Determining Air Base Installation Capacity Through Multivariate Analysis

Per the Air Force Strategic Master Plan, the Air Force will adjust their current basing structure to provide the most effective and efficient installations to support national defense objectives. The Air Force may be required to make strategic basing decisions that close installations and relocate missions to achieve an optimal basing structure. However, before making these decisions, the Air Force needs to have a comprehensive understanding of installation capacity. This research provides an operational definition of installation capacity, which is necessary for measuring installation-level, infrastructure capacity. Using this definition, the research evaluates a set of capacity indicators using principal component analysis (PCA) and exploratory factor analysis (EFA). The results identify the underlying structure of the capacity data and determine what factors influence capacity. In addition, the component and factor scores provide information about capacity characteristics at each installation, and how they compare to other installations. Finally, this research created a composite scoring model, the Installation Composite Capacity (ICC), which measures the overall capacity at each installation. The Air Force can use the results and insight gained from this research to develop an optimized basing structure that meets present, and future, defense needs

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

The bone disease that occurs as a result of chronic kidney disease (CKD) is not only debilitating but also linked to poor growth and cardiovascular disease. It is suspected that abnormal bone turnover is the main culprit for these poor outcomes. Plasma parathyroid hormone (PTH) levels are used as a surrogate marker of bone turnover, and there is a small number of studies in children that have attempted to identify the range of PTH levels that correlates with normal bone histology. It is clear that high PTH levels are associated with high bone turnover, although the range is wide. However, the ability of PTH levels to distinguish between low and normal bone turnover is less clear. This is an important issue, because current guidelines for calcium and phosphate management are based upon there being an “optimum” range for PTH. This editorial takes a critical look at the evidence upon which these recommendations are based

New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

Hyponatremia is the most common electrolyte abnormality encountered in children. In the past decade, new advances have been made in understanding the pathogenesis of hyponatremic encephalopathy and in its prevention and treatment. Recent data have determined that hyponatremia is a more serious condition than previously believed. It is a major comorbidity factor for a variety of illnesses, and subtle neurological findings are common. It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia. In this review, we discuss how to recognize patients at risk for inadvertent overcorrection of hyponatremia and what measures should taken to prevent this, including the judicious use of 1-desamino-8d-arginine vasopressin (dDAVP)

A collection of curious and interesting epitaphs, copied from the existing monuments of distinguished and noted characters in the churches and churchyards of Hornsey, Tottenham, Edmonton, Enfield, Friern Barnet and Hadley, Middlesex

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