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AEI currently utilizes a RIEGL VZ400 Terrestrial Laser Scanner on various job sites.  This proecss utilizes a high accuracy 3D terrestrial LiDAR unit.  The data collected will be brought into a feature extraction software, TopoDOT.  TopoDOT utilizes a variety of tools to identify adn quickly extrapolate features within pointcloud data.  All features can then be imported into an AutoCAD drawing file.  AEI can provide an accurate 3D pointcloud of terrain plus any existing building or structures.  The pointcloud can also be converted for Building Information Models.

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Allen Engineering is involved with the civil design and surveying for the new park in Palm Bay, Flordia.  This Regional Park will feature 150 full service campsite hookups and is scheduled to break ground in 2018.  We are extremely proud to be involved in this project.

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Allen Engineering is beginning its 21st year associated with the Space Coast Post of the Society of American Military Engineers (SAME).  During our 21 years, we have helped raise over $350,000 in scholarships and endowments.  We are extremely proud to be associated with SAME and its continued commitment to offer opportunities for students pursuing careers in the engineering field.


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  • S. Ward Casscells Professor, Department of Orthopaedics, University of Virginia, Charlottesville, Virginia


Such has been the pace of military technological development over the years that the gap between what producer nations themselves use and what is suitable for a new nation venturing into a new capability continues to medicine measurements requip 1mg lowest price grow symptoms ulcer requip 0.25mg line. The natural desire of nations to medications just like thorazine discount 2 mg requip visa buy the best they can afford frequently leads to medications vaginal dryness buy generic requip 0.25mg online procurement and logistic disasters as equipment is delivered that is too complex and expensive to maintain. It is particularly important to keep a sense of proportion about equipment performance. If one has a requirement for a transport aircraft with a range of 146 David Chuter 1 000 km, there is no point in paying more for an aircraft with a range of 1 500 km, unless there is absolutely certainty that it can be used. It often happens that the military gradually edges into new and expensive roles simply because they have acquired a new capability. On the other hand, it can be attractive to buy a proven system, even if it has a lesser capability. In most cases a nation will be offered a variety of competing products, the cost and performance of which will be very different from each other. Choosing between them is hard enough for experienced nations, but for those coming fresh to the task it can be overwhelming. Some pointers have already been offered and this may be a suitable moment to bring them all together. A possible series of priorities could be as follows: Be very sure of the capability required. There are a variety of ways, some very sophisticated, of comparing the prices and performances of equipment. Broad-order assessments of costs and capabilities are always possible and this should result in some sensible judgements. If, for example, two anti-tank systems are offered, one of which has greater penetrating power than the other, the first question to ask is: `Does it make a difference? If a radio set offers superior performance at double the price it would be wise to try to quantify the performance difference in some way. It may be hard to be exact, but either the performance difference is substantial, in which case the more expensive equipment is worth considering, or it is not substantial, in which case it should not be considered further. So-called through-life costs, which take the costs of maintenance and upgrades into account, are often a much better basis for decisions. The procurement of defence systems is one way for small states to exercise a great deal of leverage. If a number of systems will meet the requirement, then the decision should be based on other factors, such as the following: Offset and licence manufacture. A nation that does not have a strategy to cover these factors is weakening its bargaining position in a market that is now, and will be for some time, biased significantly in favour of the purchaser. Of course, integrating all of factors can be a challenge, especially as it is not really possible to do so scientifically. In the end, systems for weighting various factors are dependent on subjective judgements. But a clear and logical process that involves all of those with an interest in the matter will very often throw up a winner. Part of the difficulty is that nations buying defence equipment often do not realise how strong their position is. A small country ordering six helicopters may be overwhelmed by attention from companies and governments, and may feel intimidated into making the wrong decision. But in the end the customer has the final say, and some time spent preparing for the purchase can yield enormous savings later, and also ensure that the right equipment is obtained. Some guidance has already been given in this regard, but it needs to be stressed once more that setting and maintaining an objective is the main requirement of any procurement programme. Something may be offered with far less capability than is needed, but at a rock-bottom price. The temptation to buy it needs to be resisted, in the same way that the temptation should be resisted to purchase something with more capability than is affordable, and which may perhaps also be too sophisticated to operate easily. Supplier nations may make threats and promises in an attempt to get you to change your mind. If either of two alternatives will do, then try to manoeuvre the two governments into a bidding contest to see who will give you the best deal. Is it preferential financing, free training, local manufacturing, offset and counter trade, or political favours? A nation that decides what it wants and sticks to that decision can achieve a remarkable amount. Whereas much of the defence sector, as with government as a whole, developed for the practical reason that the private sector was unable or unwilling to perform the tasks required, the later idea of contracting services out was based essentially on ideological principles. It was argued that the private sector was inherently more efficient than the public sector and that cost savings would inevitably result by outsourcing certain tasks. The actual argument was complex and theoretical, and need not detain us here, but it was certainly not an argument based on experience since there was no experience to base it on. A generation later, the kindest judgement that can be made is that the evidence is inconclusive, not least because we do not know what would have happened if the outsourcing course had not be followed. It is easiest to see the policy of outsourcing as a reflection of a political mood, which is now waning, rather than a serious exercise in increasing efficiency. Nonetheless, those states that are considering going in this direction, or are wondering whether the steps they have already taken were wise, it is worth keeping the following caveats in mind: Supplier capture.

