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“…….In Damascus, workers were paving over two massive craters caused by the bombs that struck a Syrian military compound Thursday. The attack, which also wounded more than 370 people, was the deadliest against a regime target since the Syrian uprising began 14 months ago……
Journal of Emergency Nursing Volume 38, Issue 3 , Pages 211-217, May 2012
According to the pain management index, the majority of the patients in this study received inadequate pain management while in the emergency department. Future interventions may need to focus on giving ED nurses information about inadequate pain management and disparities in pain management in the ED setting and exploring possible reasons for disparities in order to ultimately improve patient care.
Out-of-Hospital Administration of Intravenous Glucose-Insulin-Potassium in Patients With Suspected Acute Coronary Syndromes: The IMMEDIATE Randomized Controlled Trial
Among patients with suspected ACS, out-of-hospital administration of intravenous GIK, compared with glucose placebo, did not reduce progression to MI. Compared with placebo, GIK administration was not associated with improvement in 30-day survival but was associated with lower rates of the composite outcome of cardiac arrest or in-hospital mortality.
Journal of Emergency Nursing Volume 38, Issue 3 , Pages 226-233, May 2012
This sample of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment. Symptom presentation did not appear to affect length of stay; however, survival analysis showed that patients who presented with a Hunt and Hess grade greater than 3 along with bradycardia were 15.6 times more likely to die within the first month of aSAH.
QuickStats: Birth Rates* for Teens Aged 15–19 Years, by Age Group — National Vital Statistics System, United States, 1960–2010†
Weekly
May 11, 2012 / 61(18);330
* Births per 1,000 females in specified age group.
† Data for 2010 are preliminary.
U.S. teen birth rates declined to historic lows for all age groups in 2010. The rate for teens aged 15–19 years fell 62% from 1960, when the birth rate was 89.1 per 1,000 women, and 44% from a rate of 61.8 in 1991 to 34.3 in 2010. Most of the decline in birth rates for teens occurred from 1960 to 1980 and then again after 1991. Decreases in birth rates for teens aged 18–19 years generally were greater than the decreases for teens aged 15–17 years from 1960 through 1978. From 1991 to 2010, decreases in birth rates for teens aged 15–17 years were greater.
Source: Hamilton BE, Ventura SJ. Birth rates for U.S. teenagers reach historic lows for all age and ethnic groups. NCHS data brief, no 89. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2012. Available at http://www.cdc.gov/nchs/data/databriefs/db89.htm.
Alternate Text: The figure above shows birth rates for teens aged 15-19 years, by age group, in the United States during 1960-2010. U.S. teen birth rates declined to historic lows for all age groups in 2010. The rate for teens aged 15-19 years fell 62% from 1960, when the birth rate was 89.1 per 1,000 women and 44% from a rate of 61.8 in 1991 to 34.3 in 2010. Most of the decline in birth rates for teens occurred from 1960 to 1980 and then again after 1991. Decreases in birth rates for teens aged 18-19 years generally were greater than the decreases for teens aged 15-17 years from 1960 to 1978. From 1991 to 2010, decreases in birth rates for teens aged 15-17 years were greater.
FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about Vital Signs: FoodNet MMWR, 2010 PDF 203 KB for more information about FoodNet and how we work.
NTSB Identification: WPR10FA371
Nonscheduled 14 CFR Part 91: General Aviation
Accident occurred Wednesday, July 28, 2010 in Tucson, AZ
Probable Cause Approval Date: 05/03/2012
Aircraft: AMERICAN EUROCOPTER LLC AS 350 B3, registration: N509AM
Injuries: 3 Fatal.
The single-engine helicopter was operating near its maximum gross weight and was on a repositioning flight back to its home base. About 6 minutes into the flight, cruising at 800 feet above ground level (agl), the helicopter experienced a complete loss of engine power. Witnesses observed the helicopter, which had been flying steadily in a southeast direction, suddenly descend rapidly into a densely populated residential area. Descent rates calculated from the last 10 seconds of radar data were consistent with an autorotation. The witnesses reported that, as the helicopter neared the ground, its descent became increasingly vertical. Examination of the accident site revealed that the helicopter was in a level attitude with little forward speed when it impacted a 5-foot-high concrete wall, which penetrated the fuselage and ruptured the fuel tank. A postimpact fire consumed the cabin and main fuselage of the helicopter.
An open roadway intersection was located about 300 feet beyond the accident site, in line with the helicopter’s flight path. It is likely that the pilot was attempting to make an autorotative approach to the open area; however, he was unable to reach it because he had to maneuver the helicopter over a row of 40-foot-tall power lines that crossed the helicopter’s flight path near the accident site. This maneuver depleted the rotor rpm, which, as reported by the witnesses, caused the helicopter’s descent to become near vertical before it impacted the concrete wall, which was across the street from the power lines.
The pilot had no training flights during the 317 days since his most recent 14 Code of Federal Regulations Part 135 check flight. The lack of recent autorotation training/practice, although not required, may have negatively impacted the pilot’s ability to maintain proficiency in engine failure emergency procedures and autorotations. However, because the engine failed suddenly at low altitude over a congested area, more recent training may not have changed the outcome.
External examination of the engine at the accident site revealed that the fuel inlet union that connected to the fuel injection manifold and provided fuel from the hyrdomechanical unit to the combustion section had become detached from the boss on the compressor case. The two attachment bolts and associated nuts were not present on the union flange nor were they located within the helicopter wreckage debris. Separation of the fuel inlet union from the fuel injection manifold interrupted the supply of fuel to the engine and resulted in a loss of engine power. Postaccident engine runs performed with an exemplar engine showed that, with loose attachment bolts and nuts, the union initially remained installed and fuel would not immediately leak. As the engine continued to operate, the loose nuts would progressively unscrew themselves from the bolts. With the bolts removed, the union would ultimately eject from the boss, and the engine would lose power due to fuel starvation.
The helicopter’s engine had undergone maintenance over several days preceding the accident. The maintenance was related to fuel coking of the fuel injection manifold. The operator’s mechanics removed the engine from the helicopter and separated the modules. Another engine with the identical problem was also undergoing the same maintenance procedure at the time. A repair station technician was contracted to complete the maintenance on both engines. The operator’s mechanics and the repair station technician disassembled the accident engine and set it aside. They then performed the required maintenance on the other engine, before returning to complete the work on the accident engine. While working on the accident engine, the repair station technician disassembled module 3, replaced the fuel injection manifold, and then reassembled the engine. This work required that the fuel inlet union be removed and reinstalled. It is likely that the technician did not tighten the bolts and nuts securing the union with a torque wrench and only finger tightened them. The engine was reinstalled into the helicopter by the operator’s maintenance personnel. The repair station technician was serving as both mechanic and inspector, and he inspected his own work. There were no procedures established by the operator or the repair station to ensure that the work performed by the technician was independently inspected. Further, although 14 Code of Federal Regulations 135.429, applicable to Part 135 operators using aircraft with 10 or more passenger seats, states, in part, “No person may perform a required inspection if that person performed the item of work required to be inspected,” there is no equivalent requirement for aircraft, such as the accident helicopter, with 9 or fewer passenger seats. An independent inspection of the work performed by the technician may have detected the improperly installed fuel inlet union.
In 2008, the Federal Aviation Administration (FAA) principal maintenance inspector (PMI) for the repair station removed the repair station’s authorization to perform work at locations other than its primary fixed location. However, the Repair Station Manual was not updated to reflect this change, and the PMI did not follow up on the change, nor did he log the change in the FAA’s tracking system. The PMI was unaware that, in the year before the accident, the repair station had performed work for the operator at locations other than the repair station’s primary fixed location at least 19 times. The FAA’s inadequate oversight of the repair station allowed the repair station to routinely perform maintenance at locations other than its primary fixed location even though this practice was not authorized.
The duty pilot performed a 7.5-minute abbreviated post maintenance check flight the evening before the accident. A full maintenance check flight conducted in accordance with the manufacturer’s flight manual should, under normal conditions, take 30 to 45 minutes to complete. Had a full check flight been performed, it is likely that the union would have detached from the boss during the check flight. Because the helicopter would not have been operating near its maximum gross weight and the check flight would have been conducted over an open area, the pilot would have had greater opportunities for a successful autorotative landing.
The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
The repair station technician did not properly install the fuel inlet union during reassembly of the engine; the operator’s maintenance personnel did not adequately inspect the technician’s work; and the pilot who performed the post maintenance check flight did not follow the helicopter manufacturer’s procedures. Also causal were the lack of requirements by the Federal Aviation Administration, the operator, and the repair station for an independent inspection of the work performed by the technician. A contributing factor was the inadequate oversight of the repair station by the Federal Aviation Administration, which resulted in the repair station performing recurring maintenance at the operator’s facilities without authorization.
Figure 1. Relative rates of laboratory-confirmed infections with Campylobacter, E. coli O157, Listeria, Salmonella, and Vibrio, compared with 1996–1998 rates, by year — Foodborne Diseases Active Surveillance Network, United States, 1996–2010*
Figure 2. Changes in incidence of laboratory-confirmed bacterial infections, United States, 2010 compared with 1996–1998
This year’s report (released in CDC’s Morbidity and Mortality Weekly Report [MMWR]) summarizes 2010 data from FoodNet and provides the best measure of trends in foodborne disease from 1996–2010. It confirms that Salmonella infection has not declined in 15 years, but also shows that progress has been made in reducing several foodborne infections, for example:
Infection caused by a common type of E. coli (Shiga toxin–producing Escherichia coli O157), known as E. coli O157 has declined significantly (Figure 1). In fact, it was the only one of the nine infections tracked to reach the 2010 national health objective target.
As a group, infections caused by six key pathogens in 2010 were 23% lower, including
The FoodNet 2010 data showed a lack of progress in reducing infections caused by Salmonella and Vibrio.
Salmonella was the most common infection (1.2 million U.S. illnesses annually) and the most common cause of hospitalization and death tracked by FoodNet.
Infections have actually increased since 2006—2008 (Figure 1).
In 2010, the incidence of Salmonella was nearly three times the 2010 national health objective target.
Salmonella can contaminate a wide range of foods. There are many different types of Salmonella, and each type tends to have different animal reservoirs and food sources, making control challenging.
Incidence was higher for Vibrioinfection (115% increase).
Vibrio infections are rare, but often serious, and are caused by eating contaminated seafood or exposing an open wound to seawater. Continued Vibrio illnesses highlight the lack of implementation of available control
measures.
Overall, the FoodNet 2010 report shows a downward trend in foodborne infections, which is due, at least in part, to:
Enhanced knowledge about preventing contamination. PulseNet, the national molecular subtyping network for foodborne bacterial pathogens, can detect widely dispersed outbreaks and has greatly improved the detection and investigation of multistate outbreaks.
Cleaner slaughter methods, microbial testing, and better inspections in ground beef processing plants.
Regulatory agency prohibition of contamination of ground beef with E. coli O157 (resulting in 234 beef recalls since E. coli O157 was declared an adulterant in ground beef in 1994).
Increased awareness in food service establishments and consumers’ homes of the risk of consumption of undercooked ground beef.
Other important pathogens transmitted commonly through food (e.g., norovirus, Clostridium perfringens, and Toxoplasma) are not tracked in FoodNet because tests to detect them are not generally available for clinical laboratories. Many of the control measures that would decrease illness caused by pathogens tracked in FoodNet would also decrease illnesses caused by pathogens not tracked presently.
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