An Investigation of the Rotor Tip Path Height of the MH-60S Helicopter in View of Forklift Clearance in Support of the United States Navy Medium Lift Shipboard Logistics Mission

The purpose of this paper is to summarize Department of the Navy tests performed to measure rotor tip path height of the MH-60S helicopter and present an analysis of collected data to determine if safe cargo loading operations on the MH-60S can be conducted with a forklift while the rotor is engaged. Testing was conducted to measure the dynamic height of the rotor tip path plane during incremental cyclic displacements, rotor response to external disturbances, and pilot tendencies when centering the cyclic control stick. Additional information was gathered on representative forklifts in use on U.S. Navy ships, and shipboard operating procedures for cargo movement. A comparison between the forklift and rotor heights was conducted to evaluate the clearance available for forklifts transiting the rotor arc. While it cannot be concluded that cargo loading using a forklift with the rotor engaged can be conducted without incident, substantial data were gathered that indicated that current safety precautions coupled with the clearance from the engaged rotor would allow for safe conduct of the evolution. Specifically, if operations are conducted with low profile forklifts, which have an obstruction height shorter than the average male, rotor clearance is considered sufficient to preclude catastrophic interaction between the rotor and the equipment. Additional research, safety review, and equipment and publication changes are recommended to further increase the safety of conducting these operations

Three installations: a thesis chronicle

Not listed

Evaluating the Association Between Vasopressin Use and In-Hospital Mortality in Patients with Septic Shock

Purpose/Background: The Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor in patients with septic shock to maintain a mean arterial pressure (MAP) of at least 65 mmHg. The guideline also makes a weak recommendation (2B) to use vasopressin as an adjuvant therapy to raise MAP to goal or to reduce the norepinephrine rate required to maintain the goal MAP. The recommendation is based on conflicting results of the VASST trial that showed no significant difference in 28-day all-cause mortality between patients managed with norepinephrine alone compared to norepinephrine and vasopressin. However, in subgroup analysis, the VASST trial showed mortality benefit for vasopressin in patients requiring low dose norepinephrine (5-14 mcg/min). This study will evaluate outcomes associated with the use of vasopressin in septic shock in order to validate a future protocol optimizing its utilization. Methods: A retrospective chart review conducted at Baptist Hospital of Miami. Patients admitted from January 2018 to September 2018 with septic shock were divided into two arms based on their maximum norepinephrine equivalent rate or the norepinephrine equivalent rate at the time of vasopressin initiation. Norepinephrine equivalent rates were calculated using the equation from the VASST trial. The threshold for assignment in the severe septic shock arm was a rate greater than 0.2 mcg/kg/minute. Within each arm, patients who were administered vasopressin were compared to those who were not. Pregnant patients as well as those diagnosed with cardiogenic shock or with cardiothoracic surgery during the specific admission were excluded. Patients were also excluded if they were administered vasopressor therapy for less than 12 hours total. The primary outcome was to evaluate the in-hospital mortality in patients with both less severe and severe septic shock who were treated with vasopressin. Secondary outcomes included total time on vasopressors, number of catecholamine agents required, and length of stay. Additional data collected included age, sex, weight, APACHE II score, SOFA score, lactic acid, MAP, norepinephrine equivalent dose at time of inclusion, steroid prescribing rates, midodrine prescribing rates, time to vasopressin initiation, and duration of vasopressin administration. Results: Of the 147 patients included, 53 were included in the low-dose vasopressor or less severe septic shock arm and 94 were included in the high-dose vasopressor or severe septic shock arm. For the patients in the less severe arm, 20 (38%) received vasopressin. Mean SOFA score at the time of inclusion was similar between those receiving vasopressin and those not, 7.9 and 8.1 respectively. Of the patients who received vasopressin on low-dose vasopressors, 7 (35%) expired prior to hospital discharge. This is compared to an in-hospital mortality of 6 (18%) among patients not administered vasopressin (p=0.17). The median time on vasopressors was 75 hours for patients receiving vasopressin compared to 33.4 hours for patients not administered vasopressin. For the patients in the high-dose vasopressor arm, 48 (51%) received vasopressin. Of the patients who received vasopressin with severe septic shock, 34 (70%) expired prior to hospital discharge. This is compared to an in-hospital mortality of 20 (44%) among patients not administered vasopressin (p=0.007). The median duration of vasopressor therapy was similar in each group, 76.5 hours for patients receiving vasopressin versus 74.2 hours for patients not administered vasopressin. Midodrine and steroid use was similar between groups in both arms. Discussion: Vasopressin did not result in in-hospital mortality benefit for patients with less severe or severe septic shock. Vasopressin was not associated with shorter durations of vasopressor therapy. Based on the results of this study, efforts can be made to optimize vasopressin utilization in patients with septic shock in order to maximize cost-effectiveness and clinical benefit. Future studies are required to further evaluate vasopressin use in patients with less severe septic shock