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Pola hidup tidak sehat Pola hidup tertentu seperti penggunaan busana kerja symptoms 2dpo requip 0.5mg discount, seperti korset medicine xanax buy generic requip 1 mg on line, stoking atau pakaian olahraga yang ketat dan terbuat dari bahan yang tidak menyerap keringat juga bisa menimbulkan keputihan medicine symbol order 0.5mg requip with visa. Kebiasaan karbohidrat dalam mengkonsumsi jumlah tinggi gula juga atau dapat menimbulkan keputihan karena tidak semua gula yang masuk kedalam tubuh menjadi asam laktat oleh laktobasilus medications you cant take with grapefruit best 1mg requip. Sisa gula yang beredar dalam tubuh menjadi makanan jamur candida penyebab keputihan pada perempuan (Wikipedia, 2008) 12 d. Stres Gaya hidup tertentu seperti stress, merasa cemas dan kurang istirahat dapat menimbulkan keputihan. Keadaan tersebut dapat menimbulkan bendungan pada pembuluh darah di daerah panggul, sehingga pengeluaran cairan oleh kelenjar di panggul meningkat dan menimbulkan keputihan (Wikipedia, 2008). Akibat yang sering terjadi karena keputihan Akibat yang sering ditimbulkan karena keputihan adalah sebagai berikut: 1) Gangguan Psikologis Respon psikologis seseorang terhadap keputihan akan menimbulkan kecemasan yang berlebihan dan membuat seseorang merasa kotor serta tidak percaya diri dalam menjalankan aktifitasnya sehari ­ hari (Manuaba, 1998). Infeksi alat ­ alat genetalia, menurut Manuaba (1998:405-408): a) Vulvitis Sebagaian besar dengan gejala keputihan dan tanda infeksi lokal, penyebab secara umum jamur. Infeksi kulit berambut terjadi perubahan warna, membengkak, terasa nyeri, kadang ­ kadang tampak bernanah dan menimbulkan kesukaran bergerak. Infeksi kelenjar bartholini terletak di bagian bawah 13 vulva, warna kulit berubah, membengkak, terjadi penimbunan nanah di dalam kelenjar, penderita sukar untuk berjalan dan duduk karena sakit. Tipe vaginitis yang sering dijumpai adalah vaginitis candidiasis dan trikomonalis vaginalis. Vaginitis candidiasis merupakan keputihan kental bergumpal, terasa sangat gatal dan mengganggu, pada dinding vagina sering dijumpai membran putih yang bila dihapus dapat menimbulkan perdarahan, sedangkan trikomonalis vaginalis merupakan keputihan yang encer sampai kental, kekuningan, gatal dan terasa membakar serta berbau. Infeksi serviks sering terjadi karena luka kecil bekas persalinan yang tidak dirawat dan infeksi karena hubungan seksual. Keluhan yang dirasakan terdapat keputihan, mungkin terjadi kontak bleeding saat berhubungan seksual. Tandatandanya yaitu nyeri yang menusuk-nusuk di bagian bawah perut, mengeluarkan keputihan dan bercampur darah, suhu tubuh meningkat dan pernafasan bertambah sertatekanan darah dalam batas normal. Penentuan jenis infeksi genetalia ini lebih akurat bila dilakukan pemeriksaan pap smear untuk memungkinkan keganasan(Manuaba, 1998:386). Cara menangani dan mencegah Cara menangani dan mencegah keputihan menurut Kasdu (2005) adalah sebagai berikut: a. Untuk lendir normal tidak perlu diobati, tetapi dengan menjaga kebersihan dan mencegah kelembaban yang berlebihan pada daerah organ kelamin terutama saat terjadi peningkatan jumlah lendir normal. Menggunakan antiseptik yang sesuai dengan petunjuk dokter untuk membersihkan vagina dari lendir keputihan yang berlebihan. Melakukan perawatan pemeriksaan kesehatan organ intim enam bulan