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Is the universe fine-tuned for complexity, life, or something else? This comprehensive overview of fine-tuning arguments in physics, with contributions from leading researchers in their fields, sheds light on this often used but seldom understood topic. Each chapter reviews a specific subject in modern physics, such as dark energy, inflation, or solar system formation, and discusses whether any parameters in our current theories appear to be fine-tuned and, if so, to what degree. Connections and differences between these fine-tuning arguments are made clear, and detailed mathematical derivations of various fine-tuned parameters are given. This accessible yet precise introduction to fine-tuning in physics will aid students and researchers across astrophysics, atomic and particle physics and cosmology, as well as all those working at the intersections of physics and philosophy.
Optimal emergent management of traumatic hemorrhagic shock patients requires a better understanding of treatment provided in the prehospital/Emergency Medical Services (EMS) and emergency department (ED) settings.
Described in this research are the initial clinical status, airway management, fluid and blood infusions, and time course of severely-injured hemorrhagic shock patients in the EMS and ED settings from the diaspirin cross-linked hemoglobin (DCLHb) clinical trial.
Data were analyzed from 17 US trauma centers gathered during a randomized, controlled, single-blinded efficacy trial of a hemoglobin solution (DCLHb) as add-on therapy versus standard therapy.
Among the 98 randomized patients, the mean EMS Glasgow Coma Scale (GCS) was 10.6 (SD = 5.0), the mean EMS revised trauma score (RTS) was 6.3 (SD = 1.9), and the mean injury severity score (ISS) was 31 (SD = 17). Upon arrival to the ED, the GCS was 20% lower (7.8 (SD = 5.3) vs 9.7 (SD = 6.3)) and the RTS was 12% lower (5.3 (SD = 2.0) vs 6.0 (SD = 2.1)) than EMS values in blunt trauma patients (P < .001). By ED disposition, 80% of patients (78/98) were intubated. Rapid sequence intubation (RSI) was utilized in 77% (60/78), most often utilizing succinylcholine (65%) and midazolam (50%). The mean crystalloid volume infused was 4.2 L (SD = 3.4 L), 80% of which was infused within the ED. Emergency department blood transfusion occurred in 62% of patients, with an average transfused volume of 1.2 L (SD = 2.0 L). Blunt trauma patients received 2.1 times more total fluids (7.4 L vs 3.5 L, < .001) and 2.4 times more blood (2.4 L vs 1.0 L, P < .001). The mean time of patients taken from injury site to operating room (OR) was 113 minutes (SD = 87 minutes). Twenty-one (30%) of the 70 patients taken to the OR from the ED were sent within 60 minutes of the estimated injury time. Penetrating trauma patients were taken to the OR 52% sooner than blunt trauma patients (72 minutes vs 149 minutes, P < .001).
Both GCS and RTS decreased prior to ED arrival in blunt trauma patients. Intubation was performed using RSI, and crystalloid infusion of three times the estimated blood loss volume (L) and blood transfusion of the estimated blood loss volume (L) were provided in the EMS and ED settings. Surgical intervention for these trauma patients most often occurred more than one hour from the time of injury. Penetrating trauma patients received surgical intervention more rapidly than those with a blunt trauma mechanism.
SloanEP, KoenigsbergM, WeirWB, ClarkJM, O'ConnorR, OlingerM, CydulkaR. Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial. Prehosp Disaster Med. 2015;30(1):1-8.
The Gemini Planet Imager (GPI) is a high contrast coronagraph designed to directly image exoplanets and circumstellar disks. GPI includes a polarimetry mode designed to characterize dust grains and enhance the contrast of scattered, polarized light by a factor of 100. Reflections and birefringence of optics within the optical train induce a polarization signature that needs to be measured a priori and calibrated out during data reduction. Here we report on the results of an extensive laboratory characterization campaign of the polarimetry mode. The linear instrumental polarization has been measured in 4 GPI passbands and found to be between 3.5 ± 0.3 % at 1.0 micron and 1.1 ± 0.3 % at 2.0 microns. Modulation efficiency has been measured to be 94% at 1.0 micron increasing to 97% at 2.0 microns. Stability has been shown to better than 0.6% over timescales of ~ 3 months and over cool down cycles. The tests show that GPI passes all polarimetry design requirements and should be able to measure circumstellar disk linear polarization to 1% accuracy.
