ALBERT

Description: INTRODUCTION: Sudden cardiac death is the leading cause of line of duty death among firefighters, accounting for approximately 45% of fatalities annually. Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high ambient temperatures, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events like myocardial infarction, serious dysrhythmias, or cerebrovascular accidents in firefighters with underlying cardiovascular disease. PURPOSE: The purpose of this study was to deploy and then evaluate the contribution of resting advanced ECG (A-ECG) in addition to other screening tools (family history, lipid profiles, and cardiopulmonary exercise tests, XT) in assessment of an individual fs cardiac risk profile. METHODS: Forty-four career firefighters were recruited to perform comprehensive baseline assessments including tests of aerobic performance, fasting lipids and glucose. Five-min resting 12-lead A-ECGs were obtained in a subset of firefighters (n=21) and transmitted over a secure networked system to a NASA physician collaborator. Using myocardial perfusion and other imaging as the gold standard, A-ECG scoring has been proven useful in accurately identifying a number of cardiac pathologies including coronary artery disease (CAD), left ventricular hypertrophy, hypertrophic cardiomyopathy, and non-ischemic and ischemic cardiomyopathy. RESULTS: Subjects f mean (SD) age was 43 (8) years, weight 91 (13) kg, and BMI 28 (3) kg/m2. Fifty-one percent of subjects had .3 cardiovascular risk factors. One subject had ST depression on XT ECG, at least one positive A-ECG score for CAD, and documented CAD based on cardiology referral. While all other subjects, including those with fewer risk factors, higher aerobic fitness, and normal exercise ECGs, were classified as healthy by A-ECG, there was no trend for association between risk factors and any of 20 A-ECG parameters in the grouped data.

Description: Evidence for dissected duricrust was identified in high resolution MOC images. Analysis of all available images was used to map the global distribution of this terrain. It is apparently restricted to two latitude bands: 30-60 deg. N and 30-60 deg. S.

Description: INTRODUCTION Sudden cardiac death is the leading cause of line of duty death among firefighters, accounting for approximately 45% of fatalities annually. Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high ambient temperatures, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events like myocardial infarction, serious dysrhythmias, or cerebrovascular accidents in firefighters with underlying cardiovascular disease. Screening for cardiovascular risk factors is recommended but not always followed in this population. PHASER is a project charged with identifying and prioritizing risk factors in emergency responders. We have deployed an advanced ECG (A-ECG) system developed at NASA for improved sensitivity and specificity in the detection of cardiac risk. METHODS Forty-four professional firefighters were recruited to perform comprehensive baseline assessments including tests of aerobic performance and laboratory tests for fasting lipid profiles and glucose. Heart rate and conventional 12-lead ECG were obtained at rest and during incremental treadmill exercise testing (XT). In addition, a 5-min resting 12-lead A-ECG was obtained in a subset of firefighters (n=18) and transmitted over a secure networked system to a physician collaborator at NASA for advanced-ECG analysis. This A-ECG system has been proven, using myocardial perfusion and other imaging, to accurately identify a number of cardiac pathologies including coronary artery disease (CAD), left ventricular hypertrophy, hypertrophic cardiomyopathy, non-ischemic cardiomyopathy, and ischemic cardiomyopathy. RESULTS Subjects mean (SD) age was 43 (8) years, weight 91 (13) kg, and BMI of 28 (3) kg/square meter. Maximum oxygen uptake (VO2max) was 39 (9) ml/kg/min. This compares with the 45th %ile in healthy reference values and a recommended standard of 42 ml/kg/min for firefighters. The metabolic threshold (VO2Theta) above which lactate accumulates was 23 (8) ml/kg/min. The chronotropic index, a measure of cardiovascular strain during XT was 35 (8) /L compared with reference values for men of 40 /L. Total cholesterol, LDL-C and HDL-C were 202 (34),126 (29), and 55 (15) mg/dl, respectively. Fifty-one percent of subjects had .3 cardiovascular risk factors, 2 subjects had resting hypertension (BP.140/90), and 23 had pre-hypertension (.120/80 but 〈140/90). Seven had exaggerated exercise induced hypertension but only one had ST depression on XT ECG, at least one positive A-ECG score for CAD, and documented CAD based on cardiology referral. While all other subjects, including those with fewer risk factors, higher aerobic fitness, and normal exercise ECGs, were classified as healthy by A-ECG, there was no trend for association between risk factors and any of 20 A-ECG parameters in the grouped data. CONCLUSIONS A-ECG screening correctly identified the individual with CAD although there was no trend for A-ECG parameters to distinguish those with elevated BP or multiple risk factors but normal XT ECG. We have demonstrated that a new technology, advanced-ECG, can be introduced for remote firefighter risk assessment. This simple, time and cost-effective approach to risk identification that can be acquired remotely and transmitted securely can detect individuals potentially at risk for line-of-duty death. Additional research is needed to further document its value.

Description:  An ensemble of twenty four coupled ocean-atmosphere models has been compared with respect to their performance in the tropical Pacific. The coupled models span a large portion of the parameter space and differ in many respects. The intercomparison includes TOGA (Tropical Ocean Global Atmosphere)-type models consisting of high-resolution tropical ocean models and coarse-resolution global atmosphere models, coarse-resolution global coupled models, and a few global coupled models with high resolution in the equatorial region in their ocean components. The performance of the annual mean state, the seasonal cycle and the interannual variability are investigated. The primary quantity analysed is sea surface temperature (SST). Additionally, the evolution of interannual heat content variations in the tropical Pacific and the relationship between the interannual SST variations in the equatorial Pacific to fluctuations in the strength of the Indian summer monsoon are investigated. The results can be summarised as follows: almost all models (even those employing flux corrections) still have problems in simulating the SST climatology, although some improvements are found relative to earlier intercomparison studies. Only a few of the coupled models simulate the El Niño/Southern Oscillation (ENSO) in terms of gross equatorial SST anomalies realistically. In particular, many models overestimate the variability in the western equatorial Pacific and underestimate the SST variability in the east. The evolution of interannual heat content variations is similar to that observed in almost all models. Finally, the majority of the models show a strong connection between ENSO and the strength of the Indian summer monsoon.

Description: We describe the behaviour of 23 dynamical ocean-atmosphere models, in the context of comparison with observations in a common framework. Fields of tropical sea surface temperature (SST), surface wind stress and upper ocean vertically averaged temperature (VAT) are assessed with regard to annual mean, seasonal cycle, and interannual variability characteristics. Of the participating models, 21 are coupled GCMs, of which 13 use no form of flux adjustment in the tropics. The models vary widely in design, components and purpose: nevertheless several common features are apparent. In most models without flux adjustment, the annual mean equatorial SST in the central Pacific is too cool and the Atlantic zonal SST gradient has the wrong sign. Annual mean wind stress is often too weak in the central Pacific and in the Atlantic, but too strong in the west Pacific. Few models have an upper ocean VAT seasonal cycle like that observed in the equatorial Pacific. Interannual variability is commonly too weak in the models: in particular, wind stress variability is low in the equatorial Pacific. Most models have difficulty in reproducing the observed Pacific 'horseshoe' pattern of negative SST correlations with interannual Niño3 SST anomalies, or the observed Indian-Pacific lag correlations. The results for the fields examined indicate that several substantial model improvements are needed, particularly with regard to surface wind stress.