Short-term climate response to a freshwater pulse in the Southern Ocean

The short-term response of the climate system to a freshwater anomaly in the Southern Ocean is investigated using a coupled global climate model. As a result of the anomaly, ventilation of deep waters around Antarctica is inhibited, causing a warming of the deep ocean, and a cooling of the surface. The surface cooling causes Antarctic sea-ice to thicken and increase in extent, and this leads to a cooling of Southern Hemisphere surface air temperature. The surface cooling increases over the first 5 years, then remains constant over the next 5 years. There is a more rapid response in the Pacific Ocean, which transmits a signal to the Northern Hemisphere, ultimately causing a shift to the negative phase of the North Atlantic Oscillation in years 5–10

Blood Pressure Regulation During Simulated Orthostatism Prior to and Following Endurance Exercise Training

Cardiovascular responses and tolerance to an orthostatic stress were examined in eight men before and after eight months of endurance exercise training. Following training, maximal oxygen consumption and blood volume were increased, and resting heart rate reduced. Orthostatic tolerance was reduced following training in all eight subjects. It was concluded that prolonged endurance training decreased orthostatic tolerance and this decrease in tolerance appeared associated with attenuated baroreflex sensitivity and alterations in autonomic balance secondary to an increased parasympathetic tone noted with training

The Contributions of Managed Care Plans to Public Health Practice: Evidence from the Nation's Largest Local Health Departments

OBJECTIVE: The authors examine the extent and nature of managed care plans participating in local public health activities. METHODS: In 1998, the authors surveyed the directors of all US local health departments serving jurisdictions of at least 100,000 residents to collect information about public health activities performed in their jurisdictions and about organizations participating in the activities. Multivariate logistic and linear regression models were used to examine organizational and market characteristics associated with managed care plan participation in public health activities. RESULTS: Managed care plans were reported to participate in public health activities in 164 (46%) of the jurisdictions surveyed, and to contribute to 13% of the public health activities performed in the average jurisdiction. Plans appeared most likely to participate in public health activities involving the delivery or management of personal health services and the exchange of health-related information. Managed care participation was more likely to occur in jurisdictions with higher HMO penetration, fewer competing plans, and larger proportions of plans enrolling Medicaid recipients. Participation was positively associated with the overall scope and perceived effectiveness of local public health activities. CONCLUSIONS: Although plans participate in a narrow range of activities, these contributions may complement the work of public health agencies

Detection of Crab Giant Pulses Using the Mileura Widefield Array Low Frequency Demonstrator Field Prototype System

We report on the detection of giant pulses from the Crab Nebula pulsar at a frequency of 200 MHz using the field deployment system designed for the Mileura Widefield Array's Low Frequency Demonstrator (MWA-LFD). Our observations are among the first high-quality detections at such low frequencies. The measured pulse shapes are deconvolved for interstellar pulse broadening, yielding a pulse-broadening time of 670$\pm$100 $\mu$s, and the implied strength of scattering (scattering measure) is the lowest that is estimated towards the Crab nebula from observations made so far. The sensitivity of the system is largely dictated by the sky background, and our simple equipment is capable of detecting pulses that are brighter than $\sim$9 kJy in amplitude. The brightest giant pulse detected in our data has a peak amplitude of $\sim$50 kJy, and the implied brightness temperature is $10^{31.6}$ K. We discuss the giant pulse detection prospects with the full MWA-LFD system. With a sensitivity over two orders of magnitude larger than the prototype equipment, the full system will be capable of detecting such bright giant pulses out to a wide range of Galactic distances; from $\sim$8 to $\sim$30 kpc depending on the frequency. The MWA-LFD will thus be a highly promising instrument for the studies of giant pulses and other fast radio transients at low frequencies.Comment: 10 pages, 6 figures, Accepted for publication in the Astrophysical Journa

Development of a HTSMA-Actuated Surge Control Rod for High-Temperature Turbomachinery Applications

