Pertussis Vaccination in Pregnant Women at the EMMC Family Medicine Center

Pertussis, also known as whooping cough, primarily affects infants less than 12 months of age and frequently requires lengthy hospital stays. Maine has the 3rd highest rate of documented pertussis cases in the nation. Guidelines for prenatal vaccination recommend women receive pertussis vaccination during the third trimester of every pregnancy in order to protect the neonate. A small community project was designed to investigate adherence to prenatal vaccination guidelines. Rates of vaccination and electronic medical record (EMR) documentation for patient refusal were investigated for Jan. 1, 2016 - Aug. 1, 2016. Implementation of interventions focused on improving the rate of pertussis coverage in this population will require further follow up investigation to assess efficacy.https://scholarworks.uvm.edu/fmclerk/1230/thumbnail.jp

Can consumer-led mental health services be equally effective? An integrative review of CLMH services in high-income countries

This study examined the evidence from controlled studies for the effectiveness of consumer-led mental health services. Following an extensive search of material published in English from 1980, predefined inclusion criteria were systematically applied to research articles that compared a consumer-led mental health service to a traditional mental health service. A total of 29 eligible studies were appraised; all of them were conducted in high-income countries. Overall consumer-led services reported equally positive outcomes for their clients as traditional services, particularly for practical outcomes such as employment or living arrangements, and in reducing hospitalizations and thus the cost of services. Involving consumers in service delivery appears to provide employment opportunities and be beneficial overall for the consumer-staff members and the service. Despite growing evidence of effectiveness, barriers such as underfunding continue to limit the use and evaluation of consumer-led services. Future studies need to adopt more uniform definitions and prioritize the inclusion of recovery oriented outcome measures. © Springer Science+Business Media, LLC 2010.postprin

Efficient injection from large telescopes into single-mode fibres: Enabling the era of ultra-precision astronomy

Photonic technologies offer numerous advantages for astronomical instruments such as spectrographs and interferometers owing to their small footprints and diverse range of functionalities. Operating at the diffraction-limit, it is notoriously difficult to efficiently couple such devices directly with large telescopes. We demonstrate that with careful control of both the non-ideal pupil geometry of a telescope and residual wavefront errors, efficient coupling with single-mode devices can indeed be realised. A fibre injection was built within the Subaru Coronagraphic Extreme Adaptive Optics (SCExAO) instrument. Light was coupled into a single-mode fibre operating in the near-IR (J-H bands) which was downstream of the extreme adaptive optics system and the pupil apodising optics. A coupling efficiency of 86% of the theoretical maximum limit was achieved at 1550 nm for a diffraction-limited beam in the laboratory, and was linearly correlated with Strehl ratio. The coupling efficiency was constant to within <30% in the range 1250-1600 nm. Preliminary on-sky data with a Strehl ratio of 60% in the H-band produced a coupling efficiency into a single-mode fibre of ~50%, consistent with expectations. The coupling was >40% for 84% of the time and >50% for 41% of the time. The laboratory results allow us to forecast that extreme adaptive optics levels of correction (Strehl ratio >90% in H-band) would allow coupling of >67% (of the order of coupling to multimode fibres currently). For Strehl ratios <20%, few-port photonic lanterns become a superior choice but the signal-to-noise must be considered. These results illustrate a clear path to efficient on-sky coupling into a single-mode fibre, which could be used to realise modal-noise-free radial velocity machines, very-long-baseline optical/near-IR interferometers and/or simply exploit photonic technologies in future instrument design.Comment: 15 pages, 16 figures, 1 table, published in A&

Acute Renal Replacement Therapy in Pediatrics

Acute kidney injury (AKI) independently increases morbidity and mortality in children admitted to the hospital. Renal replacement therapy (RRT) is an essential therapy in the setting of AKI and fluid overload. The decision to initiate RRT is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability. The choice of which RRT modality to use depends on numerous criteria that are both patient and treatment center specific. Surprisingly, despite decades of use, no randomized, controlled trial study involving RRT in pediatrics has been performed. Because of these factors, clear-cut consensus is lacking regarding key questions surrounding RRT delivery. In this paper, we will summarize existing data concerning RRT use in children. We discuss the major modalities and the data-driven specifics of each, followed by controversies in RRT. As no standard of care is in widespread use for RRT in AKI or in multiorgan disease, we conclude in this paper that prospective studies of RRT are needed to identify best practice guidelines

Steady-State Torsional Response With Viscous Damping

Introduction Rotating machinery trains are rotationally free-free systems, and because of finite inertia and stiffness, they have many degrees of freedom. For most torsional vibration analysis the train may be adequately modeled as a closecoupled assembly of discrete inertias and linear, torsional springs. While there is only negligible damping in most of the rotating assembly, significant damping may be encountered in the torque-speed characteristics of some machines or included by design with damped couplings or untuned, free, viscous shear dampers. The most common type of torsional vibration analysis is the steady-state response evaluation for constant average speed of operation and the associated periodic excitation torques. Steady-state response is determined by the particular solution for the equations of motion. This motion persists after damping action has effectively removed the homogeneous solution from the motion. Torsional steady-state response calculations have been standard machinery design practice for many years The purpose of this paper is to develop the complete steadystate torsional response to periodic excitation in a form directly suited to machine computation. This will be a solution for the actual rotation of each station, not the relative rotation, as this makes the roles of steady twist and rigid body oscillations (&quot;rolling modes&quot;) more clear. This is also the motion required for comparison with measurements made using single station, FFT measuring technique

The influence of inlet modifications, geologic framework, and storms on the recent evolution of Masonboro Island, NC

Masonboro Island is a 13 km long undeveloped barrier island located within a sand deficient southwestern portion of Onslow Bay. The island is situated along major storm tracks and is chronically impacted by tropical and extra-tropical storm events (HOSIER and CLEARY, 1977). The response of the island to storms is a function of the pre-storm condition of the island, the lack of sand in the offshore environment, the influence of adjacent inlets, and the underlying geology (CLEARY et al., 1999). Masonboro Island provides an exemplary setting to study changes in barrier island morphology and shoreline change in response to inlet modifications, geologic framework, and storm impact because the island is undeveloped, remains relatively unnourished, and is flanked by two modified inlets. A GIS based study utilizing aerial photography was used to ascertain shoreline change occurring during 1938 – 2002. The island was divided into a northern, central, and southern segment based on distinct erosional characteristics. Masonboro Island experienced island wide erosion during the 64-year study period. The northern segment, which includes the fillet adjacent to Masonboro Inlet, eroded an average distance of 43 m. The central segment had net shoreline erosion of 110 m, while an area of shoreline within the central reach that was perched on a paleo-interfluve eroded only 106 m. The greatest amount of shoreline change was 164 m of erosion, which occurred along the southern segment of the island adjacent to Carolina Beach Inlet. Short-term analysis (1.3 yr.) of a 2.5 km section of the island/estuary related the influence of a small Pleistocene interfluve to morphological changes within the area. Vibracore data from the estuary behind this area indicate that the Holocene fill is relatively shallow and ranged in thickness from greater than 4 m over the infilled valleys to less than 1.5 m over the interfluves. The network of interfluves extends from the mainland, beneath the estuary, and is overridden by the island. Survey data indicate that the shoreline perched on the interfluve was restricted to ~17 m of erosion compared to an average of ~30 m to either side. The profile of this entire section was lowered in elevation, and approximately 53,000 m3 of material were removed from the area. The lowered profile made this section of the island increasingly vulnerable to overwash. The coarse grained nature of existing washover fans prevented the regrowth of new dunes. Petrologic analyses indicated that the source of the coarse grained material was a sandy limestone found along the shoreface of the southern two-thirds of the island. Further analyses indicated that the limestone was similar in nature to the coquina facies of the Neuse Formation intermittently exposed in the region

Validation of northern latitude Tropospheric Emission Spectrometer stare ozone profiles with ARC-IONS sondes during ARCTAS: sensitivity, bias and error analysis

We compare Tropospheric Emission Spectrometer (TES) versions 3 and 4, V003 and V004, respectively, nadir-stare ozone profiles with ozonesonde profiles from the Arctic Intensive Ozonesonde Network Study (ARCIONS, http://croc.gsfc.nasa.gov/arcions/ during the Arctic Research on the Composition of the Troposphere from Aircraft and Satellites (ARCTAS) field mission. The ozonesonde data are from launches timed to match Aura's overpass, where 11 coincidences spanned 44° N to 71° N from April to July 2008. Using the TES "stare" observation mode, 32 observations are taken over each coincidental ozonesonde launch. By effectively sampling the same air mass 32 times, comparisons are made between the empirically-calculated random errors to the expected random errors from measurement noise, temperature and interfering species, such as water. This study represents the first validation of high latitude (>70°) TES ozone. We find that the calculated errors are consistent with the actual errors with a similar vertical distribution that varies between 5% and 20% for V003 and V004 TES data. In general, TES ozone profiles are positively biased (by less than 15%) from the surface to the upper-troposphere (~1000 to 100 hPa) and negatively biased (by less than 20%) from the upper-troposphere to the lower-stratosphere (100 to 30 hPa) when compared to the ozonesonde data. Lastly, for V003 and V004 TES data between 44° N and 71° N there is variability in the mean biases (from −14 to +15%), mean theoretical errors (from 6 to 13%), and mean random errors (from 9 to 19%)

Implementation of a Design Spine for a Mechanical Engineering Curriculum

This paper explains the approach taken to develop a “design spine” within our mechanical engineering curriculum. Developing a design spine started as a discussion about the ASME Vision 2030 document, which encourages programs to provide design experience throughout all four years of the curriculum. Towards this end, the mechanical engineering faculty reviewed our curriculum and identified where and how we do teach engineering design in lecture courses, laboratories, and in the capstone design courses. We recognized that many design elements are already incorporated throughout the curriculum but we needed to approach design in a more systematic manner. The very meaning of “engineering design” does not enjoy universal definition. For our purposes, we used the ABET Criterion 5 definition and original ABET 2000 requirements. After the design spine was defined by the faculty, a survey of senior students was administered to evaluate the effectiveness of the design spine. Student survey responses are analyzed and a map for developing a design spine at other universities is provided

Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease

OBJECTIVE: Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients. METHODS: Adults aged <80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK. RESULTS: 24 927 patients, 63% men, 63% European, median age 65 years (IQR 58-72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5.0% (IQR 3.5%-8.3%). A plot of actual against predicted event rates showed very good calibration throughout the risk range. The score performed well in the UK cohort but overestimated risk for those at highest risk, who were predominantly patients defined as having heart failure. CONCLUSIONS: The PREDICT-CVD secondary prevention score uses routine measurements from clinical practice that enable it to be implemented in a primary care setting. The score will facilitate risk communication between primary care practitioners and patients with prior CVD, particularly as a resource to show the benefit of risk factor modification