county nurse case county nurse case series legal proceedings west texas centered retaliation nurses submitted anonymous state medical board complaint physician case attracted national attention implications nurses witnessing believed unsafe medical care nurses anne mitchell submitted anonymous complaint texas medical board learned complaint spoke sheriff county friend patients alleged nurses reports medical board constituted harassment sheriff investigated obtained complaint provided information mitchell identifiable mitchell terminated hospital faced criminal charges official information charges dropped trial mitchell acquitted jury aftermath mitchell trial county officials hospital administrator faced jail time roles retaliation nurses case raised questions extent protection healthcare providers report patient care concerns licensing authorities texas law included retaliation known state laws addressed appropriate conduct according texas nurses association imagined nurse prosecuted reporting patient care concern licensing agency mitchell case protection prosecution incorporated texas laws stopped investigating anonymous complaints physicians september background case originated county memorial hospital bed hospital texas mitchell registered nurses nurses held multiple roles hospital employed years headed quality improvement management hospital mitchell served compliance officer mitchell split responsibilities medical staff coordinator position mitchell held time role county emergency management coordinator experience travel nurse instructor director licensed nursing program april arrived attended medical school philippines come united_states train baltimore buffalo texas issued medical license year came county restricted ability supervise nurse practitioners physician assistants years fined case allegedly failed adequately supervise physician assistant weight loss clinic failed exercise independent medical judgement applying written clinic owner mitchell concerns care soon arrived doctor practice included use alternative medicine witnesses later said mitchell comments work characterized witch doctor said mitchell legitimate concerns quality physician patient care said mitchell raised issues hospital administration concerns addressed incident alleged performed skin emergency room patient perform surgery facility patient came hospital crushed finger allegedly took rubber tip pair medical patient finger mitchell sent anonymous complaint detailing concerns care patients letter said nurses feared losing jobs identities revealed connection complaint aware complaint spoke county sheriff robert roberts alleging complaint amounted harassment issued copy complaint roberts understanding investigate criminal activity roberts sent complaint administrator stan small hospital details letter identified mitchell sources complaint roberts obtained search nurses computers found letter sheriff friends doctor treated roberts emergency room heart attack roberts credited saving life referred doctor caring person met roberts later commented board report saying destroy somebody reputation forcing leave town don believe good faith termination criminal charges mitchell terminated june days later nurses arrested charged official information carries possibility years imprisonment fines roberts said nurses filed complaint personal good faith reporting facts noted mitchell sent medical records patients consent reports include names patients federal law medical board reports patient privacy laws case attracted national attention july american nurses association texas nurses association began raise awareness plight nurses later said didn support emotional financial stepped filed complaint texas department state health services resulted investigation hospital february legal defense fund collected donations defense mitchell executive director robinson commented prosecution significant chilling effect reporting physician practice issues charges dropped case went trial mitchell case tried county attorney scott political supporter roberts personal attorney february executive director county attorney nearby county discouraged trying case trial mitchell testify relationship roberts explored proceedings introduced roberts supplement selling program known recommended patients roberts sold said friendship impacted actions nurses business relationship attorneys office texas attorney general took mitchell case contacted assistant attorney general david later said case bizarre seen year stint office dealing cases public officials enriched expense office public trust like theft financial benefit bad actors case jury returned guilty verdict hour present courtroom said approached mitchell verdict comments trial jury tyler said wondered nurses arrested president said verdict win behalf patient safety aftermath asserted state laws including texas nursing practice act public employee law gave health care provider right report concerns patient care providers termination presumed improper occurred days filing complaint mitchell filed civil lawsuit county roberts lawsuit alleged violations civil rights process improper termination months mitchell trial mitchell split settlement civil suit nurses live new_mexico unable find employment nursing terminated signing settlement reinforced support saying lot good county heart attack nature emergency room definitely doctor want care officials faced criminal charges involvement prosecution termination mitchell trial indicted counts retaliation pleaded guilty lesser charges sentenced days jail fine agreed cooperate prosecution involved officials terminated mitchell submitted anonymous medical board complaint submitted resignation hospital august board directors declined accept resigned october roberts convicted counts official information counts retaliation counts official oppression june sentenced days jail years probation fine sentence roberts removed sheriff forced surrender license peace officer convicted similar charges removed office sentenced days jail years probation fine trial publicly uncovered guilty plea entered charged prostitute assessed fine hospital inadequate supervision illegal termination mitchell moved practice east texas affiliated germany hospital grand hospital administrator said looked allegations found internet formally complained doctor november entered guilty plea counts official information charges dismissed pending indictment aggravated dropped forced surrender medical license sentenced days jail years probation assessed fine people involved nurses case assumed new employment summer mitchell found position new_mexico working disabled said case careers entered early retirement mitchell earned dean advocacy award texas tech university health sciences center working pizza restaurant left county appealing license practice law new legislation stopped investigating anonymous complaints concerning physicians fall change seen victory physicians rights groups said promote investigations physicians groups worried new law discourage reporting legitimate complaints physicians board received complaints percent complaints submitted anonymously


international emergency medicine international emergency medicine emergency medicine focuses global practice emergency medicine efforts promote growth emergency care branch medicine world term international emergency medicine generally refers transfer skills knowledge including knowledge ambulance operations aspects care developed emergency medical systems systems developed definition criticized given international nature medicine number physicians working internationally point view international emergency medicine better described training required reality practicing specialty outside native country emergency medicine recognized medical specialty united_states developed countries nearly years countries fully mature early 1990s point practitioners turned attention developing specialty home developing abroad leading birth international emergency medicine began support growth emergency medicine worldwide conferences national regional emergency medicine organizations relief development organizations international emergency medicine physician exchanges information transfer curriculum development developing countries taking steps develop emergency medicine specialty develop mechanisms promote development emergency medicine training programs interest result improved healthcare increasing aging populations rising number traffic fatalities heightened awareness emergency medicine citizens addition emergency medicine useful dealing time sensitive illnesses improving public health training data collection countries lack mature developing emergency medicine specialty able set training programs encourage medical students pursue emergency medicine challenges faced international emergency medicine include immature non existent training programs lack adequate emergency transport shortage resources fund emergency medicine development absence research inform developing countries best spend resources devote emergency medicine additionally standards methods countries mature suited use developing countries lack infrastructure shortage funds local demographics developed country standard costly practical road conditions present countries instead variety modes transportation furthermore place expensive medication equipment developing countries opt cheaper slightly effective alternatives increasing availability emergency medicine improve health little evidence directly support claim point methods effective improving patient health evidence based medicine seeks address issue studying effects different instead relying logic tradition background definition commonly accepted definition international emergency medicine area emergency medicine concerned development emergency medicine countries definition countries refers nations mature emergency care system exemplified board certified emergency physicians academic emergency medicine things included nations developed lack complete emergency medical system armenia china israel nicaragua philippines work international emergency medicine broken main categories promotion emergency medicine recognized established specialty countries provision humanitarian assistance william mark kenneth criticized definition given international nature medicine number physicians working internationally point view international emergency medicine solely development emergency medical systems instead better described training required reality practicing specialty outside native country history emergency medicine emergency medicine specialty developed united_states 1960s united_states high number traffic accident fatalities 1960s spurred white paper national academy sciences exposed current emergency medical system led establishment modern emergency medical services united_kingdom australia canada hong_kong singapore followed shortly developing respective emergency medicine systems 1970s 1980s beginning early 1990s emergency medicine systems united_states united_kingdom australia canada hong_kong singapore largely mature leading practitioners focus developing specialty countries international emergency medicine began 1990s isolated efforts achieve goals taken place late 1980s reasons heightened interest practitioners developing emergency medicine abroad contrast countries countries revolutions authoritarian regimes facilitated spread new ideas emergency medicine international emergency medicine conferences launched 1980s international conference emergency medicine world association disaster emergency medicine conference founded international federation emergency medicine started organization additionally 1990s national regional emergency medicine organizations began supporting development specialty countries including american college emergency physicians european society emergency medicine asian society emergency medicine furthermore countries mature began taking interest developing reason interest overall improvement healthcare countries increasing taking place worldwide corresponding shift focus infectious diseases trauma diseases better managed emergency medicine prevention addition developments aging population countries led increased need emergency medical services american popular culture particularly television shows demonstrated success emergency medicine countries mature led public countries expect better emergency medical care international emergency medicine organizations focused relief development contributed growth relief organizations doctors borders serve countries mature health occur organizations serve enhance specialty image international public eye development organizations emergency international international federation emergency medicine help establish develop emergency care systems countries providing ongoing educational organizational assistance emergency medicine developing world motor vehicle crashes major factor led development emergency medicine united_states united_kingdom australia canada hong_kong singapore major factor leading countries develop emergency medical systems today crashes represent leading cause death young adults majority deaths occurring developing world recent decades traffic fatalities declined nations rise developing ones furthermore developing nations tend higher proportion fatalities number vehicles reasons including lower safety standards vehicles lack available emergency care developing countries serves problem higher rate accident mortality vehicle exists despite fact fewer cars asia africa west argue shows need improve emergency medical care emergency medical care applies acute health problems illnesses time sensitive elements common developing countries including severe caused respiratory caused intentional injuries bleeding acute potentially life threatening conditions effective treatment unavailable world population instance study medical systems published international research society found percent hospitals emergency medical system transported patients percent carried oxygen percent carrying drugs kind furthermore intensive care beds available hospitals surveyed found major hospitals implies majority critically ill patients receiving care general hospital anderson argue aside acute care emergency medicine play significant role public health diseases administered emergency departments patients targeted specific counseling substance abuse conditions like detected treated emergency departments excellent locations train health care providers collect data high number patients emergency medicine improves public health preventing secondary disease developing initial presentation initial symptoms serves line defense disaster scenarios models emergency care primary models emergency medicine anglo american model relies bringing patient hospital franco german model operates bringing hospital patient anglo american model patient rapidly transported non physician providers definitive care emergency department hospital conversely franco german approach physician come patient provide care field patient directly appropriate department hospital anglo american model seen nations australia canada ireland new_zealand united_kingdom united_states franco german model found european countries austria france germany poland portugal russia developing emergency medical systems including china japan philippines south_korea taiwan established anglo american lines little work exists establish advantage system arnold james criticized use emergency medical systems source controversy instead arnold proposed classifying emergency medical systems following specialty model specialty systems include physicians dedicated emergency medicine systems encompass rely physicians disciplines provide emergency care approach seek pre hospital care separately hospital systems arnold understanding emergency care models current western models inadequate context developing nations instance cost benefit analysis found creating system met standards cardiac arrest response percent patients receive minutes cost million save intact lives year primary variable responsible result relatively young meaning comparatively cardiac related deaths occur example developing nation establishing model emergency medicine seen southern brazil elements major conventional models incorporated system following french influences staffed physicians american approach emergency medical residency training present role overall health system developed countries developed counties training programs specifically relating international practice emergency medicine available emergency medicine curriculum covered programs subject discussion patient care medical knowledge practice based learning communication skills system based practice basic required programs approved council graduate medical education application goals forms breadth skills needed international emergency medicine unlikely standardized program fulfill training needs scenario australian study found primary topics covered fellowship programs emergency medicine systems development humanitarian relief disaster management public health travel field medicine program administration academic skills authors argue attempting cover areas unrealistic targeted focus acquiring necessary skills productive training completed training working visiting nations way physicians participate international emergency medicine physicians choose pursue careers overseas opt shorter trips example team physicians spent seven months helping establish new emergency department emergency residency program china exchanges mutually beneficial instance percent physicians australia united_states united_kingdom canada received training medical schools outside country currently practice developing countries experience international emergency medicine developing countries ways opposite developed ones 2000s developing countries attempting establish effective systems care recognized specialty programs assistance health care providers developed world countries advanced emergency medical systems far greater number process developing systems process development usually begins patient care followed administrative economic concerns finally health policy given limited resources developing nations funding effects emergency medicine fits health system care crucial healthcare developing countries difficult budget emergency medicine cutting resources particular problem poorer nations capita health expenditure dollars regardless care available health problems requiring immediate attention occur emergency medical programs increase access care argue expanding emergency medicine need expensive particularly developing countries focus low cost effective treatments administered initiatives expand emergency medicine curriculum development argue key component nations develop emergency medical systems identify aspects training essential health care providers view standard curriculum useful identifying core issues countries different needs resources address goal international federation emergency medicine developed model curriculum initiative seeks provide minimum basic standard tailored specific needs nations implementing training emergency medicine targeted medical students order produce minimum emergency care physicians regardless specialty transferring knowledge countries decades experience comprehensive emergency medical systems expertise nations beginning emergency medical programs lack exists considerable opportunity transfer knowledge assist newly founded programs transfers distance person instance international emergency medicine fellowship university toronto sent person team romania promote local development emergency medicine assessment present status performed identified targets improvement physical plant organization patient flow staff education equipment medication supplies infection control practices following designations plans areas drawn implemented partially international exchange trips transfer knowledge international conference emergency medicine conference held years worldwide emergency physicians international federation emergency medicine conference took place dublin ireland organization founded national emergency physician organizations american college emergency physicians british association emergency medicine canadian association emergency physicians college emergency medicine conference rotated founding members held singapore new members accepted mid-1990s decided open membership nations emergency medicine organizations conference rotate instance conference hosted hong_kong held cape_town south_africa conferences international emergency medicine including world association disaster emergency medicine held years focuses disaster medicine emergency medicine system development member physicians specialists emergency medicine additionally european society emergency medicine hosted annual conference publishes european journal emergency medicine develops recommendations emergency medicine standards european countries supports disaster medicine training center degree program san asian society emergency medicine asian society founded holds conference addition asian society like develops curriculum recommendations asian countries developing emergency medicine specialty way advance emergency medical care obtain recognition emergency medicine specialty countries currently lack recognition difficult set training programs recruit potential students face training obtain end useless recognition increases visibility prestige profession promotes efforts advance development serve case study recent recognition emergency medicine specialty closely accompanied creation society emergency care establishment training centre trauma research centre university formation committee design national policy pre hospital care alternate route developing emergency medicine provide additional training specialists equip practice emergency medicine benefit rapid implement physicians trained areas add necessary emergency skills repertoire initial expansion difficult emergency medicine progress nations adopt strategy practitioners identify original specialty incentive continue press innovations emergency medicine challenges training educational opportunities emergency medicine available countries present infancy opened medical school program emergency medicine following program aims train physicians emergency medicine year limitations country training mean program includes months training international site organization program modeled south_africa program similarities resource constraints disease college emergency medicine south_africa emergency medicine society south_africa support expansion emergency medicine years clinical practice required entering residency program south african australian approaches deal shortage educational opportunities scott suggest countries developed emergency medical systems focus training trainers believes sustainable approach promote development emergency medicine worldwide works sending developed country health care workers equip small group necessary skills teach concepts able leverage insights developed emergency medical systems remaining sustainable newly trained trainers continue spread knowledge emergency medicine initiative example physicians currently working emergency departments taught teach new group emergency medical specialists emergency transport limitations resources available developing countries particularly evident area emergency transport developed country standard costly practical road conditions present countries roads study found modes transport diverse trailers platforms trailers vehicles emergency transport advanced developing countries establishing ambulance transport systems feasible requires considerable expertise planning prior pakistan organized emergency medical system year rescue launched professional pre hospital emergency service managed achieve average response time minutes comparable developed nations critical factors success included local manufacture vehicles training instructors emergency medical technicians adopting training materials local context branching include fire rescue service response united command structure resources vital nature lack resources available international emergency medicine seen proportion scientific articles topic articles identified review international emergency medicine literature classified dealing practice emergency medicine resource constrained environments new dimension thought isolated subject technology trauma care published world journal surgery topics covered included use tape best estimate children weight green effective treatment potential alternative available lack research despite thought increasing availability emergency medicine improve patient outcomes little evidence exists directly support claim developed countries controlled trials related emergency medical services published implying current standard care rests support similar lack direct proof exists effectiveness international assistance promoting emergency medicine countries efforts improve health failure international emergency medicine impact renders difficult identify best practices target areas benefit achieved development recent years seeks address issues termed evidence based medicine suggests approach study effects different instead relying logic tradition arnold argues application worldwide lead sharing best practices emergency medicine practitioners countries advancing current standard emergency care