Breathable barrier textiles for both chemical agent and moisture are being actively developed for military and industrial applications. An ideal approach is to coat textiles with a semi-permeable film that allows the transport of water while still serving as a barrier for chemical agents. Sulfonated poly (styrene-block-isobutylene-block-styrene) (SIBS) copolymer spontaneously phase separates upon drying from solution to produce a nanostructured film with the controlled barrier functionality for water permeation and repelling of chemical agents.
The objective of this research is to investigate coating uniformity and phase morphology of SIBS coating materials fabricated by novel solvent combinations. Scanning electron microscopy analysis is used for the assessment of the coating uniformity as well as the level of adhesion between the polymer coating and fabric substrate. Transmission electron microscopy is used to characterize the phase separation morphology of the SIBS copolymer coating. The mechanical behavior of the coated fabric is determined through tensile and shear tests and is compared to the bare fabric behavior. The goal of this study is to relate the processing conditions of the final nanostructured block copolymer coated fabric produced on industrial scale.
Recent policy, service and financial drivers that are aimed at improving access to psychological services with a particular focus on cognitive behavioural approaches have resulted in a number local and national service planning initiatives. The extent to which these developments ought to be informed by theory and research regarding the transfer of classroom-based learning to the work setting is made clear. The existing evidence base has implications for how education providers develop collaborative curricula with NHS employers in order to prepare students for the practice setting, and for how service providers support the students' knowledge, skills development, skills transfer and consolidation of these within the practice setting. The dangers of assuming that the dissemination of the clinical evidence base is straightforward within complex organizations and the structure of the NHS are also critically discussed.
In 1953 the United States ratified the North Atlantic Treaty Organization’s Status of Forces Agreement of 1951 (SOFA), which set forth “conditions and terms which will control the status of forces sent by one state, party to the Agreement, into the territory of another state, party to the Agreement.” The drafters foresaw that the presence and training of foreign military forces within and between their territories would probably, if not inevitably, cause injury to civilians, giving rise to claims that, if not settled quickly and satisfactorily, could spark incidents disruptive to their cooperation in mutual defense. To this end, the SOFA established ajurisdictional regime designed to minimize the political friction these incidents threatened to generate, by providing prompt and manifestly fair settlement procedures. The SOFA’s jurisdictional framework protects nationals of a foreign military force from the criminal processes of the alienjurisdiction in which they reside and train, yet permits injured citizens of the host state to pursue civil damages for the tortious acts of foreign forces without fear that their claims might receive prejudicial treatment in the foreign state’s local courts.
To examine associations between heart period variability
(HPV) and psychopathology in young urban boys at risk for
delinquency, a series of 69 7–11-year-old younger
brothers of adjudicated delinquents received a standardized
psychiatric evaluation and an assessment of heart period
variability (HPV). Psychiatric symptoms were rated in two
domains: externalizing and internalizing psychopathology.
Continuous measures of both externalizing and internalizing
psychopathology were associated with reductions in HPV
components related to parasympathetic activity. These associations
could not be explained by a number of potentially confounding
variables, such as age, ethnicity, social class, body size,
or family history of hypertension. Although familial hypertension
predicted reduced HPV and externalizing psychopathology,
associations between externalizing psychopathology and
HPV were independent of familial hypertension. Psychiatric
symptoms are associated with reduced HPV in young urban
boys at risk for delinquency.
Mobile medical clinics were established by an international medical relief organization to provide health care to victims of the war in Somalia. The study's purpose was to examine the prevalence of diseases seen and the effectiveness of mobile medical clinics, and to evaluate military support in security and care provisions.
This is a descriptive case series conducted over a 6-month period. Physicians determined clinical diagnoses, and clinic personnel assigned security scores (one to five) based on: 1) crowd control; 2) the incidence of looting; and 3) threats of violence by individuals demanding treatment.
