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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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  • Consultant Dermatopathologist and Honorary Senior Lecturer, Department of Pathology, Western General Hospital and The University of Edinburgh, Edinburgh, UK

Experience of not only the surgeon is important blood pressure normal unit cheap zestoretic 17.5mg online, but also of the nursing staff hypertension specialist best zestoretic 17.5 mg, anesthesia staff arteria circumflexa femoris lateralis cheap zestoretic 17.5 mg without a prescription, and ancillary care team arteria gastroepiploica sinistra 17.5 mg zestoretic overnight delivery. The increased capital costs associated with robotic surgical systems have been incurred by hospital systems in an effort to provide patients with state of the art surgical care. I have been very impressed by the advantages that robotic surgery offers both for me and my patients. The advanced optics allow me to see anatomical structures that I would not otherwise see at surgery, and allows me to operate more precisely. I must say that I have been impressed by the lessened pain and quicker discharge of patients from the hospital as a result of this. In a progressive country where patients demand the best, I feel it would be unwise to eliminate robotic surgery as an option for any group of patients. I feel that robotic surgery is here to stay and is a great option for patients considering hysterectomy or other gynecological procedures. Robotic assisted surgery has become a major part of my Gynecology practice the past 3 years. The majority of these patients had 3-4 day hospital stays and were on disability for an average of 6 weeks while recuperating. Starting in 2004, I committed myself to advancing my laparoscopic surgical skills, and began performing more laparoscopic hysterectomies. These patients were often able to go home in 1-2 days, and some were able to go back to work in 2 to 3 weeks. However, my open hysterectomy rate remained about 40%, as I found that the limitations of standard laparoscopic instruments caused me to have to abandon the laparoscopic approach and convert to an open hysterectomy in a significant number of patients. There were additional patients I would not consider for laparoscopic hysterectomy because of anticipated surgical complexity due to obesity, multiple prior laparotomies, larger fibroids, or severe endometriosis. That has all changed dramatically since 2009 with the introduction of robotic-assisted laparoscopic surgery into my practice. Many are discharged from the hospital on the day of surgery, the remainder are routinely discharged after a one night stay. Most of my patients return to work, school, or their other normal activities within 3 weeks. For example, none of my 200+ robotic hysterectomy patients have required a blood transfusion. Many of these robotic-assisted surgeries have been complex surgeries due to multiple prior abdominal surgeries, obesity, diabetes, and other risk factors. With the exception of massively enlarged fibroid uteruses or large pelvic masses, I find that the capabilities of the robotic instrumentation allows me to operate with more safety and precision than open abdominal surgery. In summary, the advantage of robotic-assisted laparoscopic surgery (in my experience) is that the improved instrumentation and capabilities of the robotic platform allows me to avoid an open laparotomy incision in a much higher percentage of my operative patients, perform more complex surgeries more safely, dramatically decrease hospital stays, and allow the majority of my patients to return to work and other normal activities much earlier. Furthermore there is no overall conclusive evidence or opinion that robotic assisted surgeries improve the surgical outcome for the patient. I am a practicing cardiac surgeon with extensive personal experience with robotic open heart surgery, having one of the largest experiences with robotic mitral valve surgery in the country. Having trained in the 1980s and being a practicing heart surgeon for 25 years I of course am well aware that conventional open heart surgery via a sternotomy has been the "gold standard". That said I also see that this major life-saving surgery is hard on patients and we have to strive to make that better. Our own interest in robotic assisted heart surgery began as an attempt to make mitral valve surgery better tolerated and more acceptable to patients, hopefully without compromising the excellent results which could be achieved with conventional techniques. We began conservatively with selective cases but soon realized that the robotic approach has definite advantages and the outcomes are even better than with standard approaches. Our initial efforts to do minimally invasive mitral valve surgery were via a mini-thoracotomy endoscopic approach. While this had some advantages it was technically difficult and more importantly not as reliably predictable as we would want. We hoped, and subsequently found, that the assistance of the robot with its enhanced instrument dexterity and magnified 3-D vision would make the procedure much more predictable and reliable. We began doing robotic mitral valve surgery at Sacred Heart Medical Center in 2003. We began with more simple, predictable valve repairs but gradually realized that we were able to repair much more complex valves even better than we were doing via conventional open surgery! Now when we see complex mitral valve pathology we feel significantly more confident approaching that repair Thank you for your comment. I think our results over these years indicate the excellent outcomes which can be achieved via a robotically assisted approach. The following results include our very earliest "learning curve" cases and cases done with the first generation of robot. The current robotic system, along with our experience, has made the recent results even better. From June 2003 through March 2012 we have performed 461 robotic assisted mitral valve repair operations and 55 robotic assisted mitral valve replacements. All but one of the valve replacements were planned pre-operatively to be replaced (usually due to rheumatic pathology) with only one patient converted from planned repair to replacement. While the cardiopulmonary bypass times are somewhat longer the overall operative times are similar to conventional open procedures and the outcomes are outstanding. The repair techniques included leaflet resection (63%), sliding leaflet reconstruction (20%), Gore-Tex suture (W. In this series of 410 consecutive robotic mitral valve repairs there were only two conversions from robotic to open procedure: an 80 y.

Since the question is not in disagreement heart attack zing mp3 order 17.5 mg zestoretic mastercard, it does not require revision and will be locked out from editing arteriografia discount 17.5 mg zestoretic with amex. The first reviewer can resolve the disagreements with two options: Option 1: Change my review to pulse pressure from blood pressure buy zestoretic 17.5mg without a prescription agree with other reviewer arterial stenosis purchase 17.5mg zestoretic with mastercard. After the option is selected, a message will appear on the screen confirming the change was completed. If the investigation included the completion of a mortality review, the mortality review will appear. This instance may exist if a third review was assigned due to disagreements only in the morbidity reviews. If disagreements only exist for the mortality review, the morbidity form will be automatically bypassed. In special cases this form may be completed in the M&M committee setting or by a third reviewer. The online Mortality Review Form is generated automatically upon completion of the morbid review form and is accessible only via completion of that morbid review form. For mortality reviews, only the committee associated with the cause of death should complete the mortality form. If, on the morbid form, the reviewer answers "yes" to "Did the patient die," then he/she will be prompt with a pop-up question that asks which committee (Cardiac or Stroke) should do the Mortality Review. The Stroke committee member should do the Mortality review for all stroke deaths; the Cardiac committee should do the Mortality review for all other causes of death. If reviewers have questions about which committee should do the Mortality review, those questions can be communicated to the Coordinating Center via the "Send Comments" box in the morbid form. The Coordinating Center strongly recommends that you complete a hard copy version of the form before you login to the online version. Please return to the appropriate review form if you would like to link investigations. Information about being witnessed is in the Summary Report (last page) but may be on the Form Info Sheet for the Informant Interview, as well. Note: Whether the death was "witnessed" is often obvious, but can be confusing if the witness was only nearby. Some rules found useful in other studies are: the relative credibility of conflicting witnesses is established from all available evidence, i. However, as a general rule (1) a knowledgeable physician takes priority for medical history and (2) a witness takes priority for events around death and timing of death. If you are a stroke reviewer (and think that the case is cardiac, not stroke-related), skip to the end of the form. When the data is entered online, you will have the chance to refer the review to the other committee by writing in the comments box. An unwitnessed death may be classified as "Non-cardiovascular disease" if there is a history of another likely cause of death. Death during thrombolysis or other direct vascular intervention also would be assigned according to the event process being treated. The stroke, however, would also be coded on the morbid review form and be coded as procedure related. Some general rules used in other studies are Death is assumed to have occurred at the time the patient stops breathing on his or her own and does not recover. If symptoms come and go, the onset of symptoms is the time when they crescendo, leading to death. In cases where the timing of symptoms or death is unknown, the best estimate of the chronology is to be made. Unknown chronology of death in an institutionalized patient is usually considered to be <24 hours. If you believe that the death was stroke-related, but you are not a stroke reviewer, skip to the end of the form. When the data is entered online, you will have the chance to refer the review to the stroke committee by writing in the comments field. If you are a stroke reviewer, and believe there is a stroke component to the death, please complete the remaining sections of the form. For example, the Events Contact Log may be used when a member of the Events staff needs to phone a physician to verify or inquire about something the physician documented in a medical record or on a physician questionnaire. Several calls should be attempted at different times of the day before a participant is declared unreachable. At the end of each contact attempt, record the applicable pending code from the available list of codes on the top half of the page. Pending codes are: Code 1 Category Unlisted phone number Explanation Number for this participant is unlisted. Busy signal/no answer Telephone is busy or no answer and there is no answering machine at the number. If five attempts result in no answer, determine if the number is correct or if an alternate phone number is available for the participant. For example, if the person answering the phone says that the participant will be back at home in a week, then that information may be noted so that the Events staff know when to try phoning again. Somewhere near the top or middle of the Events Contact Log, you may make a note about why it is necessary to phone the participant.

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Although we have elaborated the hypothesis that police will demonstrate less bias than the community heart attack 90 year old zestoretic 17.5 mg discount, particularly with respect to heart attack first aid purchase zestoretic 17.5mg with amex their error rates (H1) heart attack 34 years old buy zestoretic 17.5mg with mastercard, we note that the comparison between police and community presents two other possibilities heart attack risk assessment 17.5mg zestoretic with visa. Of course, it is also possible that officers will show more pronounced bias than community members (H2) or that police and civilians will show relatively similar patterns of bias (H0). In line with the former hypothesis, Teahan (1975a, 1975b) presented evidence that police departments acculturate White officers into more prejudicial views during their first years on the job. Given these findings, we might reasonably expect a "police as profilers" pattern, with officers relying heavily on racial information when making their decisions to shoot. Finally, police officers and community members may show equivalent levels of racial bias in decisions to shoot. Inasmuch as police and community members are subject to the same general cognitive heuristics (Hamilton & Trolier, 1986) and sociocultural influences (Devine & Elliot, 1995), the two groups may demon- strate similar patterns of behavior in the video game simulation. Because of this difference in processing, we predict a divergence between measures of bias that are based on errors and measures that are based on reaction times. By contrast, H2 and H0 offer no clear reason to predict differences between officers and civilians in terms of cognitive processing, and (accordingly) they offer no reason to expect a divergence between error-rate and reaction-time measures. Three samples of participants completed a 100-trial video game simulation in which armed and unarmed White and Black men appeared in a variety of background images. Partici- pants were instructed that any armed target posed an imminent threat and should be shot as quickly as possible. The speed and accuracy with which these decisions were made served as our primary dependent variables, and performance was compared across three samples: officers from the Denver Police Department, civilians drawn from the communities those officers served, and a group of officers from across the country attending a 2-day police training seminar. For the purposes of law enforcement, the city of Denver is divided into six districts. With the help of the command staff, officers were recruited for this study from four of these districts during roll call. Participation was completely voluntary, and officers were assured that there would be no way to identify individual performance on the task and that the command staff would not be informed of who did and did not participate. Our goal was to recruit primarily patrol officers, and, in this effort, we were successful: 84% of the sample listed patrol as their job category. Investigative officers accounted for 9% of the sample, administrative officers for 2% of the sample, with the remaining 5% of the officers from a mixture of other job categories. A total of 124 officers participated in the study (9 female, 114 male, 1 missing gender; 85 White, 16 Black, 19 Latina/o, 3 other, 1 missing ethnicity; mean age 37. For these areas, a bilingual research assistant recruited and instructed the participants. Eight participants were dropped from the analyses: 2 because of a computer malfunction and 6 because they had fewer than five correct trials for at least one of the four cells of the simulation design. Thus, the reported results for this sample are based on 127 civilians (51 female, 73 male, 3 missing gender; 39 White, 16 Black, 63 Latina/o, 9 other; mean age 35. To collect the national police sample, we attended a training seminar for officers. This was one of several seminars that officers voluntarily attend to obtain additional training in some particular area of law enforcement. The seminars are specifically geared for patrol officers, rather than administrative personnel. The sample of officers obtained for this study came from 14 different states, and only 7% worked in some administrative capacity. Although this clearly is not a random national sample of officers, it offers a greater diversity of background than the Denver sample. A total of 113 officers participated in the study (12 female, 100 male, 1 missing gender; 72 White, 10 Black, 15 Latina/o, 13 other, 3 missing ethnicity; mean age 38. Fifty men (25 Black, 25 White) were photographed in five poses holding one of a variety of objects, including four guns (a large black 9 mm, a small black revolver, a large silver revolver, and a small silver automatic) and four non- guns (a large black wallet, a small black cell phone, a large silver Coke can, and a small silver cell phone). For each individual, we selected two images, one with a gun and one with an innocuous object, resulting in 100 distinct images (25 of each type: armed White, armed Black, unarmed White, and unarmed Black), which served as the principal stimuli, or targets, in the game. Using Photoshop, we embedded targets in 20 otherwise unpopulated background scenes, including images of the countryside, city parks, facades of apartment build- ings, and so on. Each target was randomly assigned to a particular background, with the restriction that each type of target should be represented with equal frequency in each background. The video game, developed in PsyScope (Cohen, MacWhinney, Flatt, & Provost, 1993), followed a 2 2 within- subjects design, with Target Race (Black vs. These scenes were drawn from the set of 20 original unpopulated back- ground images. This background was replaced by an image of a target person embedded in that background. Failure to respond to a target within 850 ms of target onset resulted in a penalty of 10 points. Feedback, both visual and auditory, and point totals were presented at the conclu- sion of every trial. At the scheduled time, each officer was seated at a small cubicle in a test room equipped with a laptop computer, button box, and headphones. For the national sample of officers, an announcement was made the first day of the training seminar inviting officers to participate in the study.

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In 2011 blood pressure readings low 17.5 mg zestoretic, we performed more than 10 04 heart attack m4a 17.5 mg zestoretic otc,000 procedures for patients with simple and complex ischemic disease hypertension 1 stage cheap zestoretic 17.5mg without prescription. Therefore blood pressure medication orange juice 17.5 mg zestoretic fast delivery, there may be differences compared with totals reported elsewhere in this book. Compared with the average high-volume interventional center, Cleveland Clinic exceeds the rate of administration for all these medications. A total of 527 were isolated procedures (performed without any other operation), and 828 were performed in combination with another procedure. Percent 6 4 2 0 Percent 4 3 2 1 Cleveland Clinic Expected Cleveland Clinic Expected 0 Primary Reoperation Source: University HealthSystem Consortium 2011 discharges. These are associated with greater morbidity and mortality than are primary procedures. Percent 4 3 2 1 0 0% Primary (N = 459) Reoperation (N = 68) Observed Expected Source: University HealthSystem Consortium 2011 discharges. Reduced ventilator time leads to better outcomes and increased patient satisfaction. To reduce this rate, transition-of-care strategies are being developed and deployed at Cleveland Clinic. These include predischarge needs assessment, improved discharge processes (patient education, relay of discharge information to receiving providers) and postdischarge follow-up, including continued clinical management support. The total number of procedures includes some that are not detailed in the graph below. A total of 6,488 ablations for atrial fibrillation were performed at Cleveland Clinic from 2004 through 2011. Outcomes 2011 Ablation of Ventricular Tachycardia (N = 115) 2011 Complete Success Rate* 79% *All ventricular tachycardias were eliminated in 79 percent of patients, and the procedure was partially successful in another 15 percent. Partial success means at least one tachycardia was ablated in patients who had multiple tachycardias. Cleveland Clinic is a national referral center for patients with ventricular arrhythmias. The majority of these procedures were done in combination with other cardiac procedures. This includes 382 implantable devices to provide cardiac resynchronization therapy to patients with heart failure. Device Lead Extractions Leads in Place > 1 Year or Requiring Extraction Technology Year 2011 2010 2009 2008 2007 2006 # Extraction Procedures 270 241 263 250 249 357 # Leads Extracted 460 399 443 451 445 636 % Clinical Success* 100 99 98. Electrophysiologists at Cleveland Clinic perform the greatest number of lead extractions in the world. Many of our patients have complex conditions that result in referral to our physicians. Leads may need removal because of electrical malfunctions, blocked blood vessels or infection. Remote monitoring is also associated with increased longevity and decreased need for in-person follow-up. Cleveland Clinic continues to be the leader in the number of valve surgeries performed in the United States. These procedures are typically more complex and challenging than primary procedures. The rating is awarded to hospitals across the country that demonstrate the highest quality of cardiac surgery. Cleveland Clinic was awarded the rating based on data comparisons from January 2009 through December 2011. Cleveland Clinic performs the largest number of aortic valve operations in the nation. Ninety-one percent were valve replacements (N = 1,553), 5 percent were valve repairs (N = 101) and 4 percent were valve-sparing operations (N = 85). Valve repair, rather than replacement, is associated with better survival, improved lifestyle, better preservation of heart function, and lower risk of stroke and infection (endocarditis), and there is no need for anticoagulation therapy. The majority of mitral valve repairs at Cleveland Clinic are performed using a minimally invasive approach. Bioprostheses are preferred for most aortic and mitral valve procedures because they are durable and help most patients avoid lifelong anticoagulant therapy after surgery. Surgical Treatment of Infective Endocarditis Infective endocarditis is a life-threatening disease. It causes bacterial or fungal growths on the heart valves that can lead to perforation, rupture and subsequent valve regurgitation. Cleveland Clinic surgeons treat a variety of patients with infective endocarditis, including those with advanced disease and prosthetic valve endocardititis. The mortality rate is consistently 0 percent with this procedure, and patients experience a shorter recovery than those who have traditional surgery. Robotically Assisted Valve Surgery (N = 160) Cleveland Clinic performs more robotically assisted mitral valve surgeries than any major academic hospital in the United States. Compared with comparable hospitals, mortality rates for valve surgery are far lower.


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