Telemedicine strategic planning and implementation issues in the Navy Medical Department

Telemedicine is a system of health care delivery which combines image, video, sounds and text, enabling health care providers to consult one another and to examine patients at a distance through the use of telecommunications technology. There are currently a number of telemedicine initiatives within the Department of Defense (DoD) designed to improve the delivery of health care within the military health services system. Telemedicine demonstration projects and consultation sites have been deployed at Army, Navy, and Air Force medical treatment facilities. These initiatives have been driven by recent advances in telecommunications technology, digital imaging technology and video teleconferencing (VTC) technology, coupled with pressures to reduce health care costs and improve access to scarce medical specialist resources. This thesis provides a contextual framework for the analysis of the potential effects of telemedicine on the Navy health care delivery system. The analysis is developed through the review of current telemedicine and telecommunications technology, examination of strategic planning and implementation issues facing Navy telemedicine efforts, and an assessment of the merits and problems associated with implementing a telemedicine pilot project in a Navy medical treatment facility.http://archive.org/details/telemedicinestra1094535124NANAU.S. Navy (U.S.N.) author

A Maximum Torque Per Ampere Control Strategy for Induction Motor Drives

In this paper, a new control strategy is proposed which is simple in structure and has the straightforward goal of minimizing the stator current amplitude for a given load torque. It is shown that the resulting induction motor efficiency is reasonably close to optimal and that the approach is insensitive to variations in rotor resistance. Although the torque response is not as fast as in field-oriented (FO) control strategies, the response is reasonably fast. In fact, if the mechanical time constant is large relative to the rotor time constant, which is frequently the case, the sacrifice in dynamic performance is insignificant relative to FO strategie

Dynamic model tracking design for low inertia, high speed permanent magnet ac motors

Permanent magnet a

CD8+ T cell response to human papillomavirus 16 E7 is able to predict survival outcome in oropharyngeal cancer

Introduction: Immunological response to human papillomavirus (HPV) in the development and progression of HPV16+ oropharyngeal squamous cell carcinoma (OPSCC) (accounting for the majority of viral associated cases) is largely unknown and may provide important insights for new therapeutic strategies. Methods: In this prospective clinical trial (UKCRN11945), we examined cell-mediated immune responses to HPV16 E2, E6 and E7 in peripheral blood using IFN-γ enzyme-linked immunosorbent spot assay. CD56+, CD4+, CD8+ and regulatory T cell frequencies were also discerned by flow cytometry. Fifty-one study participants with oropharyngeal carcinoma were recruited. Control subjects were those undergoing tonsillectomy for benign disease. All patients were treated with curative intent by radiotherapy ± chemotherapy. Disease-specific survival was investigated by multivariate analysis. Results: HPV16 DNA was detected in 41/51 of the OPSCC participants. T cell responses against HPV16 E6 or E7 peptides were detected in 33/51 evaluable patients, respectively and correlated with HPV status. Matched pre- and post-treatment T cell responses were available for 39/51 OPSCC cases. Within the whole cohort, elevated post-treatment CD8+ response to HPV16 E7 correlated with longer disease free survival (multivariate DFS p < 0.03). Within the HPV + OPSCC cohort, a significant increase in regulatory T cells (p < 0.02) was noted after treatment. Conclusions: This is the first study to provide survival data in OPSCC stratified by cell-mediated immune response to HPV16 peptides. Within the HPV16+ OPSCC cohort, enhanced immunoreactivity to antigen E7 was linked to improved survival. An increase in regulatory T cell frequencies after treatment may suggest that immunosuppression can contribute to a reduced HPV-specific cell-mediated response

Limits to the muon flux from WIMP annihilation in the center of the Earth with the AMANDA detector

A search for nearly vertical up-going muon-neutrinos from neutralino annihilations in the center of the Earth has been performed with the AMANDA-B10 neutrino detector. The data sample collected in 130.1 days of live-time in 1997, ~10^9 events, has been analyzed for this search. No excess over the expected atmospheric neutrino background is oberved. An upper limit at 90% confidence level on the annihilation rate of neutralinos in the center of the Earth is obtained as a function of the neutralino mass in the range 100 GeV-5000 GeV, as well as the corresponding muon flux limit.Comment: 14 pages, 11 figures. Version accepted for publication in Physical Review

Results from the Antarctic Muon and Neutrino Detector Array (AMANDA)

We show new results from both the older and newer incarnations of AMANDA (AMANDA-B10 and AMANDA-II, respectively). These results demonstrate that AMANDA is a functioning, multipurpose detector with significant physics and astrophysics reach. They include a new higher-statistics measurement of the atmospheric muon neutrino flux and preliminary results from searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, gamma-ray bursters and diffuse sources producing muons in the detector, and diffuse sources producing electromagnetic or hadronic showers in or near the detector.Comment: Invited talk at the XXth International Conference on Neutrino Physics and Astrophysics (Neutrino 2002), Munich, Germany, May 25-30, 200

IceCube - the next generation neutrino telescope at the South Pole

IceCube is a large neutrino telescope of the next generation to be constructed in the Antarctic Ice Sheet near the South Pole. We present the conceptual design and the sensitivity of the IceCube detector to predicted fluxes of neutrinos, both atmospheric and extra-terrestrial. A complete simulation of the detector design has been used to study the detector's capability to search for neutrinos from sources such as active galaxies, and gamma-ray bursts.Comment: 8 pages, to be published with the proceedings of the XXth International Conference on Neutrino Physics and Astrophysics, Munich 200

Recurrent respiratory papillomatosis: an overview of current thinking and treatment

Human papillomaviruses (HPV) infection in benign laryngeal papillomas is well established. The vast majority of recurrent respiratory papillomatosis lesions are due to HPV types 6 and 11. Human papillomaviruses are small non-enveloped viruses (>8 kb), that replicate within the nuclei of infected host cells. Infected host basal cell keratinocytes and papillomas arise from the disordered proliferation of these differentiating keratinocytes. Surgical debulking of papillomas is currently the treatment of choice; newer surgical approaches utilizing microdebriders are replacing laser ablation. Surgery aims to secure an adequate airway and improve and maintain an acceptable quality of voice. Adjuvant treatments currently used include cidofovir, indole-3-carbinol, ribavirin, mumps vaccine, and photodynamic therapy. The recent licensing of prophylactic HPV vaccines is a most interesting development. The low incidence of RRP does pose significant problems in recruitment of sufficient numbers to show statistical significance. Large multi-centre collaborative clinical trials are therefore required. Even so, sufficient clinical follow-up data would take several years

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

OBJECTIVES: In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. METHOD AND MATERIALS: Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. RESULTS: Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. CONCLUSION: Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia