出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/09/17 14:53:48」(JST)
高カロリー輸液(こうカロリーゆえき、Total Parenteral Nutrition、TPN)は輸液の一種である。
1968年、米国の外科医スタンリー・ダドリック(Stanley J. Dudrick M.D.)によって開発され、経口栄養のできない重症患者の長期管理に革命的な影響を与えた。なお、当時ダドリックは一介の外科レジデントに過ぎなかった。
通常の末梢血管への輸液では、ことに高濃度ブドウ糖の使用によって血管炎を引き起こすリスクがある為、生命維持に必要なだけのエネルギーをそれだけで充分供給することが困難であった。つまり、大手術などで、2〜3週間以上のスパンで患者の経口摂取ができない場合、その疾患自体でなく、異化亢進による栄養失調によって患者が衰弱していくことになる。
この問題を解決する為にダドリックは、通常は点滴を行わないような太い静脈(いわゆる中心静脈…通常は鎖骨下静脈、内頸静脈、大腿静脈などの身体表層の静脈が用いられる)をあえて輸液ラインとして確保することを試みた。これにより、血液による希釈が起き、血管炎を起こさずに高濃度のブドウ糖を患者へ投与することが可能になった。この新技術により、時には1年以上にもわたり、患者を経口の栄養摂取なしで生存させることができる。TPNは周術期や慢性疾患の患者にとっては大変な福音となった。ただし、重症患者の管理に新たな倫理的問題をもたらした面も否定できない。
TPH製剤は、歴史的経緯からもわかるように、高濃度のブドウ糖を含むことが多く、中心静脈経路 (central venous line;CV line) から投与が原則となる。IVH (Intravenous Hyperalimentation) とも呼び、在宅で高カロリー輸液を受ける時は在宅中心静脈栄養 (HPN: Home Parenteral Nutrition) とも呼称する。消耗性疾患や消化器疾患などで長期間、経口摂取が出来ない時に使用する。消化管が使用可能であれば、胃瘻を用いるなど、経腸栄養 (EN : Enteral Nutrition) に切り替えて行く。
栄養の3大要素である、糖質・アミノ酸をバランス良く含んだ上でビタミンや微量元素を加えた物である。さらに脂質についても配合した製剤も上市されている。しかし、脂肪製剤は別途に末梢から投与する場合が多い。栄養が多い分高浸透圧で組織障害性があり末梢血管では血管炎を起こすので中心静脈から投与する。 十分な栄養を投与する為に高濃度のブドウ糖(100g〜250g)とアミノ酸(20g〜40g)が800ml〜1000mlに含まれる様に調整する。糖とアミノ酸はメイラード反応を起こし変成するので、二室式と言って一つのバックの中央を圧着してあり押し破って混合する製剤が主流である。さらにビタミンを入れた小部屋を持つ三室式の製剤もある。メイラード反応を防ぐ工夫を施した一室式の製剤もある。以前は別々の瓶に入った糖とアミノ酸を一つのバックに入れていた。その場合は特に慎重に調合しないと病原体が輸液に混じて敗血症を起こし易い。施設によっては、無菌ドラフトで薬剤師が調合する場合もある。
この項目は、医学に関連した書きかけの項目です。この項目を加筆・訂正などしてくださる協力者を求めています(プロジェクト:医学/Portal:医学と医療)。 |
Westchester County Airport | |||
---|---|---|---|
IATA: HPN – ICAO: KHPN – FAA LID: HPN | |||
Summary | |||
Airport type | Public-use | ||
Owner | County of Westchester | ||
Operator | AFCO AvPORTS | ||
Serves | Westchester County, New York | ||
Location | White Plains, New York | ||
Elevation AMSL | 439 ft / 134 m | ||
Coordinates | 41°04′01″N 073°42′27″W / 41.06694°N 73.70750°W / 41.06694; -73.70750Coordinates: 41°04′01″N 073°42′27″W / 41.06694°N 73.70750°W / 41.06694; -73.70750 | ||
Website | airport.WestchesterGov.com | ||
Map | |||
HPN
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Runways | |||
Direction | Length | Surface | |
ft | m | ||
11/29 | 4,451 | 1,357 | Asphalt |
16/34 | 6,548 | 1,996 | Asphalt |
Statistics (2011) | |||
Aircraft operations | 197,037 (UP 3%) | ||
Based aircraft | 310 | ||
Source: FAA[1] and official airport website[2] |
Westchester County Airport (IATA: HPN, ICAO: KHPN, FAA LID: HPN) is a county-owned airport in Westchester County, New York, [1] three miles (6 km) northeast of the central business district of White Plains,[1] in the towns of Harrison, North Castle and Rye Brook.
It serves Westchester, a northern suburb of New York City, and Fairfield County, Connecticut (the New York-Connecticut state border coincides with the airport's eastern limits). It also serves the New York metropolitan area, as it is about 33 miles (53 km) north of Midtown Manhattan.
The Westchester County Airport currently has six commercial airlines and their regional affiliates flying to sixteen destinations around the United States.
This airport is included in the National Plan of Integrated Airport Systems for 2011–2015, which categorized it as a primary commercial service airport.[3] As per Federal Aviation Administration records, the airport had 904,482 passenger boardings (enplanements) in calendar year 2008,[4] 964,927 enplanements in 2009, and 999,831 in 2010.[5]
Westchester County Airport was built during World War II in 1942 as a home to an Air National Guard unit to protect New York City and Rye Lake, part of the city's water supply system. In May 1983, with the growth of suburban Westchester, the Guard unit abandoned Westchester Air National Guard Base and moved to Stewart International Airport to the north near Newburgh.
The first scheduled airline flights were American Airlines in late 1949; they had one weekday morning flight La Guardia to HPN to Syracuse and beyond, returning in the evening. Mohawk replaced American in 1955, it and successor Allegheny Airlines serving HPN until 1979. (The first scheduled jet flight was a Mohawk BAC 1-11 in 1965.) Before the passing of the Airline Deregulation Act the airport was served by several regional airlines, including Allegheny, Command Airways and Empire Airlines. Air Florida arrived in 1980 and United Airlines in 1983-84. On January 5, 2006, the airport was the point of departure for the last flight of Independence Air; a flight to Washington, D.C. at 7:26 pm.[6]
The airport is presently served by six airlines. Former airlines include Independence Air, Continental Airlines, Air Canada and AirTran Airways. AirTran began service at the airport in 2006 with flights to Atlanta, Orlando and West Palm Beach. This ended on August 11, 2012.
JetBlue began service at the airport in 2007 and is now the airport's largest carrier with 14 daily round trips to six destinations: Fort Lauderdale, Fort Myers, Orlando, Tampa, and West Palm Beach using Embraer 190s and Airbus A320s.
In June 2009 Cape Air added service to Westchester, with service to Nantucket and Martha's Vineyard in Massachusetts. Cape Air introduced service to Lebanon Municipal Airport in New Hampshire in early 2010. All Cape Air flights depart and arrive from the Signature Flight Support facility south of the Main Terminal due to a lack of ticket counter space in the main terminal building.
In June 2010 Air Canada announced it would be dropping service at the airport. This ended international flights at the airport until service to the Bahamas started in 2011.
On November 18, 2010 American Airlines switched service to the airport from American Eagle to AmericanConnection, operated by Chautauqua Airlines, using its smaller ERJ-140 aircraft.
HPN is nestled between many existing neighborhoods and has many rules that must be followed. HPN officials started the Westchester County Airport Aircraft Noise study which set up Airport Noise and Operations Monitoring Systems (ANOMS) around the airport. The ANOMS measure the sound in the surveying area and compare it to the sound of airplanes and the sound of the neighborhoods surrounding the airport. With the help of these devices, HPN officials have located the problems where noise is affecting the area the most. HPN currently has implemented six programs that help reduce noise. The first program as stated earlier is the Voluntary Restraint from Flying or VRFF. The VRFF is a curfew for planes to encourage them not to fly during the hours of midnight to six in the morning. Another program is High Range Noise Event Program which uses the ANOMS. If an ANOMS pick up reading of higher than 90 decibels that airplane is then contacted by HPN officials. HPN also has programs that do not allow airplane larger than 12,500 pounds to takeoff at the runway intersections, or run-up their engines without prior approval of airport operations.
After several renovations, as well as discussions about the airport's viability,[7] the airport is presently served by seven airlines to a range of fifteen destinations in the United States. Although there has always been some controversy about the airport and proposed expansions,[8] more concerns have occurred recently as a result of passengers seeking relief from the long delays at the other New York airports. The most recent concerns have to do with flight paths[9] and traffic congestion; the latter has been addressed by the County of Westchester with Bee-Line bus service to the airport and the encouragement of travelers to get rides to the airport.[10]
The airport's environmental management practices are monitored through the AEMS, an ISO 14001 certified Airport Environmental Management System; airport employees receive environmental training. The facility was, in 2004, the third airport in the U.S. to achieve this level of environmental performance.[11]
Also, due to its location near a number of residential neighborhoods, Westchester County Airport instituted a Voluntary Restraint from Flying Program, sometimes referred to as a voluntary curfew,[12] which has helped to ease some of the local concern of noise resulting from airport activity. In an effort to alleviate concerns over expansion and noise, planning studies are done on a regular basis.[13]
In May 2011 NYSDOT released the "New York Statewide Airport Economic Impact Study," quantifying the level of economic activity that was attributable to the aviation sector for the year 2009 in the State of New York. The study noted that HPN was one of only three airports in the state that gained emplanements, performing better than the U.S. benchmark. The study also noted that the total economic impact of the airport was approximately $736 million.[14]
The IATA code for Westchester County Airport is HPN. There is a debate in the origins of this code. Many believe that it is derived from the name of the city, White Plains (IATA codes normally do not begin with W because those are reserved for radio signals). Others believe the IATA code represents the first letter of the three neighboring communities, Harrison, Purchase, and North Castle.[15] The full ICAO code for Westchester County Airport is KHPN.
Westchester County Airport covers 702 acres (284 ha) at an elevation of 439 feet (134 m) above mean sea level. It has two asphalt paved runways: 16/34 is 6,548 by 150 feet (1,996 x 46 m) and 11/29 is 4,451 by 150 feet (1,357 x 46 m).[1] Runway 29's threshold is displaced 1,297 feet (395 m) due to trees obstructing the approach path. The trees (in Connecticut) are 37 ft (11 m) tall and 370 ft (113 m) from the end of the runway.[16]
Westchester County Airport has several fixed-base operators (FBOs), including Avitat, Signature Flight Support, Landmark, NetJets, Panorama, and Million Air. Although varied in services offered, the FBOs at Westchester County Airport provide Jet A and 100LL fueling services, repairs and maintenance, aircraft tiedowns, de-icing, United States Customs, and other aircraft services. Some of the FBOs are particularly luxurious, providing limousine transportation services and deluxe surroundings.
There are two flight schools. Performance Flight operates out of the Million Air at Hangar M, while Panorama Flight School operates out of the Panorama Flight Services at Hangar T. Additionally, the Westchester Flying Club, a private organization of pilots, is based at the airport as well as the Westchester Aviation Association, a not-for-profit organization which promotes aviation education and understanding on the part of government authorities and the public.
Westchester County Airport is also the current home of the New York Wing of the United States Civil Air Patrol, as well as the Southeastern Group of the New York Wing. Both are housed in the same building as the Airport Precinct of the Westchester County Police. These facilities were partially remodeled to accommodate the recent arrival of the New York Wing.
Aircraft Rescue Fire Fighting (ARFF) is provided by Airport Operations Crews. Currently the airport owns 2 ARFF apparatus (1 Oshkosh Striker and 1 E-One) that are in-service 24/7. The ARFF Crews only respond to aircraft emergencies. All Structure related fire and rescue calls go to the local fire departments. For Example, The Purchase Fire Department handles all structure calls on the southern part of the airfield, The Armonk Fire Department handles calls on the northern part and the Rye Brook/Port Chester Fire Department handle all calls on the east end, including the main terminal. EMS Calls are handled by Port Chester-Rye-Rye Brook EMS, Harrison EMS and Armonk Fire/EMS depending on location of call.
For the year ending December 31, 2010 the airport had 191,017 total aircraft operations, an average of 523 per day: 23% commercial aviation, 48% heavy general aviation, and 29% light general aviation. In 2010 there were 310 based- aircraft out of this airport.[17]
Westchester County Airport has one small three-level terminal with six gate spaces, of which only four may be used because only four aircraft may be scheduled to use the Terminal Ramp at any time. The $35 million terminal was built in 1995 and designed by Lothrop Associates.[18] Gates C and F are the only gates that have jetways. The terminal also has one luggage carousel, one baggage reclaim office and two Transportation Security Administration (TSA) screening lanes. JetBlue avoids delays by using stairs when jetways are not available.
The following airlines offer scheduled passenger service:
Airlines | Destinations |
---|---|
American Connection operated by Chautauqua Airlines | Chicago-O'Hare |
Cape Air | Lebanon-Hanover, Provincetown Seasonal: Hyannis, Martha's Vineyard, Nantucket |
Delta Connection operated by Endeavor Air | Detroit Seasonal: Orlando (begins December 21, 2013) |
Delta Connection operated by ExpressJet | Atlanta |
JetBlue Airways | Fort Lauderdale, Fort Myers, Orlando, Tampa, West Palm Beach |
United Express operated by ExpressJet | Chicago-O'Hare |
US Airways Express operated by Air Wisconsin | Charlotte, Philadelphia, Washington-National |
US Airways Express operated by Piedmont Airlines | Philadelphia |
US Airways Express operated by PSA Airlines | Charlotte, Philadelphia, Washington-National |
Carrier | Passengers (arriving and departing) |
---|---|
JetBlue |
735,000(38.83%)
|
AirTran |
298,000(15.75%)
|
Pinnacle |
137,000(7.22%)
|
ExpressJet |
123,000(6.50%)
|
Other |
600,000(31.7%)
|
Rank | City | Passengers | Carriers |
---|---|---|---|
1 | Atlanta, GA | 156,560 | AirTran, Delta |
2 | Orlando, FL | 142,730 | AirTran, JetBlue |
3 | West Palm Beach, FL | 105,400 | AirTran, JetBlue |
4 | Chicago, IL (ORD) | 104,330 | American, United |
5 | Fort Lauderdale, FL | 88,250 | JetBlue |
6 | Washington, DC (DCA) | 40,230 | US Airways |
7 | Philadelphia, PA | 40,130 | US Airways |
8 | Charlotte, NC | 37,430 | US Airways |
9 | Detroit, MI | 36,960 | Delta |
10 | Fort Myers, FL | 30,270 | JetBlue |
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リンク元 | 「在宅静脈栄養法」「在宅静脈栄養」「home parenteral nutrition」 |
拡張検索 | 「HPNS」 |
関連記事 | 「HP」「H」 |
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