iraq poison grain disaster iraq poison grain disaster mass poisoning incident began late grain treated intended human consumption imported iraq seed grain mexico united_states number factors including foreign language late distribution growing cycle toxic grain consumed food iraqi residents rural areas people suffered skin lack coordination muscle movements vision loss symptoms similar seen disease affected japan recorded death toll people figures times greater suggested poisoning largest mercury poisoning disaster occurred cases peaking january february stopping end march reports disaster recommended regulation better handling mercury treated grain wider involvement world health organization monitoring preventing poisoning incidents investigation confirmed particular danger posed young children context properties mercury effective europe america health risks consumed small quantities known banned sweden country united_kingdom followed previous mercury poisoning incidents occurred iraq cases deaths cases deaths cases compounds recommendations incident colour toxic grain easy identification incident cases poisoning reported worldwide drought reduced affecting people government decided import mercury coated seed grain late planting season worked department agriculture aftermath incident causes tonnes long tons short tons grain tonnes wheat grain tonnes coloured pink orange shipped iraq united_states mexico wheat arrived trade carrier september october october november iraq government chose high yield wheat seed developed mexico norman seeds contained average mercury samples containing nearly twice decision use mercury coated grain reported iraqi government supplier northern received half shipments contributing factors epidemic included fact distribution started late grain arrived october november planting season farmers holding grain instead planting completed distribution open grain distributed free charge payment kind farmers sold grain new grain left dependent grain winter unaware significant health risk posed chose ignore warnings initially farmers signature understood grain poison according sources distributors ask indication warnings sacks spanish english understood included black white skull design meant long period granted farmers false sense security animals fed grain appeared fine red washed grain mercury washing given appearance removing poison mercury consumption bread meat animal products obtained livestock given treated vegetation grown soil contaminated mercury game birds fed grain fish caught rivers canals lakes treated grain dumped farmers ground seed dust contributing factor farmers grinding consumption ground flour bread thought major cause cases reported urban areas government flour supplies commercially regulated symptoms outbreak treatment effect mercury took time period symptoms typically days predominant cases worse cases included typically loss balance reduced vision death resulting central nervous system failure mercury suggested sufficient body weight average individuals affected consumed bread tonnes provided sufficient million cases hospital received large numbers patients symptoms doctors recognised outbreak case poisoning admitted hospital december december hospital issued specific warning government january government started strongly warn populace eating grain dispatches mention large numbers ill iraqi army soon ordered disposal grain eventually declared death penalty found selling farmers dumped supplies possible soon got water supply particularly river causing problems government issued news released little information outbreak world health organization assisted iraqi government supply drugs equipment expertise new treatments tried existing methods heavy metal poisoning particularly effective administered patients caused rapid deterioration condition ruled treatment sort poisoning following outbreak helped believed largely insignificant overall recovery outcomes tested patients late treatment period showed clinical improvement result treatments varied patients blood mercury level dramatically reduced effect patients received periods treatment interspersed lay periods continuous treatment suggested future cases later treatment effective reducing blood effects patients admitted hospitals poisoning deaths reported cases reached peak hundreds day january largely subsided beginning march march represented age gender age represented admitted cases number certainly availability hospital treatment hospital lack faith treatment severely affected areas prevalence mortality cases iraqi doctors believe number cases fatalities times low cases brain damage suggested reason vast reported estimated numbers deaths iraqi custom common large parts middle_east person die home possible home deaths recorded large number patients minor symptoms recovered completely symptoms improved contrast expected outcomes largely based analysis disease japan boys mercury levels clinical poisoning reduction school performance noted confirmed mercury poisoning caused central nervous system damage relatively low caused slower development children abnormal different treatments mercury poisoning developed quiet baby syndrome characterised baby cries recognised induced brain damage ongoing recommendations food regulation authorities focused consumption pregnant women infant children noting particular poisoning data iraq confirmed pass child mercury levels equal higher newborn child mother joint food agriculture organization world health organisation meeting recommendations prevent similar outbreak included stressing importance bags local language locally understood warning symbols possibility creating strong bitter taste studied meeting urged governments strictly regulate use respective countries including limiting use reasonable alternative available recommended involvement assisting national governments regulation enforcement setting national poison control centres november conference treated seed held baghdad supported recommendations report suggested local national media including size symptoms considered distribution information crucial laid general plan collection relevant information field potential analysis investigation called national governments use involvement feasible world governments clear terms saying country feel blame attach allowing outbreak occur iraq highest world symptoms similar mercury poisoning symptoms mercury enters brain half life years able remove


history research development context diving derives reduction ambient pressure experienced ascent end dive exposure refers reduction pressure process allowing dissolved gases eliminated tissues reduction pressure descends water column ambient pressure rises breathing gas supplied pressure surrounding water gas blood tissues gas continues taken gas dissolved state breathing gas lungs diving moves water column reduces ambient pressure breathing gas gases dissolved tissues higher concentration state start dissolved gases nitrogen form bubbles blood tissues partial pressures dissolved gases gets high compared ambient pressure bubbles products injury caused bubbles cause damage tissues known sickness bends immediate goal controlled avoid development symptoms bubble formation tissues long term goal avoid complications sub clinical injury symptoms sickness known caused damage resulting formation growth bubbles gas tissues arterial blood supply tissues gas bubbles bubble formation tissue damage precise mechanisms bubble formation damage cause subject medical research considerable time advanced tested tables predicting outcome schedules specified proposed tested usually found use entirely reliable remains procedure risk reduced generally considered acceptable tested range commercial military recreational diving recorded experimental work related conducted robert subjected experimental animals reduced ambient pressure use primitive vacuum pump earliest experiments subjects died later experiments signs later known sickness observed later technological advances allowed use mines exclude water miners observed present symptoms known disease bends sickness recognized symptoms caused gas bubbles relieve symptoms work showed possible avoid symptoms slow subsequently theoretical models derived predict low risk profiles treatment sickness timeline sir robert conducted experiment bird air pump actual intentional investigations experiment effectively rapid caused death bird sir robert performed experiment vacuum bubble observed eye displayed signs extreme discomfort recorded description sickness documented cases sickness humans miners involved work developed symptoms effectiveness treatment sickness workers described repeated experiments suggested sudden death compressed air workers caused bubble formation recommended therapy alfred roy described sickness illness divers andrew smith terms disease compressed air illness describing cases sickness physician charge construction brooklyn bridge nickname bends workers emerging construction brooklyn bridge adopted posture similar fashionable ladies period bend paul determined sickness caused nitrogen gas bubbles released tissues blood showed advantages breathing oxygen developing sickness proposed based tissue model suggested uniform minutes atmosphere pressure commissioned british admiralty study sickness john scott prepared recognised table british admiralty table based experiments performed goats end point chief gunner george united_states_navy created program test tables program ultimately led publication united_states_navy diving manual establishment navy diving school newport rhode_island training programs later cut end world war hill proposed continuous uniform naval school diving salvage established washington navy yard time united_states moved navy experimental diving unit naval yard following years experimental diving unit developed navy air tables accepted world standard diving compressed air conducted extensive experimental determine different tissue compartments model albert experimented oxygen therapy navy tables developed published altitude sickness treated oxygen time navy tables published split classification type hills published paper approach arising study diving techniques suggested conventional models results bubble formation eliminated stops slower solution indicates importance bubble phase efficient gas elimination french_navy marines table published robert introduced tables utilizing oxygen accelerate elimination gas royal_navy laboratory published tables based tissue slab model described graves christian quinn subjects gas mixture surrounded french civilian tables published showed sensitivity testing increased use methods detect mobile bubbles symptoms emerge model tables formula limits published described varied model paul louis homer edward introduced survival analysis study sickness published model constant closed circuit albert published sickness recognized problems associated altitude diving proposed method calculated maximum nitrogen loading tissues particular ambient pressure defence civil institution environmental medicine canada released tables based serial compartment model extensive testing edward published navy linear tables constant closed circuit applications extended use model constant closed circuit bruce published recreational tables based navy tables swiss sport diving tables