Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT

Probabilistic Risk Analysis (PRA) of a Mobile Offshore Drilling Unit (MODU) Dynamic Positioning System (DPS)

Probabilistic Risk Assessment (PRA) has been utilized by NASA in a variety of space oriented projects. It has served as one of the primary risk identification and ranking tools. Recent developments in the oil and gas industry have presented opportunities for NASA to lend their PRA expertise to both ongoing and developmental projects within the industry. As a result, NASA has entered into an agreement with Anadarko Petroleum Company (APC) to collaboratively develop PRAs for different aspects of the subsea drilling and completion process of well development. This paper documents how PRA was applied to estimate the probability that a Mobile Offshore Drilling Unit (MODU) equipped with a generically configured Dynamic Positioning System (DPS) loses location and needs to initiate an emergency disconnect. Since this project was in essence a pilot project, the PRA described in this paper is intended to be generic such that the vessel meets the general requirements of an International Maritime Organization (IMO) Maritime Safety Committee (MSC)/Circ. 645 Class 3 dynamically positioned vessel. The results of this analysis are not intended to be applied to any specific drilling vessel, although provisions were made to allow the analysis to be configured to a specific vessel if required

2009 Space Shuttle Probabilistic Risk Assessment Overview

Loss of a Space Shuttle during flight has severe consequences, including loss of a significant national asset; loss of national confidence and pride; and, most importantly, loss of human life. The Shuttle Probabilistic Risk Assessment (SPRA) is used to identify risk contributors and their significance; thus, assisting management in determining how to reduce risk. In 2006, an overview of the SPRA Iteration 2.1 was presented at PSAM 8 [1]. Like all successful PRAs, the SPRA is a living PRA and has undergone revisions since PSAM 8. The latest revision to the SPRA is Iteration 3. 1, and it will not be the last as the Shuttle program progresses and more is learned. This paper discusses the SPRA scope, overall methodology, and results, as well as provides risk insights. The scope, assumptions, uncertainties, and limitations of this assessment provide risk-informed perspective to aid management s decision-making process. In addition, this paper compares the Iteration 3.1 analysis and results to the Iteration 2.1 analysis and results presented at PSAM 8

Dynamic Positioning System (DPS) Risk Analysis Using Probabilistic Risk Assessment (PRA)

The National Aeronautics and Space Administration (NASA) Safety & Mission Assurance (S&MA) directorate at the Johnson Space Center (JSC) has applied its knowledge and experience with Probabilistic Risk Assessment (PRA) to projects in industries ranging from spacecraft to nuclear power plants. PRA is a comprehensive and structured process for analyzing risk in complex engineered systems and/or processes. The PRA process enables the user to identify potential risk contributors such as, hardware and software failure, human error, and external events. Recent developments in the oil and gas industry have presented opportunities for NASA to lend their PRA expertise to both ongoing and developmental projects within the industry. This paper provides an overview of the PRA process and demonstrates how this process was applied in estimating the probability that a Mobile Offshore Drilling Unit (MODU) operating in the Gulf of Mexico and equipped with a generically configured Dynamic Positioning System (DPS) loses location and needs to initiate an emergency disconnect. The PRA described in this paper is intended to be generic such that the vessel meets the general requirements of an International Maritime Organization (IMO) Maritime Safety Committee (MSC)/Circ. 645 Class 3 dynamically positioned vessel. The results of this analysis are not intended to be applied to any specific drilling vessel, although provisions were made to allow the analysis to be configured to a specific vessel if required

Leadership in Design and Construction Education and Practice

It has been conveyed that inspiration and creativity are the greatest strengths of architects. Those who possess them often demonstrate innovation and ability to transform diverse, often contradictory, information into a cohesive design. Yet, having architectural and design talent may suggest to some that they also have a broader skill set. Among the competencies that do not necessarily co-exist with inspiration and creativity are those associated with managing or leading a complex project or organization. Leadership and many of the administrative and project management competencies needed to operate in the modern complex environment of the Architecture profession are largely absent from educational programs which specialize in producing architects and designers. Therefore, if architects must possess both talent and leadership competencies, what is to be done to support the growth, development and sustainability of the profession? This challenge was presented to the College of Architecture and the Built Environment (CABE) by their Advancement Council, a community of working professionals who offered advice and support to the College. Specifically, CABE was asked to find a way to add to their academic curriculum new and appropriate education that would prepare their graduates for the leadership and management responsibilities which existed and were increasing within the professional environment of architecture and design. The premise of this challenge was that the current curriculum failed to adequately prepare students with the confidence and competence needed to be successful. In response to this, the approach taken by the Doctor of Management in Strategic Leadership (DSL) Team in this phase of our project was to focus on identifying the characteristics within the architecture industry/ professional that people should possess in terms of competencies, i.e., knowledge and skills that could be learned/developed, and in terms of traits that could be identified and supported in order to emerge as a “true leader.” Using participant interview methods from established professionals in the industry, we identified leadership themes that impact emergent behavior for CABE graduates. At the time of this project, Philadelphia University was beginning the process of integrating with Thomas Jefferson University