The Short-Form of the Coparenting Across Family Structures Scale (copafs-27): A Confirmatory Factor Analysis

To further refine the measurement of coparenting across family dynamics, this article presents data from 2 separately collected samples, the first consisting of 252 parents and the second consisting of 329 parents, analyzed as a pilot study of the Short-Form of the Coparenting Across Family Structures Scale (CoPAFS 27-Items). The purpose of the revised shortened tool is to further the design of an efficient and psychometrically strong tool to aid research and clinical practice with coparents. Our intent was to differentiate coparenting in intact, separated/divorced, and families where the parents were never romantically involved, between mothers and fathers, and between high- and low-income levels. This pilot test assessed psychometric properties (stability, reliability, and internal consistency) of the CoPAFS to determine whether the measure could be useful for evaluating the core dimensions of coparenting. Analyses reduced the 56-item CoPAFS scale developed from existing scales and literature to a 5-component scale of 27 items, including Respect, Trust, Valuing the other parent, Communication and Hostility. Implications for interventions and future research are briefly discussed

The Evolution of the Adductor Canal Block: The Emerging Technique for Motor-Sparing Analgesia to the Knee

This article summarizes current relevant data regarding the adductor canal block. It provides readers with background information of this emerging technique, including history, review of literature, relevant anatomy,and the technique itself

Ultrasound-Guided INTRAPEC Injection for Breast Surgery: A Novel Solution for Surgical Field Improvement During Electrocautery and Implantation and for Postoperative Pain and Muscle Spasm Reduction for Breast Surgery

This article introduces a novel ultrasound-guided injection called the INTRAPEC technique as a solution to the specific problem of intraoperative pectoral major muscle spasm during electrocautery and manipulation. The technique is a cost-effective, nonparenteral method for improving the surgical field during pectoral major isolation and subsequent implant placement. The technique may have added benefits such as a significant reduction in surgical complexity causing trauma and bleeding and significant reductions in postoperative pain and muscle spasm

Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care

Objective: To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods: Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results: No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. “Confidence in care provider” was the communication skill most frequently identified in comments both pre- and post-training. Conclusion: Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation: This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact

Integrating tobacco dependence treatment and tobacco-free standards into addiction treatment: New Jersey\u27s experience

New Jersey was the first State to require that all residential addiction treatment programs assess and treat patients for tobacco dependence and maintain tobacco-free facilities (including grounds). An evaluation of this policy change found that tobacco dependence treatment can be successfully integrated into residential substance abuse treatment programs through policy regulation, training, and the provision of nicotine replacement therapy (NRT) (Williams et al. 2005). Many other addiction treatment agencies (both residential and outpatient) around the country now have implemented or are planning to implement similar policies to ensure that their patients receive appropriate assessment and treatment of their tobacco dependence while receiving treatment for addiction to other substances. This paper aims to summarize the lessons learned from the experience in New Jersey

SOCIAL MEDIA, PUBLIC OPINION, AND RESOURCE IMPLICATIONS FOR THE UNITED STATES AIR FORCE

Social media has become a powerful force. t exerts influence by shaping the public’s perceptions of various issues, including defense-related topics. Public opinion, in turn, has effects on war, military policies, and budgets. Thus, understanding the public discourse and associated sentiment on defense-related issues and identifying the influencers in social media is important. Techniques such as text mining are a relatively inexpensive and efficient means to achieve these objectives. This study employs these techniques to empirically analyze Twitter references to the United States Air Force (USAF) over a seven-month period and provide recommendations for potential changes to current USAF social media operations

Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.

OBJECTIVE: To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN: Multicenter pragmatic parallel randomized controlled trial. SETTING: Six emergency departments in the United States. PARTICIPANTS: 898 adults (aged \u3e17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. INTERVENTIONS: Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. RESULTS: Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P CONCLUSIONS: Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240