Fast and Enhanced MMW Imaging System Using a Simple Row Detector Circuit with GDDs as Sensor Elements and an FFT-Based Signal Acquisition System.

The relatively high atmospheric propagation of millimeter-waves (MMW) was found to be one of the most critical reasons for the development of reliable sensors for MMW detection. According to previous research works, it has been already shown that incident MMW radiation on a glow discharge detector (GDD) can increase the discharge current. Hence, the electrical mode of detection can be employed to detect the presence of MMW radiation. In this article, a new design of a row detector using GDDs as pixel elements, and the influence of MMW incidence on GDD's discharge current, were acquired using an elementary data acquisition (DAQ) platform. The DAQ system computes the averaged Fast Fourier Transform (FFT) spectrum of the time signal and returns the FFT results as magnitude based on the level of detection. An FFT-based signal acquisition proved to be a better alternative to the lock-in detection that was commonly used in MMW detection systems. This improved detection circuit provides enhanced noise filtering, thereby resulting in better MMW images within a short time. The overhead expense of the entire system is very low, as it can avoid lock-in amplifier stages that were previously used for signal enhancement. A scanning mechanism using a motorized translation stage (step motor) is involved to place and align the row detector in the image plane. The scanning can be carried out vertically to perform the imaging, by configuring the step motor after selecting the desired step size and position. A simplified version of the MMW detection circuit with a dedicated over-voltage protection facility is presented here. This made the detection system more stable and reliable during its operation. The MMW detection circuit demonstrated in this work was found to be a milestone to develop larger focal plane arrays (FPA) with very inexpensive sensor elements.

Real-Time Metasurface Sensor for Monitoring Micropoisons in Aqueous Solutions Based on Gold Nanoparticles and Terahertz Spectroscopy.

Proof of concept of a new real-time metasurface sensor for micropoison monitoring in aqueous solutions is proposed in this study. The sensor comprises a perfect absorber metasurface and gold nanoparticle layer on the front side of it. Frequency-domain terahertz spectroscopy system was used to measure the resonance frequency shift due to the presence of the micropoison. The perfect absorber metasurface sensor was fabricated using a double-sided FR4 substrate printed board circuit, which is very inexpensive. A significant increase in the metasurface sensor sensitivity was achieved by adding a gold nanoparticle layer to the gap of the double split rectangular resonator on the front side of the metasurface sensor.

Ultra-wideband and inexpensive glow discharge detector for millimeter-wave wireless communication based on upconversion to visual light.

Data traffic is increasing rapidly, especially on wireless channels, pushing the carrier frequency to the X, K, and millimeter-wave (MMW) bands. This requires development of new technologies and communication components operating at those bands. The detectors and receivers for those bands are very expensive, have high sensitivity to electrostatic discharge, and can be damaged by high incident power. An ultra-wideband and inexpensive glow discharge detector (GDD) is presented here. The GDD was found to be an excellent microwave and MMW radiation detector. The detection mechanism presented here is based on upconversion of microwave and MMW radiation to visual light. The experimental results demonstrate ultra-wideband detection at X and at MMW bands. These results present a proof of concept for the ability of our system to be used as a detector in wireless communication for the 5th generation.

EBUS-TBNA is Sufficient for Successful Diagnosis of Silicosis with Mediastinal Lymphadenopathy.

BACKGROUND: Silicosis is an occupational lung disease resulting from inhalation of respirable crystalline silica. Recently, an international silicosis epidemic has been noted among artificial stone workers. OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is currently used for patients with unexplained lymphadenopathy. Since silicosis may present with prominent lymphadenopathy, the diagnostic yield of EBUS-TBNA in diagnosing silicosis was evaluated. METHODS: Twenty-eight patients with suspected silicosis referred for outpatient evaluation in three large tertiary hospitals were evaluated. Patients with mediastinal lymphadenopathy underwent EBUS-TBNA, while others underwent TBB and/or video-assisted thoracoscopic surgery (VATS). RESULTS: Eleven patients with mediastinal lymphadenopathy (39%) were evaluated using EBUS-TBNA. The diagnosis was accurate in all cases, demonstrating silica particles under polarized light, with no complications. Among the remaining patients, TBB was only 76% diagnostic, therefore requiring VATS. CONCLUSIONS: EBUS-TBNA is a useful and sufficient tool to diagnose silicosis in patients with mediastinal lymphadenopathy along compatible exposure histories.

