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C126838900 | Radiology | https://doi.org/10.1056/nejmoa1102873 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening | [
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] | The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. |
C126838900 | Radiology | https://doi.org/10.1056/nejmra072149 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Computed Tomography — An Increasing Source of Radiation Exposure | [
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] | The number of computed tomographic (CT) studies performed is increasing rapidly. Because CT scans involve much higher doses of radiation than plain films, we are seeing a marked increase in radiation exposure in the general population. Epidemiologic studies indicate that the radiation dose from even two or three CT scans results in a detectable increase in the risk of cancer, especially in children. This article summarizes the facts about this form of radiation exposure and the implications for public health. |
C126838900 | Radiology | https://doi.org/10.1159/000463378 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Acute Abdomen: A Rare Case of Ruptured Hepatocellular Carcinoma | [
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] | Spontaneous ruptures of hepatocellular carcinoma (HCC) are rare. Nevertheless they may lead to difficult decisions in the emergency situation. The acute therapies include conservative treatment, transarterial embolization and surgery. Curative treatment of HCC can be achieved by liver resection solely. The decision-making depends on prognostic patient’s factors, such as hepatic viral infection status, Child-Pugh grade, liver cirrhosis and number of tumors. In this case transarterial embolization was preferable as a bridging therapy prior to further diagnostics and therapy, to lower the perioperative morbidity and mortality. The therapy of these cases needs an interdisciplinary approach to choose the best possible procedure in each case. |
C126838900 | Radiology | https://doi.org/10.1056/nejm199408253310801 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease | [
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] | Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty. |
C126838900 | Radiology | https://doi.org/10.1200/jco.2013.54.8800 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification | [
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] | The purpose of this work was to modernize recommendations for evaluation, staging, and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). A workshop was held at the 11th International Conference on Malignant Lymphoma in Lugano, Switzerland, in June 2011, that included leading hematologists, oncologists, radiation oncologists, pathologists, radiologists, and nuclear medicine physicians, representing major international lymphoma clinical trials groups and cancer centers. Clinical and imaging subcommittees presented their conclusions at a subsequent workshop at the 12th International Conference on Malignant Lymphoma, leading to revised criteria for staging and of the International Working Group Guidelines of 2007 for response. As a result, fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT) was formally incorporated into standard staging for FDG-avid lymphomas. A modification of the Ann Arbor descriptive terminology will be used for anatomic distribution of disease extent, but the suffixes A or B for symptoms will only be included for HL. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. However, regardless of stage, general practice is to treat patients based on limited (stages I and II, nonbulky) or advanced (stage III or IV) disease, with stage II bulky disease considered as limited or advanced disease based on histology and a number of prognostic factors. PET-CT will be used to assess response in FDG-avid histologies using the 5-point scale. The product of the perpendicular diameters of a single node can be used to identify progressive disease. Routine surveillance scans are discouraged. These recommendations should improve evaluation of patients with lymphoma and enhance the ability to compare outcomes of clinical trials. |
C126838900 | Radiology | https://doi.org/10.1159/000347096 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | High Performance of <sup>18</sup>F-Fluorodeoxyglucose Positron Emission Tomography and Contrast-Enhanced CT in a Rapid Outpatient Diagnostic Program for Patients with Suspected Lung Cancer | [
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] | Revisions in stage grouping of the TNM subsets (T=primary tumor, N=regional lymph nodes, M=distant metastasis) in the International System for Staging Lung Cancer have been adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. These revisions were made to provide greater specificity for identifying patient groups with similar prognoses and treatment options with the least disruption of the present classification: T1N0M0, stage IA; T2N0M0, stage IB; T1N1M0, stage IIA; T2N1M0 and T3N0M0, stage IIB; and T3N1M0, T1N2M0, T2N2M0, T3N2M0, stage IIIA. The TNM subsets in stage IIIB-T4 any N M0, any T N3M0, and in stage IV-any T any N M1, remain the same. Analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5,319 patients treated for primary lung cancer confirmed the validity of the TNM and stage grouping classification schema. |
C126838900 | Radiology | https://doi.org/10.1056/nejmoa0807611 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention | [
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] | In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20).Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.) |
C126838900 | Radiology | https://doi.org/10.1097/00000658-199409000-00015 | specialty that uses medical imaging to diagnose and treat diseases seen within the body | Lymphatic Mapping and Sentinel Lymphadenectomy for Breast Cancer | [
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] | Objective The authors report the feasibility and accuracy of intraoperative lymphatic mapping with sentinel lymphadenectomy in patients with breast cancer. Summary Background Data Axillary lymph node dissection (ALND) for breast cancer generally is accepted for its staging and prognostic value, but the extent of dissection remains controversial. Blind lymph node sampling or level I dissection may miss some nodal metastases, but ALND may result in lymphedema. In melanoma, intraoperative lymph node mapping with sentinel lymphadenectomy is an effective and minimally invasive alternative to ALND for identifying nodes containing metastases. Methods One hundred seventy-four mapping procedures were performed using a vital dye injected at the primary breast cancer site. Axillary lymphatics were identified and followed to the first (“sentinel”) node, which was selectively excised before ALND. Results Sentinel nodes were identified in 114 of 174 (65.5%) procedures and accurately predicted axillary nodal status in 109 of 114 (95.6%) cases. There was a definite learning curve, and all false-negative sentinel nodes occurred in the first part of the study; sentinel nodes identified in the last 87 procedures were 100% predictive. In 16 of 42 (38.0%) clinically negative/pathologically positive axillae, the sentinel node was the only tumor-involved lymph node identified. The anatomic location of the sentinel node was examined in the 54 most recent procedures; ten cases had only level II nodal metastases that could have been missed by sampling or low (level I) axillary dissection. Conclusions This experience indicates that intraoperative lymphatic mapping can accurately identify the sentinel node–i.e., the axillary lymph node most likely to contain breast cancer metastases–in some patients. The technique could enhance staging accuracy and, with further refinements and experience, might alter the role of ALND. |
C50522688 | Economic growth | https://doi.org/10.5860/choice.44-0343 | Increase in production and consumption in an economy | Disease control priorities in developing countries | [
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] | This book is dedicated to Bill and Melinda Gates, whose vision, leadership |
C50522688 | Economic growth | https://doi.org/10.5860/choice.45-4765 | Increase in production and consumption in an economy | World development report, 2008: agriculture for development | [
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] | Agriculture is a vital development tool for achieving the Millennium Development Goal that calls for halving by 2015 the share of people suffering from extreme poverty and hunger. That is the overall message of this year's World Development Report (WDR), the 30th in the series. Three out of every four poor people in developing countries live in rural areas, and most of them depend directly or indirectly on agriculture for their livelihoods. This report provides guidance to governments and the international community on designing and implementing agriculture for development agendas that can make a difference in the lives of hundreds of millions of rural poor. The report highlights two major regional challenges. In much of Sub-Saharan Africa, agriculture is a strong option for spurring growth, overcoming poverty, and enhancing food security. Agricultural productivity growth is vital for stimulating growth in other parts of the economy. But accelerated growth requires a sharp productivity increase in smallholder farming combined with more effective support to the millions coping as subsistence farmers, many of them in remote areas. Recent improved performance holds promise, and this report identifies many emerging successes that can be scaled up. In Asia, overcoming widespread poverty requires confronting widening rural-urban income disparities. Asia's fast-growing economies remain home to over 600 million rural people living in extreme poverty, and despite massive rural-urban migration, rural poverty will remain dominant for several more decades. For this reason, the WDR focuses on ways to generate rural jobs by diversifying into labor intensive, high value agriculture linked to a dynamic rural, non-farm sector. In all regions, with rising land and water scarcity and the added pressures of a globalizing world, the future of agriculture is intrinsically tied to better stewardship of natural resources. With the right incentives and investments, agriculture's environmental footprint can be lightened and environmental services harnessed to protect watersheds and biodiversity. |
C50522688 | Economic growth | https://doi.org/10.1073/pnas.0610172104 | Increase in production and consumption in an economy | Growth, innovation, scaling, and the pace of life in cities | [
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] | Humanity has just crossed a major landmark in its history with the majority of people now living in cities. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also its main source of crime, pollution, and disease. The inexorable trend toward urbanization worldwide presents an urgent challenge for developing a predictive, quantitative theory of urban organization and sustainable development. Here we present empirical evidence indicating that the processes relating urbanization to economic development and knowledge creation are very general, being shared by all cities belonging to the same urban system and sustained across different nations and times. Many diverse properties of cities from patent production and personal income to electrical cable length are shown to be power law functions of population size with scaling exponents, β, that fall into distinct universality classes. Quantities reflecting wealth creation and innovation have β ≈1.2 >1 (increasing returns), whereas those accounting for infrastructure display β ≈0.8 <1 (economies of scale). We predict that the pace of social life in the city increases with population size, in quantitative agreement with data, and we discuss how cities are similar to, and differ from, biological organisms, for which β<1. Finally, we explore possible consequences of these scaling relations by deriving growth equations, which quantify the dramatic difference between growth fueled by innovation versus that driven by economies of scale. This difference suggests that, as population grows, major innovation cycles must be generated at a continually accelerating rate to sustain growth and avoid stagnation or collapse. |
C50522688 | Economic growth | https://doi.org/10.1257/jel.50.4.1051 | Increase in production and consumption in an economy | Women Empowerment and Economic Development | [
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] | Women empowerment and economic development are closely related: in one direction, development alone can play a major role in driving down inequality between men and women; in the other direction, empowering women may benefit development. Does this imply that pushing just one of these two levers would set a virtuous circle in motion? This paper reviews the literature on both sides of the empowerment—development nexus, and argues that the interrelationships are probably too weak to be self-sustaining, and that continuous policy commitment to equality for its own sake may be needed to bring about equality between men and women. (JEL I14, I24, I32, I38, J13, J16, O15) |
C50522688 | Economic growth | https://doi.org/10.1093/eurpub/ckv043 | Increase in production and consumption in an economy | Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU) | [
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] | Background : Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. M ethods : The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain ( n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. R esults : The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion : Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe. |
C50522688 | Economic growth | https://doi.org/10.1080/09620214.2011.616348 | Increase in production and consumption in an economy | The precariat: the new dangerous class | [
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] | by Guy Standing, London, Bloomsbury, 2011, 198 pp., £19.99 (paperback), ISBN 978-1849663519, £57 (hardback), ISBN 9781849663519 Guy Standing’s challenging new book The precariat seeks to explain th... |
C50522688 | Economic growth | https://doi.org/10.1136/jech-2020-214401 | Increase in production and consumption in an economy | The COVID-19 pandemic and health inequalities | [
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] | This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics-drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations. |
C50522688 | Economic growth | https://doi.org/10.1016/s0140-6736(20)30526-2 | Increase in production and consumption in an economy | COVID-19: the gendered impacts of the outbreak | [
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] | Policies and public health efforts have not addressed the gendered impacts of disease outbreaks.1Smith J Overcoming the "tyranny of the urgent": integrating gender into disease outbreak preparedness and response.Gender Develop. 2019; 27: 355-369Crossref Scopus (139) Google Scholar The response to coronavirus disease 2019 (COVID-19) appears no different. We are not aware of any gender analysis of the outbreak by global health institutions or governments in affected countries or in preparedness phases. Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions. Although sex-disaggregated data for COVID-19 show equal numbers of cases between men and women so far, there seem to be sex differences in mortality and vulnerability to the disease.2The Novel Coronavirus Pneumonia Emergency Response Epidemiology TeamThe epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVD-19).China CDC Weekly. 2020; 2: 113-122Google Scholar Emerging evidence suggests that more men than women are dying, potentially due to sex-based immunological3Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet. 2020; 395: 507-513Summary Full Text Full Text PDF PubMed Scopus (14366) Google Scholar or gendered differences, such as patterns and prevalence of smoking.4Liu S Zhang M Yang L et al.Prevalence and patterns of tobacco smoking among Chinese adult men and women: findings of the 2010 national smoking survey.J Epidemiol Community Health. 2017; 71: 154-161Crossref PubMed Scopus (191) Google Scholar However, current sex-disaggregated data are incomplete, cautioning against early assumptions. Simultaneously, data from the State Council Information Office in China suggest that more than 90% of health-care workers in Hubei province are women, emphasising the gendered nature of the health workforce and the risk that predominantly female health workers incur.5Boniol M McIsaac M Xu L Wuliji T Diallo K Campbell J Gender equity in the health workforce: analysis of 104 countries: Working Paper 1. World Health Organization, Geneva2019Google Scholar The closure of schools to control COVID-19 transmission in China, Hong Kong, Italy, South Korea, and beyond might have a differential effect on women, who provide most of the informal care within families, with the consequence of limiting their work and economic opportunities. Travel restrictions cause financial challenges and uncertainty for mostly female foreign domestic workers, many of whom travel in southeast Asia between the Philippines, Indonesia, Hong Kong, and Singapore.6Carvalho R Cheung E Siu P Coronavirus: Hong Kong families await return of thousands of stranded domestic helpers as the Philippines lifts travel ban.South China Morning Post. Feb 18, 2020; Google Scholar Consideration is further needed of the gendered implications of quarantine, such as whether women and men's different physical, cultural, security, and sanitary needs are recognised. Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender and health equity goals. During the 2014–16 west African outbreak of Ebola virus disease, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers.7Davies SE Bennett B A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies.Int Aff. 2016; 92: 1041-1060Crossref Scopus (184) Google Scholar Women were less likely than men to have power in decision making around the outbreak, and their needs were largely unmet.8Harman S Ebola, gender and conspicuously invisible women in global health governance.Third World Quart. 2016; 37: 524-541Crossref Scopus (120) Google Scholar For example, resources for reproductive and sexual health were diverted to the emergency response, contributing to a rise in maternal mortality in a region with one of the highest rates in the world.9Sochas L Channon AA Nam S Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone.Health Policy Plan. 2017; 32: iii32-iii39Crossref PubMed Scopus (170) Google Scholar During the Zika virus outbreak, differences in power between men and women meant that women did not have autonomy over their sexual and reproductive lives,10Wenham C Arevalo A Coast E et al.Zika, abortion and health emergencies: a review of contemporary debates.Global Health. 2019; 15: 49Crossref PubMed Scopus (37) Google Scholar which was compounded by their inadequate access to health care and insufficient financial resources to travel to hospitals for check-ups for their children, despite women doing most of the community vector control activities.11Wenham C Nunes J Correa Matta G de Oliveira Nogueira C Aparecida Valente P Pimenta DN Gender mainstreaming as a pathway for sustainable arbovirus control in Latin America.PLoS Negl Trop Dis. 2020; 14e0007954Crossref PubMed Scopus (22) Google Scholar Given their front-line interaction with communities, it is concerning that women have not been fully incorporated into global health security surveillance, detection, and prevention mechanisms. Women's socially prescribed care roles typically place them in a prime position to identify trends at the local level that might signal the start of an outbreak and thus improve global health security. Although women should not be further burdened, particularly considering much of their labour during health crises goes underpaid or unpaid, incorporating women's voices and knowledge could be empowering and improve outbreak preparedness and response. Despite the WHO Executive Board recognising the need to include women in decision making for outbreak preparedness and response,12WHOExecutive Board EB146/Conf/17: strengthening preparedness for health emergencies; implementation of International Health Regulations, IHR (2005). World Health Organization, Geneva2020Google Scholar there is inadequate women's representation in national and global COVID-19 policy spaces, such as in the White House Coronavirus Task Force.13The Economic TimesIndian-American Seema Verma appointed as key member of US COVID-19 Task Force.The Economic Times. March 3, 2020; Google Scholar If the response to disease outbreaks such as COVID-19 is to be effective and not reproduce or perpetuate gender and health inequities, it is important that gender norms, roles, and relations that influence women's and men's differential vulnerability to infection, exposure to pathogens, and treatment received, as well as how these may differ among different groups of women and men, are considered and addressed. We call on governments and global health institutions to consider the sex and gender effects of the COVID-19 outbreak, both direct and indirect, and conduct an analysis of the gendered impacts of the multiple outbreaks, incorporating the voices of women on the front line of the response to COVID-19 and of those most affected by the disease within preparedness and response policies or practices going forward. We declare no competing interests. Maintaining a gendered perspective in scientific meetings during the COVID-19 pandemicSeveral studies have pointed towards the COVID-19 pandemic's potential to negatively affect career paths of women in science.1,2 Although the impact on manuscript submissions and publications, as one career path mechanism, has been well documented,3 an area that is often difficult to elucidate as part of the mechanisms underlying differential progress of male and female researchers is that of invitations to give scientific talks and to chair scientific meetings. Here, the merit of such an invitation is not always transparent or as easy to assess as a publication record. Full-Text PDF |
C24890656 | Acoustics | https://doi.org/10.1121/1.1907229 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | Some Experiments on the Recognition of Speech, with One and with Two Ears | [
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] | This paper describes a number of objective experiments on recognition, concerning particularly the relation between the messages received by the two ears. Rather than use steady tones or clicks (frequency or time-point signals) continuous speech is used, and the results interpreted in the main statistically. Two types of test are reported: (a) the behavior of a listener when presented with two speech signals simultaneously (statistical filtering problem) and (b) behavior when different speech signals are presented to his two ears. |
C24890656 | Acoustics | https://doi.org/10.1121/1.408434 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | <i>Auditory Scene Analysis: The Perceptual Organization of Sound</i> | [
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C24890656 | Acoustics | https://doi.org/10.1121/1.1906875 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | Control Methods Used in a Study of the Vowels | [
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] | Relationships between a listener's identification of a spoken vowel and its properties as revealed from acoustic measurement of its sound wave have been a subject of study by many investigators. Both the utterance and the identification of a vowel depend upon the language and dialectal backgrounds and the vocal and auditory characteristics of the individuals concerned. The purpose of this paper is to discuss some of the control methods that have been used in the evaluation of these effects in a vowel study program at Bell Telephone Laboratories. The plan of the study, calibration of recording and measuring equipment, and methods for checking the performance of both speakers and listeners are described. The methods are illustrated from results of tests involving some 76 speakers and 70 listeners. |
