Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period. A limb salvage rate of only 46% was attained in the previous five-year period. There were no operative deaths. No complications attributable to systemic anticoagulation or extra-anatomic bypass graft occurred. These adjuncts are recommended to all who manage vascular injuries.     

Private sector unlikely to follow Medicare lead in providing health plan disenrollment comparisons

BACKGROUND: There have been substantial efforts to improve the measurement and reporting of comparative quality information. A three-stage effort to develop comparative voluntary disenrollment measures for private health insurance plans is described. The literature on disenrollment and how key groups might use disenrollment information is reviewed; the development of a comparative survey of disenrollment is described; reasons employers, purchasing coalitions, and plans were ultimately unwilling or unable to sponsor the survey are delineated; and implications of these findings are discussed. DATA AND METHODS: Methods used to develop the survey included review of existing literature on disenrollment, review of extant disenrollee surveys, cognitive testing, and expert review of the survey. Informal and formal interviews were conducted to assess the feasibility of different sponsors. RESULTS: A disenrollment survey instrument that covered areas of common interest to consumers, purchasers, and plans could be developed, but sponsors to test the collection and reporting of these data could not be recruited. This was due to four interrelated factors: technical challenges in developing appropriate samples, wide variation in resources and capabilities of purchasers and plans, the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors, and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment. IMPLICATIONS: Several major barriers must be overcome before disenrollment information can become a component of comparative health care quality measures for the privately insured.     

Bus transfer of AC induction motors: a perspective

An attempt is made to put the problem of bus transfer of induction motors into perspective by presenting, in general terms, the overall concerns and the methods of analysis recently developed. It is pointed out that a decision to transfer one or more induction motors from one power source to another is a difficult one to make. It is complicated by the conditions under which it must be made, whether in a planned or emergency situation, and by the variation in the length of time between separating the motor from the first power source and connecting it to the second. The decision is influenced by the operation of the breakers, either simultaneous pole opening or staggered openings. No simple method of analysis is available for determining the effects on the rotating components of the motor, the couplings, and the driven equipment. It is noted that several general guidelines are in use, but care must be applied when determining if they are applicable to the conditions under consideration. The ANSI C50.41 recommendation of using a 1.33 pu limit for the resultant vectorial volts per hertz as a determining factor appears to reduce the complexities of the decision too much. The NEMA MG1 recommendation to wait until the motor residual voltage decays to 30-25% of its initial value may not be practical for critical equipment. When one does not have the time to delay reclosure, the NEMA MG1 recommendation that a detailed analysis be performed is appropriate     

Need for industry standards for AC induction motors intended foruse with adjustable-frequency controllers

With the increased use of AC induction motors on adjustable-frequency controls (AFCs) offered in a wide variety of types, there is a need to develop industry standards to provide the guidance necessary for the proper selection of the motor, which will function as intended with the control. These new standards should establish requirements for both electrical and mechanical characteristics of the motor necessary to establish uniformity within the industry. The items that must be covered by such industry standards in order to assure successful applications on adjustable frequency are discussed. Proposals for the content of the standards are presented     

Considerations in Applying Induction Motors with Solid- State Adjustable Frequency Controllers

Considerations in applying ac motors with solid-state adjustable -frequency controllers are discussed, and guidelines. are offered where possible. As a background, three commonly used at drive techniques are reviewed. Test data are provided for 100-hp standard and energy-efficient designs operated on each of the three types of drives.     

Some physical characteristics and heavy metal analyses of cotton gin waste for potential use as an alternative fuel

The use of cotton gin waste as a fuel is an attractive solution to the problems of disposing of a surplus agricultural waste as well as supplementing energy resources. Because a qualified alternative fuel must meet both environmental emission standards and industrial fuel standards, the physical characteristics of cotton gin waste and its toxic element concentrations are important for its initial objective evaluation as a fuel. Constituent components, moisture contents, and ash contents of four separate parts of cotton gin waste were determined and evaluated, closely following the American Society for Testing and Materials (ASTM) test methods. The three most toxic heavy metals, arsenic (As), chromium (Cr), and lead (Pb), chosen for quantitative analyses were also determined by using an inductively coupled plasma atomic emission spectrometry and a microwave oven sample digestion method. This study revealed that the lint component is the leading candidate for fuel, which closely meets both environmental emission and industrial fuel standards.     