sekali pada wanita yang pernah melakukan hubungan seksual. Melakukan deteksi dini kemungkinan adanya kanker serviks dengan tes pap smear (Kasdu, 2005). Menjaga organ intim agar tidak lembab setelah buang air kecil atau air besar, bilas sampai bersih, kemudian keringkan sebelum memakai celana dalam. Saat membersihkan vagina, membilas dilakukan dari arah depan ke belakang untuk menghindari kuman dari anus ke vagina. Pola hidup sehat yaitu diet seimbang, olah raga rutin, istirahat cukup, hindari rokok dan alcohol serta hindari stress berkepanjangan. Selalu menjaga kebersihan daerah genetalia dengan menjaganya agartetap kering dan tidak lembab misalnya dengan menggunakan celana dengan bahan yang menyerap keringat, hindari pemakaian celana dalamketat. Biasakan untuk mengganti pembalut, pantyliner pada waktunya untuk mencegah bakteri berkembang biak. Biasakan membasuh dengan cara yang benar tiap kali buang air yaitu dari arah depan ke belakang. Penggunaan cairan pembersih vagina sebaiknya tidak berlebihan karena dapat mematikan flora normal vagina. Hindari penggunaan bedak talkum, tissue atau sabun dengan pewangi pada daerah vagina karena dapat menyebabkan iritasi. Diagnosis Penyebab keputihan dapat didiagnosis dengan memperhatikan umur, keluhan yang timbul, sifat-sifat dari tubuh vagina, hubungan dengan menstruasi, ovulasi, kehamilan, kelainan setempat, dan ditunjang dengan pemeriksaan laboratorium sederhana (Dalimartha, 2002, p. Pada pemeriksaan langsung di sekitar alat kelamin luar, bisa terlihat bibir kemaluan, muara kandung kencing, anus, dan lipat paha. Perhatikan apakah tampak bercak kemerahan yang terasa gatal, perhatikan juga adanya luka lecet, tonjolan-tonjolan kutil berbentuk jengger ayam, gelembung-gelembung kecil berisi cairan yang dasarnya kemerahan, dan cairan keputihan yang bisa ditentukan jumlahnya (sedikit atau banyak), konsistensi (encer, agak kental. Bisa langsung diperiksa di bawah mikroskop, atau setelah diberi warna baru diperiksa di bawah mikroskop. Dari pemeriksaan tersebut, bila penyebabnya infeksi akan terlihat apakah penyebabnya bakteri, jamur, atau protozoa. Pemeriksaan dalam dilakukan pada perempuan yang telah menikah dengan menggunakan alat untuk melebarkan saluran vagina yang disebut spekulum. Dengan alat ini bisa dilihat saluran vagina dan leher rahim (serviks), apakah ada peradangan (kemerahan), erosi, atau bercak putih. Juga bisa terlihat bila ada benda asing yang tertinggal di saluran vagina, tumor, papiloma ataupun kecurigaan adanya kanker serviks (Dalimartha, 2002, p. Pemeriksaan dapat dilanjutkan dengan melakukan biopsy atau pengambilan sel-sel yang lepas dengan cara mengeroknya pada selaput lendir leher rahim. Namun, bila penyebabnya infeksi, tentukan apakah akibat bakteri, jamur, parasit atau virus. Larutan ini hanya untuk membersihkan, karena tidak dapat membunuh penyebab infeksi maupun menyembuhkan keputihan akibat penyakit lainnya. Kondiloma bisa diobati dengan larutan Podofilin 25% atau larutan asam trikloro ­ asetat 40% - 50%, atau salep asam salisilat 20% - 40% yang dioleskan topikal ditempat kutil tersebut berada. Pada kandidiasis, pengobatan per vaginal dengan Nistatin, Mikonazol dan Klotrimazol, atau per oral dengan Fluconazol. Pengobatan dengan antibiotika dan anti jamur bisa per oral 19 (diminum) ditambah dengan pengobatan lokal berupa tablet atau krim per vaginal bagi yang sudah menikah.

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In particular medicine 1900s spruce cough balsam fir purchase requip 2mg on line, the competitiveness is vulnerable to medications without a script requip 0.5 mg cheap changes in macroeconomic variables treatment zit purchase requip 1mg with amex, while comparative advantages have a natural structural character (Qineti et al medications you cant drink alcohol with order 1 mg requip with amex. The most common index used to assess the comparative advantage and the competitiveness of individual economic sectors on the international market is the one proposed by Balassa (1965), which measures the export success of one or more products compared to the total exports. These studies differ in relation to the categories of products studied (single products or group of commodities), the period analyzed, the aim of the study. In this period a drop in revealed comparative advantages of the majority of the most successful commodities was detected. Contextually the positions of a number of previously uncompetitive commodities has shown an improvement. In particular, Ishchukova and Smutka (2013), analyze the specialization and the competitive performance of the Russian agricultural sector in order to determine whether or not the patterns of comparative advantage for Russian agricultural trade have experienced a significant changes over the period 19982010. The Authors showed that Russia has comparative advantages in relation to Commonwealth of Independent States and Asian countries due to its geographical location and good trade relations. In a similar study carried out for the Serbian processed food sector, Ignjatijevic et al. In the economic literature, relatively few studies analyse the competitive performance of the main actors of the world wine market and the recorded changes in their competitive position over the last few years. Our study try to fill this gap analysing the specialization patterns and the competitive performance of eight of the main international actors of the wine market and the changes occurred in the last decades. According to the Lafay index, the comparative advantage of Country i in the j production is thus measured by the deviation of product j normalized trade balance from the overall normalized trade balance, multiplied by the share of trade (export plus import) of product j in total trade. The absolute value of the index measures the intensity of this advantage of country i in product j. Similarly, a negative value of the index signals that the specialization and hence comparative advantage are lacking (Caselli and Zaghini, 2004; Zaghini, 2005). The construction of the index, which takes into account both the trade flows for each product and for the entire sector (total number of good treated), allows to determine whether a country is relatively specialized in a given economic product (in relation to all other sectors) even when the country in question appears as a whole a net importer, but on condition that the percentage difference between imports and exports is lower than the same percentage at the national level (Boffa et al. For these characteristics, this index is thus more efficient compared to other indicators commonly used in the literature for similar analyzes, such as the traditional Balassa index. Among the countries studied, Italy showed the highest specialization for the bottled wines (5. Wine, in fact, is one of the most representative products of the "Made in Italy" food productions that, thanks to its high quality and marked distinction, has contributed to strengthening the reputation of Italian products worldwide as an offer of excellence, strongly tied to the territory (Carbone and Henke, 2012; Crescimanno and Galati, 2014). Furthermore, Italy shows a strong specialization in the segment of sparkling wines (0. In particular, this country preserves its role of undisputed leader in the world market for sparkling wines, showing the highest value of trade specialization index (2. The high level of trade specialization reached by these two countries in the international scenario is partly linked to the role that the wine industry plays in these countries, due to favourable climatic conditions as well as to the favourable policies implemented in order to support the growth of the sector. As Chile is concerned, however, there is a marked specialization for wines in bottle (3. In South Africa, for example, after the end of the Apartheid in 1994, the wine industry has undergone deep structural reforms (Sandrey and Vink, 2008). As a consequence, it has pushed many producers toward production adjustment to the pattern of international demand to plant noble international varieties and the implementation of advances enology and viticulture techniques (Cusmano et al. The country is highly specialized, compared to the other countries studied, for bulk trading wines in containers holding more than 2 litres (1. Over the last few years there has been a shift from exports of bottled wines to the bulk wines, with heavy consequences on the price down of 12% (I numeri del vino, 2013). Spain, one of the most important world wine producers, shows a lower specialization level than other European countries observed in this analysis (3. This result, due to the intense activity that since 1980s, saw a change of orientation of the Australian wine industry from little more than a "domestic-oriented, cottage-style industry" to one with "a reputation for approachable, yet high quality, characterful wines of every possible style" (Clarke, 2002; Aylward, 2006). This can be largely caused by the trade restrictive measures taken by the government which are adversely affecting imports. Changes in the wine trade specialization patterns the dynamics of the Lafay index for total wine and for the three categories of wine in the period 20032012 show different trends in the countries studied (Table 1). More in detail, Italy shows a modest improvement of their trade specialization, remarkable since 2009, thus proving that despite the deep economic and financial crisis which since 2007 involving many countries integrated internationally, the wine industry has reacted positively, improving its competitive advantage in the world scenario (Crescimanno et al. The positive performance recorded is mainly due to the increasing specialization of the sparkling wines segment. A similar results is obtained by Crescimanno and Galati (2014) according to which competitiveness of Italian sparkling wines in the international market has been increased in the last few years, in particular in the Russian market, where this Italian product is increasingly appreciated, even if only by the range of consumers with high disposable income, often associated consumption of sparkling with the Italian lifestyle. Among sparkling wines, Prosecco recorded in the last few years an increase of consumption for special occasions and is presented with a "cool" image and not as cheap substitutes for Champagne (Mariani et al. As bottled wines are concerned, Italy shows a slightly increasing performance, mainly due to an increase of sales in markets that do not have an old wine tradition, where local production is insufficient to meet demand, and where the wine is an expression of the Italian lifestyle (Crescimanno et al. As suggested Castillo and Garcнa (2013), the competitive positioning strategy of these wines during the decade 2000-2010 is focused, on three aspects: (i) low-cost wine production; (ii) a distinctive policy of segmenting with respect to quality and maintaining high standards through investments on innovation; (iii) realization of economies of scale. Among the countries studied, the best performance has been showed by the Chilean wine industry that, during the period of reference, progressively increased its wine trade specialization. This performance is linked to the growing endorsement of Chilean wine in the world market, thanks to the high quality of wines led by the ideal conditions for wine production and excellent natural endowments that results in numerous wine regions characterized by favorable terroir. Furthermore, the Chilean wine industry has made considerable effort to modernize technologies and adopt novel productive practices (Cusmano et al. In particular, in this country, industry associations have been created in the latter part of the 1990s in response to the growth taking place in the industry and as a consequence of the need to achieve greater penetration in export markets (Kunc and Bas, 2009; Fleming et al. Chile gaining ground is not surprising: since 2009, the country was heralded by the global community for its "solid macro environment" and "good innovation policies" (LopezClaros, 2009-2010). Table 1 - Trend of Lafay index from 2003 to 2012 2003 2004 2005 2006 Total wine Argentina 0. The negative trend has affected all three categories of wine, and among these the sparkling.

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This procedure is often used to medicine 369 order 0.5 mg requip visa assist patients who are extubated to moroccanoil oil treatment proven 0.25mg requip ensure better outcomes with ventilator weaning symptoms anxiety discount 1 mg requip free shipping. Alternative Forms of Medical Intervention for a Patient Without Access to medications that cause hair loss requip 0.25mg line a Ventilator, for a discussion on other possible medical interventions. Alternative Forms of Medical Intervention for a Patient Without Access to a Ventilator for a discussion on ambu-bagging. However, ambu-bagging may be permitted by the facility in specific circumstances, such as when a ventilator is expected to become available in a short period of time and staff resources are available. Palliative care is focused on the prevention and relief of both physical and emotional discomfort. In the ventilator withdrawal context, appropriate measures should be taken to prepare for and ease the process of withdrawal for patients and their families. A patient and family should be educated and made aware of possible treatment options in light of available resources, which may be less than ideal during a pandemic. Appropriate measures should be taken to clarify what a patient and his/her family can expect, so they can better prepare for possible outcomes. Finally, open communication also helps to ensure that everyone understands the progression of treatment and can minimize conflict. Differences between Adult and Pediatric Palliative Care While the underlying focus and goals of adult and pediatric palliative care are the same, there are several aspects that are unique to the care of children. Because most people do not have first-hand experience with pandemics or other mass tragedy events that significantly affect children, the general public is not comfortable with the idea of children dying en masse. When a child dies, s/he cannot reach his/her potential or experience the milestones of a full life. Furthermore, the course of illness in pediatric patients is frequently cited as being different from that in adults. While children may experience more severe symptoms, they have better recovery rates for serious illnesses. Because of their resilience and significantly lower rates of mortality, it is sometimes difficult to determine the prognosis of children. Another difference between adult and pediatric palliative care is the capacity for patient understanding and communication. While most non-cognitively impaired adults can adequately understand their conditions to communicate their feelings and concerns about palliative care, children have varying abilities to understand and communicate their experiences. Even if children lack the cognitive maturity to comprehend the severity of their medical condition, they are still likely to recognize cues from their family and health care providers regarding the situation. How information is communicated, and to which parties (only the parents/caregivers, or also include the child), is crucial for promoting the least difficult experience for a patient and family. Frankel, Pediatric Palliative Care: the Role of the Intensivist, in Current Concepts in Pediatric Critical Care, 104 (Edward E. However, many of these practices may not be feasible if there is a significantly high rate of transmission and a need to isolated affected patients to protect individuals without the disease. Logistics Regarding the Implementation of the Guidelines There are several non-legal issues245 to consider once the Guidelines are implemented, including communication about triage, and real-time data collection and analysis to modify the Guidelines based on new information. Public outreach should include a component that informs people that the medical standard of care during an influenza pandemic will be different than the normal. It will also include information that during this specific scenario, patient preference will not determine ventilator access. Instead, a protocol based only on clinical factors will be used to determine whether a patient receives (or continues with) ventilator treatment to support the goal of saving the greatest number of lives where there are a limited number of available ventilators. Data collection and analysis on the pandemic viral strain, such as symptoms, disease course, treatments, and survival are necessary so that the clinical ventilator allocation protocol may be adjusted accordingly to ensure that patients receive the best care possible. Furthermore, data collection must include real-time availability of ventilators so that triage decisions are made to allocate resources most effectively. With planning, even if a pandemic does occur, community members, health care providers, and public officials may be able to diminish its impact. While the Pediatric Guidelines developed by the Task Force and the Pediatric Clinical Workgroup assist a triage officer/committee as they evaluate potential patients for ventilator therapy, decisions regarding treatment should be made on an individual (patient) basis, and all relevant clinical factors should be considered. Examining each patient within the context of his/her health status and of available resources provides a more flexible decision-making process, which results in a fair, equitable plan that saves the most lives. Finally, the pediatric clinical ventilator allocation protocol is a set of guidelines to assist clinicians in distributing limited ventilators and may be revised as more information on the nature of the pandemic viral strain is gathered. High: Survival and good outcome expected (survival > 90%) with aggressive and comprehensive resource allocation, including aggressive fluid resuscitation, admission > 14 ­ 21 days, multiple surgeries, prolonged rehabilitation. Medium: Survival 50 ­ 90% and/or aggressive care and comprehensive resource allocation required, including aggressive resuscitation, initial admission > 14 ­ 21 days, multiple surgeries and prolonged rehabilitation. Low: Survival < 50% even with long-term aggressive treatment and resource allocation. Chief, Division of Medical Ethics, Weill Medical College of Cornell University Karl P. Star Former Administrative Assistant *indicates former staff 155 Chapter 2: Pediatric Guidelines Appendix B- Members of the Pediatric Clinical Workgroup Susie A. Columbia University Medical Center Affiliation at Harlem Hospital Center George Foltin, M. Weill Cornell Medical College and New York Presbyterian Hospital George Hardart, M. New York State Department of Health Acknowledgements: Edward Conway, Bradley Fuhrman, Andrew Garrett, Scott Klein, Octavio Lafuentes, Karen Levin, Kathleen Lillis, John Morley, Tia Powell, Bradley Rice, Mayer Sagy, and Charles Schleien Robert K. Although a small subset of the general population, neonates (infants less than 28 days old) may also require ventilators and there will not be enough ventilators in New York State to meet the demand. A clinical ventilator allocation protocol will need to be implemented to ensure that ventilators are allocated in the most efficient manner to support the goal of saving the greatest number of lives.

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