C24890656 | Acoustics | https://doi.org/10.1109/58.139123 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | Calculation of pressure fields from arbitrarily shaped, apodized, and excited ultrasound transducers | [
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] | A method for simulation of pulsed pressure fields from arbitrarily shaped, apodized and excited ultrasound transducers is suggested. It relies on the Tupholme-Stepanishen method for calculating pulsed pressure fields, and can also handle the continuous wave and pulse-echo case. The field is calculated by dividing the surface into small rectangles and then Summing their response. A fast calculation is obtained by using the far-field approximation. Examples of the accuracy of the approach and actual calculation times are given. |
C24890656 | Acoustics | https://doi.org/10.1115/1.3269197 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | Acoustics: An Introduction to Its Physical Principles and Applications | [
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] | My Personal Review: Texts on acoustics approach the subject from many different angles and at many different levels. Pierce's text is classic, rigorous and complete. It should serve the needs of serious students of acoustics for a variety of purposes musical acoustics and sound are my particular perspective.Some writers cater their approach to electrical engineers or to mechanical engineers, assuming that by tieing everything to those disciplines they will make the effort easier for their readers. This may serve well those who come from those disciplines, but may not serve others well and may not serve all applications of acoustics equally well either. Pierce does not do so. His approach is rigorously mathematical and pure, going to the heart of the matter, rather than one of attempting to cut corners by making analogies to other fields that you may or may not know.The book is not for the faint of heart or the mildly curious, it is deep and demanding. But he organizes it superbly and writes intelligently with a wonderful way of integrating the history and development of the science, and the graphics are exceptionally clear and communicative.Highly recommended for the very serious about this subject. My favorite among the books I have consulted. |
C24890656 | Acoustics | https://doi.org/10.1121/1.424266 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | <i>Principles of Voice Production</i> | [
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] | First Page |
C24890656 | Acoustics | https://doi.org/10.1152/physrev.2001.81.3.1305 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | Mechanics of the Mammalian Cochlea | [
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] | In mammals, environmental sounds stimulate the auditory receptor, the cochlea, via vibrations of the stapes, the innermost of the middle ear ossicles. These vibrations produce displacement waves that travel on the elongated and spirally wound basilar membrane (BM). As they travel, waves grow in amplitude, reaching a maximum and then dying out. The location of maximum BM motion is a function of stimulus frequency, with high-frequency waves being localized to the “base” of the cochlea (near the stapes) and low-frequency waves approaching the “apex” of the cochlea. Thus each cochlear site has a characteristic frequency (CF), to which it responds maximally. BM vibrations produce motion of hair cell stereocilia, which gates stereociliar transduction channels leading to the generation of hair cell receptor potentials and the excitation of afferent auditory nerve fibers. At the base of the cochlea, BM motion exhibits a CF-specific and level-dependent compressive nonlinearity such that responses to low-level, near-CF stimuli are sensitive and sharply frequency-tuned and responses to intense stimuli are insensitive and poorly tuned. The high sensitivity and sharp-frequency tuning, as well as compression and other nonlinearities (two-tone suppression and intermodulation distortion), are highly labile, indicating the presence in normal cochleae of a positive feedback from the organ of Corti, the “cochlear amplifier.” This mechanism involves forces generated by the outer hair cells and controlled, directly or indirectly, by their transduction currents. At the apex of the cochlea, nonlinearities appear to be less prominent than at the base, perhaps implying that the cochlear amplifier plays a lesser role in determining apical mechanical responses to sound. Whether at the base or the apex, the properties of BM vibration adequately account for most frequency-specific properties of the responses to sound of auditory nerve fibers. |
C24890656 | Acoustics | https://doi.org/10.1088/0960-1317/17/7/007 | science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound | A micro electromagnetic generator for vibration energy harvesting | [
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] | Vibration energy harvesting is receiving a considerable amount of interest as a means for powering wireless sensor nodes. This paper presents a small (component volume 0.1 cm3, practical volume 0.15 cm3) electromagnetic generator utilizing discrete components and optimized for a low ambient vibration level based upon real application data. The generator uses four magnets arranged on an etched cantilever with a wound coil located within the moving magnetic field. Magnet size and coil properties were optimized, with the final device producing 46 µW in a resistive load of 4 kΩ from just 0.59 m s−2 acceleration levels at its resonant frequency of 52 Hz. A voltage of 428 mVrms was obtained from the generator with a 2300 turn coil which has proved sufficient for subsequent rectification and voltage step-up circuitry. The generator delivers 30% of the power supplied from the environment to useful electrical power in the load. This generator compares very favourably with other demonstrated examples in the literature, both in terms of normalized power density and efficiency. |
C8010536 | Crystallography | https://doi.org/10.1107/s2053229614024218 | study of crystals | Crystal structure refinement with<i>SHELXL</i> | [
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] | The improvements in the crystal structure refinement program SHELXL have been closely coupled with the development and increasing importance of the CIF (Crystallographic Information Framework) format for validating and archiving crystal structures. An important simplification is that now only one file in CIF format (for convenience, referred to simply as `a CIF') containing embedded reflection data and SHELXL instructions is needed for a complete structure archive; the program SHREDCIF can be used to extract the .hkl and .ins files required for further refinement with SHELXL . Recent developments in SHELXL facilitate refinement against neutron diffraction data, the treatment of H atoms, the determination of absolute structure, the input of partial structure factors and the refinement of twinned and disordered structures. SHELXL is available free to academics for the Windows, Linux and Mac OS X operating systems, and is particularly suitable for multiple-core processors. |
C8010536 | Crystallography | https://doi.org/10.1107/s2053273314026370 | study of crystals | <i>SHELXT</i>– Integrated space-group and crystal-structure determination | [
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] | The new computer program SHELXT employs a novel dual-space algorithm to solve the phase problem for single-crystal reflection data expanded to the space group P 1. Missing data are taken into account and the resolution extended if necessary. All space groups in the specified Laue group are tested to find which are consistent with the P 1 phases. After applying the resulting origin shifts and space-group symmetry, the solutions are subject to further dual-space recycling followed by a peak search and summation of the electron density around each peak. Elements are assigned to give the best fit to the integrated peak densities and if necessary additional elements are considered. An isotropic refinement is followed for non-centrosymmetric space groups by the calculation of a Flack parameter and, if appropriate, inversion of the structure. The structure is assembled to maximize its connectivity and centred optimally in the unit cell. SHELXT has already solved many thousand structures with a high success rate, and is optimized for multiprocessor computers. It is, however, unsuitable for severely disordered and twinned structures because it is based on the assumption that the structure consists of atoms. |
C8010536 | Crystallography | https://doi.org/10.1073/pnas.0502848102 | study of crystals | Two-dimensional atomic crystals | [
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] | We report free-standing atomic crystals that are strictly 2D and can be viewed as individual atomic planes pulled out of bulk crystals or as unrolled single-wall nanotubes. By using micromechanical cleavage, we have prepared and studied a variety of 2D crystals including single layers of boron nitride, graphite, several dichalcogenides, and complex oxides. These atomically thin sheets (essentially gigantic 2D molecules unprotected from the immediate environment) are stable under ambient conditions, exhibit high crystal quality, and are continuous on a macroscopic scale. |
C8010536 | Crystallography | https://doi.org/10.1126/science.280.5360.69 | study of crystals | The Structure of the Potassium Channel: Molecular Basis of K <sup>+</sup> Conduction and Selectivity | [
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] | The potassium channel from Streptomyces lividans is an integral membrane protein with sequence similarity to all known K + channels, particularly in the pore region. X-ray analysis with data to 3.2 angstroms reveals that four identical subunits create an inverted teepee, or cone, cradling the selectivity filter of the pore in its outer end. The narrow selectivity filter is only 12 angstroms long, whereas the remainder of the pore is wider and lined with hydrophobic amino acids. A large water-filled cavity and helix dipoles are positioned so as to overcome electrostatic destabilization of an ion in the pore at the center of the bilayer. Main chain carbonyl oxygen atoms from the K + channel signature sequence line the selectivity filter, which is held open by structural constraints to coordinate K + ions but not smaller Na + ions. The selectivity filter contains two K + ions about 7.5 angstroms apart. This configuration promotes ion conduction by exploiting electrostatic repulsive forces to overcome attractive forces between K + ions and the selectivity filter. The architecture of the pore establishes the physical principles underlying selective K + conduction. |
C8010536 | Crystallography | https://doi.org/10.1126/science.aaa5760 | study of crystals | Electron-hole diffusion lengths > 175 μm in solution-grown CH <sub>3</sub> NH <sub>3</sub> PbI <sub>3</sub> single crystals | [
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] | Balanced carrier diffusion in perovskites The efficient operation of solar cells based on inorganic-organic perovskites requires balanced transport of positive and negative charge carriers over long distances. Dong et al. used a top-seeded solution growth method to obtain millimeter-scale single crystals of the organolead trihalide perovskite CH 3 NH 3 PbI 3 . Under low light illumination, the electron and hole diffusion lengths exceeded 3 mm, and under full sunlight illumination, they exceeded 175 µm. Science , this issue p. 967 |
C8010536 | Crystallography | https://doi.org/10.1107/s0907444904011679 | study of crystals | <i>PRODRG</i>: a tool for high-throughput crystallography of protein–ligand complexes | [
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] | The small-molecule topology generator PRODRG is described, which takes input from existing coordinates or various two-dimensional formats and automatically generates coordinates and molecular topologies suitable for X-ray refinement of protein–ligand complexes. Test results are described for automatic generation of topologies followed by energy minimization for a subset of compounds from the Cambridge Structural Database, which shows that, within the limits of the empirical GROMOS87 force field used, structures with good geometries are generated. X-ray refinement in X-PLOR/CNS, REFMAC and SHELX using PRODRG-generated topologies produces results comparable to refinement with topologies from the standard libraries. However, tests with distorted starting coordinates show that PRODRG topologies perform better, both in terms of ligand geometry and of crystallographic R factors. |
C8010536 | Crystallography | https://doi.org/10.1103/physrev.100.564 | study of crystals | Theory of the Role of Covalence in the Perovskite-Type Manganites<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline"><mml:mo>[</mml:mo><mml:mi mathvariant="normal">La</mml:mi><mml:mo>,</mml:mo><mml:mi> </mml:mi><mml:mi>M</mml:mi><mml:mo>(</mml:mo><mml:mi mathvariant="normal">II</mml:mi><mml:mo>)</mml:mo><mml:mo>]</mml:mo><mml:mi mathvariant="normal">Mn</mml:mi><mml:mrow><mml:msub><mml:mrow><mml:mi mathvariant="normal">O</mml:mi></mml:mrow><mml:mrow><mml:mn>3</mml:mn></mml:… | [
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] | The theory of semicovalent exchange is reviewed and applied to the perovskite-type manganites $[\mathrm{La}, M(\mathrm{II})]\mathrm{Mn}{\mathrm{O}}_{3}$. With the hypothesis of covalent and semicovalent bonding between the oxygen and manganese ions plus the mechanism of double exchange, detailed qualitative predictions are made about the magnetic lattice, the crystallographic lattice, the electrical resistivity, and the Curie temperature as functions of the fraction of ${\mathrm{Mn}}^{4+}$ present. These predictions are found to be in accord with recent findings from neutron-diffraction and x-ray data as well as with the earlier experiments on this system by Jonker and van Santen. |
C8010536 | Crystallography | https://doi.org/10.1159/000350122 | study of crystals | Evidence for the Formation of Symmetric and Asymmetric DLPC-DAPC Lipid Bilayer Domains | [
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] | Background/Aims: We investigated if mixtures of the phosphatidylcholine (PC) lipids 1,2-dilauroyl-sn-glycero-3-phosphocholine (C12:0 PC; DLPC) and 1,2-diarachidoyl-sn-glycero-3-phosphocholine (C20:0 PC; DAPC), which differ by eight methylene groups in acyl chain length, lead to the spontaneous formation of distinct lipid rafts and asymmetric bilayers. Methods: The experiments were performed using Atomic Force Microscopy (AFM). Results: We show that DLPC and DAPC mixed at a molar ratio of 1:1 lead to the formation of single, double and triple bilayers with peaks at 6.14 ± 0.11, 13.27 ± 0.17 and 20.54 ± 0.46 nm, respectively (n=750). Within these formations discrete height steps of 0.92 nm can be resolved (n=422). Conclusion: The most frequently observed height steps value of 0.92 nm matches best with the calculated mean lipid hydrophobic thickness difference for asymmetric C12:0 PC and C20:0 PC lipid bilayers of 0.88 nm. This indicates the ability of DLPC and DAPC to form asymmetric lipid bilayers. |
C124952713 | Literature | https://doi.org/10.1525/rep.2009.108.1.1 | polysemous term referring to a written art form, and the set of literary work | Surface Reading: An Introduction | [
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] | In the text-based disciplines, psychoanalysis and Marxism have had a major influence on how we read, and this has been expressed most consistently in the practice of symptomatic reading, a mode of interpretation that assumes that a text's truest meaning lies in what it does not say, describes textual surfaces as superfluous, and seeks to unmask hidden meanings. For symptomatic readers, texts possess meanings that are veiled, latent, all but absent if it were not for their irrepressible and recurring symptoms. Noting the recent trend away from ideological demystification, this essay proposes various modes of "surface reading" that together strive to accurately depict the truth to which a text bears witness. Surface reading broadens the scope of critique to include the kinds of interpretive activity that seek to understand the complexity of literary surfaces---surfaces that have been rendered invisible by symptomatic reading. |
C124952713 | Literature | https://doi.org/10.1017/cbo9780511816932 | polysemous term referring to a written art form, and the set of literary work | The Cambridge Introduction to Narrative | [
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] | What is narrative? How does it work and how does it shape our lives and the texts we read? H. Porter Abbott emphasizes that narrative is found not just in literature, film, and theater, but everywhere in the ordinary course of people's lives. This widely used introduction, now thoroughly revised, is informed throughout by recent developments in the field and includes two new chapters. With its lucid exposition of concepts and suggestions for further reading, this book is not only an excellent introduction for courses focused on narrative but also an invaluable resource for students and scholars across a wide range of fields, including literature and drama, film and media, society and politics, journalism, autobiography, history, and still others throughout the arts, humanities, and social sciences. |
C124952713 | Literature | https://doi.org/10.1017/9781108913928 | polysemous term referring to a written art form, and the set of literary work | The Cambridge Introduction to Narrative | [
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] | What is narrative? How does it work and how does it shape our lives? H. Porter Abbott emphasizes that narrative is found not just in literature, film, and theatre, but everywhere in the ordinary course of people's lives. This widely used introduction, now revised and expanded in its third edition, is informed throughout by recent developments in the field and includes one new chapter. The glossary and bibliography have been expanded, and new sections explore unnatural narrative, retrograde narrative, reader-resistant narratives, intermedial narrative, narrativity, and multiple interpretation. With its lucid exposition of concepts, and suggestions for further reading, this book is not only an excellent introduction for courses focused on narrative but also an invaluable resource for students and scholars across a wide range of fields, including literature and drama, film and media, society and politics, journalism, autobiography, history, and still others throughout the arts, humanities, and social sciences. |
C124952713 | Literature | https://doi.org/10.1093/0198261829.001.0001 | polysemous term referring to a written art form, and the set of literary work | The Apocryphal New Testament | [
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] | Abstract An English translation of the oldest and most important early Christian non‐canonical writings. It is based on the earlier collection edited in 1924 by Montague Rhodes James. The book is divided into the conventional categories of gospels, acts, epistles, and revelatory texts. A long subsection deals with stories of Jesus’ infancy and childhood. Another section deals with fragmentary gospel texts on papyrus. The bulk of the book is given over to second‐century legends of individual apostles. Another section covers apocryphal acpocalypses. An appendix gives a selection of stories about the Virgin Mary's assumption and dormition. Each translated text is prefaced with an introduction and select bibliography. Full indexes of citations and themes are provided. |
C124952713 | Literature | https://doi.org/10.5860/choice.30-4108 | polysemous term referring to a written art form, and the set of literary work | Madness and modernism: insanity in the light of modern art, literature, and thought | [
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] | The similarities between madness and modernism are striking: defiance of authority, nihilism, extreme relativism, distortions of time, strange transformations of self, and much more. In this book, Louis Sass, a clinical psychologist, offers a new vision of schizophrenia, comparing it with the works of such artists and writers as Kafka, Beckett, and Duchamp and philosophers including Nietzsche, Heidegger, Foucault and Derrida. It provides a portrait of the world of the madman, along with a commentary on modernist and postmodernist culture. |
C124952713 | Literature | https://doi.org/10.11157/ogs-vol2id73 | polysemous term referring to a written art form, and the set of literary work | Glossary of Literary Terms - A | [
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C124952713 | Literature | https://doi.org/10.5860/choice.29-2135 | polysemous term referring to a written art form, and the set of literary work | Doctors' stories: the narrative structure of medical knowledge | [
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] | Reviewsat the same time fundamental public criticism of it and a need for alternative therapies (cf.pp. 31 9f. |
C124952713 | Literature | https://doi.org/10.5860/choice.44-1370 | polysemous term referring to a written art form, and the set of literary work | The language of the gods in the world of men: Sanskrit, culture, and power in premodern India | [
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] | List of Maps Preface and Acknowledgments Introduction Culture, Power, (Pre)modernity The Cosmopolitan in Theory and Practice The Vernacular in Theory and Practice Theory, Metatheory, Practice, Metapractice PART 1. THE SANSKRIT COSMOPOLIS Chapter 1. The Language of the Gods Enters the World 1.1 Precosmopolitan Sanskrit: Monopolization and Ritualization 1.2 From Resistance to Appropriation 1.3. Expanding the Prestige Economy of Sanskrit Chapter 2. Literature and the Cosmopolitan Language of Literature 2.1. From Liturgy to Literature 2.2. Literary Language as a Closed Set 2.3. The Final Theory of Literary Language: Bhoja's Poetics Chapter 3. The World Conquest and Regime of the Cosmopolitan Style 3.1. Inscribing Political Will in Sanskrit 3.2. The Semantics of Inscriptional Discourse: The Poetics of Power, Malava, 1141 3.3. The Pragmatics of Inscriptional Discourse: Making History, Kalyana, 1008 Chapter 4. Sanskrit Culture as Courtly Practice 4.1. Grammatical and Political Correctness: The Politics of Grammar 4.2. Grammatical and Political Correctness: Grammar Envy 4.3. Literature and Kingly Virtuosity Chapter 5. The Map of Sanskrit Knowledge and the Discourse on the Ways of Literature 5.1. The Geocultural Matrix of Sanskrit Knowledge 5.2. Poetry Man, Poetics Woman, and the Birth-Space of Literature 5.3. The Ways of Literature: Tradition, Method, and Stylistic Regions Chapter 6. Political Formations and Cultural Ethos 6.1. Production and Reproduction of Epic Space 6.2. Power and Culture in a Cosmos Chapter 7. A European Countercosmopolis 7.1. Latinitas 7.2. Imperium Romanum PART 2. THE VERNACULAR MILLENIUM Chapter 8. Beginnings, Textualization, Superposition 8.1. Literary Newness Enters the World 8.2. From Language to Text 8.3. There Is No Parthenogenesis in Culture Chapter 9. Creating a Regional World: The Case of Kannada 9.1. Vernacularization and Political Inscription 9.2. The Way of the King of Poets and the Places of Poetry 9.3. Localizing the Universal Political: Pampa Bharatam 9.4. A New Philology: From Norm-Bound Practice to Practice-Bound Norm Chapter 10. Vernacular Poetries and Polities in Southern Asia 10.1. The Cosmopolitan Vernacularization of South and Southeast Asia 10.2. Region and Reason 10.3. Vernacular Polities 10.4. Religion and Vernacularization Chapter 11. Europe Vernacularized 11.1. Literacy and Literature 11.2. Vernacular Anxiety 11.3. A New Cultural Politics Chapter 12. Comparative and Connective Vernacularization 12.1. European Particularism and Indian Difference 12.2. A Hard History of the Vernacular Millennium PART 3. THEORY AND PRACTICE OF CULTURE AND POWER Chapter 13. Actually Existing Theory and Its Discontents 13.1. Natural Histories of Culture-Power 13.2. Primordialism, Linguism, Ethnicity, and Other Unwarranted Generalizations 13.3. Legitimation, Ideology, and Related Functionalisms Chapter 14. Indigenism and Other Culture-Power Concepts of Modernity 14.1. Civilizationalism, or Indigenism with Too Little History 14.2. Nationalism, or Indigenism with Too Much History Epilogue. From Cosmopolitan-or-Vernacular to Cosmopolitan-and-Vernacular Appendix A A.1 Bhoja's Theory of Literary Language (from the Srngaraprakasa) A. 2 Bhoja's Theory of Ornamentation (from the Sarasvatikanthabharana) A.3 Sripala's Bilpank Prasasti of King Jayasimha Siddharaja A.4 The Origins of Hemacandra's Grammar (from Prabhacandra's Prabhavakacarita) A.5 The Invention of Kavya (from Rjaekhara's Kavyamimamsa) Appendix B B.1 Approximate Dates of Principal Dynasties B.2 Names of Important Peoples and Places with Their Approximate Modern Equivalents or Locations Publication History Bibliography Index |
C42360764 | Chemical engineering | https://doi.org/10.1351/pac198557040603 | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Reporting physisorption data for gas/solid systems with special reference to the determination of surface area and porosity (Recommendations 1984) | [
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C42360764 | Chemical engineering | https://doi.org/10.1126/science.1147241 | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Mussel-Inspired Surface Chemistry for Multifunctional Coatings | [
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] | We report a method to form multifunctional polymer coatings through simple dip-coating of objects in an aqueous solution of dopamine. Inspired by the composition of adhesive proteins in mussels, we used dopamine self-polymerization to form thin, surface-adherent polydopamine films onto a wide range of inorganic and organic materials, including noble metals, oxides, polymers, semiconductors, and ceramics. Secondary reactions can be used to create a variety of ad-layers, including self-assembled monolayers through deposition of long-chain molecular building blocks, metal films by electroless metallization, and bioinert and bioactive surfaces via grafting of macromolecules. |
C42360764 | Chemical engineering | https://doi.org/10.1038/srep00591 | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Lead Iodide Perovskite Sensitized All-Solid-State Submicron Thin Film Mesoscopic Solar Cell with Efficiency Exceeding 9% | [
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] | We report on solid-state mesoscopic heterojunction solar cells employing nanoparticles (NPs) of methyl ammonium lead iodide (CH3NH3)PbI3 as light harvesters. The perovskite NPs were produced by reaction of methylammonium iodide with PbI2 and deposited onto a submicron-thick mesoscopic TiO2 film, whose pores were infiltrated with the hole-conductor spiro-MeOTAD. Illumination with standard AM-1.5 sunlight generated large photocurrents (JSC) exceeding 17 mA/cm2, an open circuit photovoltage (VOC) of 0.888 V and a fill factor (FF) of 0.62 yielding a power conversion efficiency (PCE) of 9.7%, the highest reported to date for such cells. Femto second laser studies combined with photo-induced absorption measurements showed charge separation to proceed via hole injection from the excited (CH3NH3)PbI3 NPs into the spiro-MeOTAD followed by electron transfer to the mesoscopic TiO2 film. The use of a solid hole conductor dramatically improved the device stability compared to (CH3NH3)PbI3 -sensitized liquid junction cells. |
C42360764 | Chemical engineering | https://doi.org/10.1073/pnas.0602439103 | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Exceptional chemical and thermal stability of zeolitic imidazolate frameworks | [
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] | Twelve zeolitic imidazolate frameworks (ZIFs; termed ZIF-1 to -12) have been synthesized as crystals by copolymerization of either Zn(II) (ZIF-1 to -4, -6 to -8, and -10 to -11) or Co(II) (ZIF-9 and -12) with imidazolate-type links. The ZIF crystal structures are based on the nets of seven distinct aluminosilicate zeolites: tetrahedral Si(Al) and the bridging O are replaced with transition metal ion and imidazolate link, respectively. In addition, one example of mixed-coordination imidazolate of Zn(II) and In(III) (ZIF-5) based on the garnet net is reported. Study of the gas adsorption and thermal and chemical stability of two prototypical members, ZIF-8 and -11, demonstrated their permanent porosity (Langmuir surface area = 1,810 m(2)/g), high thermal stability (up to 550 degrees C), and remarkable chemical resistance to boiling alkaline water and organic solvents. |
C42360764 | Chemical engineering | https://doi.org/10.1021/ja407115p | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Benchmarking Heterogeneous Electrocatalysts for the Oxygen Evolution Reaction | [
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] | Objective evaluation of the activity of electrocatalysts for water oxidation is of fundamental importance for the development of promising energy conversion technologies including integrated solar water-splitting devices, water electrolyzers, and Li-air batteries. However, current methods employed to evaluate oxygen-evolving catalysts are not standardized, making it difficult to compare the activity and stability of these materials. We report a protocol for evaluating the activity, stability, and Faradaic efficiency of electrodeposited oxygen-evolving electrocatalysts. In particular, we focus on methods for determining electrochemically active surface area and measuring electrocatalytic activity and stability under conditions relevant to an integrated solar water-splitting device. Our primary figure of merit is the overpotential required to achieve a current density of 10 mA cm(-2) per geometric area, approximately the current density expected for a 10% efficient solar-to-fuels conversion device. Utilizing the aforementioned surface area measurements, one can determine electrocatalyst turnover frequencies. The reported protocol was used to examine the oxygen-evolution activity of the following systems in acidic and alkaline solutions: CoO(x), CoPi, CoFeO(x), NiO(x), NiCeO(x), NiCoO(x), NiCuO(x), NiFeO(x), and NiLaO(x). The oxygen-evolving activity of an electrodeposited IrO(x) catalyst was also investigated for comparison. Two general observations are made from comparing the catalytic performance of the OER catalysts investigated: (1) in alkaline solution, every non-noble metal system achieved 10 mA cm(-2) current densities at similar operating overpotentials between 0.35 and 0.43 V, and (2) every system but IrO(x) was unstable under oxidative conditions in acidic solutions. |
C42360764 | Chemical engineering | https://doi.org/10.1039/c5ee03874j | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Cesium-containing triple cation perovskite solar cells: improved stability, reproducibility and high efficiency | [
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] | Today's best perovskite solar cells use a mixture of formamidinium and methylammonium as the monovalent cations. With the addition of inorganic cesium, the resulting triple cation perovskite compositions are thermally more stable, contain less phase impurities and are less sensitive to processing conditions. This enables more reproducible device performances to reach a stabilized power output of 21.1% and ∼18% after 250 hours under operational conditions. These properties are key for the industrialization of perovskite photovoltaics. |
C42360764 | Chemical engineering | https://doi.org/10.1126/science.1116275 | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | A Chromium Terephthalate-Based Solid with Unusually Large Pore Volumes and Surface Area | [
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] | We combined targeted chemistry and computational design to create a crystal structure for porous chromium terephthalate, MIL-101, with very large pore sizes and surface area. Its zeotype cubic structure has a giant cell volume (approximately 702,000 cubic angstroms), a hierarchy of extra-large pore sizes (approximately 30 to 34 angstroms), and a Langmuir surface area for N2 of approximately 5900 +/- 300 square meters per gram. Beside the usual properties of porous compounds, this solid has potential as a nanomold for monodisperse nanomaterials, as illustrated here by the incorporation of Keggin polyanions within the cages. |
C42360764 | Chemical engineering | https://doi.org/10.1021/nn901850u | branch of science that applies physical sciences and life sciences together with applied mathematics and economics to produce, transform, transport, and properly use chemicals, materials and energy | Nitrogen-Doped Graphene as Efficient Metal-Free Electrocatalyst for Oxygen Reduction in Fuel Cells | [
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] | Nitrogen-doped graphene (N-graphene) was synthesized by chemical vapor deposition of methane in the presence of ammonia. The resultant N-graphene was demonstrated to act as a metal-free electrode with a much better electrocatalytic activity, long-term operation stability, and tolerance to crossover effect than platinum for oxygen reduction via a four-electron pathway in alkaline fuel cells. To the best of our knowledge, this is the first report on the use of graphene and its derivatives as metal-free catalysts for oxygen reduction. The important role of N-doping to oxygen reduction reaction (ORR) can be applied to various carbon materials for the development of other metal-free efficient ORR catalysts for fuel cell applications, even new catalytic materials for applications beyond fuel cells. |
C111368507 | Oceanography | https://doi.org/10.1175/1520-0477(1997)078<1069:apicow>2.0.co;2 | branch of Earth science that studies the ocean | A Pacific Interdecadal Climate Oscillation with Impacts on Salmon Production | [
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] | Evidence gleaned from the instrumental record of climate data identifies a robust, recurring pattern of ocean–atmosphere climate variability centered over the midlatitude North Pacific basin. Over the past century, the amplitude of this climate pattern has varied irregularly at interannual-to-interdecadal timescales. There is evidence of reversals in the prevailing polarity of the oscillation occurring around 1925, 1947, and 1977; the last two reversals correspond to dramatic shifts in salmon production regimes in the North Pacific Ocean. This climate pattern also affects coastal sea and continental surface air temperatures, as well as streamflow in major west coast river systems, from Alaska to California. |
C111368507 | Oceanography | https://doi.org/10.1126/science.1152509 | branch of Earth science that studies the ocean | Coral Reefs Under Rapid Climate Change and Ocean Acidification | [
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{
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] | Atmospheric carbon dioxide concentration is expected to exceed 500 parts per million and global temperatures to rise by at least 2°C by 2050 to 2100, values that significantly exceed those of at least the past 420,000 years during which most extant marine organisms evolved. Under conditions expected in the 21st century, global warming and ocean acidification will compromise carbonate accretion, with corals becoming increasingly rare on reef systems. The result will be less diverse reef communities and carbonate reef structures that fail to be maintained. Climate change also exacerbates local stresses from declining water quality and overexploitation of key species, driving reefs increasingly toward the tipping point for functional collapse. This review presents future scenarios for coral reefs that predict increasingly serious consequences for reef-associated fisheries, tourism, coastal protection, and people. As the International Year of the Reef 2008 begins, scaled-up management intervention and decisive action on global emissions are required if the loss of coral-dominated ecosystems is to be avoided. |
C111368507 | Oceanography | https://doi.org/10.1098/rstb.2008.0205 | branch of Earth science that studies the ocean | Accumulation and fragmentation of plastic debris in global environments | [
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] | One of the most ubiquitous and long-lasting recent changes to the surface of our planet is the accumulation and fragmentation of plastics. Within just a few decades since mass production of plastic products commenced in the 1950s, plastic debris has accumulated in terrestrial environments, in the open ocean, on shorelines of even the most remote islands and in the deep sea. Annual clean-up operations, costing millions of pounds sterling, are now organized in many countries and on every continent. Here we document global plastics production and the accumulation of plastic waste. While plastics typically constitute approximately 10 per cent of discarded waste, they represent a much greater proportion of the debris accumulating on shorelines. Mega- and macro-plastics have accumulated in the highest densities in the Northern Hemisphere, adjacent to urban centres, in enclosed seas and at water convergences (fronts). We report lower densities on remote island shores, on the continental shelf seabed and the lowest densities (but still a documented presence) in the deep sea and Southern Ocean. The longevity of plastic is estimated to be hundreds to thousands of years, but is likely to be far longer in deep sea and non-surface polar environments. Plastic debris poses considerable threat by choking and starving wildlife, distributing non-native and potentially harmful organisms, absorbing toxic chemicals and degrading to micro-plastics that may subsequently be ingested. Well-established annual surveys on coasts and at sea have shown that trends in mega- and macro-plastic accumulation rates are no longer uniformly increasing: rather stable, increasing and decreasing trends have all been reported. The average size of plastic particles in the environment seems to be decreasing, and the abundance and global distribution of micro-plastic fragments have increased over the last few decades. However, the environmental consequences of such microscopic debris are still poorly understood. |
C111368507 | Oceanography | https://doi.org/10.1038/s41467-020-20314-w | branch of Earth science that studies the ocean | Anomalous collapses of Nares Strait ice arches leads to enhanced export of Arctic sea ice | [
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"wikidata": "https://www.wikidata.org/wiki/Q52139"
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] | Abstract The ice arches that usually develop at the northern and southern ends of Nares Strait play an important role in modulating the export of Arctic Ocean multi-year sea ice. The Arctic Ocean is evolving towards an ice pack that is younger, thinner, and more mobile and the fate of its multi-year ice is becoming of increasing interest. Here, we use sea ice motion retrievals from Sentinel-1 imagery to report on the recent behavior of these ice arches and the associated ice fluxes. We show that the duration of arch formation has decreased over the past 20 years, while the ice area and volume fluxes along Nares Strait have both increased. These results suggest that a transition is underway towards a state where the formation of these arches will become atypical with a concomitant increase in the export of multi-year ice accelerating the transition towards a younger and thinner Arctic ice pack. |
C111368507 | Oceanography | https://doi.org/10.1371/journal.pone.0111913 | branch of Earth science that studies the ocean | Plastic Pollution in the World's Oceans: More than 5 Trillion Plastic Pieces Weighing over 250,000 Tons Afloat at Sea | [
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{
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"level": 2,
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] | Plastic pollution is ubiquitous throughout the marine environment, yet estimates of the global abundance and weight of floating plastics have lacked data, particularly from the Southern Hemisphere and remote regions. Here we report an estimate of the total number of plastic particles and their weight floating in the world's oceans from 24 expeditions (2007–2013) across all five sub-tropical gyres, costal Australia, Bay of Bengal and the Mediterranean Sea conducting surface net tows (N = 680) and visual survey transects of large plastic debris (N = 891). Using an oceanographic model of floating debris dispersal calibrated by our data, and correcting for wind-driven vertical mixing, we estimate a minimum of 5.25 trillion particles weighing 268,940 tons. When comparing between four size classes, two microplastic <4.75 mm and meso- and macroplastic >4.75 mm, a tremendous loss of microplastics is observed from the sea surface compared to expected rates of fragmentation, suggesting there are mechanisms at play that remove <4.75 mm plastic particles from the ocean surface. |
C111368507 | Oceanography | https://doi.org/10.4319/lo.1967.12.2.0343 | branch of Earth science that studies the ocean | DETERMINATION OF CHLOROPHYLL AND PHEO‐PIGMENTS: SPECTROPHOTOMETRIC EQUATIONS1 | [
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] | Limnology and OceanographyVolume 12, Issue 2 p. 343-346 Notes and CommentFree Access DETERMINATION OF CHLOROPHYLL AND PHEO-PIGMENTS: SPECTROPHOTOMETRIC EQUATIONS1 CARL J. LORENZEN, CARL J. LORENZEN Institute of Marine Resources, Scripps Institution of Oceanography, La Jolla, California 92038Present address : Woods Hole Oceanographic Institution, Woods Hole, Massachusetts 02543.Search for more papers by this author CARL J. LORENZEN, CARL J. LORENZEN Institute of Marine Resources, Scripps Institution of Oceanography, La Jolla, California 92038Present address : Woods Hole Oceanographic Institution, Woods Hole, Massachusetts 02543.Search for more papers by this author First published: April 1967 https://doi.org/10.4319/lo.1967.12.2.0343Citations: 2,628 †Contribution from the Scripps Institution of Oceanography, University of California, San Diego. This investigation was part of the Scripps Tuna Oceanography Research program and was supported by U.S. Bureau of Commercial Fisheries Contract No. 14-17-0007-458. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume12, Issue2April 1967Pages 343-346 This article also appears in:L&O 60th Anniversary Special Collection RelatedInformation |
C111368507 | Oceanography | https://doi.org/10.1641/b570707 | branch of Earth science that studies the ocean | Marine Ecoregions of the World: A Bioregionalization of Coastal and Shelf Areas | [
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] | ABSTRACT The conservation and sustainable use of marine resources is a highlighted goal on a growing number of national and international policy agendas. Unfortunately, efforts to assess progress, as well as to strategically plan and prioritize new marine conservation measures, have been hampered by the lack of a detailed, comprehensive biogeographic system to classify the oceans. Here we report on a new global system for coastal and shelf areas: the Marine Ecoregions of the World, or MEOW, a nested system of 12 realms, 62 provinces, and 232 ecoregions. This system provides considerably better spatial resolution than earlier global systems, yet it preserves many common elements and can be cross-referenced to many regional biogeographic classifications. The designation of terrestrial ecoregions has revolutionized priority setting and planning for terrestrial conservation; we anticipate similar benefits from the use of a coherent and credible marine system. |
C111368507 | Oceanography | https://doi.org/10.4319/lo.1973.18.6.0897 | branch of Earth science that studies the ocean | MEASUREMENT OF THE APPARENT DISSOCIATION CONSTANTS OF CARBONIC ACID IN SEAWATER AT ATMOSPHERIC PRESSURE1 | [
{
"display_name": "Seawater",
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{
"display_name": "Atmospheric sciences",
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"level": 1,
"score": 0.41578305,
"wikidata": "https://www.wikidata.org/wiki/Q757520"
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] | The apparent dissociation constants of carbonic acid in seawater were determined as functions of temperature (2–35°C) and salinity (19–43 ‰ ) at atmospheric pressure by measurement of K’x and the product K'� K'2. At 35%° salinity and 25°C the measured values were p K ′ 1 = 6.000 and p K ′ 2 = 9.115; at 35 ‰ and 2°C the measured values were p K ′ 1 = 6.177 and p K ′ 2 = 9.431. |
C36289849 | Social science | https://doi.org/10.5860/choice.32-4463 | academic discipline concerned with society and the relationships | The New production of knowledge: the dynamics of science and research in contemporary societies | [
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"wikidata": "https://www.wikidata.org/wiki/Q9471"
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] | In this provocative and broad-ranging work, a distinguished team of authors argues that the ways in which knowledge scientific, social and cultural is produced are undergoing fundamental changes at the end of the twentieth century. They claim that these changes mark a distinct shift into a new mode of knowledge production which is replacing or reforming established institutions, disciplines, practices and policies. Identifying a range of features of the new moder of knowledge production reflexivity, transdisciplinarity, heterogeneity the authors show the connections between these features and the changing role of knowledge in social relations. While the knowledge produced by research and development in science and technology (both public and industrial) is accorded central concern, the authors also outline the changing dimensions of social scientific and humanities knowledge and the relations between the production of knowledge and its dissemination through education. Placing science policy and scientific knowledge in its broader context within contemporary societies, this book will be essential reading for all those concerned with the changing nature of knowledge, with the social study of science, with educational systems, and with the relations between R&D and social, economic and technological development. |
C36289849 | Social science | https://doi.org/10.1126/science.1165821 | academic discipline concerned with society and the relationships | Network Analysis in the Social Sciences | [
{
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] | Over the past decade, there has been an explosion of interest in network research across the physical and social sciences. For social scientists, the theory of networks has been a gold mine, yielding explanations for social phenomena in a wide variety of disciplines from psychology to economics. Here, we review the kinds of things that social scientists have tried to explain using social network analysis and provide a nutshell description of the basic assumptions, goals, and explanatory mechanisms prevalent in the field. We hope to contribute to a dialogue among researchers from across the physical and social sciences who share a common interest in understanding the antecedents and consequences of network phenomena. |
C36289849 | Social science | https://doi.org/10.1177/030631284014003004 | academic discipline concerned with society and the relationships | The Social Construction of Facts and Artefacts: or How the Sociology of Science and the Sociology of Technology might Benefit Each Other | [
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] | The need for an integrated social constructivist approach towards the study of science and technology is outlined. Within such a programme both scientific facts and technological artefacts are to be understood as social constructs. Literature on the sociology of science, the science-technology relationship, and technology studies is reviewed. The empirical programme of relativism within the sociology of scientific knowledge and a recent study of the social construction of technological artefacts are combined to produce the new approach. The concepts of `interpretative flexibility' and `closure mechanism', and the notion of `social group' are developed and illustrated by reference to a study of solar physics and a study of the development of the bicycle. The paper concludes by setting out some of the terrain to be explored in future studies. |
