Toward joint Medical Logistics 2010 and beyond: process innovation and redesign of Class VIII supply chain at a medical logistics company

The purpose of this thesis is to evaluate current Class VIII supply chain procedures at a U.S. Medical Logistics Company (Med Log Co), process map the "as is" baseline process and propose possible "to be" process redesign alternatives that will possibly improve efficiency and produce long-term cost savings. To perform this analysis, the 1st Med Log Co at Camp Pendleton, CA was chosen. The assessment of their "as is" process includes a historical background on medical logistics within the Department of Defense, a comprehensive material logistics literature review, site visits, personnel interviews, process mapping of the baseline "as is" process, and proposal of two redesign alternatives for the "to be" process. A comprehensive analysis was conducted using Thomas Davenport's Process Innovation Framework and quantitative measurements were obtained using the Knowledge-based Organizational Process Redesign (KOPeR) methodology to diagnosis existing pathologies. KOPeR measurements indicate that the 1st Med Log Co's existing "as is" process is a fragmented, mostly manual procurement process that can be innovated now using information technology as a process enabler. Our results indicate that by formally injecting the use of electronic mail and shared databases into the "as is" procurement process an immediate impact can be realized. Further efficiency and cost savings can be accomplished by coupling the injection of information technology with a web- based end-to-end procurement process that assigns a case manager to the "to be" process.http://www.archive.org/details/towardjointmedic00auguMajor, United States Marine CorpsLieutenant, United States NavyApproved for public release; distribution is unlimited

Development of recurrent facial palsy during plasmapheresis in Guillain-Barré syndrome: a case report

Introduction: Guillain-Barré syndrome is an immune-mediated polyneuropathy that is routinely initially treated with either intravenous immunoglobulin or plasmapheresis. To the best of our knowledge, no association between plasmapheresis treatment and acute onset of facial neuropathy has been reported. Case presentation: A 35-year-old Caucasian man with no significant prior medical history developed ascending motor weakness and laboratory findings consistent with a diagnosis of Guillain-Barré syndrome. Plasmapheresis was initiated. Acute facial palsy developed during the plasma exchange that subsequently resolved and then acutely recurred during the subsequent plasma exchange. Conclusion: To the best of our knowledge, no prior cases of acute facial palsy developing during plasmapheresis treatment are known. Although facial nerve involvement is common in typical Guillain-Barré syndrome, the temporal association with treatment, near-complete resolution and later recurrence support the association. The possible mechanism of plasmapheresis-induced worsening of peripheral nerve function in Guillain-Barré syndrome is unknown

Fabrication of 2-2 Connectivity PZT/Thermoplastic Composites for High Frequency Linear Arrays

An alternate approach for fabricating PZT/polymer composites with 2-2 connectivity with fine scales is described. Thin (less than or equal to 20 micrometers) sintered PZT plates and sheets of a thermoplastic polymer film (less than or equal to 10 micrometers) were bonded together via thermal processing. Stack sintering of tape cast PZT generated the necessary PZT plates, while tape cast polymers were used to control the thermoplastic thickness. Composite blocks were cut to required dimensions for linear arrays, electroded, and poled. Electromechanical properties were measured to evaluate the composites. The significance of this fabrication technique is that it is able to generate 2-2 structures at a scale level unachievable by conventional dice-and-fill fabrication methods

Three Week Hypergravity Training Intervention Decreases Ground Contact Time During Repeated Jumping and Improves Sprinting and Shuttle Running Performance

International Journal of Exercise Science 9(2): 149-158, 2016. This study examined the effects of a non-traditional training method, hypergravity training (HT), on anaerobic performance. Highly active men (n = 9) completed a 3 week HT protocol in which weighted vests were worn 8 h/day, 4+ days/week separate from training. Vest loads were 11.2 ± 0.6% of body mass during week one, and increased to 13.2 ± 0.7% (week 2), and 16.1 ± 0.4% (week 3). Performance testing included power clean 1-RM (PC), counter movement jumps, 4 continuous jumps, 36.6 m sprints (SP), a 137.2 m short shuttle run (SSR), and a 274.3 m long shuttle run (LSR). A 3 week non-hypergravity training period (NHT) proceeded HT. Baseline SP improved from 4.69 ± 0.29 s to 4.58 ± 0.22 s post-treatment, and regressed after NHT (4.69 ± 0.24 s) (p = 0.006, ES = 1.80). Improvements in SSR (p = 0.012, ES = 1.71) occurred from baseline (26.7 ± 1.5 s) to post-treatment (26.2 ± 1.4 s), followed by a return to near-baseline values (26.9 ± 1.8 s). Jumping tasks displayed similar trends, but no statistical differences and modest effect sizes (0.51 - 0.62) were found except for improved ground contact time during repeated jumps post-HT (ES = 2.26). PC and LSR performances did not improve. Three weeks of HT significantly enhanced short running task performances and decreased ground contact time between 4 continuous jumps. HT may be incorporated into training programs prior to key points in an athletic season without hindering the quality of regular training session activities

