian man who presented with the clinical picture of laryngeal cancer, but which turned out to be tuberculosis. We illustrate the difficulty of recognizing laryngeal tuberculosis both clinically and even with radiological examination.</p> <p>Conclusion</p> <p>Although laryngeal tuberculosis is uncommon, especially in developed countries, it still occurs and should be considered as a differential diagnosis in any laryngeal disease, in particular in the case of a laryngeal carcinoma.</p

The Effects of Experimentally Induced Rumination, Positive Reappraisal, Acceptance, and Distancing When Thinking About a Stressful Event on Affect States in Adolescents

The current study compares the effects of experimentally induced rumination, positive reappraisal, distancing, and acceptance on affect states in adolescents aged 13–18. Participants (N = 160) were instructed to think about a recent stressful event. Next, they received specific instructions on how to think about that event in each condition. Manipulation checks revealed that the manipulations were successful, except for acceptance. The two most reported events were “a fight” and “death of loved one”. Results showed that positive reappraisal (i.e., thinking about the benefits and personal growth) caused a significantly larger increase in positive affect and decrease in negative affect compared to rumination, distancing, and acceptance. Current findings implicate that positive reappraisal seems an adequate coping strategy in the short-term, and therefore could be applied in interventions for youth experiencing difficulties managing negative affect. Future research should focus on long-term effects of these cognitive strategies and on more intensive training of acceptance

Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives

OBJECTIVES: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. SETTING: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents. SUBJECTS: Clinicians from 21 sites. MEASUREMENT AND MAIN RESULTS: Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. CONCLUSIONS: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles

Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives

Objective: To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs. Methods: Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data. Results: Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes. Conclusions: The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area