C36289849 | Social science | https://doi.org/10.1080/13645570701401305 | academic discipline concerned with society and the relationships | Sampling Knowledge: The Hermeneutics of Snowball Sampling in Qualitative Research | [
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] | Abstract During the past two decades we have witnessed a rather impressive growth of theoretical innovations and conceptual revisions of epistemological and methodological approaches within constructivist‐qualitative quarters of the social sciences. Methodological discussions have commonly addressed a variety of methods for collecting and analyzing empirical material, yet the critical grounds upon which these were reformulated have rarely been extended to embrace sampling concepts and procedures. The latter have been overlooked, qualifying only as a ‘technical’ research stage. This article attends to snowball sampling via constructivist and feminist hermeneutics, suggesting that when viewed critically, this popular sampling method can generate a unique type of social knowledge—knowledge which is emergent, political and interactional. The article reflects upon researches about backpacker tourists and marginalized men, where snowball sampling was successfully employed in investigating these groups' organic social networks and social dynamics. In both studies, interesting interrelations were found between sampling and interviewing facets, leading to a reconceptualization of the method of snowball sampling in terms of power relations, social networks and social capital. Acknowledgments I am indebted to the students who attended qualitative and feminist courses I taught during the last four years at the Hebrew University of Jerusalem and at the University of Haifa. Many of the observations discussed in this article were initially raised by frustrated students, grappling with constructivist epistemologies and methods of interviewing. I am also indebted to the helpful comments suggested by Shirly Bar‐Lev, Michal Hamo and by anonymous referees of this journal. Notes [1] For the purpose of this article, the terms informants, interviewees, subjects and referees are used synonymously. [2] Note the writing (and reading) about conducting interviews is also an activity that researchers do, which is to say it is also a practice of ‘doing a researcher.’ Hence the hermeneutics of the interview interaction permeate the systems of academic scholarship. |
C36289849 | Social science | https://doi.org/10.30845/ijhss | academic discipline concerned with society and the relationships | International Journal of Humanities and Social Science | [
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] | In Theater-Therapy, that is Stanislavskij's method linked to Positive Psychology, emotions are produced through body actions; where the body is the custodian of the actions associated with emotions.This association could improve some aspects of personality.Everyone can feel themselves in an immediate way.Hence, an increased knowledge of emotions and thoughts can improve the relationship with others.In the current study, 6 subjects took part in a research to ascertain if participation to Theater-therapy to verify if they can improve some personality aspects, according to the Big Five theory.The experiment included one three-hours weekly meeting for six months.On the first day, the BFQ was administered to each subject and re-administered on the last day of the experiment.Results showed that all factors improve after the Theater-therapy meeting.This can be explained by Theater-therapy enabling subjects to feel emotion and handle conflicts immediately through the body and the use of actions. |
C36289849 | Social science | https://doi.org/10.5860/choice.45-5536 | academic discipline concerned with society and the relationships | The Handbook of science and technology studies | [
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] | Science and Technology Studies is a flourishing interdisciplinary field that examines the creation, development, and consequences of science and technology in their cultural, historical, and social contexts. The Handbook of Science and Technology Studies provides a comprehensive and authoritative overview of the field, reviewing current research and major theoretical and methodological approaches and analyzing emergent issues in a form that is accessible to new and established scholars from a range of disciplines. Handbook chapters review the dominant theoretical perspectives of S&TS, present the current state of research on a spectrum of topics in the field, analyze changes brought about by the commercialization of science, study interactions between science and other institutions, examine the role of experts and the public in scientific and technological decision making, and consider the cultural and social dimensions of new technologies. |
C36289849 | Social science | https://doi.org/10.1037/0003-066x.63.7.602 | academic discipline concerned with society and the relationships | The neglected 95%: Why American psychology needs to become less American. | [
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] | This article proposes that psychological research published in APA journals focuses too narrowly on Americans, who comprise less than 5% of the world's population. The result is an understanding of psychology that is incomplete and does not adequately represent humanity. First, an analysis of articles published in six premier APA journals is presented, showing that the contributors, samples, and editorial leadership of the journals are predominantly American. Then, a demographic profile of the human population is presented to show that the majority of the world's population lives in conditions vastly different from the conditions of Americans, underlining doubts of how well American psychological research can be said to represent humanity. The reasons for the narrowness of American psychological research are examined, with a focus on a philosophy of science that emphasizes fundamental processes and ignores or strips away cultural context. Finally, several suggestions for broadening the scope of American psychology are offered. |
C36289849 | Social science | https://doi.org/10.1191/030913200674086272 | academic discipline concerned with society and the relationships | The social construction of scale | [
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] | Over the last ten years, scholars in human geography have been paying increasing theoretical and empirical attention to understanding the ways in which the production of scale is implicated in the production of space. Overwhelmingly, this work reflects a social constructionist approach, which situates capitalist production (and the role of the state, capital, labor and nonstate political actors) as of central concern. What is missing from this discussion about the social construction of scale is serious attention to the relevance of social reproduction and consumption. In this article I review the important literature on scale construction and argue for enlarging our scope for understanding scale to include the complex processes of social reproduction and consumption. I base my critique on a short case study which illustrates that attention to other processes besides production and other systems of domination besides capitalism can enhance our theorizing and improve our attempts to effect real social change. |
C159110408 | Nursing | https://doi.org/10.1111/j.1468-0009.2005.00409.x | activity within the health care sector | Contribution of Primary Care to Health Systems and Health | [
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] | Evidence of the health‐promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross‐national and within‐national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups. |
C159110408 | Nursing | https://doi.org/10.1542/peds.2011-3552 | activity within the health care sector | Breastfeeding and the Use of Human Milk | [
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] | Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF “Ten Steps to Successful Breastfeeding.” National strategies supported by the US Surgeon General’s Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The “Business Case for Breastfeeding” details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice. |
C159110408 | Nursing | https://doi.org/10.1370/afm.1713 | activity within the health care sector | From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider | [
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] | The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. |
C159110408 | Nursing | https://doi.org/10.1016/j.aorn.2009.09.014 | activity within the health care sector | Patient Safety and Quality: An Evidence‐Based Handbook for Nurses | [
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{
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{
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"wikidata": "https://www.wikidata.org/wiki/Q9418"
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] | Patient Safety and Quality: An Evidence‐Based Handbook for Nurses Ronda G. Hughes Agency for Healthcare Research and Quality 2008, 1,400 pages One free copy, hardcover and CD‐ROM |
C159110408 | Nursing | https://doi.org/10.1186/s12913-017-2031-8 | activity within the health care sector | Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework | [
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] | It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions. |
C159110408 | Nursing | https://doi.org/10.18332/ejm/76820 | activity within the health care sector | Midwives’ contribution to normal childbirth care. Cross-sectional study in public health Settings. MidconBirth Study protocol | [
{
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"score": 0.35640073,
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{
"display_name": "Pregnancy",
"id": "https://openalex.org/C2779234561",
"level": 2,
"score": 0.32942837,
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{
"display_name": "Alternative medicine",
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"score": 0.32038593,
"wikidata": "https://www.wikidata.org/wiki/Q188504"
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] | 1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. doi: 10.1002/14651858.cd004667.pub3 CrossRef Google Scholar |
C159110408 | Nursing | https://doi.org/10.1056/nejmsa012247 | activity within the health care sector | Nurse-Staffing Levels and the Quality of Care in Hospitals | [
{
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"score": 0.88928413,
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] | It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. |
C159110408 | Nursing | https://doi.org/10.1136/bmj.e1717 | activity within the health care sector | Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States | [
{
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{
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"score": 0.5404926,
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{
"display_name": "Burnout",
"id": "https://openalex.org/C143916079",
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"wikidata": "https://www.wikidata.org/wiki/Q2629248"
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{
"display_name": "Family medicine",
"id": "https://openalex.org/C512399662",
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{
"display_name": "Job satisfaction",
"id": "https://openalex.org/C2718322",
"level": 2,
"score": 0.49029186,
"wikidata": "https://www.wikidata.org/wiki/Q629463"
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{
"display_name": "Patient satisfaction",
"id": "https://openalex.org/C2775944032",
"level": 2,
"score": 0.4644105,
"wikidata": "https://www.wikidata.org/wiki/Q22907659"
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{
"display_name": "Acute care",
"id": "https://openalex.org/C2781385661",
"level": 3,
"score": 0.45584908,
"wikidata": "https://www.wikidata.org/wiki/Q4677918"
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{
"display_name": "Health care",
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"level": 2,
"score": 0.37704527,
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] | <b>Objective</b> To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. <b>Design</b> Cross sectional surveys of patients and nurses. <b>Setting</b> Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. <b>Participants</b> 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. <b>Main outcome measures</b> Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). <b>Results</b> The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. <b>Conclusions</b> Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction. |
C1276947 | Astronomy | https://doi.org/10.1086/307221 | scientific study of celestial objects and phenomena | Measurements of Ω and Λ from 42 High‐Redshift Supernovae | [
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] | We report measurements of the mass density, ΩM, and cosmological-constant energy density, ΩΛ, of the universe based on the analysis of 42 type Ia supernovae discovered by the Supernova Cosmology Project. The magnitude-redshift data for these supernovae, at redshifts between 0.18 and 0.83, are fitted jointly with a set of supernovae from the Calán/Tololo Supernova Survey, at redshifts below 0.1, to yield values for the cosmological parameters. All supernova peak magnitudes are standardized using a SN Ia light-curve width-luminosity relation. The measurement yields a joint probability distribution of the cosmological parameters that is approximated by the relation 0.8ΩM-0.6ΩΛ≈-0.2±0.1 in the region of interest (ΩM≲1.5). For a flat (ΩM+ΩΛ=1) cosmology we find ΩMflat=0.28+0.09-0.08 (1 σ statistical) +0.05-0.04 (identified systematics). The data are strongly inconsistent with a Λ=0 flat cosmology, the simplest inflationary universe model. An open, Λ=0 cosmology also does not fit the data well: the data indicate that the cosmological constant is nonzero and positive, with a confidence of P(Λ>0)=99%, including the identified systematic uncertainties. The best-fit age of the universe relative to the Hubble time is t0flat=14.9+1.4-1.1(0.63/h) Gyr for a flat cosmology. The size of our sample allows us to perform a variety of statistical tests to check for possible systematic errors and biases. We find no significant differences in either the host reddening distribution or Malmquist bias between the low-redshift Calán/Tololo sample and our high-redshift sample. Excluding those few supernovae that are outliers in color excess or fit residual does not significantly change the results. The conclusions are also robust whether or not a width-luminosity relation is used to standardize the supernova peak magnitudes. We discuss and constrain, where possible, hypothetical alternatives to a cosmological constant. |
C1276947 | Astronomy | https://doi.org/10.1086/305772 | scientific study of celestial objects and phenomena | Maps of Dust Infrared Emission for Use in Estimation of Reddening and Cosmic Microwave Background Radiation Foregrounds | [
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{
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"wikidata": "https://www.wikidata.org/wiki/Q5422078"
},
{
"display_name": "Infrared",
"id": "https://openalex.org/C158355884",
"level": 2,
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"wikidata": "https://www.wikidata.org/wiki/Q11388"
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] | We present a full-sky 100 μm map that is a reprocessed composite of the COBE/DIRBE and IRAS/ISSA maps, with the zodiacal foreground and confirmed point sources removed. Before using the ISSA maps, we remove the remaining artifacts from the IRAS scan pattern. Using the DIRBE 100 and 240 μm data, we have constructed a map of the dust temperature so that the 100 μm map may be converted to a map proportional to dust column density. The dust temperature varies from 17 to 21 K, which is modest but does modify the estimate of the dust column by a factor of 5. The result of these manipulations is a map with DIRBE quality calibration and IRAS resolution. A wealth of filamentary detail is apparent on many different scales at all Galactic latitudes. In high-latitude regions, the dust map correlates well with maps of H I emission, but deviations are coherent in the sky and are especially conspicuous in regions of saturation of H I emission toward denser clouds and of formation of H2 in molecular clouds. In contrast, high-velocity H I clouds are deficient in dust emission, as expected. |
C1276947 | Astronomy | https://doi.org/10.1086/498708 | scientific study of celestial objects and phenomena | The Two Micron All Sky Survey (2MASS) | [
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"id": "https://openalex.org/C73329638",
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{
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{
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"id": "https://openalex.org/C79499522",
"level": 3,
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{
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"id": "https://openalex.org/C62649853",
"level": 1,
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{
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"id": "https://openalex.org/C165838908",
"level": 2,
"score": 0.41251698,
"wikidata": "https://www.wikidata.org/wiki/Q736777"
},
{
"display_name": "Infrared",
"id": "https://openalex.org/C158355884",
"level": 2,
"score": 0.39844805,
"wikidata": "https://www.wikidata.org/wiki/Q11388"
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] | Between 1997 June and 2001 February the Two Micron All Sky Survey (2MASS) collected 25.4 Tbytes of raw imaging data covering 99.998% of the celestial sphere in the near-infrared J (1.25 μm), H (1.65 μm), and Ks (2.16 μm) bandpasses. Observations were conducted from two dedicated 1.3 m diameter telescopes located at Mount Hopkins, Arizona, and Cerro Tololo, Chile. The 7.8 s of integration time accumulated for each point on the sky and strict quality control yielded a 10 σ point-source detection level of better than 15.8, 15.1, and 14.3 mag at the J, H, and Ks bands, respectively, for virtually the entire sky. Bright source extractions have 1 σ photometric uncertainty of <0.03 mag and astrometric accuracy of order 100 mas. Calibration offsets between any two points in the sky are <0.02 mag. The 2MASS All-Sky Data Release includes 4.1 million compressed FITS images covering the entire sky, 471 million source extractions in a Point Source Catalog, and 1.6 million objects identified as extended in an Extended Source Catalog. |
C1276947 | Astronomy | https://doi.org/10.1086/301513 | scientific study of celestial objects and phenomena | The Sloan Digital Sky Survey: Technical Summary | [
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{
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{
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{
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"id": "https://openalex.org/C43481613",
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{
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"wikidata": "https://www.wikidata.org/wiki/Q788790"
},
{
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"id": "https://openalex.org/C62649853",
"level": 1,
"score": 0.36089218,
"wikidata": "https://www.wikidata.org/wiki/Q199687"
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] | The Sloan Digital Sky Survey (SDSS) will provide the data to support detailed investigations of the distribution of luminous and nonluminous matter in the universe: a photometrically and astrometrically calibrated digital imaging survey of π sr above about Galactic latitude 30° in five broad optical bands to a depth of g' ∼ 23 mag, and a spectroscopic survey of the approximately 106 brightest galaxies and 105 brightest quasars found in the photometric object catalog produced by the imaging survey. This paper summarizes the observational parameters and data products of the SDSS and serves as an introduction to extensive technical on-line documentation. |
C1276947 | Astronomy | https://doi.org/10.1046/j.1365-8711.2003.06897.x | scientific study of celestial objects and phenomena | Stellar population synthesis at the resolution of 2003 | [
{
"display_name": "Physics",
"id": "https://openalex.org/C121332964",
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{
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{
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{
"display_name": "Star formation",
"id": "https://openalex.org/C125857072",
"level": 3,
"score": 0.6466814,
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{
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"id": "https://openalex.org/C2778623024",
"level": 4,
"score": 0.59796584,
"wikidata": "https://www.wikidata.org/wiki/Q1436016"
},
{
"display_name": "Metallicity",
"id": "https://openalex.org/C99465377",
"level": 3,
"score": 0.5860054,
"wikidata": "https://www.wikidata.org/wiki/Q217030"
},
{
"display_name": "Stars",
"id": "https://openalex.org/C150846664",
"level": 2,
"score": 0.56021434,
"wikidata": "https://www.wikidata.org/wiki/Q7602306"
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{
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"id": "https://openalex.org/C1276947",
"level": 1,
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"wikidata": "https://www.wikidata.org/wiki/Q333"
},
{
"display_name": "Asymptotic giant branch",
"id": "https://openalex.org/C181313176",
"level": 3,
"score": 0.45793843,
"wikidata": "https://www.wikidata.org/wiki/Q50089"
},
{
"display_name": "Surface brightness fluctuation",
"id": "https://openalex.org/C201051825",
"level": 5,
"score": 0.45304632,
"wikidata": "https://www.wikidata.org/wiki/Q1999487"
},
{
"display_name": "Spectral line",
"id": "https://openalex.org/C4839761",
"level": 2,
"score": 0.45039457,
"wikidata": "https://www.wikidata.org/wiki/Q212111"
},
{
"display_name": "Star cluster",
"id": "https://openalex.org/C48393594",
"level": 3,
"score": 0.44725165,
"wikidata": "https://www.wikidata.org/wiki/Q168845"
},
{
"display_name": "Stellar evolution",
"id": "https://openalex.org/C110472602",
"level": 3,
"score": 0.42787713,
"wikidata": "https://www.wikidata.org/wiki/Q6472"
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] | We present a new model for computing the spectral evolution of stellar populations at ages between 100,000 yr and 20 Gyr at a resolution of 3 A across the whole wavelength range from 3200 to 9500 A for a wide range of metallicities. These predictions are based on a newly available library of observed stellar spectra. We also compute the spectral evolution across a larger wavelength range, from 91 A to 160 micron, at lower resolution. The model incorporates recent progress in stellar evolution theory and an observationally motivated prescription for thermally-pulsing stars on the asymptotic giant branch. The latter is supported by observations of surface brightness fluctuations in nearby stellar populations. We show that this model reproduces well the observed optical and near-infrared colour-magnitude diagrams of Galactic star clusters of various ages and metallicities. Stochastic fluctuations in the numbers of stars in different evolutionary phases can account for the full range of observed integrated colours of star clusters in the Magellanic Clouds. The model reproduces in detail typical galaxy spectra from the Early Data Release (EDR) of the Sloan Digital Sky Survey (SDSS). We exemplify how this type of spectral fit can constrain physical parameters such as the star formation history, metallicity and dust content of galaxies. Our model is the first to enable accurate studies of absorption-line strengths in galaxies containing stars over the full range of ages. Using the highest-quality spectra of the SDSS EDR, we show that this model can reproduce simultaneously the observed strengths of those Lick indices that do not depend strongly on element abundance ratios [abridged]. |
C1276947 | Astronomy | https://doi.org/10.1103/physrevlett.119.161101 | scientific study of celestial objects and phenomena | GW170817: Observation of Gravitational Waves from a Binary Neutron Star Inspiral | [
{
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{
"display_name": "Neutron star",
"id": "https://openalex.org/C192887742",
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"wikidata": "https://www.wikidata.org/wiki/Q4202"
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{
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"id": "https://openalex.org/C190330329",
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"wikidata": "https://www.wikidata.org/wiki/Q190035"
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{
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{
"display_name": "LIGO",
"id": "https://openalex.org/C2780688901",
"level": 3,
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"wikidata": "https://www.wikidata.org/wiki/Q255371"
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{
"display_name": "Kilonova",
"id": "https://openalex.org/C2777983807",
"level": 4,
"score": 0.5437949,
"wikidata": "https://www.wikidata.org/wiki/Q14468623"
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{
"display_name": "Gamma-ray burst",
"id": "https://openalex.org/C17599544",
"level": 2,
"score": 0.5409416,
"wikidata": "https://www.wikidata.org/wiki/Q22247"
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{
"display_name": "Astronomy",
"id": "https://openalex.org/C1276947",
"level": 1,
"score": 0.5153996,
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{
"display_name": "Magnetar",
"id": "https://openalex.org/C86888617",
"level": 3,
"score": 0.44919348,
"wikidata": "https://www.wikidata.org/wiki/Q190426"
},
{
"display_name": "Galaxy",
"id": "https://openalex.org/C98444146",
"level": 2,
"score": 0.41782048,
"wikidata": "https://www.wikidata.org/wiki/Q318"
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] | On August 17, 2017 at 12∶41:04 UTC the Advanced LIGO and Advanced Virgo gravitational-wave detectors made their first observation of a binary neutron star inspiral. The signal, GW170817, was detected with a combined signal-to-noise ratio of 32.4 and a false-alarm-rate estimate of less than one per 8.0×10^{4} years. We infer the component masses of the binary to be between 0.86 and 2.26 M_{⊙}, in agreement with masses of known neutron stars. Restricting the component spins to the range inferred in binary neutron stars, we find the component masses to be in the range 1.17-1.60 M_{⊙}, with the total mass of the system 2.74_{-0.01}^{+0.04}M_{⊙}. The source was localized within a sky region of 28 deg^{2} (90% probability) and had a luminosity distance of 40_{-14}^{+8} Mpc, the closest and most precisely localized gravitational-wave signal yet. The association with the γ-ray burst GRB 170817A, detected by Fermi-GBM 1.7 s after the coalescence, corroborates the hypothesis of a neutron star merger and provides the first direct evidence of a link between these mergers and short γ-ray bursts. Subsequent identification of transient counterparts across the electromagnetic spectrum in the same location further supports the interpretation of this event as a neutron star merger. This unprecedented joint gravitational and electromagnetic observation provides insight into astrophysics, dense matter, gravitation, and cosmology. |
C1276947 | Astronomy | https://doi.org/10.1051/0004-6361/201833051 | scientific study of celestial objects and phenomena | <i>Gaia</i> Data Release 2 | [
{
"display_name": "Astrometry",
"id": "https://openalex.org/C133725777",
"level": 3,
"score": 0.8997093,
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{
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"id": "https://openalex.org/C68271606",
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{
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},
{
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{
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{
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"id": "https://openalex.org/C150846664",
"level": 2,
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{
"display_name": "Astronomy",
"id": "https://openalex.org/C1276947",
"level": 1,
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{
"display_name": "Context (archaeology)",
"id": "https://openalex.org/C2779343474",
"level": 2,
"score": 0.5021329,
"wikidata": "https://www.wikidata.org/wiki/Q3109175"
},
{
"display_name": "Planet",
"id": "https://openalex.org/C51244244",
"level": 2,
"score": 0.4761536,
"wikidata": "https://www.wikidata.org/wiki/Q634"
},
{
"display_name": "Remote sensing",
"id": "https://openalex.org/C62649853",
"level": 1,
"score": 0.32408082,
"wikidata": "https://www.wikidata.org/wiki/Q199687"
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] | Context. We present the second Gaia data release, Gaia DR2, consisting of astrometry, photometry, radial velocities, and information on astrophysical parameters and variability, for sources brighter than magnitude 21. In addition epoch astrometry and photometry are provided for a modest sample of minor planets in the solar system. Aims. A summary of the contents of Gaia DR2 is presented, accompanied by a discussion on the differences with respect to Gaia DR1 and an overview of the main limitations which are still present in the survey. Recommendations are made on the responsible use of Gaia DR2 results. Methods. The raw data collected with the Gaia instruments during the first 22 months of the mission have been processed by the Gaia Data Processing and Analysis Consortium (DPAC) and turned into this second data release, which represents a major advance with respect to Gaia DR1 in terms of completeness, performance, and richness of the data products. Results. Gaia DR2 contains celestial positions and the apparent brightness in G for approximately 1.7 billion sources. For 1.3 billion of those sources, parallaxes and proper motions are in addition available. The sample of sources for which variability information is provided is expanded to 0.5 million stars. This data release contains four new elements: broad-band colour information in the form of the apparent brightness in the G BP (330–680 nm) and G RP (630–1050 nm) bands is available for 1.4 billion sources; median radial velocities for some 7 million sources are presented; for between 77 and 161 million sources estimates are provided of the stellar effective temperature, extinction, reddening, and radius and luminosity; and for a pre-selected list of 14 000 minor planets in the solar system epoch astrometry and photometry are presented. Finally, Gaia DR2 also represents a new materialisation of the celestial reference frame in the optical, the Gaia -CRF2, which is the first optical reference frame based solely on extragalactic sources. There are notable changes in the photometric system and the catalogue source list with respect to Gaia DR1, and we stress the need to consider the two data releases as independent. Conclusions. Gaia DR2 represents a major achievement for the Gaia mission, delivering on the long standing promise to provide parallaxes and proper motions for over 1 billion stars, and representing a first step in the availability of complementary radial velocity and source astrophysical information for a sample of stars in the Gaia survey which covers a very substantial fraction of the volume of our galaxy. |
C1276947 | Astronomy | https://doi.org/10.1088/0004-6256/140/6/1868 | scientific study of celestial objects and phenomena | THE WIDE-FIELD INFRARED SURVEY EXPLORER (WISE): MISSION DESCRIPTION AND INITIAL ON-ORBIT PERFORMANCE | [
{
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"id": "https://openalex.org/C73329638",
"level": 2,
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"wikidata": "https://www.wikidata.org/wiki/Q527"
},
{
"display_name": "Observatory",
"id": "https://openalex.org/C2779919027",
"level": 2,
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{
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"id": "https://openalex.org/C193587279",
"level": 4,
"score": 0.67873985,
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},
{
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"id": "https://openalex.org/C155832589",
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{
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"level": 0,
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},
{
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"level": 2,
"score": 0.4775242,
"wikidata": "https://www.wikidata.org/wiki/Q26540"
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] | The all sky surveys done by the Palomar Observatory Schmidt, the European Southern Observatory Schmidt, and the United Kingdom Schmidt, the InfraRed Astronomical Satellite, and the Two Micron All Sky Survey have proven to be extremely useful tools for astronomy with value that lasts for decades. The Wide-field Infrared Survey Explorer (WISE) is mapping the whole sky following its launch on 2009 December 14. WISE began surveying the sky on 2010 January 14 and completed its first full coverage of the sky on July 17. The survey will continue to cover the sky a second time until the cryogen is exhausted (anticipated in 2010 November). WISE is achieving 5σ point source sensitivities better than 0.08, 0.11, 1, and 6 mJy in unconfused regions on the ecliptic in bands centered at wavelengths of 3.4, 4.6, 12, and 22 μm. Sensitivity improves toward the ecliptic poles due to denser coverage and lower zodiacal background. The angular resolution is 61, 64, 65, and 120 at 3.4, 4.6, 12, and 22 μm, and the astrometric precision for high signal-to-noise sources is better than 015. |
C57879066 | Mechanics | https://doi.org/10.1201/9781482234213 | science concerned with physical bodies subjected to forces or displacements | Numerical Heat Transfer and Fluid Flow | [
{
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"id": "https://openalex.org/C57879066",
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"wikidata": "https://www.wikidata.org/wiki/Q41217"
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{
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{
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"id": "https://openalex.org/C90278072",
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"wikidata": "https://www.wikidata.org/wiki/Q216320"
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{
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"id": "https://openalex.org/C38349280",
"level": 2,
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"wikidata": "https://www.wikidata.org/wiki/Q1434290"
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{
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"id": "https://openalex.org/C192562407",
"level": 0,
"score": 0.4003498,
"wikidata": "https://www.wikidata.org/wiki/Q228736"
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] | This book focuses on heat and mass transfer, fluid flow, chemical reaction, and other related processes that occur in engineering equipment, the natural environment, and living organisms. Using simple algebra and elementary calculus, the author develops numerical methods for predicting these processes mainly based on physical considerations. Through this approach, readers will develop a deeper understanding of the underlying physical aspects of heat transfer and fluid flow as well as improve their ability to analyze and interpret computed results. |
C57879066 | Mechanics | https://doi.org/10.2514/3.12149 | science concerned with physical bodies subjected to forces or displacements | Two-equation eddy-viscosity turbulence models for engineering applications | [
{
"display_name": "Turbulence modeling",
"id": "https://openalex.org/C204573209",
"level": 3,
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{
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"id": "https://openalex.org/C196558001",
"level": 2,
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{
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"id": "https://openalex.org/C150711758",
"level": 3,
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"wikidata": "https://www.wikidata.org/wiki/Q17148242"
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{
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"id": "https://openalex.org/C57879066",
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] | Two new two-equation eddy-viscosity turbulence models will be presented.They combine different elements of existing models that are considered superior to their alternatives.The first model, referred to as the baseline (BSL) model, utilizes the original k-u model of Wilcox in the inner region of the boundary layer and switches to the standard A>e model in the outer region and in free shear flows.It has a performance similar to the Wilcox model, but avoids that model's strong freestream sensitivity.The second model results from a modification to the definition of the eddy-viscosity in the BSL model, which accounts for the effect of the transport of the principal turbulent shear stress.The new model is called the shear-stress transport-model and leads to major improvements in the prediction of adverse pressure gradient flows. |
C57879066 | Mechanics | https://doi.org/10.1175/1520-0493(1963)091<0099:gcewtp>2.3.co;2 | science concerned with physical bodies subjected to forces or displacements | GENERAL CIRCULATION EXPERIMENTS WITH THE PRIMITIVE EQUATIONS | [
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] | An extended period numerical integration of a baroclinic primitive equation model has been made for the simulation and the study of the dynamics of the atmosphere's general circulation. The solution corresponding to external gravitational propagation is filtered by requiring the vertically integrated divergence to vanish identically. The vertical structure permits as dependent variables the horizontal wind at two internal levels and a single temperature, with the static stability entering as a parameter. The incoming radiation is a function of latitude only corresponding to the annual mean, and the outgoing radiation is taken to be a function of the local temperature. With the requirement for thermal equilibrium, the domain mean temperature is specified as a parameter. The role of condensation is taken into account only as it effectively reduces the static stability. All other external sources and sinks of heat are assumed to balance each other locally, and are thus omitted. The kinematics are that of a fluid on a sphere bounded by smooth zonal walls at the equator and at approximately 64° latitude. The dissipative sinks are provided by: (a) surface stresses proportional through a drag coefficient to the square of the surface wind which is suitably extrapolated from above, (b) internal convective stresses proportional to the vertical wind shear, and (c) lateral diffusion of momentum and heat through an exchange coefficient which depends on the local horizontal rate of strain—a horizontal length scale entering as the governing parameter. For a given specification of the parameters, an integration for 60 days has been made from initial conditions where random temperature disturbances have been superimposed on a zonally symmetric regime which is baroclinically unstable according to linear theory. This experiment not only displays the scale selective character of baroclinic instability, yielding zonal wave number 5 to 6, but also predicts an index or energy cycle. The period of this cycle is 11 to 12 days for the first 40 days of the experiment, then lengthening to 17 days while diminishing in amplitude during the latter part. The resulting mean zonal velocity profile is in good qualitative agreement with observation, but too intense, presumably because the effective static stability parameter is taken too large. Furthermore this profile is found to be no more than 5 percent super-geostrophic poleward of the angular momentum maximum and no more than 2 percent sub-geostrophic equatorward. The total zonal angular momentum remains constant to within 2 percent irrespective of the phase of the index cycle. This balance is controlled by the surface wind distribution which agrees quite well with observation. The poleward transport is mainly accomplished by the large-scale eddies, whereas the internal vertical flux is predominantly a transfer of the earth's angular momentum by the meridional circulation. The poleward heat transport is primarily accomplished by a Hadley circulation at low latitudes but by the large-scale horizontal eddies in mid-latitudes, where a Ferrel circulation tends to compensate through an equatorward flux. This compensation at mid-latitudes by an indirect meridional circulation is also quite evident, in the potential-kinetic energy transformations. Comparison of the momentum and heat transfer with observed data when available shows reasonably good quantitative agreement. The lateral transfer of momentum and heat by the non-linear diffusion, which parametrically is supposed to simulate the action of motions of sub-grid scale, accounts for a significant portion of the total eddy transfer. Although no direct comparison with the corresponding transfer in the real atmosphere is available, intuitively our small-scale diffusion appears to play too large a role. A diagnosis is made of the transformations among the baratropic and baroclinic parts of the kinetic energy as well as the zonal mean and zonal perturbation parts of the available potential and kinetic energy. This reveals the dominant paths that the energy passes through from source to ultimate sinks and the processes responsible for these transformations. It is found that the partitioning of dissipation by the energy components may differ considerably from estimates made from observation. |
C57879066 | Mechanics | https://doi.org/10.1121/1.1908239 | science concerned with physical bodies subjected to forces or displacements | Theory of Propagation of Elastic Waves in a Fluid-Saturated Porous Solid. I. Low-Frequency Range | [
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] | A theory is developed for the propagation of stress waves in a porous elastic solid containing compressible viscous fluid. The emphasis of the present treatment is on materials where fluid and solid are of comparable densities as for instance in the case of water-saturated rock. The paper denoted here as Part I is restricted to the lower frequency range where the assumption of Poiseuille flow is valid. The extension to the higher frequencies will be treated in Part II. It is found that the material may be described by four nondimensional parameters and a characteristic frequency. There are two dilatational waves and one rotational wave. The physical interpretation of the result is clarified by treating first the case where the fluid is frictionless. The case of a material containing viscous fluid is then developed and discussed numerically. Phase velocity dispersion curves and attenuation coefficients for the three types of waves are plotted as a function of the frequency for various combinations of the characteristic parameters. |
C57879066 | Mechanics | https://doi.org/10.1175/mwr3199.1 | science concerned with physical bodies subjected to forces or displacements | A New Vertical Diffusion Package with an Explicit Treatment of Entrainment Processes | [
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] | Abstract This paper proposes a revised vertical diffusion package with a nonlocal turbulent mixing coefficient in the planetary boundary layer (PBL). Based on the study of Noh et al. and accumulated results of the behavior of the Hong and Pan algorithm, a revised vertical diffusion algorithm that is suitable for weather forecasting and climate prediction models is developed. The major ingredient of the revision is the inclusion of an explicit treatment of entrainment processes at the top of the PBL. The new diffusion package is called the Yonsei University PBL (YSU PBL). In a one-dimensional offline test framework, the revised scheme is found to improve several features compared with the Hong and Pan implementation. The YSU PBL increases boundary layer mixing in the thermally induced free convection regime and decreases it in the mechanically induced forced convection regime, which alleviates the well-known problems in the Medium-Range Forecast (MRF) PBL. Excessive mixing in the mixed layer in the presence of strong winds is resolved. Overly rapid growth of the PBL in the case of the Hong and Pan is also rectified. The scheme has been successfully implemented in the Weather Research and Forecast model producing a more realistic structure of the PBL and its development. In a case study of a frontal tornado outbreak, it is found that some systematic biases of the large-scale features such as an afternoon cold bias at 850 hPa in the MRF PBL are resolved. Consequently, the new scheme does a better job in reproducing the convective inhibition. Because the convective inhibition is accurately predicted, widespread light precipitation ahead of a front, in the case of the MRF PBL, is reduced. In the frontal region, the YSU PBL scheme improves some characteristics, such as a double line of intense convection. This is because the boundary layer from the YSU PBL scheme remains less diluted by entrainment leaving more fuel for severe convection when the front triggers it. |
C57879066 | Mechanics | https://doi.org/10.1115/1.3443401 | science concerned with physical bodies subjected to forces or displacements | Continuum Theory of Ductile Rupture by Void Nucleation and Growth: Part I—Yield Criteria and Flow Rules for Porous Ductile Media | [
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] | Widely used constitutive laws for engineering materials assume plastic incompressibility, and no effect on yield of the hydrostatic component of stress. However, void nucleation and growth (and thus bulk dilatancy) are commonly observed is some processes which are characterized by large local plastic flow, such as ductile fracture. The purpose of this work is to develop approximate yield criteria and flow rules for porous (dilatant) ductile materials, showing the role of hydrostatic stress in plastic yield and void growth. Other elements of a constitutive theory for porous ductile materials, such as void nucleation, plastic flow and hardening behavior, and a criterion for ductile fracture will be discussed in Part II of this series. The yield criteria are approximated through an upper bound approach. Simplified physical models for ductile porous materials (aggregates of voids and ductile matrix) are employed, with the matrix material idealized as rigid-perfectly plastic and obeying the von Mises yield criterion. Velocity fields are developed for the matrix which conform to the macroscopic flow behavior of the bulk material. Using a distribution of macroscopic flow fields and working through a dissipation integral, upper bounds to the macroscopic stress fields required for yield are calculated. Their locus in stress space forms the yield locus. It is shown that normality holds for this yield locus, so a flow rule results. Approximate functional forms for the yield loci are developed. |
C57879066 | Mechanics | https://doi.org/10.1515/znc-1973-11-1209 | science concerned with physical bodies subjected to forces or displacements | Elastic Properties of Lipid Bilayers: Theory and Possible Experiments | [
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] | Abstract A theory of the elasticity of lipid bilayers is proposed. Three types of strain, i. e. stretching, tilt and curvature, are distinguished and the associated stresses are identified. It is argued that in the case of vesicles (= closed bilayer films) the only elasticity controlling nonspherical shapes is that of curvature. Euler-Lagrange equations are derived for the shape in magnetic fields and under excess outside pressure. It is shown that magnetic fields can deform spherical vesicles into ellipsoids of revolution. Under excess outside pressure the spherical shape becomes unstable at a certain threshold pressure. Both effects can be influenced by a spontaneous curvature of the bilayer. Some possible experiments to determine the elastic properties are also discussed |
C57879066 | Mechanics | https://doi.org/10.1017/s0022112010001217 | science concerned with physical bodies subjected to forces or displacements | Dynamic mode decomposition of numerical and experimental data | [
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] | The description of coherent features of fluid flow is essential to our understanding of fluid-dynamical and transport processes. A method is introduced that is able to extract dynamic information from flow fields that are either generated by a (direct) numerical simulation or visualized/measured in a physical experiment. The extracted dynamic modes, which can be interpreted as a generalization of global stability modes, can be used to describe the underlying physical mechanisms captured in the data sequence or to project large-scale problems onto a dynamical system of significantly fewer degrees of freedom. The concentration on subdomains of the flow field where relevant dynamics is expected allows the dissection of a complex flow into regions of localized instability phenomena and further illustrates the flexibility of the method, as does the description of the dynamics within a spatial framework. Demonstrations of the method are presented consisting of a plane channel flow, flow over a two-dimensional cavity, wake flow behind a flexible membrane and a jet passing between two cylinders. |
C52119013 | Art history | https://doi.org/10.1161/cir.0000000000000350 | academic study of objects of art in their historical development | Heart Disease and Stroke Statistics—2016 Update | [
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] | Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee |
C52119013 | Art history | https://doi.org/10.18653/v1/2020.emnlp-demos.6 | academic study of objects of art in their historical development | Transformers: State-of-the-Art Natural Language Processing | [
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] | Thomas Wolf, Lysandre Debut, Victor Sanh, Julien Chaumond, Clement Delangue, Anthony Moi, Pierric Cistac, Tim Rault, Remi Louf, Morgan Funtowicz, Joe Davison, Sam Shleifer, Patrick von Platen, Clara Ma, Yacine Jernite, Julien Plu, Canwen Xu, Teven Le Scao, Sylvain Gugger, Mariama Drame, Quentin Lhoest, Alexander Rush. Proceedings of the 2020 Conference on Empirical Methods in Natural Language Processing: System Demonstrations. 2020. |
C52119013 | Art history | https://doi.org/10.1161/cir.0b013e31828124ad | academic study of objects of art in their historical development | Heart Disease and Stroke Statistics—2013 Update | [
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] | Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Magid, David; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Schreiner, Pamela J; Sorlie, Paul D; Stein, Joel; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee |
C52119013 | Art history | https://doi.org/10.1161/01.cir.0000441139.02102.80 | academic study of objects of art in their historical development | Heart Disease and Stroke Statistics—2014 Update | [
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] | Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Blaha, Michael J; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Judd, Suzanne E; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Mackey, Rachel H; Magid, David J; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Neumar, Robert W; Nichol, Graham; Pandey, Dilip K; Paynter, Nina P; Reeves, Matthew J; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee |
C52119013 | Art history | https://doi.org/10.1115/1.1421119 | academic study of objects of art in their historical development | <i>Metal Foams: A Design Guide</i> | [
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] | 11R27. Metal Foams: A Design Guide. - MF Ashby (Eng Dept, Centre for Micromech, Univ of Cambridge, Cambridge, CB2 1PZ, UK), A Evans (Princeton Mat Inst, Princeton Univ, 70 Prospect Ave, Bowen Hall, Princeton NJ 08540), NA Fleck (Eng Dept, Centre for Micromech, Univ of Cambridge, Cambridge, CB2 1PZ, UK), LJ Gibson (Dept of Mat Sci and Eng, MIT, Cambridge, MA), JW Hutchinson (Div of Eng and Appl Sci, Harvard Univ, Oxford St, Cambridge MA 02138), HNG Wadley (Dept of Mat Sci and Eng, Sch of Eng and Appl Sci, Univ of Virginia, Charlottesville VA 22903). Butterworth-Heinemann, Woburn MA. 2000. 251 pp. ISBN 0-7506-7219-6. $75.00. Reviewed by F Delale (Dept of Mech Eng, CCNY, 138th St and Convent Ave, New York NY 10031).Metal foams are a new class of materials with application potential in many areas, especially in the design of lightweight structures. The publication of this book is a timely contribution given the current interest of developing lightweight structures for defense as well as commercial applications. The book is a collaborative effort with contributions from many prominent researchers. It consists of 19 chapters, an Appendix, and an Index. It is a concise treatise in that all this material fits in 251 pages.In the first introductory chapter, metal foams are defined and their potential applications discussed. The next three chapters deal with the making of metal foams, the methods used to characterize them, and the current knowledge about their properties. The authors then proceed to discuss design formulas for simple structures made of metal foams. In the second chapter, a constitutive model for metal foams is presented. The next seven chapters discuss design with metal foams in various applications and under different loading conditions, namely: fatigue, creep, sandwich structures, packaging and blast protection, sound absorption and vibration suppression, and thermal and electrical applications. The cutting, finishing, and joining of foam metals is the subject of the ensuing chapter. In Chapter 17, several case studies are presented. Finally, the book concludes with a listing of metal foam suppliers and of websites related to the subject. As this description indicates, after a brief introduction on the behavior of metal foams, the book is totally dedicated to designing with metal foams. One distinction of this book is that it deals not only with design under mechanical loads, but also with design methodology for other types of loading conditions and phenomena, such as: fatigue, creep, thermal management, sound and vibration, blast protection, etc. The level of mathematics is intentionally kept low to cater to a wider audience. The book is geared toward the practicing engineer, and in that respect, succeeds in fulfilling that goal. Metal Foams: A Design Guide is a worthy addition to the engineering literature, and it is recommended that libraries carry a copy. |
C52119013 | Art history | https://doi.org/10.1161/circulationaha.110.971002 | academic study of objects of art in their historical development | Part 9: Post–Cardiac Arrest Care | [
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] | HomeCirculationVol. 122, No. 18_suppl_3Part 9: Post–Cardiac Arrest Care Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPart 9: Post–Cardiac Arrest Care2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Mary Ann Peberdy, Clifton W. Callaway, Robert W. Neumar, Romergryko G. Geocadin, Janice L. Zimmerman, Michael Donnino, Andrea Gabrielli, Scott M. Silvers, Arno L. Zaritsky, Raina Merchant, Terry L. Vanden Hoek and Steven L. Kronick Mary Ann PeberdyMary Ann Peberdy *Co-chairs and equal first co-authors. Search for more papers by this author , Clifton W. CallawayClifton W. Callaway *Co-chairs and equal first co-authors. Search for more papers by this author , Robert W. NeumarRobert W. Neumar Search for more papers by this author , Romergryko G. GeocadinRomergryko G. Geocadin Search for more papers by this author , Janice L. ZimmermanJanice L. Zimmerman Search for more papers by this author , Michael DonninoMichael Donnino Search for more papers by this author , Andrea GabrielliAndrea Gabrielli Search for more papers by this author , Scott M. SilversScott M. Silvers Search for more papers by this author , Arno L. ZaritskyArno L. Zaritsky Search for more papers by this author , Raina MerchantRaina Merchant Search for more papers by this author , Terry L. Vanden HoekTerry L. Vanden Hoek Search for more papers by this author and Steven L. KronickSteven L. Kronick Search for more papers by this author Originally published2 Nov 2010https://doi.org/10.1161/CIRCULATIONAHA.110.971002Circulation. 2010;122:S768–S786is corrected byCorrectionCorrectionThere is increasing recognition that systematic post–cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post–cardiac arrest syndrome.1–3 Post–cardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality from multiorgan failure and brain injury.3,4 This section summarizes our evolving understanding of the hemodynamic, neurological, and metabolic abnormalities encountered in patients who are initially resuscitated from cardiac arrest.The initial objectives of post–cardiac arrest care are to Optimize cardiopulmonary function and vital organ perfusion.After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia.Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post–cardiac arrest care.Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest. Subsequent objectives of post–cardiac arrest care are to Control body temperature to optimize survival and neurological recoveryIdentify and treat acute coronary syndromes (ACS)Optimize mechanical ventilation to minimize lung injuryReduce the risk of multiorgan injury and support organ function if requiredObjectively assess prognosis for recoveryAssist survivors with rehabilitation services when requiredSystems of Care for Improving Post–Cardiac Arrest OutcomesPost–cardiac arrest care is a critical component of advanced life support (Figure). Most deaths occur during the first 24 hours after cardiac arrest.5,6 The best hospital care for patients with ROSC after cardiac arrest is not completely known, but there is increasing interest in identifying and optimizing practices that are likely to improve outcomes (Table 1).7 Positive associations have been noted between the likelihood of survival and the number of cardiac arrest cases treated at any individual hospital.8,9 Because multiple organ systems are affected after cardiac arrest, successful post–cardiac arrest care will benefit from the development of system-wide plans for proactive treatment of these patients. For example, restoration of blood pressure and gas exchange does not ensure survival and functional recovery. Significant cardiovascular dysfunction can develop, requiring support of blood flow and ventilation, including intravascular volume expansion, vasoactive and inotropic drugs, and invasive devices. Therapeutic hypothermia and treatment of the underlying cause of cardiac arrest impacts survival and neurological outcomes. Protocolized hemodynamic optimization and multidisciplinary early goal-directed therapy protocols have been introduced as part of a bundle of care to improve survival rather than single interventions.10–12 The data suggests that proactive titration of post–cardiac arrest hemodynamics to levels intended to ensure organ perfusion and oxygenation may improve outcomes. There are multiple specific options for acheiving these goals, and it is difficult to distinguish between the benefit of protocols or any specific component of care that is most important.Download figureDownload PowerPointFigure. Post–cardiac arrest care algorithm.Table 1. Multiple System Approach to Post–Cardiac Arrest CareVentilationHemodynamicsCardiovascularNeurologicalMetabolicCapnography Rationale: Confirm secure airway and titrate ventilationEndotracheal tube when possible for comatose patientsPetco2∼35–40 mm HgPaco2∼40–45 mm HgFrequent Blood Pressure Monitoring/Arterial-line Rationale: Maintain perfusion and prevent recurrent hypotensionMean arterial pressure ≥65 mm Hg or systolic blood pressure ≥90 mm HgContinuous Cardiac Monitoring Rationale: Detect recurrent arrhythmiaNo prophylactic antiarrhythmicsTreat arrhythmias as requiredRemove reversible causesSerial Neurological Exam Rationale: Serial examinations define coma, brain injury, and prognosisResponse to verbal commands or physical stimulationPupillary light and corneal reflex, spontaneous eye movementGag, cough, spontaneous breathsSerial Lactate Rationale: Confirm adequate perfusionChest X-ray Rationale: Confirm secure airway and detect causes or complications of arrest: pneumonitis, pneumonia, pulmonary edemaTreat Hypotension Rationale: Maintain perfusionFluid bolus if toleratedDopamine 5–10 mcg/kg per minNorepinephrine 0.1–0.5 mcg/kg per minEpinephrine 0.1–0.5 mcg/kg per min12-lead ECG/Troponin Rationale: Detect Acute Coronary Syndrome/ST-Elevation Myocardial Infarction; Assess QT intervalEEG Monitoring If Comatose Rationale: Exclude seizuresAnticonvulsants if seizingSerum Potassium Rationale: Avoid hypokalemia which promotes arrhythmiasReplace to maintain K >3.5 mEq/LPulse Oximetry/ABG Rationale: Maintain adequate oxygenation and minimize Fio2Spo2 ≥94%Pao2∼100 mm HgReduce Fio2 as toleratedPao2/Fio2 ratio to follow acute lung injury…Treat Acute Coronary Syndrome Aspirin/heparinTransfer to acute coronary treatment centerConsider emergent PCI or fibrinolysisCore Temperature Measurement If Comatose Rationale: Minimize brain injury and improve outcomePrevent hyperpyrexia >37.7°CInduce therapeutic hypothermia if no contraindicationsCold IV fluid bolus 30 mL/kg if no contraindicationSurface or endovascular cooling for 32°C–34°C×24 hoursAfter 24 hours, slow rewarming 0.25°C/hrUrine Output, Serum Creatinine Rationale: Detect acute kidney injuryMaintain euvolemiaRenal replacement therapy if indicatedMechanical Ventilation Rationale: Minimize acute lung injury, potential oxygen toxicityTidal Volume 6–8 mL/kgTitrate minute ventilation to Petco2∼35–40 mm Hg Paco2∼40–45 mm HgReduce Fio2 as tolerated to keep Spo2 or Sao2 ≥94%…Echocardiogram Rationale: Detect global stunning, wall-motion abnormalities, structural problems or cardiomyopathyConsider Non-enhanced CT Scan Rationale: Exclude primary intracranial processSerum Glucose Rationale: Detect hyperglycemia and hypoglycemiaTreat hypoglycemia (<80 mg/dL) with dextroseTreat hyperglycemia to target glucose 144–180 mg/dLLocal insulin protocols…Treat Myocardial Stunning Fluids to optimize volume status (requires clinical judgment)Dobutamine 5–10 mcg/kg per minMechanical augmentation (IABP)Sedation/Muscle Relaxation Rationale: To control shivering, agitation, or ventilator desynchrony as neededAvoid Hypotonic Fluids Rationale: May increase edema, including cerebral edemaA comprehensive, structured, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post–cardiac arrest patients (Class I, LOE B). Programs should include as part of structured interventions therapeutic hypothermia; optimization of hemodynamics and gas exchange; immediate coronary reperfusion when indicated for restoration of coronary blood flow with percutaneous coronary intervention (PCI); glycemic control; and neurological diagnosis, management, and prognostication.Overview of Post–Cardiac Arrest CareThe provider of CPR should ensure an adequate airway and support breathing immediately after ROSC. Unconscious patients usually require an advanced airway for mechanical support of breathing. It may be necessary to replace a supraglottic airway used for initial resuscitation with an endotracheal tube, although the timing of replacement may vary. Methods for securing an advanced airway are discussed in Part 8.1: “Airway Management,” but several simple maneuvers deserve consideration. For example, rescuers and long-term hospital providers should avoid using ties that pass circumferentially around the patient's neck, potentially obstructing venous return from the brain. They should also elevate the head of the bed 30° if tolerated to reduce the incidence of cerebral edema, aspiration, and ventilatory-associated pneumonia. Correct placement of an advanced airway, particularly during patient transport, should be monitored using waveform capnography as described in other sections of the 2010 AHA Guidelines for CPR and ECC. Oxygenation of the patient should be monitored continuously with pulse oximetry.Although 100% oxygen may have been used during initial resuscitation, providers should titrate inspired oxygen to the lowest level required to achieve an arterial oxygen saturation of ≥94%, so as to avoid potential oxygen toxicity. It is recognized that titration of inspired oxygen may not be possible immediately after out-of-hospital cardiac arrest until the patient is transported to the emergency department or, in the case of in-hospital arrest, the intensive care unit (ICU). Hyperventilation or “overbagging” the patient is common after cardiac arrest and should be avoided because of potential adverse hemodynamic effects. Hyperventilation increases intrathoracic pressure and inversely lowers cardiac output. The decrease in Paco2 seen with hyperventilation can also potentially decrease cerebral blood flow directly. Ventilation may be started at 10 to 12 breaths per minute and titrated to achieve a Petco2 of 35 to 40 mm Hg or a Paco2 of 40 to 45 mm Hg.The clinician should assess vital signs and monitor for recurrent cardiac arrhythmias. Continuous electrocardiographic (ECG) monitoring should continue after ROSC, during transport, and throughout ICU care until stability has been achieved. Intravenous (IV) access should be obtained if not already established and the position and function of any intravenous catheter verified. IV lines should be promptly established to replace emergent intraosseous access achieved during resuscitation. If the patient is hypotensive (systolic blood pressure <90 mm Hg), fluid boluses can be considered. Cold fluid may be used if therapeutic hypothermia is elected. Vasoactive drug infusions such as dopamine, norepinephrine, or epinephrine may be initiated if necessary and titrated to achieve a minimum systolic blood pressure of ≥90 mm Hg or a mean arterial pressure of ≥65 mm Hg.Brain injury and cardiovascular instability are the major determinants of survival after cardiac arrest.13 Because therapeutic hypothermia is the only intervention demonstrated to improve neurological recovery, it should be considered for any patient who is unable to follow verbal commands after ROSC. The patient should be transported to a facility that reliably provides this therapy in addition to coronary reperfusion (eg, PCI) and other goal-directed postarrest care therapies.Overall the most common cause of cardiac arrest is cardiovascular disease and coronary ischemia.14,15 Therefore, a 12-lead ECG should be obtained as soon as possible to detect ST elevation or new or presumably new left bundle-branch block. When there is high suspicion of acute myocardial infarction (AMI), local protocols for treatment of AMI and coronary reperfusion should be activated. Even in the absence of ST elevation, medical or interventional treatments may be considered for treatment of ACS14,16,17 and should not be deferred in the presence of coma or in conjunction with hypothermia. Concurrent PCI and hypothermia are safe, with good outcomes reported for some comatose patients who undergo PCI.Patients who are unconscious or unresponsive after cardiac arrest should be directed to an inpatient critical-care facility with a comprehensive care plan that includes acute cardiovascular interventions, use of therapeutic hypothermia, standardized medical goal-directed therapies, and advanced neurological monitoring and care. Neurological prognosis may be difficult to determine during the first 72 hours, even for patients who are not undergoing therapeutic hypothermia. This time frame for prognostication is likely to be extended in patients being cooled.18 Many initially comatose survivors of cardiac arrest have the potential for full recovery such that they are able to lead normal lives.1,2,19 Between 20% and 50% or more of survivors of out-of-hospital cardiac arrest who are comatose on arrival at the hospital may have good one-year neurological outcome.1,2,11 Therefore, it is important to place patients in a hospital critical-care unit where expert care and neurological evaluation can be performed and where appropriate testing to aid prognosis is available and performed in a timely manner.Attention should be directed to treating the precipitating cause of cardiac arrest after ROSC. The provider should initiate or request studies that will further aid in evaluation of the patient. It is important to identify and treat any cardiac, electrolyte, toxicological, pulmonary, and neurological precipitants of arrest. The clinician may find it helpful to review the H's and T's mnemonic to recall factors that may contribute to cardiac arrest or complicate resuscitation or postresuscitation care: hypovolemia, hypoxia, hydrogen ion (acidosis of any etiology), hyper-/hypokalemia, moderate to severe hypothermia, toxins, tamponade (cardiac), tension pneumothorax, and thrombosis of the coronary or pulmonary vasculature. For further information on treating other causes of cardiac arrest, see Part 12: “Special Resuscitation Situations.”Targeted Temperature ManagementInduced HypothermiaFor protection of the brain and other organs, hypothermia is a helpful therapeutic approach in patients who remain comatose (usually defined as a lack of meaningful response to verbal commands) after ROSC. Questions remain about specific indications and populations, timing and duration of therapy, and methods for induction, maintenance, and subsequent reversal of hypothermia. One good randomized trial1 and a pseudorandomized trial2 reported improved neurologically intact survival to hospital discharge when comatose patients with out-of-hospital ventricular fibrillation (VF) cardiac arrest were cooled to 32°C to 34°C for 12 or 24 hours beginning minutes to hours after ROSC. Additional studies with historical control groups show improved neurological outcome after therapeutic hypothermia for comatose survivors of VF cardiac arrest.20,21No randomized controlled trials have compared outcome between hypothermia and normothermia for non-VF arrest. However, 6 studies with historical control groups reported a beneficial effect on outcome from use of therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest associated with any arrest rhythm.11,22–26 Only one study with historical controls reported better neurological outcome after VF cardiac arrest but no difference in outcome after cardiac arrest associated with other rhythms.27 Two nonrandomized studies with concurrent controls28,29 indicate a possible benefit of hypothermia after in- and out-of-hospital cardiac arrest associated with non-VF initial rhythms.Case series have reported the feasibility of using therapeutic hypothermia after ROSC in the setting of cardiogenic shock23,30,31 and therapeutic hypothermia in combination with emergent PCI.32–36 Case series also report successful use of fibrinolytic therapy for AMI after ROSC,37,38 but data are lacking about interactions between fibrinolytics and hypothermia in this population.The impact of the timing of initiating hypothermia after cardiac arrest is not completely understood. Studies of animal models of cardiac arrest showed that short-duration hypothermia (≤1 hour) achieved <10 to 20 minutes after ROSC had a beneficial effect that was lost when hypothermia was delayed.39–41 Beyond the initial minutes of ROSC and when hypothermia is prolonged (>12 hours), the relationship between the onset of hypothermia and the resulting neuroprotection is less clear.42,43 Two prospective clinical trials in which hypothermia was achieved within 2 hours2 or at a median of 8 hours (interquartile range [IQR] 4 to 16 hours)1 after ROSC both demonstrated better outcomes in the hypothermia-treated than the normothermia-treated subjects. Subsequent to these studies, one registry-based case series of 986 comatose post–cardiac arrest patients35 suggested that time to initiation of cooling (IQR 1 to 1.8 hours) and time to achieving target temperature (IQR 3 to 6.7 hours) were not associated with improved neurological outcome after discharge. A case series of 49 consecutive comatose post–cardiac arrest patients44 cooled intravascularly after out-of-hospital cardiac arrest also documented that time to target temperature (median 6.8 hours [IQR 4.5 to 9.2 hours]) was not an independent predictor of neurological outcome.The optimal duration of induced hypothermia is at least 12 hours and may be >24 hours. Hypothermia was maintained for 122 or 24 hours1 in the studies of out-of-hospital patients presenting in VF. Most case series of adult patients have reported 24 hours of hypothermia. The effect of a longer duration of cooling on outcome has not been studied in adults, but hypothermia for up to 72 hours was used safely in newborns.45,46Although there are multiple methods for inducing hypothermia, no single method has proved to be optimal. Feedback-controlled endovascular catheters and surface cooling devices are available.47–49 Other techniques (eg, cooling blankets and frequent application of ice bags) are readily available and effective but may require more labor and closer monitoring. As an adjunct, iced isotonic fluid can be infused to initiate core cooling but must be combined with a follow-up method for maintenance of hypothermia.50–52 Although a theoretical concern is that rapid fluid loading could have adverse cardiopulmonary effects such as pulmonary edema, 9 case series indicate that cooling can be initiated safely with IV ice-cold fluids (500 mL to 30 mL/kg of saline 0.9% or Ringer's lactate).51–59 One human case series56 showed that the deterioration in oxygenation that often occurs after ROSC was not significantly affected by the infusion of cold fluids (3427 mL ± 210 mL). Two randomized controlled trials,60,61 one study with concurrent controls,62 and 3 case series63,64 indicate that cooling with IV cold saline can be initiated safely in the prehospital setting.Clinicians should continuously monitor the patient's core temperature using an esophageal thermometer, bladder catheter in nonanuric patients, or pulmonary artery catheter if one is placed for other indications.1,2 Axillary and oral temperatures are inadequate for measurement of core temperature changes, especially during active manipulation of temperature for therapeutic hypothermia,65,66 and true tympanic temperature probes are rarely available and often unreliable. Bladder temperatures in anuric patients and rectal temperatures may differ from brain or core temperature.66,67 A secondary source of temperature measurement should be considered, especially if a closed feedback cooling system is used for temperature management.A number of potential complications are associated with cooling, including coagulopathy, arrhythmias, and hyperglycemia, particularly with an unintended drop below target temperature.35 The likelihood of pneumonia and sepsis may increase in patients treated with therapeutic hypothermia.1,2 Although these complications were not significantly different between groups in the published clinical trials, infections are common in this population, and prolonged hypothermia is known to decrease immune function. Hypothermia also impairs coagulation, and any ongoing bleeding should be controlled before decreasing temperature.In summary, we recommend that comatose (ie, lack of meaningful response to verbal commands) adult patients with ROSC after out-of-hospital VF cardiac arrest should be cooled to 32°C to 34°C (89.6°F to 93.2°F) for 12 to 24 hours (Class I, LOE B). Induced hypothermia also may be considered for comatose adult patients with ROSC after in-hospital cardiac arrest of any initial rhythm or after out-of-hospital cardiac arrest with an initial rhythm of pulseless electric activity or asystole (Class IIb, LOE B). Active rewarming should be avoided in comatose patients who spontaneously develop a mild degree of hypothermia (>32°C [89.6°F]) after resuscitation from cardiac arrest during the first 48 hours after ROSC. (Class III, LOE C).HyperthermiaAfter resuscitation, temperature elevation above normal can impair brain recovery. The etiology of fever after cardiac arrest may be related to activation of inflammatory cytokines in a pattern similar to that observed in sepsis.68,69 There are no randomized controlled trials evaluating the effect of treating pyrexia with either frequent use of antipyretics or “controlled normothermia” using cooling techniques compared to no temperature intervention in post–cardiac arrest patients. Case series70–74 and studies75–80 suggest that there is an association between poor survival outcomes and pyrexia ≥37.6°C. In patients with a cerebrovascular event leading to brain ischemia, studies75–80 demonstrate worsened short-term outcome and long-term mortality. By extrapolation this data may be relevant to the global ischemia and reperfusion of the brain that follows cardiac arrest. Patients can develop hyperthermia after rewarming posthypothermia treatment. This late hyperthermia should also be identified and treated. Providers should closely monitor patient core temperature after ROSC and actively intervene to avoid hyperthermia (Class I, LOE C).Organ-Specific Evaluation and SupportThe remainder of Part 9 focuses on organ-specific measures that should be included in the immediate post–cardiac arrest period.Pulmonary SystemPulmonary dysfunction after cardiac arrest is common. Etiologies include hydrostatic pulmonary edema from left ventricular dysfunction; noncardiogenic edema from inflammatory, infective, or physical injuries; severe pulmonary atelectasis; or aspiration occurring during cardiac arrest or resuscitation. Patients often develop regional mismatch of ventilation and perfusion, contributing to decreased arterial oxygen content. The severity of pulmonary dysfunction often is measured in terms of the Pao2/Fio2 ratio. A Pao2/Fio2 ratio of ≤300 mm Hg usually defines acute lung injury. The acute onset of bilateral infiltrates on chest x-ray and a pulmonary artery pressure ≤18 mm Hg or no evidence of left atrial hypertension are common to both acute lung injury and acute respiratory distress syndrome (ARDS). A Pao2/Fio2 ratio <300 or <200 mm Hg separates acute lung injury from ARDS, respectively.81 Positive end-expiratory pressure (PEEP), a lung-protective strategy for mechanical ventilation, and titrated Fio2 are strategies that can improve pulmonary function and Pao2 while the practitioner is determining the pathophysiology of the pulmonary dysfunction.Essential diagnostic tests in intubated patients include a chest radiograph and arterial blood gas measurements. Other diagnostic tests may be added based on history, physical examination, and clinical circumstances. Evaluation of a chest radiograph should verify the correct position of the endotracheal tube and the distribution of pulmonary infiltrates or edema and identify complications from chest compressions (eg, rib fracture, pneumothorax, and pleural effusions) or pneumonia.Providers should adjust mechanical ventilatory support based on the measured oxyhemoglobin saturation, blood gas values, minute ventilation (respiratory rate and tidal volume), and patient-ventilator synchrony. In addition, mechanical ventilatory support to reduce the work of breathing should be considered as long as the patient remains in shock. As spontaneous ventilation becomes more efficient and as concurrent medical conditions allow, the level of support may be gradually decreased.The optimal Fio2 during the immediate period after cardiac arrest is still debated. The beneficial effect of high Fio2 on systemic oxygen delivery should be balanced with the deleterious effect of generating oxygen-derived free radicals during the reperfusion phase. Animal data suggests that ventilations with 100% oxygen (generating Pao2 >350 mm Hg at 15 to 60 minutes after ROSC) increase brain lipid peroxidation, increase metabolic dysfunctions, increase neurological degeneration, and worsen short-term functional outcome when compared with ventilation with room air or an inspired oxygen fraction titrated to a pulse oximeter reading between 94% and 96%.82–87 One randomized prospective clinical trial compared ventilation for the first 60 minutes after ROSC with 30% oxygen (resulting in Pao2=110±25 mm Hg at 60 minutes) or 100% oxygen (resulting in Pao2=345±174 mm Hg at 60 minutes).88 This small trial detected no difference in serial markers of acute brain injury, survival to hospital discharge, or percentage of patients with good neurological outcome at hospital discharge but was inadequately powered to detect important differences in survival or neurological outcome.Once the circulation is restored, monitor systemic arterial oxyhemoglobin saturation. It may be reasonable, when the appropriate equipment is available, to titrate oxygen administration to maintain the arterial oxyhemoglobin saturation ≥94%. Provided appropriate equipment is available, once ROSC is achieved, adjust the Fio2 to the minimum concentration needed to achieve arterial oxyhemoglobin saturation ≥94%, with the goal of avoiding hyperoxia while ensuring adequate oxygen delivery. Since an arterial oxyhemoglobin saturation of 100% may correspond to a Pao2 anywhere between ∼80 and 500 mm Hg, in general it is appropriate to wean Fio2 when saturation is 100%, provided the oxyhemoglobin saturation can be maintained ≥94% (Class I, LOE C).Because patients may have significant metabolic acidosis after cardiac arrest, there is a temptation to institute hyperventilation to normalize blood pH. However, metabolic acidosis is likely to be reversed once adequate perfusion is restored, and there are several physiological reasons why hyperventilation may be detrimental. Minute ventilation alters the partial pressure of carbon dioxide (Paco2), which in turn can affect cerebral blood flow. In a normal brain a 1-mm Hg decrease in Paco2 results in a decrease in cerebral blood flow of approximately 2.5% to 4%; cerebral blood flow remains CO2-reactive after cardiac arrest,89,90 although the magnitude of the CO2 reactivity (magnitude of change in cerebral blood flow per millimeters of mercury [mm Hg] change in Pco2) may be diminished or suppressed for 1 to 3 hours after reperfusion,91,92 especially after prolonged ischemia (≥15 minutes).93,94 After ROSC there is an initial hyperemic blood flow response that lasts 10 to 30 minutes, followed by a more prolonged period of low blood flow.95,96 During this latter period of late hypoperfusion, a mismatch between blood flow (as a component of oxygen delivery) and oxygen requirement may occur. Hyperventilation at this stage may lower Paco2, cause cerebral vasoconstriction, and exacerbate cerebral ischemic injury.Physiological data in humans suggests that hyperventilation could cause additional cerebral ischemia in the post–cardiac arrest patient because sustained hypocapnia (low Pco2) may reduce cerebral blood flow.97,98 Transcranial Doppler measurements of the middle cerebral artery and jugular bulb oxygen saturation measurements in 10 comatose subjects after cardiac arrest revealed that hyperventilation with hypocapnia did not affect median flow velocity but did decrease jugular bulb oxygen saturation below the ischemic threshold (55%). Conversely, hypoventilation with hypercapnia produced the opposite effect.99 In one study, controlled ventilation with specific goals to keep Paco2 37.6 to 45.1 mm Hg (5 to 6 kPa) and Sao2 95% to 98% as part of a bundle with multiple other goals (including hypothermia and blood pressure goals) increased survival from 26% to 56%.11 In that study it was impossible to ascertain an independent effect of controlled ventilation separate from |
C52119013 | Art history | https://doi.org/10.1161/circulationaha.110.970988 | academic study of objects of art in their historical development | Part 8: Adult Advanced Cardiovascular Life Support | [
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] | HomeCirculationVol. 122, No. 18_suppl_3Part 8: Adult Advanced Cardiovascular Life Support Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPart 8: Adult Advanced Cardiovascular Life Support2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Robert W. Neumar, Charles W. Otto, Mark S. Link, Steven L. Kronick, Michael Shuster, Clifton W. Callaway, Peter J. Kudenchuk, Joseph P. Ornato, Bryan McNally, Scott M. Silvers, Rod S. Passman, Roger D. White, Erik P. Hess, Wanchun Tang, Daniel Davis, Elizabeth Sinz and Laurie J. Morrison Robert W. NeumarRobert W. Neumar Search for more papers by this author , Charles W. OttoCharles W. Otto Search for more papers by this author , Mark S. LinkMark S. Link Search for more papers by this author , Steven L. KronickSteven L. Kronick Search for more papers by this author , Michael ShusterMichael Shuster Search for more papers by this author , Clifton W. CallawayClifton W. Callaway Search for more papers by this author , Peter J. KudenchukPeter J. Kudenchuk Search for more papers by this author , Joseph P. OrnatoJoseph P. Ornato Search for more papers by this author , Bryan McNallyBryan McNally Search for more papers by this author , Scott M. SilversScott M. Silvers Search for more papers by this author , Rod S. PassmanRod S. Passman Search for more papers by this author , Roger D. WhiteRoger D. White Search for more papers by this author , Erik P. HessErik P. Hess Search for more papers by this author , Wanchun TangWanchun Tang Search for more papers by this author , Daniel DavisDaniel Davis Search for more papers by this author , Elizabeth SinzElizabeth Sinz Search for more papers by this author and Laurie J. MorrisonLaurie J. Morrison Search for more papers by this author Originally published2 Nov 2010https://doi.org/10.1161/CIRCULATIONAHA.110.970988Circulation. 2010;122:S729–S767is corrected byCorrectionCorrectionAdvanced cardiovascular life support (ACLS) impacts multiple key links in the chain of survival that include interventions to prevent cardiac arrest, treat cardiac arrest, and improve outcomes of patients who achieve return of spontaneous circulation (ROSC) after cardiac arrest. ACLS interventions aimed at preventing cardiac arrest include airway management, ventilation support, and treatment of bradyarrhythmias and tachyarrhythmias. For the treatment of cardiac arrest, ACLS interventions build on the basic life support (BLS) foundation of immediate recognition and activation of the emergency response system, early CPR, and rapid defibrillation to further increase the likelihood of ROSC with drug therapy, advanced airway management, and physiologic monitoring. Following ROSC, survival and neurologic outcome can be improved with integrated post–cardiac arrest care.Part 8 presents the 2010 Adult ACLS Guidelines: 8.1: “Adjuncts for Airway Control and Ventilation”; 8.2: “Management of Cardiac Arrest”; and 8.3: “Management of Symptomatic Bradycardia and Tachycardia.” Post–cardiac arrest interventions are addressed in Part 9: “Post–Cardiac Arrest Care.”Key changes from the 2005 ACLS Guidelines include Continuous quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal tube placement.Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of high-quality CPR (including chest compressions of adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in chest compressions and avoiding excessive ventilation).Atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA)/asystole.There is an increased emphasis on physiologic monitoring to optimize CPR quality and detect ROSC.Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia.Adenosine is recommended as a safe and potentially effective therapy in the initial management of stable undifferentiated regular monomorphic wide-complex tachycardia.Part 8.1: Adjuncts for Airway Control and VentilationOverview of Airway ManagementThis section highlights recommendations for the support of ventilation and oxygenation during CPR and the peri-arrest period. The purpose of ventilation during CPR is to maintain adequate oxygenation and sufficient elimination of carbon dioxide. However, research has not identified the optimal tidal volume, respiratory rate, and inspired oxygen concentration required during resuscitation from cardiac arrest.Both ventilation and chest compressions are thought to be important for victims of prolonged ventricular fibrillation (VF) cardiac arrest and for all victims with other presenting rhythms. Because both systemic and pulmonary perfusion are substantially reduced during CPR, normal ventilation-perfusion relationships can be maintained with a minute ventilation that is much lower than normal. During CPR with an advanced airway in place, a lower rate of rescue breathing is needed to avoid hyperventilation.Ventilation and Oxygen Administration During CPRDuring low blood flow states such as CPR, oxygen delivery to the heart and brain is limited by blood flow rather than by arterial oxygen content.1,2 Therefore, rescue breaths are less important than chest compressions during the first few minutes of resuscitation from witnessed VF cardiac arrest and could reduce CPR efficacy due to interruption in chest compressions and the increase in intrathoracic pressure that accompanies positive-pressure ventilation. Thus, during the first few minutes of witnessed cardiac arrest a lone rescuer should not interrupt chest compressions for ventilation. Advanced airway placement in cardiac arrest should not delay initial CPR and defibrillation for VF cardiac arrest (Class I, LOE C).Oxygen During CPROxygen Administration During CPRThe optimal inspired oxygen concentration during adult CPR has not been established in human or animal studies. In addition, it is unknown whether 100% inspired oxygen (Fio2=1.0) is beneficial or whether titrated oxygen is better. Although prolonged exposure to 100% inspired oxygen (Fio2=1.0) has potential toxicity, there is insufficient evidence to indicate that this occurs during brief periods of adult CPR.3–5 Empirical use of 100% inspired oxygen during CPR optimizes arterial oxyhemoglobin content and in turn oxygen delivery; therefore, use of 100% inspired oxygen (Fio2=1.0) as soon as it becomes available is reasonable during resuscitation from cardiac arrest (Class IIa, LOE C). Management of oxygen after ROSC is discussed in Part 9: “Post-Cardiac Arrest Care.”Passive Oxygen Delivery During CPRPositive-pressure ventilation has been a mainstay of CPR but recently has come under scrutiny because of the potential for increased intrathoracic pressure to interfere with circulation due to reduced venous return to the heart. In the out-of-hospital setting, passive oxygen delivery via mask with an opened airway during the first 6 minutes of CPR provided by emergency medical services (EMS) personnel was part of a protocol of bundled care interventions (including continuous chest compressions) that resulted in improved survival.6–8 When passive oxygen delivery using a fenestrated tracheal tube (Boussignac tube) during uninterrupted physician-managed CPR was compared with standard CPR, there was no difference in oxygenation, ROSC, or survival to hospital admission.9,10 Chest compressions cause air to be expelled from the chest and oxygen to be drawn into the chest passively due to the elastic recoil of the chest. In theory, because ventilation requirements are lower than normal during cardiac arrest, oxygen supplied by passive delivery is likely to be sufficient for several minutes after onset of cardiac arrest with a patent upper airway.2At this time there is insufficient evidence to support the removal of ventilations from CPR performed by ACLS providers.Bag-Mask VentilationBag-mask ventilation is an acceptable method of providing ventilation and oxygenation during CPR but is a challenging skill that requires practice for continuing competency. All healthcare providers should be familiar with the use of the bag-mask device.11,12 Use of bag-mask ventilation is not recommended for a lone provider. When ventilations are performed by a lone provider, mouth-to-mouth or mouth-to-mask are more efficient. When a second provider is available, bag-mask ventilation may be used by a trained and experienced provider. But bag-mask ventilation is most effective when performed by 2 trained and experienced providers. One provider opens the airway and seals the mask to the face while the other squeezes the bag. Bag-mask ventilation is particularly helpful when placement of an advanced airway is delayed or unsuccessful. The desirable components of a bag-mask device are listed in Part 5: “Adult Basic Life Support.”The provider should use an adult (1 to 2 L) bag and the provider should deliver approximately 600 mL of tidal volume sufficient to produce chest rise over 1 second.13 This volume of ventilation is adequate for oxygenation and minimizes the risk of gastric inflation. The provider should be sure to open the airway adequately with a head tilt–chin lift, lifting the jaw against the mask and holding the mask against the face, creating a tight seal. During CPR give 2 breaths (each 1 second) during a brief (about 3 to 4 seconds) pause after every 30 chest compressions.Bag-mask ventilation can produce gastric inflation with complications, including regurgitation, aspiration, and pneumonia. Gastric inflation can elevate the diaphragm, restrict lung movement, and decrease respiratory system compliance.14–16Airway AdjunctsCricoid PressureCricoid pressure in nonarrest patients may offer some measure of protection to the airway from aspiration and gastric insufflation during bag-mask ventilation.17–20 However, it also may impede ventilation and interfere with placement of a supraglottic airway or intubation.21–27 The role of cricoid pressure during out-of-hospital cardiac arrest and in-hospital cardiac arrest has not been studied. If cricoid pressure is used in special circumstances during cardiac arrest, the pressure should be adjusted, relaxed, or released if it impedes ventilation or advanced airway placement. The routine use of cricoid pressure in cardiac arrest is not recommended (Class III, LOE C).Oropharyngeal AirwaysAlthough studies have not specifically considered the use of oropharyngeal airways in patients with cardiac arrest, airways may aid in the delivery of adequate ventilation with a bag-mask device by preventing the tongue from occluding the airway. Incorrect insertion of an oropharyngeal airway can displace the tongue into the hypopharynx, causing airway obstruction. To facilitate delivery of ventilations with a bag-mask device, oropharyngeal airways can be used in unconscious (unresponsive) patients with no cough or gag reflex and should be inserted only by persons trained in their use (Class IIa, LOE C).Nasopharyngeal AirwaysNasopharyngeal airways are useful in patients with airway obstruction or those at risk for developing airway obstruction, particularly when conditions such as a clenched jaw prevent placement of an oral airway. Nasopharyngeal airways are better tolerated than oral airways in patients who are not deeply unconscious. Airway bleeding can occur in up to 30% of patients following insertion of a nasopharyngeal airway.28 Two case reports of inadvertent intracranial placement of a nasopharyngeal airway in patients with basilar skull fractures29,30 suggest that nasopharyngeal airways should be used with caution in patients with severe craniofacial injury.As with all adjunctive equipment, safe use of the nasopharyngeal airway requires adequate training, practice, and retraining. No studies have specifically examined the use of nasopharyngeal airways in cardiac arrest patients. To facilitate delivery of ventilations with a bag-mask device, the nasopharyngeal airway can be used in patients with an obstructed airway. In the presence of known or suspected basal skull fracture or severe coagulopathy, an oral airway is preferred (Class IIa, LOE C).Advanced AirwaysVentilation with a bag and mask or with a bag through an advanced airway (eg, endotracheal tube or supraglottic airway) is acceptable during CPR. All healthcare providers should be trained in delivering effective oxygenation and ventilation with a bag and mask. Because there are times when ventilation with a bag-mask device is inadequate, ideally ACLS providers also should be trained and experienced in insertion of an advanced airway.Providers must be aware of the risks and benefits of insertion of an advanced airway during a resuscitation attempt. Such risks are affected by the patient's condition and the provider's expertise in airway control. There are no studies directly addressing the timing of advanced airway placement and outcome during resuscitation from cardiac arrest. Although insertion of an endotracheal tube can be accomplished during ongoing chest compressions, intubation frequently is associated with interruption of compressions for many seconds. Placement of a supraglottic airway is a reasonable alternative to endotracheal intubation and can be done successfully without interrupting chest compressions.The provider should weigh the need for minimally interrupted compressions against the need for insertion of an endotracheal tube or supraglottic airway. There is inadequate evidence to define the optimal timing of advanced airway placement in relation to other interventions during resuscitation from cardiac arrest. In a registry study of 25 006 in-hospital cardiac arrests, earlier time to invasive airway (<5 minutes) was not associated with improved ROSC but was associated with improved 24-hour survival.31 In an urban out-of-hospital setting, intubation that was achieved in <12 minutes was associated with better survival than intubation achieved in ≥13 minutes.32In out-of-hospital urban and rural settings, patients intubated during resuscitation had a better survival rate than patients who were not intubated,33 whereas in an in-hospital setting, patients who required intubation during CPR had a worse survival rate.34 A recent study8 found that delayed endotracheal intubation combined with passive oxygen delivery and minimally interrupted chest compressions was associated with improved neurologically intact survival after out-of-hospital cardiac arrest in patients with adult witnessed VF/pulseless VT. If advanced airway placement will interrupt chest compressions, providers may consider deferring insertion of the airway until the patient fails to respond to initial CPR and defibrillation attempts or demonstrates ROSC (Class IIb, LOE C).For a patient with perfusing rhythm who requires intubation, pulse oximetry and electrocardiographic (ECG) status should be monitored continuously during airway placement. Intubation attempts should be interrupted to provide oxygenation and ventilation as needed.To use advanced airways effectively, healthcare providers must maintain their knowledge and skills through frequent practice. It may be helpful for providers to master one primary method of airway control. Providers should have a second (backup) strategy for airway management and ventilation if they are unable to establish the first-choice airway adjunct. Bag-mask ventilation may serve as that backup strategy.Once an advanced airway is inserted, providers should immediately perform a thorough assessment to ensure that it is properly positioned. This assessment should not interrupt chest compressions. Assessment by physical examination consists of visualizing chest expansion bilaterally and listening over the epigastrium (breath sounds should not be heard) and the lung fields bilaterally (breath sounds should be equal and adequate). A device also should be used to confirm correct placement (see the section “Endotracheal Intubation” below).Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube (Class I, LOE A). Providers should observe a persistent capnographic waveform with ventilation to confirm and monitor endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any patient transfer to reduce the risk of unrecognized tube misplacement or displacement.The use of capnography to confirm and monitor correct placement of supraglottic airways has not been studied, and its utility will depend on airway design. However, effective ventilation through a supraglottic airway device should result in a capnograph waveform during CPR and after ROSC.Once an advanced airway is in place, the 2 providers should no longer deliver cycles of CPR (ie, compressions interrupted by pauses for ventilation) unless ventilation is inadequate when compressions are not paused. Instead the compressing provider should give continuous chest compressions at a rate of at least 100 per minute, without pauses for ventilation. The provider delivering ventilation should provide 1 breath every 6 to 8 seconds (8 to 10 breaths per minute). Providers should avoid delivering an excessive ventilation rate because doing so can compromise venous return and cardiac output during CPR. The 2 providers should change compressor and ventilator roles approximately every 2 minutes to prevent compressor fatigue and deterioration in quality and rate of chest compressions. When multiple providers are present, they should rotate the compressor role about every 2 minutes.Supraglottic AirwaysSupraglottic airways are devices designed to maintain an open airway and facilitate ventilation. Unlike endotracheal intubation, intubation with a supraglottic airway does not require visualization of the glottis, so both initial training and maintenance of skills are easier. Also, because direct visualization is not necessary, a supraglottic airway is inserted without interrupting compressions. Supraglottic airways that have been studied in cardiac arrest are the laryngeal mask airway (LMA), the esophageal-tracheal tube (Combitube) and the laryngeal tube (Laryngeal Tube or King LT). When prehospital providers are trained in the use of advanced supraglottic airways such as the esophageal-tracheal tube, laryngeal tube, and the laryngeal mask airway, they appear to be able to use these devices safely and can provide ventilation that is as effective as that provided with a bag and mask or an endotracheal tube.12,35–41Advanced airway interventions are technically complicated. Failure can occur; thus maintenance of skills through frequent experience or practice is essential.42 It is important to remember that there is no evidence that advanced airway measures improve survival rates in the setting of out-of-hospital cardiac arrest. During CPR performed by providers trained in its use, the supraglottic airway is a reasonable alternative to bag-mask ventilation (Class IIa, LOE B) and endotracheal intubation (Class IIa, LOE A).Esophageal-Tracheal TubeThe advantages of the esophageal-tracheal tube (Combitube) are similar to the advantages of the endotracheal tube when either is compared with bag-mask ventilation: isolation of the airway, reduced risk of aspiration, and more reliable ventilation. The advantages of the esophageal-tracheal tube over the endotracheal tube are related chiefly to ease of training.12,43 Ventilation and oxygenation with the esophageal-tracheal tube compare favorably with those achieved with the endotracheal tube.44In several controlled clinical trials involving both in-hospital and out-of-hospital resuscitation of adults, providers with all levels of experience were able to insert the esophageal-tracheal tube and deliver ventilation comparable to that achieved with endotracheal intubation.35,45–48 In a retrospective study no difference in outcome was observed in patients treated with the esophageal-tracheal tube compared with those treated with endotracheal intubation.38 The esophageal-tracheal tube is reported to provide successful ventilation during CPR in 62% to 100% of patients.35,45–49 For healthcare professionals trained in its use, the esophageal-tracheal tube is an acceptable alternative to both bag-mask ventilation (Class IIa, LOE C) or endotracheal intubation (Class IIa, LOE A) for airway management in cardiac arrest.Fatal complications may occur with use of the esophageal-tracheal tube if the position of the distal lumen of the esophageal-tracheal tube in the esophagus or trachea is identified incorrectly. For this reason, confirmation of tube placement is essential. Other possible complications related to the use of the esophageal-tracheal tube are esophageal trauma, including lacerations, bruising, and subcutaneous emphysema.45,50,51Laryngeal TubeThe advantages of the laryngeal tube (Laryngeal Tube or King LT) are similar to those of the esophageal-tracheal tube; however, the laryngeal tube is more compact and less complicated to insert (unlike the esophageal-tracheal tube, the laryngeal tube can only go into the esophagus). At this time there are limited data published on the use of the laryngeal tube in cardiac arrest.40,41,52,53 In one case series assessing 40 out-of-hospital cardiac arrest patients, insertion of the laryngeal tube by trained paramedics was successful and ventilation was effective in 85% of patients.41 For 3 patients, ventilation was ineffective because of cuff rupture; for 3 other patients, ventilation was ineffective because of massive regurgitation and aspiration before laryngeal tube placement.Another out-of-hospital assessment of 157 attempts at laryngeal tube placement revealed a 97% success rate in a mixed population of cardiac arrest and noncardiac arrest patients.40 For healthcare professionals trained in its use, the laryngeal tube may be considered as an alternative to bag-mask ventilation (Class IIb, LOE C) or endotracheal intubation for airway management in cardiac arrest (Class IIb, LOE C).Laryngeal Mask AirwayThe laryngeal mask airway provides a more secure and reliable means of ventilation than the face mask.54,55 Although the laryngeal mask airway does not ensure absolute protection against aspiration, studies have shown that regurgitation is less likely with the laryngeal mask airway than with the bag-mask device and that aspiration is uncommon. When compared with the endotracheal tube, the laryngeal mask airway provides equivalent ventilation49,55; successful ventilation during CPR has been reported in 72% to 97% of patients.36,37,44,56–58Because insertion of the laryngeal mask airway does not require laryngoscopy and visualization of the vocal cords, training in its placement and use is simpler than that for endotracheal intubation. The laryngeal mask airway also may have advantages over the endotracheal tube when access to the patient is limited,59,60 there is a possibility of unstable neck injury,61 or appropriate positioning of the patient for endotracheal intubation is impossible.Results from studies in anesthetized patients comparing the laryngeal mask airway with endotracheal intubation, as well as additional studies comparing it with other airways or ventilation techniques support the use of the laryngeal mask airway for airway control in a variety of settings by nurses, respiratory therapists, and EMS personnel, many of whom had not previously used this device.12,39,44,55,62–65After successful insertion, a small proportion of patients cannot be ventilated with the laryngeal mask airway.12,44,55 With this in mind, it is important for providers to have an alternative strategy for airway management. Providers who insert the laryngeal mask airway should receive adequate initial training and then should practice insertion of the device regularly. Success rates and the occurrence of complications should be monitored closely. For healthcare professionals trained in its use, the laryngeal mask airway is an acceptable alternative to bag-mask ventilation (Class IIa, LOE B) or endotracheal intubation (Class IIa, LOE C) for airway management in cardiac arrest.Endotracheal IntubationThe endotracheal tube was once considered the optimal method of managing the airway during cardiac arrest. However, intubation attempts by unskilled providers can produce complications, such as trauma to the oropharynx, interruption of compressions and ventilations for unacceptably long periods, and hypoxemia from prolonged intubation attempts or failure to recognize tube misplacement or displacement. It is now clear that the incidence of complications is unacceptably high when intubation is performed by inexperienced providers or monitoring of tube placement is inadequate. The optimal method of managing the airway during cardiac arrest will vary based on provider experience, characteristics of the EMS or healthcare system, and the patient's condition. Frequent experience or frequent retraining is recommended for providers who perform endotracheal intubation (Class I, LOE B).31,66 EMS systems that perform prehospital intubation should provide a program of ongoing quality improvement to minimize complications (Class IIa, LOE B).No prospective randomized clinical trials have performed a direct comparison of bag-mask ventilation versus endotracheal intubation in adult victims of cardiac arrest. One prospective, randomized controlled trial in an EMS system with short out-of-hospital transport intervals67 showed no survival advantage for endotracheal intubation over bag-mask ventilation in children; providers in this study had limited training and experience in intubation.The endotracheal tube keeps the airway patent, permits suctioning of airway secretions, enables delivery of a high concentration of oxygen, provides an alternative route for the administration of some drugs, facilitates delivery of a selected tidal volume, and, with use of a cuff, may protect the airway from aspiration.Indications for emergency endotracheal intubation are (1) the inability of the provider to ventilate the unconscious patient adequately with a bag and mask and (2) the absence of airway protective reflexes (coma or cardiac arrest). The provider must have appropriate training and experience in endotracheal intubation.During CPR providers should minimize the number and duration of interruptions in chest compressions, with a goal to limit interruptions to no more than 10 seconds. Interruptions for supraglottic airway placement should not be necessary at all, whereas interruptions for endotracheal intubation can be minimized if the intubating provider is prepared to begin the intubation attempt—ie, insert the laryngoscope blade with the tube ready at hand—as soon as the compressing provider pauses compressions. Compressions should be interrupted only for the time required by the intubating provider to visualize the vocal cords and insert the tube; this is ideally less than 10 seconds. The compressing provider should be prepared to resume chest compressions immediately after the tube is passed through the vocal cords. If the initial intubation attempt is unsuccessful, a second attempt may be reasonable, but early consideration should be given to using a supraglottic airway.In retrospective studies, endotracheal intubation has been associated with a 6% to 25% incidence of unrecognized tube misplacement or displacement.68–72 This may reflect inadequate initial training or lack of experience on the part of the provider who performed intubation, or it may have resulted from displacement of a correctly positioned tube when the patient was moved. The risk of tube misplacement, displacement, or obstruction is high,67,70 especially when the patient is moved.73 Thus, even when the endotracheal tube is seen to pass through the vocal cords and tube position is verified by chest expansion and auscultation during positive-pressure ventilation, providers should obtain additional confirmation of placement using waveform capnography or an exhaled CO2 or esophageal detector device (EDD).74The provider should use both clinical assessment and confirmation devices to verify tube placement immediately after insertion and again when the patient is moved. However, no single confirmation technique is completely reliable.75,76 Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube (Class I, LOE A).If waveform capnography is not available, an EDD or nonwaveform exhaled CO2 monitor in addition to clinical assessment is reasonable (Class IIa, LOE B). Techniques to confirm endotracheal tube placement are further discussed below.Clinical Assessment to Confirm Tube PlacementProviders should perform a thorough assessment of endotracheal tube position immediately after placement. This assessment should not require interruption of chest compressions. Assessment by physical examination consists of visualizing chest expansion bilaterally and listening over the epigastrium (breath sounds should not be heard) and the lung fields bilaterally (breath sounds should be equal and adequate). A device should also be used to confirm correct placement in the trachea (see below). If there is doubt about correct tube placement, use the laryngoscope to visualize the tube passing through the vocal cords. If still in doubt, remove the tube and provide bag-mask ventilation until the tube can be replaced.Use of Devices |
C52119013 | Art history | https://doi.org/10.2307/1901541 | academic study of objects of art in their historical development | Reconstructing Womanhood: The Emergence of the Afro-American Woman Novelist | [
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] | Journal Article Reconstructing Womanhood: The Emergence of the Afro-American Woman Novelist. By Hazel V. Carby. (New York: Oxford University Press, 1987. ix + 223 pp. $19.95.) Get access Donald B. Gibson Donald B. Gibson Rutgers University, New Brunswick Search for other works by this author on: Oxford Academic Google Scholar Journal of American History, Volume 75, Issue 3, December 1988, Pages 881–882, https://doi.org/10.2307/1901541 Published: 01 December 1988 |
C105702510 | Anatomy | https://doi.org/10.1159/000350708 | study of the structure and parts of organisms | Isolated Hand Paresis: A Case Series | [
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] | Using functional magnetic resonance imaging (fMRI) we have evaluated the anatomical location of the motor hand area. The segment of the precentral gyrus that most often contained motor hand function was a knob-like structure, that is shaped like an omega or epsilon in the axial plane and like a hook in the sagittal plane. On the cortical surface of cadaver specimens this precentral knob corresponded precisely to the characteristic 'middle knee' of the central sulcus that has been described by various anatomists in the last century. We were then able to show that this knob is a reliable landmark for identifying the precentral gyrus directly. We therefore conclude that neural elements involved in motor hand function are located in a characteristic 'precentral knob' which is a reliable landmark for identifying the precentral gyrus under normal and pathological conditions. It faces and forms the 'middle knee' of the central sulcus, is located just at the cross point between the precentral sulcus and the central sulcus, and is therefore also visible on the cortical surface. |
C105702510 | Anatomy | https://doi.org/10.1083/jcb.17.2.375 | study of the structure and parts of organisms | JUNCTIONAL COMPLEXES IN VARIOUS EPITHELIA | [
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] | The epithelia of a number of glands and cavitary organs of the rat and guinea pig have been surveyed, and in all cases investigated, a characteristic tripartite junctional complex has been found between adjacent cells. Although the complex differs in precise arrangement from one organ to another, it has been regularly encountered in the mucosal epithelia of the stomach, intestine, gall bladder, uterus, and oviduct; in the glandular epithelia of the liver, pancreas, parotid, stomach, and thyroid; in the epithelia of pancreatic, hepatic, and salivary ducts; and finally, between the epithelial cells of the nephron (proximal and distal convolution, collecting ducts). The elements of the complex, identified as zonula occludens (tight junction), zonula adhaerens (intermediary junction), and macula adhaerens (desmosome), occupy a juxtaluminal position and succeed each other in the order given in an apical-basal direction. The zonula occludens (tight junction) is characterized by fusion of the adjacent cell membranes resulting in obliteration of the intercellular space over variable distances. Within the obliterated zone, the dense outer leaflets of the adjoining cell membranes converge to form a single intermediate line. A diffuse band of dense cytoplasmic material is often associated with this junction, but its development varies from one epithelium to another. The zonula adhaerens (intermediate junction) is characterized by the presence of an intercellular space ( approximately 200 A) occupied by homogeneous, apparently amorphous material of low density; by strict parallelism of the adjoining cell membranes over distances of 0.2 to 0.5 micro; and by conspicuous bands of dense material located in the subjacent cytoplasmic matrix. The desmosome or macula adhaerens is also characterized by the presence of an intercellular space ( approximately 240 A) which, in this case, contains a central disc of dense material; by discrete cytoplasmic plaques disposed parallel to the inner leaflet of each cell membrane; and by the presence of bundles of cytoplasmic fibrils converging on the plaques. The zonula occludens appears to form a continuous belt-like attachment, whereas the desmosome is a discontinuous, button-like structure. The zomula adhaerens is continuous in most epithelia but discontinuous in some. Observations made during experimental hemoglobinuria in rats showed that the hemoglobin, which undergoes enough concentration in the nephron lumina to act as an electron-opaque mass tracer, does not penetrate the intercellular spaces beyond the zonula occludens. Similar observations were made in pancreatic acini and ducts where discharged zymogen served as a mass tracer. Hence the tight junction is impervious to concentrated protein solutions and appears to function as a diffusion barrier or "seal." The desmosome and probably also the zonula adhaerens may represent intercellular attachment devices. |
C105702510 | Anatomy | https://doi.org/10.1113/jphysiol.1966.sp007909 | study of the structure and parts of organisms | The variation in isometric tension with sarcomere length in vertebrate muscle fibres | [
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] | 1. The variation of isometric tetanus tension with sarcomere length in single fibres from frog striated muscle has been re-investigated with special precautions to ensure uniformity of sarcomere length within the part of the fibre being studied.2. In most respects the results of Ramsey & Street (1940) were confirmed, but (a) the peak of the curve was found to consist of a plateau between sarcomere lengths of 2.05 and 2.2 mu, (b) the decline of tension above this plateau is steeper than found by Ramsey & Street, and (c) the decline of tension below the plateau becomes suddenly steeper at a sarcomere length of about 1.67 mu.3. Many features of this length-tension relation are simply explained on the sliding-filament theory.4. It is concluded that, in the plateau and at greater lengths, the tension on each thin filament is made up of equal contributions from each bridge which it overlaps on adjacent thick filaments.5. Internal resistance to shortening is negligible in this range but becomes progressively more important with shortening below the plateau. |
C105702510 | Anatomy | https://doi.org/10.1113/jphysiol.1970.sp009022 | study of the structure and parts of organisms | The period of susceptibility to the physiological effects of unilateral eye closure in kittens | [
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] | 1. Kittens were visually deprived by suturing the lids of the right eye for various periods of time at different ages. Recordings were subsequently made from the striate cortex, and responses from the two eyes compared. As previously reported, monocular eye closure during the first few months of life causes a sharp decline in the number of cells that can be influenced by the previously closed eye.2. Susceptibility to the effects of eye closure begins suddenly near the start of the fourth week, remains high until some time between the sixth and eighth weeks, and then declines, disappearing finally around the end of the third month. Monocular closure for over a year in an adult cat produces no detectable effects.3. During the period of high susceptibility in the fourth and fifth weeks eye closure for as little as 3-4 days leads to a sharp decline in the number of cells that can be driven from both eyes, as well as an over-all decline in the relative influence of the previously closed eye. A 6-day closure is enough to give a reduction in the number of cells that can be driven by the closed eye to a fraction of the normal. The physiological picture is similar to that following a 3-month monocular deprivation from birth, in which the proportion of cells the eye can influence drops from 85 to about 7%.4. Cells of the lateral geniculate receiving input from a deprived eye are noticeably smaller and paler to Nissl stain following 3 or 6 days' deprivation during the fourth week.5. Following 3 months of monocular deprivation, opening the eye for up to 5 yr produces only a very limited recovery in the cortical physiology, and no obvious recovery of the geniculate atrophy, even though behaviourally there is some return of vision in the deprived eye. Closing the normal eye, though necessary for behavioural recovery, has no detectable effect on the cortical physiology. The amount of possible recovery in the striate cortex is probably no greater if the period of eye closure is limited to weeks, but after a 5-week closure there is a definite enhancement of the recovery, even though it is far from complete. |
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