Studies of extended planetary atmospheres

There was a theoretical study of physical and chemical processes in the stratosphere, later broadened to include the mesosphere. Particular emphasis was laid on testing of proposed height profiles of the eddy diffusion coefficient against observed tracer data. Eventually the effort shifted to study of ozone time series in satellite data, and interpretation in terms of aeronomical processes. Since all this work is computer-intensive, the first year of funding also contributed to the acquisition of a powerful minicomputer system, in collaboration with several other faculty members. This proved to be highly successful and cost effective

Treatment of heart failure in the elderly: never say it's too late

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Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction

<p><b>Background:</b> The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality.</p> <p><b>Methods and Results:</b> The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B–type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P<0.05).</p> <p><b>Conclusions:</b> Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF.</p&gt

Newborn screening for cystic fibrosis

Since the late 1970s when the potential of the immunoreactive trypsinogen assay for early identification of infants with cystic fibrosis was first recognised, the performance of newborn blood spot screening (NBS) has been continually assessed and its use has gradually expanded. NBS for cystic fibrosis is a cost-effective strategy and, if standards of care are fully implemented and robust management pathways are in place, has a positive effect on clinical outcomes. In the past decade, NBS has undergone rapid expansion and an unprecedented number of infants with cystic fibrosis have access to early diagnosis and care. Cystic fibrosis NBS has now moved on from the development phase and is entering an era of consolidation. In the future, research should focus on the rationalisation and optimisation of existing programmes, with particular attention to bioethical implications such as unwanted detection of carriers and inconclusive diagnoses

Information Requirements for MCM and ISR Missions : PUMA Phase II

This document contains display requirements for Littoral Combat Ship (LCS) control station displays to be used by unmanned vehicle units in support of heterogeneous unmanned vehicle missions (such as Special Operations Force (SOF) insertion). The method used for generating the requirements was that of a Hybrid Cognitive Task Analysis (CTA)1 which entails describing a scenario overview of a representative mission, generating event flow diagrams, and depicting decision ladders for the key decisions identified in the event flow diagrams. These steps are then used together to generate an informational requirements summary which includes the situational awareness requirements that are derived from the event flow and display requirements of the decision ladders. This method was developed in Phase I of the PUMA (Plan Understanding for Mixed-initiative control of Autonomous systems) project2. In PUMA I, the mission scenario primarily consisted of Intelligence, Surveillance and Reconnaissance (ISR) tasks. For PUMA II, the scenario has been expanded to include Mine Counter Measures (MCM), Harbor Bottom Image-Mapping (HBI), and Anti- Terrorism / Force Protection (AT/FP) mission types. There is a specific emphasis on the MCM and ISR missions to highlight the informational requirement differences between the two task types. This document incorporates the expanded vehicle and mission type heterogeneities that are present in PUMA II in order to develop a cohesive set of informational requirements necessary for such a complex mission.Prepared for Charles River Analytic

KONSEKUENSI HUKUM BAGI PENYIMPANGAN TERHADAP KEWAJIBAN PERSETUJUAN LINGKUNGAN HIDUP TERKAIT DENGAN PERIZINAN BERUSAHA

  Tujuan penelitian adalah untuk mengetahui dan memahami pemenuhan persyaratan terhadap persetujuan lingkungan hidup dan untuk mengetahui dan memahami konsekuensi hukum bagi penyimpangan pelaksanaan kegiatan terhadap kewajiban pada Persetujuan Lingkungan dalam Perizinan Berusaha. Dengan metode penelitian yuridis normatif, kesimpulan yang didapat: 1. Pemenuhan persyaratan persetujuan lingkungan hidup merupakan hal yang penting dalam upaya melindungi dan mengelola lingkungan hidup. Beberapa persyaratan utama yang harus dipenuhi meliputi studi Analisis Mengenai Dampak Lingkungan (AMDAL), konsultasi publik, izin lingkungan, evaluasi ahli, dan rencana pengelolaan lingkungan. Studi AMDAL menjadi landasan penting dalam proses persetujuan lingkungan hidup, karena melalui studi tersebut, dampak potensial suatu proyek terhadap lingkungan dapat diidentifikasi, dianalisis, dan mitigasi yang tepat dapat dirumuskan. 2. Konsekuensi hukum bagi penyimpangan pelaksanaan kegiatan terhadap kewajiban pada persetujuan lingkungan dalam perizinan berusaha, kepada mereka dikenakan sanksi pidana berupa denda atau hukuman penjara, tergantung pada tingkat keseriusan pelanggaran, pencabutan izin dan pemulihan lingkungan. Kata Kunci : persetujuan lingkungan, perizinan berusah

Differences Between Primary Care Physicians and Cardiologists in Management of Congestive Heart Failure: Relation to Practice Guidelines 11This work was supported in part by unrestricted grants from Bristol-Myers Squibb Co., Princeton, New Jersey; Burroughs Wellcome Co., Research Triangle Park, North Carolina; Merck & Co., West Point, Pennsylvania; and the Department of Veterans Affairs Research Service.22All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California in San Francisco.

AbstractObjectives. This study was designed to characterize physician practices in the management of congestive heart failure (CHF) and to determine whether these practices vary by specialty and how they relate to guideline recommendations.Background. Congestive heart failure is responsible for considerable mortality, morbidity and health care resource utilization. Although there have been important advances in the diagnostic evaluation and treatment of CHF, little information is available on physician practices in this area.Methods. We surveyed physicians concerning their management of patients with CHF. The results were analyzed in multivariate models to determine the relation of diagnostic and treatment approaches to physician specialty, time since training, board certification and volume of patients with CHF. Surveys were sent to a sample of 2,250 family and general practitioners (FP/GPs), internists and cardiologists. Responses were examined in relation to guidelines issued by the Agency for Health Care Policy and Research that had been released 9 months previously.Results. Significant differences were found between physician groups with regard to each of the major guideline recommendations. For example, routine evaluation of left ventricular function, a point of emphasis in the guideline, is performed by 87% of cardiologists, but by only 77% of internists and 63% of FP/GPs (p < 0.001 between groups). Angiotensin-converting enzyme inhibitors were used by cardiologists, internists and FP/GPs in 80%, 71% and 60% of patients with mild to moderate CHF, respectively (p < 0.001 between groups). Larger differences were reported in the prescribed dosages of these drugs and their use in patients with renal dysfunction.Conclusions. Cardiologists report practices more in conformity with published guidelines for CHF than do internists and FP/GPs. Because of the large numbers of patients with CHF and their substantial mortality, morbidity and cost of care, these differences may have a major impact on outcomes and health care costs