Mobile medical teams that provided health care to regions in urban and rural Somalia assisted by United States and Italian military forces.
At 149 mobile clinics, 25,265 patients were treated.
Medical treatment included dispensing medications, intravenous rehydration, and minor surgical procedures. The effectiveness of security measures was scored based on: 1) effective crowd control; 2) the lack of theft or threats of violence; and 3) the unimpaired operation of the clinic.
Medical teams treated 25,265 patients. The most common medical problems encountered were skin infections (19.5%), upper and lower respiratory tract infections (16.1%), and gastroenteritis with dehydration (7.1%). Malnutrition was seen in 4.7% of cases, and trauma accounted for only 0.7% of complaints. When military escorts were provided, the mean security score was 43% higher (4.85 ±0.46) as compared to the absence of a military escort (3.40 ±0.60) (p <0.001).
Mobile medical clinics were found to be effective in this setting despite difficult conditions, limited therapeutic modalities, and few in-patient facilities. Infectious diseases were most common, while malnutrition and trauma were less commonly seen. The cooperation of United States and Italian military forces facilitated relief efforts by maintaining security, particularly in unstable areas.
Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.
Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.
Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.
Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.
Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.
The civil war in Somalia has destroyed the medical system and left hundreds of thousands of people without access to medical care. Samaritan's Purse and World Medical Missions, two relief organizations, developed mobile medical teams to provide health care to urban and rural Somalia. Gastroenteritis with severe dehydration was encountered frequently, and difficult intravenous (TV) access presented a challenging dilemma for patients who were unable to tolerate oral or nasogastric fluid administration.
Intraperitoneal (IV) fluid infusion may be used to treat dehydration in patients with poor venous access and ongoing fluid losses.
Two mobile medical teams treated patients from 1 January to 1 April 1993. Intraperitoneal fluid infusions were given to 16 patients with severe dehydration in whom IV access was unobtainable. Children received approximately 80 ml/kg of 0.45% normal saline, and adults received 40 ml/kg of 0.9% normal saline. Patients were reexamined at one and seven days.
A total of 25,659 patients were seen in the mobile medical clinics during a 3-month period. Dehydration was diagnosed in 1,833 (7.1%) patients, and 1,203 (4.7%) patients were found to be malnourished. Sixteen patients were treated with IP fluid infusions, 14 patients (87.5%) survived, and two patients (12.5%) died, both within 24 hours. In one patient (6.3%), subcutaneous infiltration occurred without subsequent adverse effects.
This case series found that in the mobile clinic setting in Somalia, IP fluid administration improved the hydration status in patients with significant dehydration. Although IV infusion remains the treatment of choice when oral or nasogastric fluid administration is not possible, IP infusion is easily performed and may be an important alternative in disaster setting.
Personality traits in euthymic elderly subjects with and without past histories of major depressive episodes were assessed using the Structured Clinical Interview for DSM-III-R and the Social Adjustment Scale-SR. Recovered depressed subjects were characterized by significantly more personality traits from DSM-III-R Clusters B and C than controls, and they exhibited differences in social adjustment, as well. Subjects who have recovered from depressive episodes may show significant diferences in personality and social adjustment that might represent residua of past depression, a trait characteristic, or a risk factor for recurrence.
Amorphous carbon films were prepared by the ion beam deposition of methane saturated with silicon pump oil 704. The concentration of Si in the ion deposited coatings could be varied by the temperature of silicon oil bath where saturated vapor was produced. In the process, the vapor ionized at 800 V was accelerated and impinged on glass or stainless steel substrates at ion densities between 0.3–1.5 mA/cm2 for a period of less than 60 minutes. The resulting films were characterized by x-ray photoelectron and Raman spectroscopies. The elemental components of these films include carbon, oxygen and silicon with varying amounts of nitrogen, iron and tungsten contaminations. The microstructure mainly consists of tiny graphitic carbon with sp2 ordered and disordered configurations, numerous carbon-oxygen and carbon-silicon linkages. This simple unique process yields a homogeneous thin coating suitable for many tribological applications.
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