based model published proposed bubble model core varying model tables published sport diving tables released french_navy marine tables published french civilian tables published national association underwater instructors published tables based bruce model core finalized published recreational air tables based model model baker released revision work participants wayne david published sets tables programs based produced internally compatible set tables open circuit air including water air oxygen surface oxygen proposed compartment model compartment series parallel model single risk bearing active tissue compartment non risk bearing peripheral compartments indirectly affect risk central compartment model initially fast gas time navy diving manual revision published includes version tables limited dissolved phase models early theory generally assumed gas bubble formation tissues avoided aim tables prevent bubble formation time dissolved phase models limited differ mainly number compartments range half times assumed models commonly referred theory tables john scott commissioned royal_navy develop safe procedure current method slow linear concerned ineffective additional nitrogen buildup slow early stages ascent hypothesis ascend immediately depth reaches exceed critical level depth pressure gradient efficient remain depth reduced sufficiently ascend feet new depth critical process repeated safe reach surface assumed constant critical ratio dissolved nitrogen pressure ambient pressure depth large number experiments goats compressed hours assumed rapidly surface pressure examined symptoms sickness goats compressed bar absolute showed signs rapid surface goats compressed bar rapidly bar pressure ratio showed signs workers concluded pressure ratio unlikely produce symptoms model model formulated findings following assumptions living tissues saturated different rates different parts body time varies minutes hours rate follows curve approximately complete hours goats hours humans process follows pressure time function symmetrical provided bubbles formed slow tissues important avoiding bubble formation pressure ratio produce symptoms dissolved nitrogen exceeds twice ambient atmospheric pressure unsafe efficient high pressures start rapidly absolute pressure followed slower ascent ensure partial pressure tissues stage exceed twice ambient pressure different tissues designated tissue groups different half times assumed half times tissue compartments chosen half times minutes depth intervals chosen stops tables model set tables method comprises choosing depth time exposure calculation nitrogen partial pressure tissue compartments end exposure depth stop found tissue compartment highest partial pressure depth stop standard stop depth partial pressure nearest exceeding critical pressure ratio time stop time required reduce partial pressure compartments level safe stop shallower controlling compartment stop usually fastest tissue generally changes ascent slower tissues usually control shallower stop times longer time closer slower tissues slower tissue controlling final stops chamber tests open water divers divers successfully exposure tables adopted royal_navy tables considered true set tables basic concept parallel tissue compartments half times critical limits use later models tables computers navy tables navy tables gone lot development years based parallel multi compartment models number compartments varied compartments ascent undergone major development based experimental work records sickness incidents tables tables produced navy developed bureau construction repair consequently known tables derived model oxygen depths air successfully depths slightly 1930s submarine escape training led navy personnel believe fast tissues conservative calculated values indicated exceeded limits develop large number experimental conducted years derive compartment model compartment half times minutes values critical derived experimental work different tissue compartment values slow tissues minute close findings considerably higher values found fast tissues values high researchers concluded minute tissues relevant development based conclusions set tables omitted minute tissues tables tables based compartment model compartment half times minutes ascent rate chosen minute convenient rate pull standard dress tables van der worked procedures surface oxygen use early 1950s research found problems tables long dive times found fast tissues dropped 1930s control cases introduced fast compartments model added extra slower compartment better model long duration assumptions model parallel tissue compartments elimination gas compartment half times minutes symmetrical elimination half times half time compartment elimination decrease increased ambient pressure values different compartment tissue compartment assumed fully half times means slowest min compartment takes hours hour surface interval dive considered repetitive tables ascent rate chosen min compromise practical requirements military surface supplied diving operations repetitive diving accommodated tables slowest compartment control surface minimum surface interval minutes found necessary ensure minute compartment controlling effect repetitive navy exceptional exposure tables navy tables soon found problematic deeper longer hours navy exceptional exposure tables use compartment model developed half times minutes compatible rest navy air tables repetitive diving convenience standard navy air tables tables warn repetitive diving permitted following exceptional exposure dive minute tissue completely hours restriction assuming hours navy tables recreational diving community earliest modifications navy tables involved changes layout recreational diving community include way repetitive dive tables calculation dive tables tables original version modified navy tables theory exact science models approximate process understood complex simple mathematical models hope producing useful procedure low risk injury user new information allows theories models modified provide reliable results availability faster powerful computer low cost numerical methods relatively far complex models possible real time factors encouraged researchers modify existing tables develop new models bubble detection allows models use bubble formation use safety stops shown andrew marine science centre greatly reduce bubble formation divers models use slower ascent rate min navy tables navy tables reduced ascent rate min multiple repetitive navy tables designed single repetitive dive concerns safety extending use multiple repetitive attempt address issue tables modified reduce time repetitive longer nitrogen retention addition longer half time compartments allows accumulation nitrogen longer periods accounted tables simplest modification navy tables drawing new line reduce stop limits unchanged table divers recommended remain modified stop limit new time limits listed navy table shorter table entry selected tables tables based navy tables limits recommended bruce changes table rules requirements ascent rate minute safety stop minutes metres recommended possible deeper total dive time repetitive group tables tables based navy tables issued early 1980s version modification navy tables following modifications released years later limits reduced cases results repetitive group shifting letter shifted letters letters stop safety stop minutes recommended time spent safety stop included time repetitive group surface interval hour repetitive recommended repetitive dive depths limited repetitive dive defined occurring hours previous dive allows slowest tissues atmospheric partial pressures required stop depth adapted sports table use courses replaced based tables recreational air tables based model tables released tables tables designed use excavation wreck table values feet deeper shortened minutes putting divers higher repetitive groups sooner repetitive group selection tables repetitive modified repetitive dive uses repetitive group selection navy tables subsequent use conservative tables place higher repetitive group navy tables profile tendency continued fourth repetitive safety stops metres required repetitive minutes required second dive minutes minutes fourth dive maximum ascent rate specified min min model tables modified navy compartment model values derived follow limits tables exclusively diving presented format navy tables major difference navy tables repetitive group represent nitrogen levels tissues unlike table represent minute compartment repetitive group indicates percentage saturated tissue intended tables applicable diving procedures tables officially tested conservative navy tables calculated limits theoretically produce bubbles time recreational dive tables known recreational dive developed rogers tested diving science technology affiliate inc values derived stop limits repetitive group based minute tissue compartment combination resulted conservative conservative repetitive tables developed stop diving recommend safety stop minutes emergency inadvertently exceed stop limit specified tables available formats regular table wheel circular slide rule type allows depths read intervals times nearest minute tested single day multi level multi day multiple day testing tables professor laboratory medicine medical clinic university developed swiss tables referred tables early 1960s model tissue compartments half times minutes minutes varying limits depending tissue ambient pressure based absolute pressures application altitude diving set swiss tables consists tables altitude ranges ascent rate chosen minute stop limits schedules tend conservative navy air tables swiss tables use minute tissue compartment control repetitive dive calculations tends conservative navy tables application modified tables swiss sport diving tables model generate dive tables recreational divers set altitudes sea level altitudes repetitive group based minute compartment tables german german tables developed max derivative model half times ranging minutes sets published altitude ranges repetitive group based minute compartment safety factors added depths table account depth gauge errors depths calculations greater depths listed lower altitude tables greater depths listed highest altitude table french_navy marine tables mathematical model development tables marines table assumptions limiting factors ascent gas exchange symmetrical compression role bubbles modification blood tissue exchange neglected normal produce bubbles occurs bubbles appear bubbles appear compartment ratio dissolved gas pressure ambient pressure reaches critical value maximum pressure compartment specific assumptions conditions use model tables follows air breathing gas sea level initially saturated atmospheric pressure parallel tissue compartments half times minutes critical ratio ascent rate metres minute stop tables stop surface reduced min reference population respect physiology based medically fit divers french_navy weight plus minus height plus minus age plus minus years minute tissue calculation nitrogen repetitive letter groups indicate gas content minute tissue letter groups modified according surface interval nitrogen time found repetitive group repetitive dive depth added planned time stops intervals tables experimental modified necessary maximum permitted depth use air data depths included table case accidentally exceeding depth limit repetitive dive allowed data multiple repetitive altitude available tables calculating equivalent air depth oxygen accelerate water depths exceeding unusual feature tables table reduction nitrogen breathing pure oxygen surface non dissolved phase models royal_navy laboratory model early 1950s developed limited model gas transfer tissues model model basis model radial surrounding tissue assuming closely packed plane model developed tissue slab equivalent dimensional linear bulk directions tissues central surface tables based modified tissue slab model conservative navy tables version tables british sub club production tables model tables mid-1960s canadian defence civil institute environmental medicine developed serial model differs models parallel models assume compartments exposed ambient partial pressures gas interchange occurs compartments serial model assumes takes