The non-reporting of negative studies results in a scientific record that is incomplete, one-sided and misleading. The consequences of this range from inappropriate initiation of further studies that might put participants at unnecessary risk to treatment guidelines that may be in error, thus compromising day-to-day clinical practice.

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.

(Disaster Med Public Health Preparedness. 2011;5:S20-S31)

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use (“dual utility”) and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.

(Disaster Med Public Health Preparedness. 2012;6:408-414)

Congenital absence of aortic valvar leaflets is a rare and fatal variant of the hypoplastic left heart syndrome. We describe a recent patient seen at our institution with this lesion, illustrating a combined echocardiographic and angiographic approach that delineates both anatomy and physiology. The early mortality experienced in previous reports, as well as unsuccessful surgical palliation in our case, should promote further discussion regarding the optimal treatment.

Imploding indirect-drive double shell targets may provide an alternative, non-cryogenic path to ignition at the National Ignition Facility (NIF). Experiments are being pursued at OMEGA to understand the hydrodynamics of these implosions and the possibility of scaling it to the NIF design. We have used 40 beams from the OMEGA laser to directly drive the capsules, and we have used the remaining 20 beams to backlight the imploding shells from two different directions at multiple times. We will review the recent experiments to measure the hydrodynamics of the targets using two-view X-ray radiography of the capsules. We will present data on measured yields from the targets. We will present a measured time history of the hydrodynamics of the implosion. Experiments were pursued using direct drive in which the M-band effect (experienced in the indirect drive experiments) could be eliminated or controlled. It was learned in the direct drive experiments that the best performing capsules were those that had a thin outer layer of gold. This effectively causes M-band pre-heat effects giving implosion hydrodynamics and performance closer to the indirect drive case. We will review the methods used to radiograph the targets and the techniques used to extract useful information to compare with calculations. The effect of imperfections in the target construction will be shown to be minimal during the initial stage of implosion. The yields from the targets were observed to be uniformly low compared to indirect-drive.

We consider the linear stability of exact, temporally periodic solutions of the Euler equations of incompressible, inviscid flow in an ellipsoidal domain. The problem of linear stability is reduced, without approximation, to a hierarchy of finite-dimensional Floquet problems governing fluid-dynamical perturbations of differing spatial scales and symmetries. We study two of these Floquet problems in detail, emphasizing parameter regimes of special physical significance. One of these regimes includes periodic flows differing only slightly from steady flows. Another includes long-period flows representing the nonlinear outcome of an instability of steady flows. In both cases much of the parameter space corresponds to instability, excepting a region adjacent to the spherical configuration. In the second case, even if the ellipsoid departs only moderately from a sphere, there are filamentary regions of instability in the parameter space. We relate this and other features of our results to properties of reversible and Hamiltonian systems, and compare our results with related studies of periodic flows.

The inference of locomotor mode in Paleogene mammalian faunas has traditionally been based on qualitative comparisons between fossil postcranial skeletal elements and those of modern forms whose range of locomotor behavior is known. Recently, Van Valkenburgh (1987) has shown that detailed functional interpretations can also be obtained by using a series of geometric indices to quantitatively assess correspondences between Oligocene carnivores and a predominately carnivorous assemblage of modern mammalian species. We generalize and extend Van Valkenburgh's morphometric approach by focusing on the analysis of ungual phalanx and proximal radial head outlines using a variant of the eigenshape procedure.

Results of the phalanx analyses show that the geometric consideration of the lateral outline is, for the most part, sufficient to discriminate among modern arboreal / scansorial, fossorial, and cursorial species. In modern mammals, this skeletal element displays a wide range of variational modes (e.g., relative thickness of the proximal phalanx shaft, curvature of the ventral margin, degree of both lateral and dorso-ventral compression, relative differentiation of the extensor tubercle) that appear to reflect differences among the various locomotor guilds involving relative degrees of phalanx robustness along with both the precision and strength of phalanx movement. While a separate analysis of modern mammal phalanx shape in dorsal view failed to reveal a similar degree of variation among the various locomotor guilds, our study did uncover an intriguing geometric conservatism in this aspect of phalanx morphology that appears to cut across both taxonomic and adaptive classifications. Two-dimensional outline analyses of modern mammal proximal radial heads indicate that this skeletal element can ordinate taxa on the basis of relative ability to supinate the forearm that, in turn recognizes functional distinctions between arboreal / scansorial and fossorial / cursorial taxa. Finally, our results reveal that when modern mammalian taxa are grouped by geometric correspondences among these two skeletal character complexes, the consequent associations of taxa are almost invariably polyphyletic, indicating widespread evolutionary convergence on a relatively small number of alternative morphotypes.

In order to test the feasibility of using an outline-based morphometric approach for the inference of locomotor behavior in fossil mammals, ungual phalanx and proximal radial head outlines from a suite of Paleogene species were projected into their respective modern mammal shape spaces, thereby allowing these morphologies to be directly compared with those of modern morphological analogues at highly detailed levels of shape resolution. These results indicate that Cantius, Chriacus, Kopidodon, Nannodectes, Plesiadapis, Thyptacodon, and Vulpavus ungual phalanx and/or radial head outlines are similar to those of modern arboreal / scansorial mammals; Bunophorus, Diacodexis, Pachyaena, Prolimnocyon, and Oxyaena appear to be morphologically similar to modern ambulatory or cursorial forms; and Palaeanodon exhibits a strong shape correspondence with modern fossorial taxa. In each case, our outline-based functional diagnoses are consistent with independent interpretations based on qualitative studies of other skeletal character complexes and associated paleoenvironmental evidence.

Asymptotic formulas and Laplace–Stieltjes transforms are derived for the first two moments of a renewal process with a random number of delays. These are simplified when all the delays follow the same distribution. An asymptotic occupancy result is also derived for two-stage renewal processes with random numbers of delays. As an example, a demographic model of conception and birth is discussed. This model represents the sequence of live births to a woman as a renewal process. If the woman practises birth control after achieving her desired family composition, the renewal process has a random number of delays.