Military Weapon Injury Among Illegal Immigrants at the Southern Border of Israel: A Single Level I Trauma Center Series.

This article describes the characteristics of injuries of illegal immigrants admitted to a Level I trauma center after being shot at the southern border of Israel. This is a retrospective descriptive study. Some of the variables were compared to a group of soldiers who sustained penetrating injury at the same region where the illegal migrant were injured. The study includes 162 patients. The lower body absorbed a higher percentage of the injuries (61 %). The hospitalization time is longer for the migrant patients compared to the soldiers (13 ± 2 vs. 3 ± 0.3 days p = 0.0001). This study on wounded immigrants shows that a conjoint military and civilian system can result in favourable outcomes. The manuscript is an attempt to bring this unique situation, its type of injuries, and the difficulties of the health system in coping with it, to the notice of all authorities that may address a similar challenge.

A Phase Ib/II Study Evaluating the Combination of Weekly Docetaxel and Cisplatin Together with Capecitabine and Bevacizumab in Patients with Advanced Esophago-Gastric Cancer.

INTRODUCTION: Current treatment options for advanced esophagogastric cancer (AEGC) are still unsatisfactory. The aim of this prospective phase Ib/II study was to evaluate the safety and efficacy of a novel regimen, AVDCX, consisting of weekly docetaxel and cisplatin together with capecitabine and bevacizumab, in AEGC. METHODS: Patients with AEGC received treatment with different dose levels of AVDCX (cisplatin and docetaxel 25-35 mg/m2, days 1,8, capecitabine 1,600 mg/m2 days 1-14, bevacizumab 7.5 mg/kg, day 1, Q:21 days). The study's primary objectives were to establish the recommended phase II doses of docetaxel and cisplatin in AVDCX (phase Ib part) and to determine the tumor response rate (phase II part). RESULTS: The study was closed early, after the accrual of 22 patients, due to accumulating toxicity-related deaths. The median age was 59 years and 77% of patients had gastric or gastroesophageal adenocarcinomas. Grade ≥3 adverse events were documented in 18 patients (82%), usually neutropenia (36%), fatigue (54%) or diarrhea (23%). There were three fatal toxicities (14%): mesenteric thromboembolism, gastric perforation and pancytopenic sepsis. The recommended phase II doses of cisplatin and docetaxel were determined to be 25 mg/m2 and 30 mg/m2, respectively. Twenty-one patients were evaluable for response: 12 (54%) had partial response (PR), 4 (18%) had stable disease (SD) and none had complete response (CR). Hence, the objective response rate (CR+PR) was 54% and the disease control rate (CR+PR+SD) was 72%. For the 17 patients treated at the MTD, the objective response rate was 41% and the disease control rate was 88%. The median overall survival (OS) for these patients was 13.9 months (range, 1.5-52.2 months) and the median progression-free survival was 7.6 months (range, 1.3-26.6 months). The 2-year OS rate reached 23.7%. CONCLUSIONS: AVDCX was associated with a high rate of regimen related fatal adverse events and is not appropriate for further development in AEGC patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00845884.

Tissue repair genes: the TiRe database and its implication for skin wound healing.

Wound healing is an inherent feature of any multicellular organism and recent years have brought about a huge amount of data regarding regular and abnormal tissue repair. Despite the accumulated knowledge, modulation of wound healing is still a major biomedical challenge, especially in advanced ages. In order to collect and systematically organize what we know about the key players in wound healing, we created the TiRe (Tissue Repair) database, an online collection of genes and proteins that were shown to directly affect skin wound healing. To date, TiRe contains 397 entries for four organisms: Mus musculus, Rattus norvegicus, Sus domesticus, and Homo sapiens. Analysis of the TiRe dataset of skin wound healing-associated genes showed that skin wound healing genes are (i) over-conserved among vertebrates, but are under-conserved in invertebrates; (ii) enriched in extracellular and immuno-inflammatory genes; and display (iii) high interconnectivity and connectivity to other proteins. The latter may provide potential therapeutic targets. In addition, a slower or faster skin wound healing is indicative of an aging or longevity phenotype only when assessed in advanced ages, but not in the young. In the long run, we aim for TiRe to be a one-station resource that provides researchers and clinicians with the essential data needed for a better understanding of the mechanisms of wound healing, designing new experiments, and the development of new therapeutic strategies. TiRe is freely available online at http://www.tiredb.org.

Evaluating the risk of decompression sickness for a yo-yo dive using a rat model.

PURPOSE: The frequent ascents made during yo-yo diving may contribute to gas bubble clearance but paradoxically may also increase the risk of central nervous system decompression illness (DCI). We evaluated the risk of DCI due to yo-yo dives with very short surface intervals, using a controlled animal model. METHODS: Dives were conducted on air to a depth of 90 meters (10 atmospheres absolute) for 32 minutes of bottom time, at a descent/ascent rate of 10 meters/ minute. Sprague-Dawley rats weighing ~ 300 grams were divided randomly into three groups. Group A performed a square dive protocol without any surface intervals, Group B conducted a protocol that included two surface intervals during the dive, and Group C performed a protocol with three surface intervals. Ascent/descent rate for surface intervals, each lasting one minute, was also 10 meters/minute. RESULTS: Manifestations of DCI were observed in 13 of 16 animals in Group A (81.3%), six of 12 in Group B (58.3%), and two of 12 in Group C (16.7%). Mortality rates were similar in all groups. CONCLUSIONS: Surface intervals during dives breathing air significantly reduced DCI risk in the rat. Further studies are required using a larger animal model to reinforce the results of the present investigation.

Reevaluating the selection process for the Israeli Defense Force's paramedic training program.

BACKGROUND: Selecting candidates for medical training programs is a complicated process aimed at identifying specific personal competencies, in an attempt to minimize attrition and produce better medical providers. The objective of this study was to evaluate the accuracy of the selection process for the Israeli Defense Force's paramedic training program and its ability to predict success measured at different end points. METHODS: Selection process test scores were crossed and measured against three different end points: attrition, national certification test scores, and training program graduation scores. RESULTS: Data were available for 146 candidates. A positive association was detected between lower formulated selection scores and attrition rates (p<0.01). Out of the 11 tests conducted that comprise the final selection score, two had shown significant association with attrition. The calculated score of these specific two tests was found to have similar association with attrition as the formulated selection score. CONCLUSIONS: The current Israeli Defense Force's paramedic-formulated selection score has shown association with attrition; candidates performing poorly throughout the selection process were less likely to complete training. Similar results may be achieved by implementing a more efficient selection process based on fewer tests. Further studies are required to identify the optimal composition for selection processes. Ongoing learning and research form the ground for improvement, not only of trauma medicine but of all aspects of medicine.

Tranexamic acid at the point of injury: the Israeli combined civilian and military experience.

BACKGROUND: Accumulating evidence established the benefit of tranexamic acid (TXA) for traumatic bleeding in the hospital setting. TXA use in the field (at or near the point of injury [POI]) was described in the military setting but not in the civilian one. The current study describes the Israeli combined experience (civilian and military) of administering TXA in the field. METHODS: The Israel Defense Forces (IDF) and Magen David Adom (MDA) (the national Israeli civilian emergency medical service) protocols for giving TXA at the POI are presented. We then review all trauma patients who received TXA in the field in accord with either protocol. Data were abstracted from the IDF Trauma Registry and from the MDA database. RESULTS: Data regarding casualties treated with TXA by the IDF Medical Corps and MDA between December 2011 and August 2013 are presented. One hundred three casualties who received TXA in the field were identified. The median age was 26.5 years, and 83 (88%) were male. The mechanism of injury was penetrating in 48 cases (51%). POI data indicate slightly higher injury severity for the group of patients treated by MDA compared with patients treated by the IDF (systolic blood pressure, 90 mm Hg vs. 110 mm Hg; Glasgow Coma Scale [GCS] score, 11 vs. 15; hemoglobin, 11.9 vs. 13.3; p < 0.05). CONCLUSION: On the basis of our combined data, it appears that administering TXA in the field is feasible in the civilian and the military setting. Lessons learned in military settings are applicable to civilian medical systems. Action investigations and comparison of the different protocols may further improve treatment at or near the POI. LEVEL OF EVIDENCE: Therapeutic study, level V.

Capability of long distance 100 GHz FMCW using a single GDD lamp sensor.

Millimeter wave (MMW)-based imaging systems are required for applications in medicine, homeland security, concealed weapon detection, and space technology. The lack of inexpensive room temperature imaging sensors makes it difficult to provide a suitable MMW system for many of the above applications. A 3D MMW imaging system based on chirp radar was studied previously using a scanning imaging system of a single detector. The radar system requires that the millimeter wave detector will be able to operate as a heterodyne detector. Since the source of radiation is a frequency modulated continuous wave (FMCW), the detected signal as a result of heterodyne detection gives the object's depth information according to value of difference frequency, in addition to the reflectance of the 2D image. New experiments show the capability of long distance FMCW detection by using a large scale Cassegrain projection system, described first (to our knowledge) in this paper. The system presents the capability to employ a long distance of at least 20 m with a low-cost plasma-based glow discharge detector (GDD) focal plane array (FPA). Each point on the object corresponds to a point in the image and includes the distance information. This will enable relatively inexpensive 3D MMW imaging.

Tranexamic acid in the prehospital setting: Israel Defense Forces' initial experience.

BACKGROUND: The leading cause of preventable death in the military setting is haemorrhage. Accumulating evidence has established the benefit of tranexamic acid (TXA), an antifibrinolytic, for treating traumatic haemorrhage in the hospital setting. The use of TXA in the prehospital setting, however, has not been previously described. The present study details our initial experience with a field protocol that advances TXA administration to (or as close as possible to) the point of injury. METHODS: We present a series of all casualties treated with TXA by Israel Defense Forces' (IDF) prehospital advanced life support providers between December 2011 and February 2013. Data were abstracted from the IDF Trauma Registry at the Research Section of the Trauma and Combat Medicine Branch, Surgeon General's Headquarters. RESULTS: Forty casualties who received TXA in the prehospital setting were identified. Most casualties were male (n=35; 88%) and young adults (median 28 years). The mechanism of injury was penetrating in 22 cases (55%). TXA was administered earlier than it could have been in the hospital setting without delaying evacuation. There were no reports of adverse outcomes that could be reasonably attributed to TXA. Casualties who received TXA per protocol were sicker than those who received it not per protocol. CONCLUSIONS: We have shown that TXA may be successfully given in the prehospital setting without any apparent delays in evacuation. In light of recent evidence, the ability to give TXA closer to the time of wounding represents an important step towards improving the survival of trauma victims with haemorrhage, even before definitive care is available. While this may be especially relevant in austere combat environments, there is likely benefit in the civilian sector as well. The safety profile of TXA is an important consideration as prehospital personnel tended to overtreat casualties without indications for TXA per protocol. We suggest that TXA be considered a viable option for use by advanced life support providers at or near the point of injury.

Freeze-dried plasma at the point of injury: from concept to doctrine.

While early plasma transfusion for the treatment of patients with ongoing major hemorrhage is widely accepted as part of the standard of care in the hospital setting, logistic constraints have limited its use in the out-of-hospital setting. Freeze-dried plasma (FDP), which can be stored at ambient temperatures, enables early treatment in the out-of-hospital setting. Point-of-injury plasma transfusion entails several significant advantages over currently used resuscitation fluids, including the avoidance of dilutional coagulopathy, by minimizing the need for crystalloid infusion, beneficial effects on endothelial function, physiological pH level, and better maintenance of intravascular volume compared with crystalloid-based solutions. The Israel Defense Forces Medical Corps policy is that plasma is the resuscitation fluid of choice for selected, severely wounded patients and has thus included FDP as part of its armamentarium for use at the point of injury by advanced life savers, across the entire military. We describe the clinical rationale behind the use of FDP at the point-of-injury, the drafting of the administration protocol now being used by Israel Defense Forces advanced life support providers, the process of procurement and distribution, and preliminary data describing the first casualties treated with FDP at the point of injury. It is our hope that others will be able to learn from our experience, thus improving trauma casualty care around the world.

Women candidates for diving with oxygen-enriched gas mixtures have a lower end tidal CO2 than men during moderate exercise.

We have previously determined the thresholds for CO2 detection (conscious recognition of elevated CO2) and retention in male divers, beyond which a diving candidate should not continue his diving activity due to an increased risk of CNS oxygen toxicity. The purpose of the present study was to establish whether there is a difference in end tidal PCO2 between male and female divers who use oxygen-enriched gas mixtures. Ventilatory and perceptual responses to variations in inspired CO2 (range 0-42 mm Hg) were assessed during moderate exercise in 18 males and 18 females. End tidal PCO2 was lower in the female divers when breathing oxygen with 42 mm Hg CO2 (58.2±3.0 mm Hg vs. 61.5±4.5 mm Hg, P<0.03). These results suggest that female divers have a lower end tidal CO2 than males when breathing a hyperoxic gas mixture during exercise, which might imply that women are less susceptible to CNS oxygen toxicity than men.

A dynamic mass casualty incident at sea: lessons learned from the Mavi Marmara.

BACKGROUND: Mass casualty incidents (MCIs) represent one of the most difficult prehospital challenges faced by medical personnel. When they occur at sea, this challenge may be further complicated by isolation, distance, vessel structure, number of passengers, and limited evacuation means. METHODS: We describe our experience and lessons learned from a dynamic MCI in an austere environment at sea. RESULTS: Following an armed attack on navy operators boarding the MV Mavi Marmara, a vessel heading for Gaza, the Israel Defense Forces' medical teams triaged and cared for 62 casualties, among them 9 soldiers; 9 additional casualties were declared dead at the scene. The injured, including 10 triaged as severely wounded, were all evacuated to Israeli hospitals within several hours of the start of the event. Despite the austere conditions and the severity of injuries, all of the injured passengers were able to return to their home countries, and all soldiers returned to duty. Multiple issues were identified as requiring changes or heightened awareness so as to be better prepared for future events of this special nature. CONCLUSION: The primary lessons learned related to difficulties in functioning without effective communication, maintaining command and control, coordinating serial evacuation of casualties who were being triaged in parallel, planning for an event with lengthy evacuation times, resolving real-time ethical dilemmas, and preparing our providers mentally. As MCIs tend to be unexpected, preplanning, using preestablished manuals, and drilling for them may prove crucial in such extreme events. Importantly, the lessons learned from this event, with its unique synthesis of multiple contributing factors, remain relevant even in less austere settings.

Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine.

BACKGROUND: Advanced airway management is composed of a set of vital yet potentially difficult skills for the prehospital provider, with widely different clinical guidelines. In the military setting, there are few data available to inform guideline development. We reevaluated our advanced airway protocol in light of our registry data to determine if there were a preferred maximum number of endotracheal intubation (ETI) attempts; our success with cricothyroidotomy (CRIC) as a backup procedure; and whether there were cases where advanced airway interventions should possibly be avoided. METHODS: This is a descriptive, registry-based study conducted using records of the Israel Defense Forces Trauma Registry at the research section of the Trauma and Combat Medicine Branch, Surgeon General's Headquarters. We included all casualties for whom ETI was the initial advanced airway maneuver, and the number of ETI attempts was known. Descriptive statistics were used. RESULTS: Of 5,553 casualties in the Israel Defense Forces Trauma Registry, 406 (7.3%) met the inclusion criteria. Successful ETI was performed in 317 casualties (78%) after any number of ETI attempts; an additional 46 (11%) underwent CRIC, and 43 (11%) had advanced airway efforts discontinued. ETI was successful in 45%, 36%, and 31% of the first, second, and third attempts, respectively, with an average of 28% success over all subsequent attempts. CRIC was successful in 43 (93%) of 46 casualties in whom it was attempted. Of the 43 casualties in whom advanced airway efforts were discontinued, 29 (67%) survived to hospital discharge. CONCLUSION: After the first ETI attempt, success with subsequent attempts tended to fall, with minimal improvement in overall ETI success seen after the third attempt. Because CRIC exhibited excellent success as a backup airway modality, we advocate controlling the airway with CRIC if ETI efforts have failed after two or three attempts. We recommend that providers reevaluate whether definitive airway control is truly necessary before each attempt to control the airway.

Heterodyne detection at 300 GHz using neon indicator lamp glow discharge detector.

A miniature neon indicator lamp, also known as a glow discharge detector (GDD), costing about 50 cents, was found to be an excellent room temperature terahertz radiation detector. Proof-of-concept 300 GHz heterodyne detection using GDD is demonstrated in this paper. Furthermore, a comparison to direct detection was carried out as well. Previous results with the GDD at 10 GHz showed 40 times better sensitivity using heterodyne detection compared to direct detection. Preliminary results at 300 GHz showed better sensitivity by a factor of 20 with only 56 µW local-oscillator power using heterodyne compared to direct detection. The higher the local-oscillator power (P(lo)), the better the sensitivity of the detector. Further improvement can be achieved by employing better quasi-optical design.