Performance and perceptual responses of collegiate female soccer players to a practical external and internal cooling protocol

International Journal of Exercise Science 8(4): 331-340, 2015. This study examined practical pre- and mid practice cooling interventions on running performance, perceived exertion (RPE), and thermal sensation (TS) during soccer. During two formal pre-season practices female, NCAA Division II soccer players participated in three, 15 min scrimmage bouts followed by a 4th 10 min bout. Following the 1st, 2nd, and 3rd bouts, 8 field position players completed competitive sets of two, 30 yard sprints against other team members with time recorded between 5 and 30 yards. After the 4th bout, players completed an indoor shuttle running beep test (BT). In the treatment group (COOL) ice towels (IT) were applied to the head and neck regions and draped across both legs for 10 min following a standardized warm-up and for 10 min during a 15 min break between the 2nd and 3rd scrimmage sessions. Sport beverage slurries (350 mL; -0.3 °C, ~6% carbohydrate) were also served during IT cooling for COOL; while the control (CON) received no IT and drank the same ,uncooled sport beverage. No main effect was found for sprint performance (COOL = 3.55 ± 0.16 s; CON = 3.51 ± 0.07 s; P = 0.51) or numbers of reps completed in the BT (COOL = 17.6 ± 5.6; CON = 17.3 ± 6.0; P = 0.88). RPE did not differ following any performance test, but TS was lower following the 3rd sprint bout (P = 0.04) and the BT (P = 0.005) for COOL. COOL promoted lower TS, but had no effect on performance

Glycolytic and Gluconeogenic Growth of \u3cem\u3eEscherichia coli\u3c/em\u3e O157:H7 (EDL933) and \u3cem\u3eE. coli\u3c/em\u3e K-12 (MG1655) in the Mouse Intestine

Escherichia coli EDL933, an O157:H7 strain, is known to colonize the streptomycin-treated CD-1 mouse intestine by growing in intestinal mucus (E. A. Wadolkowski, J. A. Burris, and A. D. O\u27Brien, Infect. Immun. 58:2438-2445, 1990), but what nutrients and metabolic pathways are employed during colonization has not been determined. In this study, when the wild-type EDL933 strain was fed to mice along with an EDL933 ΔppsA ΔpckA mutant, which is unable to utilize tricarboxylic acid cycle intermediates and gluconeogenic substrates for growth, both strains colonized the mouse intestine equally well. Therefore, EDL933 utilizes a glycolytic substrate(s) for both initial growth and maintenance when it is the only E. coli strain fed to the mice. However, in the presence of large numbers of MG1655, a K-12 strain, it is shown that EDL933 utilizes a glycolytic substrate(s) for initial growth in the mouse intestine but appears to utilize both glycolytic and gluconeogenic substrates in an attempt to maintain colonization. It is further shown that MG1655 predominantly utilizes glycolytic substrates for growth in the mouse intestine whether growing in the presence or absence of large numbers of EDL933. Data are presented showing that although small numbers of EDL933 grow to large numbers in the intestine in the presence of large numbers of MG1655 when both strains are fed to mice simultaneously, precolonization with MG1655 affords protection against subsequent colonization by EDL933. Moreover, in mice that are precolonized with EDL933, small numbers of MG1655 are able to grow rapidly in the intestine and EDL933 is eliminated. In situ hybridization experiments using E. coli-specific rRNA probes showed that while MG1655 is found only in mucus, EDL933 is found both in mucus and closely associated with intestinal epithelial cells. The data are discussed with respect to competition for nutrients and to the protection that some intestinal commensal E. coli strains might afford against infection by O157:H7 strains

Mouse Intestine Selects Nonmotile \u3cem\u3eflhDC\u3c/em\u3e Mutants of \u3cem\u3eEscherichia coli\u3c/em\u3e MG1655 with Increased Colonizing Ability and Better Utilization of Carbon Sources

d-Gluconate which is primarily catabolized via the Entner-Doudoroff (ED) pathway, has been implicated as being important for colonization of the streptomycin-treated mouse large intestine by Escherichia coli MG1655, a human commensal strain. In the present study, we report that an MG1655 Δedd mutant defective in the ED pathway grows poorly not only on gluconate as a sole carbon source but on a number of other sugars previously implicated as being important for colonization, including l-fucose, d-gluconate, d-glucuronate, N-acetyl-d-glucosamine, d-mannose, and d-ribose. Furthermore, we show that the mouse intestine selects mutants of MG1655 Δedd and wild-type MG1655 that have improved mouse intestine-colonizing ability and grow 15 to 30% faster on the aforementioned sugars. The mutants of MG1655 Δedd and wild-type MG1655 selected by the intestine are shown to be nonmotile and to have deletions in the flhDC operon, which encodes the master regulator of flagellar biosynthesis. Finally, we show that ΔflhDC mutants of wild-type MG1655 and MG1655 Δedd constructed in the laboratory act identically to those selected by the intestine; i.e., they grow better than their respective parents on sugars as sole carbon sources and are better colonizers of the mouse intestine

