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

Wide-Bandwidth Multi-Resolutional Analysis of a Surface-Mounted PM Synchronous Machine

Advances in power semiconductor devices have led to inverters with unprecedented voltage edge rates. This has decreased inverter switching losses and enabled the use of increasingly higher switching frequencies. However, faster edge rates and higher switching frequencies increase electromagnetic compatibility (EMC) problems, machine insulation stress, bearing currents, and other aspects of system design. Typical computer simulations used to design and evaluate proposed electric drive systems cannot be used to predict these high-frequency effects. A wide-bandwidth multi-resolutional analysis that allows designers to anticipate and quantify high-frequency effects is detailed in this paper. The approach is specifically applied to permanent magnet synchronous machine drives, and is validated experimentally

Behavioral IGBT Modeling for Predicting High Frequency Effects in Motor Drives

A first-order behavioral IGBT/gate drive model is proposed together with a procedure for deriving all model parameters. Despite the simplicity of the proposed model, comparison of model predictions with hardware measurements demonstrate the model to be accurate in predicting turn-on and turn-off transients

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

Early immune anergy towards recall antigens and mitogens in patients at onset of septic shock

The pathology of sepsis is typically characterized by an infection and excessive initial inflammation including a cytokine storm, followed by a state of immune suppression or paralysis. This classical view of a two peak kinetic immune response is currently controversially discussed. This study was a sub-study of the randomized clinical Trial SISPCT registered with www. clinicaltrials. gov (NCT00832039, Registration date: 29/01/2009). Blood samples from 76 patients with severe sepsis and septic shock were incubated for 48 h at 37 degrees C in vitro with bacterial or fungal recall-antigens or specific mitogen antigens within 24 hours of sepsis onset. Recall-antigen stimulation led to a severe dampening of normal cytokine release. This immunologic anergy was similarly observed after mitogen stimulation. Moreover, patients under hydrocortisone therapy or with lowered arterial oxygen tension had further reductions in cytokine levels upon B- and T-cell mitogen stimulation. This investigation reveals an early onset of immunoparalysis during sepsis. This immune incompetence in mounting an adequate response to further infections includes previously sensitized pathogens, as seen with recall- antigens. Also, the immune-suppressive role of hydrocortisone and low PaO2 is highlighted. Aside from early broad-spectrum antimicrobial therapy, our findings reinforce the need for maximal immunological support and protection against further infections at the onset of sepsis

The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study

BACKGROUND: The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation. In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically. METHODS: The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces. RESULTS: We could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery. CONCLUSION: This anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time

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

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