It\u27s Midnight. Do you know how your patient is doing?

Transitions of care are vulnerable points in patient care. With the volume of information transferred, quality of care and patient safety are at risk. Numerous attempts at standardization of transitions of care have been utilized; however no consensus regarding the optimal method has been reached. We developed a “watcher” model in addition to standard end of shift sign out. Patients at risk were identified by the day team and seen overnight by a senior and junior surgery resident, along with a nursing representative: either a bedside RN or nursing supervisor. We hypothesized that these midnight rounds could proactively identify patient care issues and intervention would be implemented sooner in a patient’s hospital coursehttps://jdc.jefferson.edu/patientsafetyposters/1036/thumbnail.jp

Standardized Consent Forms for Surgical Procedures: An Intervention to Improve the Resident-led Informed Consent Process

Objectives and Goals: To provide high quality, consistent consent forms for common surgical procedures and improve resident workflow by creating and implementing standardized printed consents for common surgical procedures. These consents will be used by residents consenting patients in the ED or inpatient setting. Consents shall include standardized procedure descriptions, risks and benefits of the procedure, and alternative treatment option descriptions, risks and benefitshttps://jdc.jefferson.edu/patientsafetyposters/1057/thumbnail.jp

Low-speed aerodynamic characteristics of a 9.3-percent-thick supercritical airfoil section

An investigation was conducted in the Langley low turbulence pressure tunnel to determine the low-speed, two dimensional characteristics of a 9.3 percent-thick supercritical airfoil. The airfoil was tested at Reynolds numbers (based on chord) from 2.9 million to 16.8 million, at Mach numbers from 0.10 to 0.36, and at geometric angles of attack from -8 degrees to 14 degrees

Low-speed aerodynamic characteristics of a 16-percent-thick variable-geometry airfoil designed for general aviation applications

Tests were conducted in the Langley low-turbulence pressure tunnel to determine the aerodynamic characteristics of climb, cruise, and landing configurations. These tests were conducted over a Mach number range from 0.10 to 0.35, a chord Reynolds number range from 2.0 x 1 million to 20.0 x 1 million, and an angle-of-attack range from -8 deg to 20 deg. Results show that the maximum section lift coefficients increased in the Reynolds number range from 2.0 x 1 million to 9.0 x 1 million and reached values of approximately 2.1, 1.8, and 1.5 for the landing, climb, and cruise configurations, respectively. Stall characteristics, although of the trailing-edge type, were abrupt. The section lift-drag ratio of the climb configuration with fixed transition near the leading edge was about 78 at a lift coefficient of 0.9, a Mach number of 0.15, and a Reynolds number of 4.0 x 1 million. Design lift coefficients of 0.9 and 0.4 for the climb and cruise configurations were obtained at the same angle of attack, about 6 deg, as intended. Good agreement was obtained between experimental results and the predictions of a viscous, attached-flow theoretical method

Is England's public health nutrition system in crisis? A qualitative analysis of the capacity to feed all in need during the COVID-19 pandemic

Methodology: An exploratory methodology was adopted to examine experiences relating to capability and capacity among formal and informal helpers within the PHN domain. An online survey, mainly open-ended questions, was used to capture experiences over the period 2010 - 2020. A mixed sampling strategy, including snowball and convenience sampling, via social media and social network contact-sharing approaches, was adopted. Data was analysed using an inductive thematic approach. Results: A total of 89 participants representing the PHN system in England were recruited over two months. Three main themes and eight sub-themes were identified. The first reflected unequivocal accounts of the impact of austerity and the inability of PHN services to meet demand for food security. The second articulated capacity and capability issues within the system, with geographical variations in service delivery, and a lack of connectivity between central, local government, and third sector providers. These were attributed to widening nutrition and health inequalities. Participants felt that the government needed to invest more technical and financial resources to support public health nutrition. They also felt that schools could play a larger role at local level, but there was a need for a clear national recovery plan, setting out a comprehensive and fully supported national strategy to eradicate food insecurity in England Conclusions: Further in-depth research is needed to continue to track the impact of recovery strategies on food insecure people and the capacity of the PHN system. Urgent investment in the capacity and coordination of PHN services is needed to support food insecure people in England. The UK could include the ratification of the right to food in national laws, in line with global commitments already agreed to by the UK State Party

High resolution HLA analysis reveals independent class I haplotypes and amino-acid motifs protective for multiple sclerosis.

We investigated association between HLA class I and class II alleles and haplotypes, and KIR loci and their HLA class I ligands, with multiple sclerosis (MS) in 412 European American MS patients and 419 ethnically matched controls, using next-generation sequencing. The DRB1*15:01~DQB1*06:02 haplotype was highly predisposing (odds ratio (OR) = 3.98; 95% confidence interval (CI) = 3-5.31; p-value (p) = 2.22E-16), as was DRB1*03:01~DQB1*02:01 (OR = 1.63; CI = 1.19-2.24; p = 1.41E-03). Hardy-Weinberg (HW) analysis in MS patients revealed a significant DRB1*03:01~DQB1*02:01 homozyote excess (15 observed; 8.6 expected; p = 0.016). The OR for this genotype (5.27; CI = 1.47-28.52; p = 0.0036) suggests a recessive MS risk model. Controls displayed no HW deviations. The C*03:04~B*40:01 haplotype (OR = 0.27; CI = 0.14-0.51; p = 6.76E-06) was highly protective for MS, especially in haplotypes with A*02:01 (OR = 0.15; CI = 0.04-0.45; p = 6.51E-05). By itself, A*02:01 is moderately protective, (OR = 0.69; CI = 0.54-0.87; p = 1.46E-03), and haplotypes of A*02:01 with the HLA-B Thr80 Bw4 variant (Bw4T) more so (OR = 0.53; CI = 0.35-0.78; p = 7.55E-04). Protective associations with the Bw4 KIR ligand resulted from linkage disequilibrium (LD) with DRB1*15:01, but the Bw4T variant was protective (OR = 0.64; CI = 0.49-0.82; p = 3.37-04) independent of LD with DRB1*15:01. The Bw4I variant was not associated with MS. Overall, we find specific class I HLA polymorphisms to be protective for MS, independent of the strong predisposition conferred by DRB1*15:01

Geostationary Operational Environmental Satellite (GOES)-8 mission flight experience

The Geostationary Operational Environmental Satellite (GOES)-8 spacecraft was launched on April 13, 1994, at 06:04:02 coordinated universal time (UTC), with separation from the Atlas-Centaur launch vehicle occurring at 06:33:05 UTC. The launch was followed by a series of complex, intense operations to maneuver the spacecraft into its geosynchronous mission orbit. The Flight Dynamics Facility (FDF) of the Goddard Space Flight Center (GSFC) Flight Dynamics Division (FDD) was responsible for GOES-8 attitude, orbit maneuver, orbit determination, and station acquisition support during the ascent phase. This paper summarizes the efforts of the FDF support teams and highlights some of the unique challenges the launch team faced during critical GOES-8 mission support. FDF operations experience discussed includes: (1) The abort of apogee maneuver firing-1 (AMF-1), cancellation of AMF-3, and the subsequent replans of the maneuver profile; (2) The unexpectedly large temperature dependence of the digital integrating rate assembly (DIRA) and its effect on GOES-8 attitude targeting in support of perigee raising maneuvers; (3) The significant effect of attitude control thrusting on GOES-8 orbit determination solutions; (4) Adjustment of the trim tab to minimize torque due to solar radiation pressure; and (5) Postlaunch analysis performed to estimate the GOES-8 separation attitude. The paper also discusses some key FDF GOES-8 lessons learned to be considered for the GOES-J launch which is currently scheduled for May 19, 1995

A Characterisation of Strong Wave Tails in Curved Space-Times

A characterisation of when wave tails are strong is proposed. The existence of a curvature induced tail (i.e. a Green's function term whose support includes the interior of the light-cone) is commonly understood to cause backscattering of the field governed by the relevant wave equation. Strong tails are characterised as those for which the purely radiative part of the field is backscattered. With this definition, it is shown that electromagnetic waves in asymptotically flat space-times and fields governed by tail-free propagation have weak tails, but minimally coupled scalar fields in a cosmological scenario have strong tails.Comment: 17 pages, Revtex, to appear in Classical and Quantum Gravit

Optimizing tuning masses for helicopter rotor blade vibration reduction including computed airloads and comparison with test data

The development and validation of an optimization procedure to systematically place tuning masses along a rotor blade span to minimize vibratory loads are described. The masses and their corresponding locations are the design variables that are manipulated to reduce the harmonics of hub shear for a four-bladed rotor system without adding a large mass penalty. The procedure incorporates a comprehensive helicopter analysis to calculate the airloads. Predicting changes in airloads due to changes in design variables is an important feature of this research. The procedure was applied to a one-sixth, Mach-scaled rotor blade model to place three masses and then again to place six masses. In both cases the added mass was able to achieve significant reductions in the hub shear. In addition, the procedure was applied to place a single mass of fixed value on a blade model to reduce the hub shear for three flight conditions. The analytical results were compared to experimental data from a wind tunnel test performed in the Langley Transonic Dynamics Tunnel. The correlation of the mass location was good and the trend of the mass location with respect to flight speed was predicted fairly well. However, it was noted that the analysis was not entirely successful at predicting the absolute magnitudes of the fixed system loads