We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases.

No abstract

These emergency physicians describe what it was like in the ED on the night of the Orlando mass-casualty incident, and what they learned from the experience that can help other EDs.

Gas turbine flexibility is key in markets with significant renewable energy resources. Operational load flexibility and fuel flexibility ensure the gas turbine remains competitive in supporting power generation in renewable markets. For applications where heat is required in support of a process industry the gas turbine offers an additional advantage. Alternate fuels such as hydrogen are generated as byproducts from chemical processing plants. Hydrogen also has the ability to be a ‘battery fuel’ as excess energy produced by wind and solar can be used to produce hydrogen through electrolysis. This work focuses on the retrofit and commercial introduction of significant quantities of hydrogen fuel into the gas supply of an existing commercial E-class gas turbine in Europe. The commercially operating plant provides combined heat (in the form of process steam) and power. The gas turbine operates with a lean premixed combustor without the need for diluent injection, and is able to operate flexibly with hydrogen mixed into the base natural gas fuel supply. The fuel mixing allows consumption of a chemical plant process gas resulting in positive economic and environmental benefit. This involves several considerations including combustor control/operation, safe flashback margin, emissions, stability and hardware durability. Enhancements to the control system through an automated combustor tuning package which is able to compensate real time for fluctuations in fuel gas constituents was implemented. Significant testing of the fuel flexible concept in a full scale high pressure combustor test facility was performed to ensure the desired increase in hydrogen consumption could be achieved. The experience, in addition to adaptations for field testing, was used to test and validate a new long term operational limit of 25% hydrogen content in the fuel. The success of the test campaign allows reduction in natural gas fuel consumption and cost, reduction in flaring of product waste gas, with a reduced power plant CO2 footprint. The development program and engine field testing substantiation are described in detail herein.