Removal of the Northern Paleo-Teton Range along the Yellowstone Hotspot Track

Classically held mechanisms for removing mountain topography (e.g., erosion and gravitational collapse) require 10-100 Myr or more to completely remove tectonically generated relief. Here, we propose that mountain ranges can be completely and rapidly (\u3c 2 Myr) removed by a migrating hotspot. In western North America, multiple mountain ranges, including the Teton Range, terminate at the boundary with the relatively low relief track of the Yellowstone hotspot. This abrupt transition leads to a previously untested hypothesis that preexisting mountainous topography along the track has been erased. We integrate thermochronologic data collected from the footwall of the Teton fault with flexural-kinematic modeling and length-displacement scaling to show that the paleo-Teton fault and associated Teton Range was much longer (min. original length 190-210 km) than the present topographic expression of the range front (~65 km) and extended across the modern-day Yellowstone hotspot track. These analyses also indicate that the majority of fault displacement (min. 11.4-12.6 km) and the associated footwall mountain range growth had accumulated prior to Yellowstone encroachment at ~2 Ma, leading us to interpret that eastward migration of the Yellowstone hotspot relative to stable North America led to removal of the paleo-Teton mountain topography via posteruptive collapse of the range following multiple supercaldera (VEI 8) eruptions from 2.0 Ma to 600 ka and/or an isostatic collapse response, similar to ranges north of the Snake River plain. While this extremely rapid removal of mountain ranges and adjoining basins is probably relatively infrequent in the geologic record, it has important implications for continental physiography and topography over very short time spans

Invasive Group A Streptococcal Infection in Older Adults in Long-term Care Facilities and the Community, United States, 1998–20031

Invasive infection develops almost 6 times as frequently in the elderly in long-term care facilities

Outcome of ATP-based tumor chemosensitivity assay directed chemotherapy in heavily pre-treated recurrent ovarian carcinoma

BACKGROUND: We wished to evaluate the clinical response following ATP-Tumor Chemosensitivity Assay (ATP-TCA) directed salvage chemotherapy in a series of UK patients with advanced ovarian cancer. The results are compared with that of a similar assay used in a different country in terms of evaluability and clinical endpoints. METHODS: From November 1998 to November 2001, 46 patients with pre-treated, advanced ovarian cancer were given a total of 56 courses of chemotherapy based on in-vitro ATP-TCA responses obtained from fresh tumor samples or ascites. Forty-four patients were evaluable for results. Of these, 18 patients had clinically platinum resistant disease (relapse < 6 months after first course of chemotherapy). There was evidence of cisplatin resistance in 31 patients from their first ATP-TCA. Response to treatment was assessed by radiology, clinical assessment and tumor marker level (CA 125). RESULTS: The overall response rate was 59% (33/56) per course of chemotherapy, including 12 complete responses, 21 partial responses, 6 with stable disease, and 15 with progressive disease. Two patients were not evaluable for response having received just one cycle of chemotherapy: if these were excluded the response rate is 61%. Fifteen patients are still alive. Median progression free survival (PFS) was 6.6 months per course of chemotherapy; median overall survival (OAS) for each patient following the start of TCA-directed therapy was 10.4 months (95% confidence interval 7.9-12.8 months). CONCLUSION: The results show similar response rates to previous studies using ATP-TCA directed therapy in recurrent ovarian cancer. The assay shows high evaluability and this study adds weight to the reproducibility of results from different centre

Rectal Transmission of Transmitted/Founder HIV-1 Is Efficiently Prevented by Topical 1% Tenofovir in BLT Humanized Mice

Rectal microbicides are being developed to prevent new HIV infections in both men and women. We focused our in vivo preclinical efficacy study on rectally-applied tenofovir. BLT humanized mice (n = 43) were rectally inoculated with either the primary isolate HIV-1(JRCSF) or the MSM-derived transmitted/founder (T/F) virus HIV-1(THRO) within 30 minutes following treatment with topical 1% tenofovir or vehicle. Under our experimental conditions, in the absence of drug treatment we observed 50% and 60% rectal transmission by HIV-1(JRCSF) and HIV-1(THRO), respectively. Topical tenofovir reduced rectal transmission to 8% (1/12; log rank p = 0.03) for HIV-1(JRCSF) and 0% (0/6; log rank p = 0.02) for HIV-1(THRO). This is the first demonstration that any human T/F HIV-1 rectally infects humanized mice and that transmission of the T/F virus can be efficiently blocked by rectally applied 1% tenofovir. These results obtained in BLT mice, along with recent ex vivo, Phase 1 trial and non-human primate reports, provide a critically important step forward in the development of tenofovir-based rectal microbicides