In recent years, a demand for compact, lightweight, solid-state actuation systems has emerged, driven in part by the needs of the aeronautics industry. However, most actuation systems used in turbomachinery require not only elevated temperature but high-force capability. As a result, shape memory alloy (SMA) based systems have worked their way to the forefront of a short list of viable options to meet such a technological challenge. Most of the effort centered on shape memory systems to date has involved binary NiTi alloys but the working temperatures required in many aeronautics applications dictate significantly higher transformation temperatures than the binary systems can provide. Hence, a high temperature shape memory alloy (HTSMA) based on NiTiPdPt, having a transformation temperature near 300 C, was developed. Various thermo-mechanical processing schemes were utilized to further improve the dimensional stability of the alloy and it was later extruded/drawn into wire form to be more compatible with envisioned applications. Mechanical testing on the finished wire form showed reasonable work output capability with excellent dimensional stability. Subsequently, the wire form of the alloy was incorporated into a benchtop system, which was shown to provide the necessary stroke requirements of approx.0.125 inches for the targeted surge-control application. Cycle times for the actuator were limited to ~4 seconds due to control and cooling constraints but this cycle time was determined to be adequate for the surge control application targeted as the primary requirement was initial actuation of a surge control rod, which could be completed in approximately one second

Detection of Crab Giant Pulses Using the Mileura Widefield Array Low Frequency Demonstrator Field Prototype System

We report on the detection of giant pulses from the Crab Nebula pulsar at a frequency of 200 MHz using the field deployment system designed for the Mileura Widefield Array's Low Frequency Demonstrator (MWA-LFD). Our observations are among the first high-quality detections at such low frequencies. The measured pulse shapes are deconvolved for interstellar pulse broadening, yielding a pulse-broadening time of 670 ± 100 μs, and the implied strength of scattering (scattering measure) is the lowest that is estimated toward the Crab Nebula from observations made so far. The sensitivity of the system is largely dictated by the sky background, and our simple equipment is capable of detecting pulses that are brighter than ∼9 kJy in amplitude. The brightest giant pulse detected in our data has a peak amplitude of ∼50 kJy, and the implied brightness temperature is 10 31.6 K. We discuss the giant pulse detection prospects with the full MWA-LFD system. With a sensitivity over 2 orders of magnitude larger than the prototype equipment, the full system will be capable of detecting such bright giant pulses out to a wide range of Galactic distances; from ∼ 15 to ∼30 kpc depending on the frequency. The MWA-LFD will thus be a highly promising instrument for the studies of giant pulses and other fast radio transients at low frequencies

Targeted Therapy After Brain Radiotherapy for BRAF-Mutated Melanoma With Extensive Ependymal Disease With Prolonged Survival: Case Report and Review of the Literature

Melanoma brain metastasis with ependymal spread/metastases is uncommon. These cases are frequently classified together with leptomeningeal disease. However, the commonalities and differences in the underlying pathophysiology and clinical outcomes between these two types of spread are not clear. Very few reports on long term outcome and durable central nervous system (CNS) disease control have been reported in the literature. Here, we report a case of a 45 year-old Caucasian lady with BRAF-V600E mutant metastatic melanoma to the brain who had whole brain radiotherapy followed by two Gamma knife radiosurgery treatments for localized disease progression. She then developed extensive ependymal disease progression with no evidence of leptomeningeal spread. She was treated with a repeat course of whole brain radiotherapy and maintained on BRAF and MEK inhibitors with durable CNS disease control for more than a year. This study reviews the management of BRAF-V600E mutant melanoma with ependymal involvement. Management using radiation therapy with maintenance targeted therapy seems to be a reasonable approach to this challenging disease

Do Social Bonds Matter for Emerging Adults?

The extent to which social bonds and turning points influence criminal activity has been the focus of much empirical research. However, there have been few empirical studies exploring social bonds and turning points and offending for those who have experienced emerging adulthood, a recently identified stage of the life course. Using data from the National Longitudinal Study of Adolescent Health we examined if indicators of social bonds and turning points were predictors of criminal offending. Several of the turning points and social bonds included in these analyses were found to influence decreases in criminal offending for a cohort of emerging adults. We extend previous research by examining the influence of social bonds and turning points on patterns of criminal offending during emerging adulthood

ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. METHODS: This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review. RESULTS: Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews). CONCLUSION: The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation