Properties and Processing of Aviation Exhaust Aerosol at Cruise Altitude Observed from the IAGOS-CARIBIC Flying Laboratory.

The characteristics of aviation-induced aerosol, its processing, and effects on cirrus clouds and climate are still associated with large uncertainties. Properties of aviation-induced aerosol, however, are crucially needed for the assessment of aviation's climate impacts today and in the future. We identified more than 1100 aircraft plume encounters during passenger aircraft flights of the IAGOS-CARIBIC Flying Laboratory from July 2018 to March 2020.

Long-term stable, synchronizable, low-noise picosecond Ho:fiber NALM oscillator for Ho:YLF amplifier seeding.

We demonstrate a 41.6 MHz, 1.3 ps, 140 pJ Ho:fiber oscillator using a nonlinear amplifying loop mirror (NALM) as saturable absorber.

Return on Investment Analysis of Health Experts onLine at Portsmouth: A 2-Year Review of the Navy's Newest Teleconsultation System.

Background: Health Experts onLine at Portsmouth (HELP) is a web-based teleconsultation system launched in June 2014 to facilitate communication between specialists at Naval Medical Center Portsmouth and providers assigned to both the fleet forces and primary care clinics across the eastern United States, Europe, and the Middle East. Specialist consultations through the HELP system purport to improve access to care for patients who otherwise might be referred to the civilian network or medically evacuated (MEDEVACed) to Naval Medical Center Portsmouth for specialized care. If HELP-facilitated communications help avoid civilian referrals or MEDEVACs, the associated costs of that care should be reduced.

Automated Bone Age Analysis with Lossy Image Files.

Background: In our U.S. Department of Defense hospital system, pediatric endocrinology and radiology resources to evaluate bone age radiographs are limited.

A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport.

Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii.

The Health Experts onLine at Portsmouth (HELP) system: One-year review of adult and Pediatric Asynchronous Telehealth Consultations.

Introduction: The Health Experts onLine at Portsmouth teleconsultation system is designed to connect health providers in the Navy Medicine East Region to specialists at Naval Medical Center Portsmouth.

Methods: A review of the first year of the Health Experts onLine at Portsmouth system was performed. Data on each teleconsultation were extracted from the Health Experts onLine at Portsmouth system database and analyzed.

Extensive clinical experience: a simple guide to basal insulin adjustments for long-distance travel.

Long-distance travel across multiple time zones presents unique challenges for patients taking insulin, requiring adjustments in both timing and dosage of basal insulin when several times zones (≥5) are traversed. Travel across the International Date Line adds to the confusion, as existing resources and dosing calculators often do not account for the date change. We review recommendations from available guidelines and dosage calculators used for long-distance travel basal insulin adjustments and then present our patient handouts which allow for a safe, specific, single dose adjustment for eastward and westward travel.

Rogue events in the group velocity horizon.

The concept of rogue waves arises from a mysterious and potentially calamitous phenomenon of oceanic surfaces. There is mounting evidence that they are actually commonplace in a variety of different physical settings. A set of defining criteria has been advanced; this set is of great generality and therefore applicable to a wide class of systems.

[Company integration management in small and medium-sized companies. Legal requirements and prerequisites for successful implementation].

Unlabelled: The article is based on the results of the project “Company integration management in small and medium-sized companies. Legal requirements and prerequisites for a successful implementation” (01 January 2009-31 August 2010).

Background: Since 2004 all employers have been legally bound to offer company integration management (BEM, Betriebliches Eingliederungsmanagement) for all employees who have been incapacitated for work for more than 6 weeks within a year (Section 84 SGB IX, Book 9 of the German Social Code).

Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno-venous extracorporeal membrane oxygenation.

Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports.

Acute sleep deprivation reduces energy expenditure in healthy men.

Background: Epidemiologic evidence indicates that chronic sleep curtailment increases risk of developing obesity, but the mechanisms behind this relation are largely unknown.

Objective: We examined the influence of a single night of total sleep deprivation on morning energy expenditures and food intakes in healthy humans.

Design: According to a balanced crossover design, we examined 14 normal-weight male subjects on 2 occasions during a regular 24-h sleep-wake cycle (including 8 h of nocturnal sleep) and a 24-h period of continuous wakefulness.

The Pacific Asynchronous TeleHealth (PATH) system: review of 1,000 pediatric teleconsultations.

Objective: The aim of this study was to evaluate the impact on pediatric care of the Pacific Asynchronous TeleHealth (PATH) system, a provider-to-provider teleconsultation platform utilized by military medical facilities throughout the Pacific Region. This review focuses on access to care, quality of care, and cost savings for the Department of Defense as a result of ongoing development of the PATH system from 2006 to 2009.