place series compartments exposed ambient partial pressures effect version bulk slab model model serial compartments half time approximately minutes initial compartments taken gas concentration compartments considered continuously evaluated modified model years revised set tables released based thousands evaluated model calculation model model modifications model fit observed data original model observed shortcomings retaining basic model structure applied existing hardware minimal modifications mixed phase models dissolved bubble phases model hills published paper approach arising study diving techniques suggests conventional models results bubble formation eliminated stops slower elimination solution indicating importance bubble phase efficient gas elimination tables tables french official civilian air tables published tables french government funded research project evaluation tables computer analysis dive report database indicated tables limitations severe government supported second project develop new tables complete set air tables options pure oxygen breathing surface supplied wet bell surface split level diving repetitive diving etc developed early model implemented concept continuous compartment half times safe ascent criteria arterial bubble model derived defined fitting mathematical expressions selected database time best fit obtained expression called set tables evaluated offshore selected minor adjustments tables included diving standard procedures tables included new french diving regulations tables tables arterial bubble model arterial bubble assumption capacity lung threshold radius size red blood cell sufficiently small bubbles pass arterial especially initial phase ascent later ascent bubbles grow larger size remain trapped lung explain conventional measurements detected bubbles arterial circulation arterial bubble assumption introduce outcome lung function variable individual capacity lung assumed vary individuals given individual day day account inter personal persona observed basically good good bubble filter justification divers seek physical fitness severe second variable related dive conditions speculates influence lung filter raised levels decrease lungs capacity allow bubbles pass arterial circulation diving situations associated retention associated higher risk type explain following situations related high levels identified contributing factors anxiety stress exhaustion intense activity cold high work arterial bubble assumption consistent accidental production arterial bubbles scenario considers heart lung level passes bubbles arterial patent thought open certain conditions explains accidents recreational air diving procedure violation explain hits deep diving symptoms appear early long massive bubble production required system second scenario considers pressure increases reduce bubble allow bubbles trapped lung normal suddenly pass responsible type symptoms explain difference outcomes water versus surface data collected north_sea shown overall rate diving methods surface tends produce times type water assumed surface bubbles produced trapped lung deck chamber bubbles reduced diameter pass arterial later causing symptoms scenario proposed type recorded diving profiles multiple repetitive arterial bubble assumption provides explanation initial ascent phase bubbles associated symptoms necessarily generated site growth process beginning ascent cycles bubbles reached critical size filtered lung stopped tissue level production shower small arterial bubbles minutes initial ascent precursor symptoms attempt turn scenario model arterial bubble model assumptions compressed gas mixture contains gas tissues pressure exposure ascent initiated gas loaded soon suitable gradient created bubbles normally produced bed transported system heart lungs lungs work filter trap bubbles smaller diameter gas transfer bubbles critical issue capacity lung system small bubbles pass lungs circulation level arch distribution blood likely carry bubbles tissue brain spinal cord brain fast tissue state early phase acts gas reservoir feeds local bubble grow bubble proceed cycle trapped grow place causing local restriction blood supply finally develop central symptoms similarly arterial bubbles reach spinal cord grow site local gas produce spinal symptoms later bubbles reach significant size exert local particularly tissues nerve produces pain arterial bubble model model based arterial bubble assumption arterial bubble model version model developed calculation tables gas phase model uses equation compared classic value associated factor reduces permitted gradient small values compartment time constant consequence introduction deeper stops classic dissolved phase model arterial bubble assumption considers situations initial phase critical event assumed arrival arterial bubble tissue bubble exchanges gas surrounding tissue blood bubble exceed critical radius eventually leave site growing block blood circulation cause critical bubble radius criterion prevent type symptoms strategy safe rate ascent stage balance gas exchange later phase critical event assumed presence large bubble taken large quantity dissolved gas adjacent tissue joint bubble reaches critical volume mechanical effect nerve endings causing pain bubble volume critical criterion prevent type pain symptoms strategy safe ascent stage prevent gas phase growing critical volume critical volume concept developed formulated simple mathematical condition linking dissolved gas safe ascent pressure represents dissolved gas tension ambient pressure linear relationship dissolved gas ambient pressure mathematical form value suggests models values including navy tables previous based model tables french_navy tables considered expressions critical volume criterion authors argued interpretations navy tables use simple symmetrical gas models shown need model slower tissue early 1980s navy experimental diving unit developed model gas absorption usual model slower linear release ascent effect adding linear model duration risk accumulation given compartment time constant model originally developed programming computers constant oxygen partial pressure closed circuit initial experimental diving resulted unacceptable change model linear release model reduction principles applied developing tables constant oxygen partial pressure model diving linear component active tissue pressure exceeds ambient pressure given specific tissue compartment tissue pressure drops cross criterion tissue modelled gas tissue pressure exceeds ambient modelled results model desired characteristics slower linear transition smooth choice cross pressure determines slope linear region equal slope region cross point development tables recognized successful replace existing collection incompatible tables air diving modes currently navy diving manual set mutually compatible tables based single model proposed revision navy diving manual published changes independent implementation real time developed consulting carried navy dive computer guidance interpretation computer testing theoretical bubble growth model reported ball homer produced results led interpretation compartments model fast min intermediate min slow min time intermediate compartment uses linear modification possibly representing distinct identifiable tissues different processes relate different elements risk conclude bubble evolution sufficient explain aspects risk relationship gas phase dynamics tissue injury requires investigation tables tables published form booklet table sets giving calculation repetitive diving solutions sea level metres altitude tables developed tom replace tables club wanted set tables approach versatility dive computer little information theoretical model tables appears available known tables developed specifically recreational diving british sub club tom released chapter titled modelling human exposure altered pressure environments published environmental discussing shortcomings models associated experimental procedures work proposes alternative combined model number compartments discussed ranges model limited tissue limited tissue limited tissue limited tissue model assumption gas bubbles limited compartments limited concludes dissolved gas content tissue independently measured directly indirectly safe maximum limits relative ambient pressure accurately determined trials possible systematically develop comprehensive model gas exchange proposes best fit double compartment model dissolved gas single compartment model gas simplest models consistent available data parameters design tables include bubbles assumed form bubbles affect gas release repetitive resulting faster repetitive combination nitrogen bubbles dissolved nitrogen plus nitrogen repeated exposure bubbles immediately rates gas alter initial dive repetitive repetitive handled differently mathematical model predict safe rates gas elimination considered model conservative number depth duration increases tables use series seven tables labelled account variation rates assumed depth significant departure conventional practice tables based time defined time leaving surface time leaving time reach depth ascent ascent rate restricted maximum minute ascent surface minute stops surface surface interval considered period stops scheduled considered difficult maintain consistent depth waves initial dive uses table allocated code based depth time dive surface interval minutes select new current tissue code models nitrogen load uses code select repetitive dive table tables presented format require calculation user varying model model developed university hawaii model laboratory observations bubble formation growth systems exposed pressure variations microscopic bubble exist media including living tissues bubble spherical gas phases small remain suspension strong resist collapse stability provided elastic surface layer consisting surface active molecules variable gas skins resist effect surface tension surface tension tends collapse small bubble raising internal pressure ambient partial pressure gradient bubble proportion radius surface larger specific critical size grow aims limit cumulative volume growing bubbles level limiting pressure difference gas bubbles ambient pressure effect equivalent limiting instead arbitrary linear fit experimental data physics bubble growth model acceptable given pressure exposure history growth size number gas bubbles based factors representing pressure bubbles physical properties skins surrounding environment total volume gas bubbles predicted critical volume assumed safe limits model bubble model multiple parallel tissue compartment model assumed follow classic model bubble population distribution bubble size number distribution bubble gas bubbles radius greater float surface standing liquid smaller ones dissolve rapidly surface tension tiny bubble group able resolve apparent developing new model stable gas according varying model gas bubble simply stable stability elastic skins membranes consisting surface active molecules skins normally gas collapse prevented compression strength skins stiff effectively gas subjected large typically exceeding stage pressure inside increases compression predicted law essentially parameters model compression strength skin initial radius onset pressure ordering hypothesis ordering hypothesis states created destroyed pressure schedule initial ordering according size preserved follows ordering hypothesis bubble count determined properties behavior critical nucleus right bubble formation threshold larger critical nucleus form bubbles smaller furthermore family pressure schedules yields bubble count characterized critical nucleus critical radius compression onset development model original assumption bubble number directly proportional stress approach worked long exposure time varied considerably better model obtained allowing bubbles form shorter longer constant bubble number assumption replaced dynamic critical volume hypothesis earlier applications critical volume criterion assumed total volume gas phase accumulated exceeds critical value signs symptoms appear special case long models equivalent dynamic aspect hypothesis gas continuously entering leaving gas phase accumulated volume calculated function time integrating product bubble number degree free gas dissipated continuously lung gas elimination assumed conventional models taken account oxygen partial pressures bar quantity oxygen dissolved arterial blood exceeds body use saturated oxygen veins oxygen added partial pressure oxygen blood rises comparison profiles models comparisons profiles schedules extreme exposure consistently produce similar total ascent times significantly deeper stops reduced gradient bubble model developed bruce los national laboratory hybrid model model factors account bubble mechanics model gas phase production bubble factor values model making conservative features modifying factor include starts dive repetitive series maximum value model conservative unchanged decreases repetitive decreases exposure time increases increases increased surface interval fast compartments slow compartments decreases depth dive segment effect repetitive deeper previous series effect reduce stop dive time increase requirements repetitive dive following categories following short surface interval following long dive following deep dive deeper previous model extent dive computers explorer computer user selected option formula choice additional factors complete treats coupled transport stage process providing boundary condition gas penetration tissues process dominate exchange depending time rate simplified require power available use personal computers dominated inherent biological tissues considered calculations model assumes bubble present specific size distribution certain number induced grow compression model ascent limit combined volume gas phase gas nitrogen oxygen contain bubble different sizes phase volume limit model bubble skin structure number size distribution equation state like assumes size distribution decreasing size unlike varying model bubble seeds assumed gas transfer skin boundaries pressures size grow proportional gradient higher pressures skin tension bubble reduces gas slower rate model assumes bubble skins stabilized times scales results variable persistence bubble tissues modifications models gases nitrogen models developed nitrogen oxygen gases containing significant amounts gases modification account different alternative added highly desirable test modifications sure schedules produced safe alternative gases far important alternative date hydrogen neon combinations gases particularly nitrogen oxygen known models adapted include alternative multiple commercial diving tables large extent commercial offshore diving uses tables developed major commercial diving enterprises international alpha tables american diving company gas tables modifications navy partial pressure tables navy tables revision considered result high rate sickness commercial applications tables developed tables available versions designed surface supplied diving limited mix oxygen stop designed closed bell bounce diving allowed minutes depths water bell air transfer deck chamber finally oxygen built breathing system surface tables produced relatively high sickness french tables tables developed specifically commercial diving norwegian diving treatment tables isbn referenced standard manned underwater operations available norwegian danish english text approved commercial diving reading bennett physiology medicine diving 5th revised united_states isbn hamilton robert edward practice tom bennett physiology medicine diving 5th revised united_states isbn david december theory minutes journal south pacific underwater medicine society retrieved march

History of decompression research and development


system system weights historical system mass units physicians medical recipes scientists english version system closely related english system weights pound grain exactly divides pound grains exact form system united_kingdom colonies survived 20th century system measures similar system volume units based fluid long time medical recipes written latin special symbols denote weights measures use different measure weight systems depending purpose universal phenomenon europe decline roman empire connected international commerce especially need use standards target market compensate common weighing practice caused difference actual nominal weight 19th century european countries cities commercial civil system english system general trading second system system precious metals gold silver system precious metals usually divided different way commercial system special units significantly based different weight standards system precious metals system number pound different pound divided special units inherited influential greek physicians 1st 2nd century general purpose weight system romans weights normal commercial weights different clear systems trade merchants system weighed medicine actually sold old merchants system referred system distinguished system english speaking countries traditional english system weights shown table pound grain identical pound grain united_kingdom reform pound primary weight unit role superseded half century later pound effect weights act completely abolished system favour standard system confusing variety definitions conversions pounds covered table pound definitions united_states system remained official abolished favour metric system pound english system roman weight system pound subdivisions slightly heavier roman pound subdivisions similar systems europe considerable local variation described variants english speaking countries system units fluid measure modern terminology volume units based system volume liquid approximately water called fluid divided fluid fluid grain called imperial systems differ size basic unit equal number fluid systems volumes internationally common weights introduction imperial units measures based wine survived liquid wet wine abolished britain system replaced new based newly introduced imperial imperial liquid true imperial relation liquid explains number fluid adjusted new system fluid changed reform modern fluid fluid true smaller units years systems concurrently measures eventually fell use officially abolished occasionally example prescribed medicine sold bottles medical recipes medical recipes european written latin typical example middle 19th century use latin ensured recipes read international audience technical reason written letters latin meaning half written sharp latin numbers generally written roman immediately following symbol units system way clear civil weight system meant variants diversity local standards basic form system essentially roman weight system pound normally consisted france changed spain customary unit mark south europe france generally divided grains consisted grains subdivision somewhat uniform pound common feature variants roughly grain roughly weight physical grain convenient compare local weight standards metric weights actual mass varied typical value table shows approximate values important standards nominal standard vary slightly city neighbour range filled numerous variants especially italian range relatively large gap product 18th century weight reform turkey system weights similar european system purpose medical purposes divided grains close classical greek weight system corresponding roughly roman divided beginning countries standardized pound easily remembered multiple french netherlands dutch pound standardized match similar reform france british pound retained value legally defined metric terms time use illegal purposes trading precious metals basic variants romance speaking europe divided grains rest europe grains notable exceptions venice sicily divided grains divided divided grains like northern countries consisted grains different situation mediterranean countries consisted grains france stage pound replaced larger civil pound subdivisions romance countries different subdivisions identical civil origins roman weight system basic system consists units pound classical roman weight system originally greek new subdivision wheat grains latin countries units original system remained use example spain cases civil weight systems civil pound consisted latin seed tree attempts reconstruct exact mass roman pound method consists weighing old coins uses fact roman weight units derived roman units length similarly way originally derived metre weighing known volume water roman pound given mind apart come reconstruction roman weight standard unlikely remained constant precision centuries provinces somewhat copies standard weight subdivision pound holy roman empire reformed byzantine_empire remained essentially byzantine coins circulated scandinavia old roman standard continued influential middle ages weight system history medicine started roughly year school medicine combined elements latin greek arabic jewish medicine roman weight system important authorities arabic physicians works systematically translated latin according famous 13th century text exists numerous variations ascribed system weights different systems seen table different roman weight system modern systems divided centuries later region exception rule units fallen use subdivided exactly way roman system divided romance countries naturally changes centuries section tries general overview situation recorded detail numerous 19th century merchants peninsula peninsula weights 19th century relatively uniform grains grains standard romance countries weight pound spain portugal italy additional subdivisions roman system use standard use defined instead pound france 18th century france national weight standard paris civil pound equivalent marks pound considerably heavier romance countries french system remarkable history connections english flemish standards discussed weight standards named italy political conditions united_kingdom italy variation systems standard weights region enormous background information history italy foreign domination unification pound generally consisted standard civil weight systems generally similar system different systems use light heavy goods generally suitable weight pound purpose extreme cases rome genoa system including medicine hand relatively large differences cities state papal states pound local civil pound lighter pound rome weight pound ranged generally slightly pound roman empire important exception rule kingdom rule monarchy extremely large pound standard large city milan system based pound officially replaced metric system early milan napoleonic italian republic successor little state napoleonic kingdom italy fell time france introduced metric system accepted population system officially introduced based pound weighed pound venice exactly subdivisions non romance countries total weight range reign exception venice result extreme weights state immediate proximity venice standard example called use partially continued long time spite official weight reform measure weight systems large mainland kingdom unified area consisted southern half italian peninsula included naples subdivision weight unified system essentially gold silver coins silk variant divided usual like venice unlike rest romance region divided grains existence unit called equivalent interesting original weight system divided weight standards named early champagne middle ages important trading town unit weight called national french standard based famous called pile probably dates second half 15th century elaborate set nesting weight pieces total metric weight set shown des arts paris total nominal value set paris mark metric equivalent national french standard trading gold silver weighing medicine international communications scientists time french revolution civil pound played role pound french system remained standard system romance grains type amsterdam flemish cities unit pond use standard valuable materials medicine france way flemish subdivided depended weighed unlike french flemish divided grains flemish pound standard gold system united_kingdom netherlands way london pound referred pond dutch mark consisted flemish divided amsterdam pound marks commerce weighed amsterdam pound weighed exactly marks years treaty statute henry england gave directions terms pound apparently introduced appear statute weights measures evidence 15th century pound weighing metals tower pound henry_viii england pound official basis english coin weights british system based pound survived united_states australia 20th century modern english american imperial roughly heavier late paris exact historical relations original french flemish pond english pound unclear known numerical relation english french exactly 14th century standard middle ages imperial free city important trading place south germany produced large amounts nesting weight pieces european standards modern sense printed weight standard pound set weight german standard north east europe cities kept local copies standard german states cities dutch standard followed standard standard denmark norway russian_empire switzerland poland sweden variants standard differed bavaria legally defined pound lost status free city bavaria pound longer official pound difference greek pound officially defined standard years son king bavaria king greece german states followed example bavaria long delay pound adopted official austria states monarchy officially different standard prussia followed neighbours opposite direction reform cases continued use standard unofficially long time illegal russia system survived 20th century soviet_union officially abolished january standard empress maria austria reformed measures weights monarchy weight pound increased value later defined found called major defined unusually heavy civil pound defined civil pound cologne corresponded record weight reform north empire standard effect italy local standards lighter surprising increase met edition standard minor indicating austrian capital vienna took time reform effective new standard old weight pieces use directed destroyed venice reforms kept standard approximately austria started producing scales weight pieces new standard excellent quality price ratio occasionally german early time industrial revolution fact state system weights measures increasingly problematic work scientific system started france louis completed french revolution implementation french population initially unhappy new system napoleon reintroduced old measures weights modified form defined respect metric system finally abolished illegal large expansion french empire napoleon french affected parts france neighbour countries congress vienna netherlands partially french years effective january netherlands reformed pond new pound apart rounding issues concerning subdivisions corresponded exactly french reform followed north german city continued use pond belgium weight effective german regions west river rhine french organised result congress vienna german states large fell bavaria having metric system reform weights measures prussia path prussia reform defined prussian civil pound terms prussian foot water pound civil pound reform popular broke pound germany time german national state beginning form follow reduction reform increased civil pound german civil pound defined step consequence official pound increased close standards law introduced reform said weight civil weight place suspended notice system meant doctors place terms current civil weight kilograms considered state received numerous protests asked earlier reform finally force countries systems britain initially involved development metric system initial signatories metre convention spite enthusiastic support new system intellectuals charles countries particularly slow implement unify weight systems irish introduced new variant system subdivided new pound instead pound allow effective use new system new weight pieces produced corresponds proposed system similar use portugal spain locations italy doubled value existing unit weighing silk conflicted non standard variations based nearly obsolete unit irish proposal widely adopted british legislation form act radical prescribed use system united_kingdom including ireland traditional subdivisions innovation united british practice old system based pound widely abolished weights measures act measure precious metals stones pound declared illegal uses weights measures act metric system replaced system united_states


french photographer real took series photographs young person male build stature female assigned self identified female possibly commission photographs described probably medical photo illustrations patient originally restricted scientific uses publish photographs subjects followed decades evidence photographers knew work background son publisher previously medical training late 1830s left medicine focus printed press journalist novelist began photography end decade known portraits famous persons advances photographic techniques developed decades earlier photography rarely medical documentation 1850s france request photographer documented experiments facial muscles electrically stimulated example clinical photography documented german physician journal article entitled die der use photographs research purposes years later late elder brother took series photographs young person possibly commission commission suggested letter requests help documentation subject strange truth art subject brought friends doctor surgeon present subject subject series released person male build stature self identified female assigned female birth subject small probably rudimentary male hair pattern subject retracted rudimentary hood opening photographs subject face chest covered series series consists photographs documenting subject poses angles anna writing journal describes images different work writes normal portraits captured personality instead focused body specifically body include images subject standing captures length view subject pair shoes subject right leg raised provide view image presents subject lying arm covering face hand pulls tissue similar photograph shows subject examination position hand visible uncut photographic plate belonging spreading lips series includes close subject legs open post photography publish photographs limited scientific uses excluding public display journal sexual medicine thomas suggest photographs probably medical photo illustrations patient describe milestone history sexual medicine according earlier suggested surgery viable option evidence subject subsequently received treatment suggest possible factors including legal issues subject refusal failed treatment followed lack reporting lack surgery evidence partially shown photographs treated patient photographs paris metropolitan museum art met new_york met occasionally puts photographs display works exhibition featured series legacy medical photography continued develop france abroad images shot europe cases documented evidence photographers aware work april presented photographs individual german physician published portrait individual volume louis published images cases handled book les surgery


history malaria history malaria stretches prehistoric origin disease africa 21st century widespread potentially lethal human infectious disease peak malaria infested continent antarctica prevention treatment targeted science medicine hundreds years discovery parasites cause research attention focused biology transmit parasites references unique periodic found recorded history beginning china thousands years traditional treat malaria effective treatment malaria came bark tree contains link parasites identified early twentieth century control measures widespread use ddt swamp drainage covering surface open water sources indoor use treated nets initiated prescribed malaria endemic areas new drugs including resist malaria researchers won multiple nobel prizes achievements disease continues million patients year killing malaria important health hazard encountered troops south pacific world war men infected according joseph patrick thousand american soldiers died malaria african south pacific campaigns close 20th century malaria remained endemic countries tropical subtropical zones including large areas central south_america hispaniola haiti dominican_republic africa middle_east indian southeast_asia oceania resistance anti malaria drugs resistance discovery species parasite complicated control measures origin prehistoric period evidence malaria parasites found preserved amber period approximately million years old human malaria likely originated africa hosts non human malaria bird host humans originally caught species humans likely originated african species recently discovered humans originated asian highly host specific humans evidence low level non infection wild years ago malaria started having major impact human survival coinciding start agriculture revolution consequences included natural selection cell disease southeast asian loss blood disorders selective advantage malaria infection balancing selection major types inherited genetic resistance cell disease present mediterranean world time roman empire years ago molecular methods confirmed high prevalence malaria ancient egypt ancient greek historian wrote builders egyptian circa bce given large amounts probably protect malaria founder fourth dynasty egypt reigned bce bed nets protection vii ancient egypt similarly slept net nets purpose malaria prevention mundane purpose avoiding discomfort bites unknown presence malaria egypt circa bce onwards confirmed dna based methods classical period malaria widely recognized ancient greece 4th century bce implicated decline city state populations term greek stain pollution coined describe dangerous ground transported winds cause illnesses bce father medicine related presence intermittent climatic environmental conditions classified fever according fever day fever fourth day chinese inner canon yellow emperor dating bce apparently refers repeated associated enlarged tendency epidemic occurrence bce remedy came use china treat female translated recipes kinds diseases unearthed tombs recommended acute intermittent fever episodes effective medication 4th century chinese manuscript usually translated emergency kept sleeve recommendation fresh plants cold water expressed bitter juice raw state roman fever refers particularly deadly strain malaria affected roman city rome history epidemic roman fever fifth century contributed fall roman empire reduce suggested response chronic malaria roman empire celebration moved november behest pope gregory practical grounds rome summer accommodate great number pilgrims public health considerations roman fever claimed number lives pilgrims sultry summers region middle ages middle ages treatments malaria diseases included blood letting inducing limb turned physicians folk administered ineffective deadly herbs example european renaissance malaria derived aria bad air medieval italian idea came ancient romans thought disease came horrible swamps word malaria roots theory described historian chancellor florence major example renaissance historical writing fare tempo era tempo del conquered stronghold putting good guardians discussing proceed appeared useful necessary reduce army extremely stressed disease bad air long lasting difficult camps places autumn considered army reduced numbers leave permits granted soldiers officers fact siege soldiers asked obtained leave permits camp hardships fear illness translated medieval italian dialect coastal plains southern italy fell international prominence malaria expanded sixteenth century roughly time coastal marshes england mortality marsh fever french medieval latin acute fever comparable sub africa today william_shakespeare born start especially cold period little ice age aware disease mention plays medical accounts ancient autopsy reports state caused death members prominent family florence claims confirmed modern spread americas malaria referenced medical books european settlers west african slaves likely brought malaria americas 16th century book author charles cites sources speculate reason african slaves brought british americas immunity malaria britain large number african slaves plenty unemployed workers come servants area mason line malaria fare english speaking servant proved profitable work freedom worked supervision malaria spread places virginia south_carolina previously white people endemic malaria small white disadvantage plantation owners risk complete economic ruin sick plantation owners relied malaria resistant west african slaves malaria caused huge losses british forces south revolutionary war union forces civil war malaria helped weaken native american population susceptible