Is Rocky Mountain Spotted Fever Transmitted in Maine?

Introduction: Tickborne disease occurs worldwide with recent recognition of changes in tick vector distributions. Rocky Mountain Spotted Fever (RMSF) is already widespread across the United States; however, it is being monitored for introduction to non-endemic areas. Clinical Findings: A 65-year-old male with a history of psoriatic arthritis on adalimumab and local tick exposures but no known recent bites presented to the emergency department with fevers, myalgias, arthralgias, and a maculopapular rash of unclear etiology. Initial testing showed transaminitis, worsened chronic thrombocytopenia, and slight neutropenia with absolute neutrophil count 2,330 (reference value: 2,400-7,600 cells per µL); however, he was stable and his tick panel including Lyme, anaplasma, babesia, and ehrlichia was negative so he was discharged. Diagnoses, Therapeutics, and Outcomes: The patient was then evaluated in clinic and found to have improving symptoms but worsening transaminitis. He was empirically started on doxycycline, and the same tick panel was repeated which resulted negative. Abdominal ultrasound, and viral serologies for Hepatitis B and C, Human Immunodeficiency Virus, Cytomegalovirus, Epstein-Barr Virus were negative. His Spotted Fever Group IgG then resulted positive and he completed empiric treatment with resolution of his symptoms and lab abnormalities. The case was reported to the state of Maine Center of Disease Control and Prevention. Conclusion: This case does not meet requirements for diagnostic confirmation of RMSF, but illustrates the diagnostic considerations for tickborne febrile illness in Maine

Providing Appropriate Information: an Analysis of Procedures in Computer User Documentation

I developed this study in an effort to analyze some of the more obvious discrepancies I have observed between the literature and practice in the field of technical communication. As a practitioner and author of computer software documentation similar to the samples studied in this thesis, 1 believe that much research in technical communication remains transfixed by old paradigms of documentation. I hope this thesis may, in some small way, provoke a renewed analysis of computer documentation and a fresh look at some of the existing assumptions and standards of computer documentation

The Planetary Mass Companion 2MASS1207-3932 B: Temperature, Mass and Evidence for an Edge-On Disk

We present J-band imaging and H+K-band low-resolution spectroscopy of 2MASS1207-3932 AB, obtained with VLT NACO. For the putative planetary mass secondary, we find J = 20.0+/-0.2 mag. The HK spectra of both components imply low gravity, and a dusty atmosphere for the secondary. Comparisons to synthetic spectra yield Teff_A ~ 2550+/-150K, and Teff_B ~ 1600+/-100K, consistent with their late-M and mid-to-late L types. For these Teff, and an age of 5-10 Myrs, evolutionary models imply M_A ~ 24+/-6 M_Jup and M_B ~ 8+/-2 M_Jup. Independent comparisons of these models to the observed colors, spanning ~I to L', also yield the same masses and temperatures. Our primary mass agrees with other recent analyses; however, our secondary mass, while still in the planetary regime, is 2-3 times larger than claimed previously. This discrepancy can be traced to the luminosities: while the absolute photometry and Mbol of the primary agree with theoretical predictions, the secondary is ~ 2.5+/-0.5 mag fainter than expected in all bands from I to L' and in Mbol. This accounts for the much lower secondary mass (and temperature) derived earlier. We argue that this effect is highly unlikely to result from a variety of model-related problems, and is instead real. This conclusion is bolstered by the absence of any luminosity problems in either the primary, or in AB Pic B which we also analyse. We therefore suggest grey extinction in 2M1207B, due to occlusion by an edge-on circum-secondary disk. This is consistent with the observed properties of edge-on disks around T Tauri stars, and with the known presence of a high-inclination evolved disk around the primary. Finally, the system's implied mass ratio of ~0.3 suggests a binary-like formation scenario. (abridged)Comment: Accepted by The Astrophysical Journal, 43 pages text + 16 figs + 1 tabl

Economic analysis of endovascular repair versus surveillance for patients with small abdominal aortic aneurysms

BackgroundThe Positive Impact of EndoVascular Options for Treating Aneurysms Early (PIVOTAL) trial enrolled individuals with small (4.0- to 5.0-cm diameter) abdominal aortic aneurysms (AAA) and reported no difference in rupture or aneurysm-related death for patients who received early endovascular repair (EVAR) vs surveillance with serial imaging studies. We evaluated resource use, medical cost, and quality of life outcomes associated with the PIVOTAL treatment strategies.MethodsThis prospective economic and quality of life study was conducted within a randomized trial, with PIVOTAL sites participating in the quality of life (n = 67) and economic (n = 63) studies. The PIVOTAL trial randomized 728 patients (366 early EVAR and 362 surveillance). We used information from 701 quality of life (351 early EVAR and 350 surveillance) and 614 economic (314 early EVAR and 300 surveillance) study participants enrolled in the PIVOTAL trial. The main outcome measures were total medical costs and the aneurysm repair rate at 48 months.ResultsAfter 6 months, the rate of aneurysm repair was 96 vs 10 per 100 patients in the early EVAR and surveillance groups, respectively (difference, 86; 95% confidence interval [CI], 82-90; P < .0001), and total medical costs were greater in the early EVAR group ($33,471 vs$5520; difference, $27,951; 95$25,156-$30,746; P < .0001). In months 7 through 48, however, the rate of aneurysm repair was 54 per 100 patients in the surveillance group, and total medical costs were higher for patients in the surveillance vs the early EVAR group ($40,592 vs $15,197; difference,$25,394; 95% CI, $15,184-$35,605; P < .0001). At 48 months' follow-up, early EVAR patients had greater cumulative use of AAA repair (97 vs 64 per 100 patients; difference, 34; 95% CI, 21-46; P < .0001), but there was no difference in total medical costs ($48,669 vs$46,112; difference, $2557; 95$8043 to $13,156; P = .64). After discounting at 3$47,765 vs $43,532; difference, 4232; 95$5561 to $14,025; P = .40). There were no treatment-related differences in quality of life at 24 months.ConclusionsA treatment strategy involving early repair of smaller AAA with EVAR is associated with no difference in total medical costs at 48 months vs surveillance with serial imaging studies. Longer follow-up is required to determine whether the late medical cost increases observed for surveillance will persist beyond 48 months

TRADEOFF ANALYSIS OF BACKUP POWER GENERATION SOLUTIONS FOR MILITARY BASES

Energy security is becoming increasingly important as the DOD relies on energy to build and project combat power from military installations. Installation energy managers currently ensure uninterrupted power to mission-critical facilities through emergency stand-alone diesel generators. Research has recently indicated that networks of smaller diesel generators offer greater energy security benefits than a network of a few large diesel generators. However, existing research has not compared or analyzed the cost and resilience between the two strategies. This capstone examines the cost and resilience of centralized and decentralized power architectures by developing a general methodology to capture comprehensive life-cycle costs and metrics. It examines resilience for various configurations of networked diesel generators. Installation power managers can apply this method to quantitatively compare life-cycle cost and resilience of emergency diesel generator solutions to improve energy security within the unique constraints of an installation. The capstone then applied this methodology to the aging diesel generator power plant at Naval Station, Rota, Spain, which demonstrated that decentralized architecture was the most cost-effective strategy for resilience. Finally, the capstone presents these findings and general methodology for future application.Navy Shore Energy Technology Transition and Integration (NSETTI), Naval Facilities (NAVFAC) Engineering and Expeditionary Warfare Center (EXWC), Port Hueneme, CA, 93043Captain, United States ArmyMajor, United States ArmyMajor, United States ArmyCaptain, United States ArmyCaptain, United States ArmyApproved for public release. Distribution is unlimited

Molecular Characterization of Two Opecoelid Trematodes From Fishes in the Gulf of Mexico, With a Desceiption of a New Species of \u3ci\u3eHelicometra\u3c/i\u3e

The plagioporine opecoelids Helicometra fasciata (Rudolphi, 1819) Odhner, 1902, and Macvicaria crassigula (Linton, 1910) Bartoli, Bray, and Gibson, 1989 have been reported from fishes in expansive geographic regions, disjointed from their type localities. New material of M. crassigula was collected from near its type locality as well as specimens resembling Helicometra fasciata sensu lato from three triglids in the Gulf of Mexico. Comparisons of the ribosomal DNA (rDNA) sequences, comprising the partial 18S rDNA, internal transcribed spacer region (= ITS1, 5.8S, and ITS2), and partial 28S rDNA gene, from M. crassigula and Helicometra fasciata sensu lato in the Gulf of Mexico were made with sequences deposited in GenBank from those species from the Mediterranean Sea. Results reveal that M. crassigula sensu stricto from the Gulf of Mexico is distinct from the two cryptic species of M. crassigula sensu lato from the Mediterranean Sea and Helicometra fasciata sensu lato in this study differs from H. fasciata sequences from the Mediterranean Sea, thus Helicometra manteri sp. nov. is described

The Embryonic Transcriptome Of The Red-Eared Slider Turtle (Trachemys Scripta)

The bony shell of the turtle is an evolutionary novelty not found in any other group of animals, however, research into its formation has suggested that it has evolved through modification of conserved developmental mechanisms. Although these mechanisms have been extensively characterized in model organisms, the tools for characterizing them in non-model organisms such as turtles have been limited by a lack of genomic resources. We have used a next generation sequencing approach to generate and assemble a transcriptome from stage 14 and 17 Trachemys scripta embryos, stages during which important events in shell development are known to take place. The transcriptome consists of 231,876 sequences with an N-50 of 1,166 bp. GO terms and EC codes were assigned to the 61,643 unique predicted proteins identified in the transcriptome sequences. All major GO categories and metabolic pathways are represented in the transcriptome. Transcriptome sequences were used to amplify several cDNA fragments designed for use as RNA in situ probes. One of these, BMP5, was hybridized to a T. scripta embryo and exhibits both conserved and novel expression patterns. The transcriptome sequences should be of broad use for understanding the evolution and development of the turtle shell and for annotating any future T. scripta genome sequences

International Health Regulations—What Gets Measured Gets Done

Focus on goals and metrics for 4 core capacities illustrates 1 approach to implementing IHR

Summary of CPAS Gen II Parachute Analysis

The Orion spacecraft is currently under development by NASA and Lockheed Martin. Like Apollo, Orion will use a series of parachutes to slow its descent and splashdown safely. The Orion parachute system, known as the CEV Parachute Assembly System (CPAS), is being designed by NASA, the Engineering and Science Contract Group (ESCG), and Airborne Systems. The first generation (Gen I) of CPAS testing consisted of thirteen tests and was executed in the 2007-2008 timeframe. The Gen I tests provided an initial understanding of the CPAS parachutes. Knowledge gained from Gen I testing was used to plan the second generation of testing (Gen II). Gen II consisted of six tests: three singleparachute tests, designated as Main Development Tests, and three Cluster Development Tests. Gen II required a more thorough investigation into parachute performance than Gen I. Higher fidelity instrumentation, enhanced analysis methods and tools, and advanced test techniques were developed. The results of the Gen II test series are being incorporated into the CPAS design. Further testing and refinement of the design and model of parachute performance will occur during the upcoming third generation of testing (Gen III). This paper will provide an overview of the developments in CPAS analysis following the end of Gen I, including descriptions of new tools and techniques as well as overviews of the Gen II tests

Simulating New Drop Test Vehicles and Test Techniques for the Orion CEV Parachute Assembly System

The Crew Exploration Vehicle Parachute Assembly System (CPAS) project is engaged in a multi-year design and test campaign to qualify a parachute recovery system for human use on the Orion Spacecraft. Test and simulation techniques have evolved concurrently to keep up with the demands of a challenging and complex system. The primary simulations used for preflight predictions and post-test data reconstructions are Decelerator System Simulation (DSS), Decelerator System Simulation Application (DSSA), and Drop Test Vehicle Simulation (DTV-SIM). The goal of this paper is to provide a roadmap to future programs on the test technique challenges and obstacles involved in executing a large-scale, multi-year parachute test program. A focus on flight simulation modeling and correlation to test techniques executed to obtain parachute performance parameters are presented