Methods: This is a retrospective review of 1,000 consecutive teleconsultations occurring from January 2006 to March 2009.

Automated heartsound analysis/computer-aided auscultation: a cardiologist's perspective and suggestions for future development.

Heart disease is a major cause of worldwide morbidity and mortality. Properly performed, the cardiac auscultatory examination (listening to the heart with a stethoscope) is an inexpensive, widely available tool in the detection and management of heart disease. Unfortunately, accurate interpretation of heartsounds by primary care providers is fraught with error, leading to missed diagnosis of disease and/or excessive costs associated with evaluation of normal variants.

A portable graphical representation tool for phonocardiograms.

This paper describes a prototype software application to display graphical and editable representations of patient data for use in electronic medical records (EMRs). The application dynamically generates graphics of cardiac and other patient data, and displays or saves them both in graphic and in text formats. The presentation of heart and other data in a consistent, clinically familiar, graphical format is designed to reduce the time necessary for anyone to review and understand this important information.

Pacemaker upgrade causing new-onset heart failure in a patient with complete congenital atrioventricular block.

For infants with congenital complete atrioventricular block (CCAVB), the choice of pacing modalities is limited. Due to their size and surgical limitations, neonates typically start with an epicardial right ventricular pacing system, then upgrade to right-sided dual-chamber pacing once appropriate size is achieved. These modes are generally well tolerated.

Generalized arterial calcification of infancy associated with meconium peritonitis: a case report and review of the literature.

Generalized arterial calcification of infancy (GACI) is a rare genetic disorder consisting of diffuse arterial calcification and intimal proliferation. The disease typically results in progressive arterial stenosis and frequently leads to death from myocardial ischemia by 6 months of life. Affected infants are usually diagnosed before birth or in the neonatal period with symptoms of congestive heart failure.

Neonatal pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn.

Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term infant with a pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. The risk factors identified in the case included maternal diabetes and heterozygous factor V Leiden deficiency.

Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds.

Because pediatric cardiologists can accurately diagnose innocent murmurs by physical exam alone, the authors developed a system for remote cardiac auscultation. They hypothesized that their system could accurately classify auscultatory findings as normal/innocent or pathologic. Patients undergoing evaluation underwent examination, echocardiography, and heart sound recording.

Beta-blocker therapy does not alter the rate of aortic root dilation in pediatric patients with Marfan syndrome.

Objective: To test the hypothesis that chronic beta-blocker therapy in pediatric patients with Marfan syndrome alters the rate of aortic root dilation. Beta-blockade has been advocated as preventive therapy for Marfan syndrome based on reports indicating a decreased rate of aortic root dilation in treated patients.

Study Design: Patients with Marfan syndrome (n = 63) followed at Children's Hospital of Pittsburgh or Children's Hospital of New York-Presbyterian who had > or =18 months of echocardiographic follow-up were studied.

Comparison of two educational interventions on pediatric resident auscultation skills.

Objective: Multiple cross-sectional physician surveys have documented poor cardiac auscultation skills. We evaluated the impact of 2 different educational interventions on pediatric resident auscultation skills.

Methods: The auscultation skills of all first-year (PGY1; n = 20) and second-year pediatric residents (PGY2; n = 20) were evaluated at the beginning and end of the academic year.

Anticoagulation and incidence of late cerebrovascular accidents following the Fontan procedure.

Thromboembolic events are a well-reported complication following the Fontan procedure, but no previous studies have compared the incidence of thromboembolic events relative to the prophylactic anticoagulation strategy utilized. We examined the time-adjusted incidence of late thromboembolic events relative to chronic anticoagulation strategy. All patients who have undergone Fontan palliation and are followed at our institution were reviewed.

Tacrolimus dosage requirements after initiation of azole antifungal therapy in pediatric thoracic organ transplantation.

Azole antifungals inhibit the metabolism of tacrolimus mediated by CYP3A4. Upon initiation of azole therapy, the required dose reduction of tacrolimus is unknown. We reviewed our experience with azole antifungals in our pediatric thoracic transplant population receiving tacrolimus.

The growth and development of a specialty: the history of pediatrics.

Spanning less than two centuries, pediatrics is a relatively young medical specialty. Prior to the development of pediatrics, the medical needs of infants and children were provided by families, friends, and midwives; physicians rarely contributed to the health of this population. However, events beginning in the 19th century resulted in the development of physicians who specifically addressed the medical problems of infancy and childhood; thus the pediatric specialty was born.