diseases tree spanish missionaries found fever treated near peru powder bark later established trees genus indians peru reduce shaking effects caused severe jesuit brother lived training observed bark tree purpose effect treating malaria malaria induced unrelated effect controlling cold effective malaria use fever tree bark introduced european medicine jesuit missionaries jesuit bark jesuit explored mexico peru credited taking bark europe brought bark spain rome parts italy wrote intermittent fever fever tree bark work finally established specific nature bark brought general use medicine nearly years active principles bark isolated toxic plant addition anti properties effective muscle modern use nocturnal leg suggests use indians clinical indications dark brain published maria malaria text book earliest reports characteristic dark color brain constant post indications chronic malaria infection related prevalence malaria areas presence flies recommended swamp drainage prevent 19th century nineteenth century drugs developed treat malaria parasites identified source drugs french chemist joseph french joseph separated fever tree bark allowing creation standardized active ingredients prior bark simply dried ground fine powder mixed liquid commonly wine drinking english trader charles servant spent years collecting seeds highly prized export prohibited managed seeds dutch government cultivated trees java indonesia end nineteenth century dutch established world monopoly supply british german physician invented medicine secret remedy contained herbs trials europe 1840s 1850s officially adopted austrian empire considered eminent medical professionals economical british government supplied troops india colonies blue blue synthesized german chemist paul described use neutral acidic basic cells peripheral blood independently developed techniques mixture modified blue produced surprising component shade purple treated blue solutions blue solutions aged new method differentiated blood cells demonstrated parasites technique significant technical advances history malaria paul noted blue high affinity tissues slight property blue act preventing identification german recorded black brown pigment blood patient died mental hospital thought looking malaria parasites realizing mention malaria report pigment relationship pigment parasite established french physician charles louis working military hospital constantine algeria observed parasites inside red blood cells malaria witnessed events convinced moving parasitic noted removed parasites blood called microscopic organism proposed malaria caused discovery remained controversial development oil lens superior methods studied reproduction cycles human blood cycles observed parasites present blood divided simultaneously regular intervals division coincided attacks fever described morphological differences distinguish malaria parasite species shortly independently identified species distinct reviewed available information named genus generally accepted initial ideas discarded favor taxonomic work clinical italian school called new soon renamed proved multiple forms seen single species species eventually named awarded nobel prize physiology medicine recognition work role played causing diseases dutch physician proposed tissue stage malaria parasite discovery years suggestion reiterated suggested parasites tissue phase time cells supported phase theory establishment scientific method mid-19th century demanded phenomena transmission reports discovery yellow fever eventually led investigation connection malaria early effort malaria prevention occurred massachusetts outbreak prompted health officer white write report state board health led study malaria links efforts malaria prevention massachusetts state smith asked white son collect specimens analysis citizens add screens windows drain collections water britain sir ross army surgeon working india proved malaria transmitted event commemorated world day able find malaria parasites artificially fed malaria patient blood continued research malaria showing certain species transmit malaria isolated malaria parasites fed infected birds reported british medical association edinburgh professor comparative anatomy rome university showed human malaria transmitted greek good announced session december healthy man non zone contracted malaria infected specimen observe complete transmission cycle malaria human dispute broke british italian schools priority ross received nobel prize physiology medicine work malaria shown enters organism laid foundation successful research disease methods synthesis william henry student august von royal college chemistry london unsuccessfully tried 1850s commercial process idea oxygen produce water instead produced attempting total synthesis discovery derived roots leaves insects case purple wouldn successfully synthesized synthesis remains elaborate expensive low yield additional problem separation major drugs treatment modern production relies extraction tree 20th century tissue stage reproduction noted william recounted experiences physician months leaving endemic area proposed existence tissue stage confirmed patrick allowed infected feed eldest son younger described months apparent cure found individual blood containing possibility existence chronic blood stage infection proposed ross david thompson existence malaria parasites cells internal organs demonstrated possible mechanisms proposed persistence small numbers blood immunity later disappears iii body blood james proposed carried internal organs enter cells undergo cycle development based lack activity bloom demonstrated stages malaria outside blood cells reported blood patient fail induce malaria donor subsequently exhibit condition disappeared blood stream hour reappeared days later suggested presence forms persist tissues blood described similar phenomenon proposed existence body resting form following year proposed link tissue stage discovered described following year described liver stages year human volunteer receive massive dose infected undergo liver months later allowing demonstrate tissue stage tissue form described infected dormant liver form parasite apparently responsible characteristic observed 1980s term coined miles student speculated behave fashion related like malaria parasites ability survive tissues similar way reported identification liver cells infected early twentieth century patients intentionally infected malaria induce fever called wagner psychiatrist began treat induced malaria bouts fever kill temperature sensitive bacteria known terminated accurately controlling fever effects malaria patients died malaria certain death malaria opened wide field research practised wagner awarded nobel prize physiology medicine discovery value malaria treatment henry advocated treatment aids studies hiv infection performed china recommend use hiv panama canal control scottish physician practising havana yellow fever transmitted specific later designated theory remained controversial years confirmed walter reed scientific proof disease transmitted exclusively insect demonstrated control diseases necessarily entailed control insect yellow fever malaria workers seriously delayed construction panama canal control instituted william dramatically reduced problem drugs colleagues synthesized tested compounds eventually producing substitute 1930s related possession nucleus chain similar compound synthesized march drug officially named production affect parasites life stages parasites forming pigment degradation resistant forms emerged years later resistant strains detected thailand border colombia 1950s resistance reported new_guinea resistant strains spread rapidly producing large mortality increase particularly africa 1990s systematic screening traditional chinese medical herbs carried chinese research teams consisting hundreds scientists 1960s 1970s later named cold extracted neutral dried leaves isolated nobel prize physiology medicine headed team tasked chinese government finding treatment resistant malaria work known project named date announced team investigated chinese preparations extracts herbs extract effective results variable reviewed literature including handbook written chinese physician book contained useful reference handful immersed litres water juice drink team subsequently isolated neutral extract effective animals successful trials containing group believed essential anti activity derivatives treatment drug resistant drug sensitive malaria especially cerebral malaria drugs characterized fast action high good tolerance kill forms transmission blocking activity team combined single tablet registered medicine china later known combination treatments acts widely treat malaria access acts limited malaria endemic countries minority patients need based combination treatments receive white predicted improved agricultural practices selection high yielding hybrids production development synthetic lower prices efforts control spread malaria suffered major setback shannon discovered imported disease bearing living brazil dna analysis later revealed actual species species particularly efficient malaria native africa introduction caused greatest epidemic malaria seen new world complete northeast brazil new world achieved systematic application containing compound paris green breeding places spray killing adult resting places ddt austrian chemist credited synthesis ddt properties ddt identified chemist paul discovery ddt contact poison awarded nobel prize physiology medicine fall samples chemical acquired united_states britain germany laboratory tests demonstrated highly effective insects foundation studies showed mexico ddt remained effective weeks sprayed inside walls ceilings houses buildings field test ddt applied interior surfaces carried central italy spring objective determine effect spray density absence control measures began months delta unprecedented effectiveness chemical confirmed new able malaria end world war massive malaria control program based ddt carried italy second largest island mediterranean foundation conducted large scale experiment test feasibility strategy species endemic malaria malaria effectively eliminated united_states use ddt national malaria program concept prevailed eighth world health assembly ddt adopted primary tool fight malaria world health organization launched program parts pilot project determine feasibility malaria tropical africa projects encountered difficulties general retreat malaria efforts tropical africa mid-1960s ddt banned discussion opened silent spring written american biologist rachel launched environmental movement west book environmental impacts ddt suggested ddt cause cancer agricultural use threat wildlife agency international development supports indoor ddt vital component malaria control programs initiated ddt programs tropical countries available control physical measures draining wetland breeding grounds provision better flowering plant economically important source natural attack nervous systems insects minutes application insect fly female biting use preparations dates bce break easily exposure light majority world supply comes kenya flower introduced kenya highlands eastern africa late 1920s flowers plant harvested shortly dried flowers extracted research mouse monkey models 1950s screening anti drugs carried malaria malaria species differ humans discovery wild later species laboratory rats transformed drug development short phase life cycle parasites useful animal models status retain 1960s test drugs active growth liver stages animal free systems achieved 1980s pre stages grown human lung cell line cells specimen followed growth human line grown human liver cells partial development human liver cells achieved grown monkey liver cells successful continuous malaria culture established william james facilitated research molecular biology parasite development new drugs increasing volumes culture medium grown higher levels use based malaria rapid tests emerged 1980s century preferred techniques malaria require special equipment offer potential extend accurate malaria diagnosis areas lacking services parasite known 1930s asian capable humans natural human infection reported soldier returning jungle malaysian peninsula