Monocular passive ranging of maneuvering intruder for UAS detect‐and‐avoid

We investigate a planar orbiting intruder passive ranging problem, where an ownship aircraft is moving with a constant velocity and a co‐planar intruder aircraft is conducting an orbiting maneuver. The objective is to estimate the state information of the intruder, such as range, speed and heading, using only bearing measurements of the intruder from the ownship. This is relevant to detect‐and‐avoid applications where an unmanned aerial system (UAS) is equipped with only a monocular camera sensor and needs to determine the range to the intruder. We utilize a filter bank algorithm parameterized with respect to the range, heading, and angular velocity of the intruder's initial states. In previous work, we performed investigations on the effects of parameterizing the filter bank algorithm and the system model using Monte Carlo Simulations. We extend our previous study to include a study on the effects of the ownship speed on the filter performance as well as a Cramer‐Rao lower bound comparison. Since the intruder's motion may be composed of straight legs and orbits, we integrate our filter bank algorithm into an Interacting Multiple Model (IMM) framework for two maneuver models: constant velocity and coordinated turn. We conduct Monte Carlo simulations of the IMM algorithm to study the effects of varying the IMM mixing stage frequency and the off diagonal values for the transition probability matrix. Our simulation results demonstrate the effectiveness of the proposed algorithms.     

NEMA Design E motors and controls. What's it all about?

The purpose of this paper is to present the performance differences between NEMA Design B and NEMA Design E motors and the impact that this may have on the control, protection and application of the motor. It is shown that, while the NEMA Design E motor may be a physical equivalent of a NEMA Design B motor, the differences in performance may require changes in control and protection equipment     

Characteristics of persons with mental illness in a representative payee program

This study compared the characteristics of 56 clients with severe mental illness in a community mental health agency's representative payeeship program with those of 54 clients who did not participate in the program. Based on data from a two-year period, participants in the representative payee program were characterized by disability or financial distress, indicated by a diagnosis of schizophrenia, homelessness, lack of rent money, and lack of financial skills; long-term dependence on income from Social Security and services provided by the mental health system, evidenced by receipt of Supplemental Security Income and frequent hospitalizations; and lack of financial independence, as reflected by inability to earn income from employment and lack of financial support from family.     

Unethical and unprofessional conduct observed by residents during their first year of training

PURPOSE: To present residents' personal observations of unethical and unprofessional conduct in medicine during their first year of training. METHOD: Eight hundred and fifty-seven second-year residents who had previously participated in a study of perceived mistreatment as senior medical students were resurveyed by a three-tiered mail process concerning their experiences during their first postgraduate year, including their personal observations of four types of unethical and unprofessional conduct. RESULTS: Surveys were returned by 571 residents, for a response rate of 67%. Personal observations of falsification of patient records by others on at least one occasion were reported by 44.5% of the responding residents, while 73.8% reported direct observations of mistreatment of patients. Nearly half of the residents (46.7%) reported that others had taken credit for their work, and 72.8% said they had observed colleagues working in an impaired condition at least once during their first year of training. Over one fourth of the residents (28.6%) stated that they had been required to do something during the year that they believed was immoral, unethical, or personally unacceptable. There was an inverse relationship between the residents' observations of unethical and unprofessional conduct and their overall satisfaction with their first year of training (p < .001). CONCLUSIONS: The residents reported observing several types of unethical and unprofessional conduct among their colleagues and superiors. These findings confirm similar reports among medical students and residents and raise questions about the possible effect of such observations on the ethical principles and behavior of physicians-in-training.