Carbon nutrition of \u3cem\u3eEscherichia coli\u3c/em\u3e in the mouse intestine

Whole-genome expression profiling revealed Escherichia coli MG1655 genes induced by growth on mucus, conditions designed to mimic nutrient availability in the mammalian intestine. Most were nutritional genes corresponding to catabolic pathways for nutrients found in mucus. We knocked out several pathways and tested the relative fitness of the mutants for colonization of the mouse intestine in competition with their wild-type parent. We found that only mutations in sugar pathways affected colonization, not phospholipid and amino acid catabolism, not gluconeogenesis, not the tricarboxylic acid cycle, and not the pentose phosphate pathway. Gluconate appeared to be a major carbon source used by E. coli MG1655 to colonize, having an impact on both the initiation and maintenance stages. N-acetylglucosamine and N-acetylneuraminic acid appeared to be involved in initiation, but not maintenance. Glucuronate, mannose, fucose, and ribose appeared to be involved in maintenance, but not initiation. The in vitro order of preference for these seven sugars paralleled the relative impact of the corresponding metabolic lesions on colonization: gluconate \u3e N-acetylglucosamine \u3e N-acetylneuraminic acid = glucuronate \u3e mannose \u3e fucose \u3e ribose. The results of this systematic analysis of nutrients used by E. coli MG1655 to colonize the mouse intestine are intriguing in light of the nutrient-niche hypothesis, which states that the ecological niches within the intestine are defined by nutrient availability. Because humans are presumably colonized with different commensal strains, differences in nutrient availability may provide an open niche for infecting E. coli pathogens in some individuals and a barrier to infection in others

The Victorian Newsletter (Fall 1981)

The Victorian Newsletter is sponsored for the Victorian Group of Modern Language Association by the Western Kentucky University and is published twice annually.Tennyson and Carlyle: A Source for "The Eagle" / Paul F. Mattheisen -- The Schooling of John Bull: Form and Moral in Talbot Baines Reed's Boys' Stories and in Kipling's Stalky & Co. / Patrick Scott -- How It Struck A Contemporary: Tennyson's "Lancelot and Elaine" and Pre-Raphaelite Art / Catherine Barnes Stevenson -- Amours de Voyage and Matthew Arnold in Love: An Inquiry / Eugene R. August -- Tennyson's "Ulysses" as Rhetorical Monologue / Mary Saunders -- The Mathematical References to the Adoption of the Gregorian Calendar in Lewis Carroll's Alice's Adventures in Wonderland / Laurence Dreyer -- Self-Helpers and Self-Seekers: Some Changing Attitudes to Wealth, 1840-1910 / J. L. Winte

Respiratory temperature responses of tropical conifers differ with leaf morphology

1. Photosynthetic traits suggest that shade tolerance may explain the contrasting success of two conifer taxa, Podocarpaceae and Pinaceae, in tropical forests. Needle-leaved species from Pinus (Pinaceae) are generally absent from tropi- cal forests, whereas Pinus krempfii, a flat-leaved pine, and numerous flat-leaved Podocarpaceae are abundant. Respiration (R) traits may provide additional insight into the drivers of the contrasting success of needle- and flat-leaved conifers in tropical forests. 2. We measured the short-term respiratory temperature (RT) response between 10 and 50°C and foliar morphological traits of three needle- and seven flat-leaved conifer species coexisting in a tropical montane forest in the Central Highlands of Vietnam containing notable conifer diversity. We fit a lognormal polynomial model to each RT curve and extracted the following three parameters: a (basal R), and b and c (together describing the shape of the response). 3. Needle-leaved species (Pinus kesiya, Pinus dalatensis and Dacrydium elatum) had higher rates of area-based R at 25°C (R25-area) as well as higher area-based mod- elled basal respiration (a) than flat-leaved species (P. krempfii, Podocarpus neriifolius, Dacrycarpus imbricatus, Nageia nana, Taxus wallichiana, Keteeleria evelyniana and Fokienia hodginsii). No significant differences were found between needle- and flat-leaved species in mass-based R25 (R25-mass) or in the shape of the RT response (b and c); however, interspecific differences in R25-mass, R at nighttime temperature extremes (R4.1 and R20.6) and leaf traits were apparent. 4. Differences in R25-area and a suggest that needle-leaved foliage may be more en- ergetically costly to maintain than flat-leaved foliage, providing new insight and additional support for the hypothesis that shade tolerance is an important driver of Podocarpaceae success and Pinaceae absence in the majority of tropical forests. 5. Interspecific differences in R25-mass and leaf traits highlight that varying ecological strategies are employed by conifers to coexist and survive in the Central Highland