Porcine bladder acellular matrix (ACM): protein expression, mechanical properties

Energy Technology Data Exchange (ETDEWEB)

Farhat, Walid A [Department of Surgery, Division of Urology, University of Toronto and Hospital for Sick Children, Toronto, ON M5G 1X8 (Canada); Chen Jun; Haig, Jennifer; Antoon, Roula; Litman, Jessica; Yeger, Herman [Department of Developmental and Stem Cell Biology, Research Institute, Hospital for Sick Children, Toronto, ON M5G 1X8 (Canada); Sherman, Christopher [Department of Anatomic Pathology, Sunnybrook and Women' s College Health Sciences Centre, Toronto, ON (Canada); Derwin, Kathleen [Department of Biomedical Engineering, Lerner Research Institute and Orthopaedic Research Center, Cleveland Clinic Foundation, Cleveland, OH (United States)], E-mail: walid.farhat@sickkids.ca

2008-06-01

Experimentally, porcine bladder acellular matrix (ACM) that mimics extracellular matrix has excellent potential as a bladder substitute. Herein we investigated the spatial localization and expression of different key cellular and extracellular proteins in the ACM; furthermore, we evaluated the inherent mechanical properties of the resultant ACM prior to implantation. Using a proprietary decellularization method, the DNA contents in both ACM and normal bladder were measured; in addition we used immunohistochemistry and western blots to quantify and localize the different cellular and extracellular components, and finally the mechanical testing was performed using a uniaxial mechanical testing machine. The mean DNA content in the ACM was significantly lower in the ACM compared to the bladder. Furthermore, the immunohistochemical and western blot analyses showed that collagen I and IV were preserved in the ACM, but possibly denatured collagen III in the ACM. Furthermore, elastin, laminin and fibronectin were mildly reduced in the ACM. Although the ACM did not exhibit nucleated cells, residual cellular components (actin, myosin, vimentin and others) were still present. There was, on the other hand, no significant difference in the mean stiffness between the ACM and the bladder. Although our decellularization method is effective in removing nuclear material from the bladder while maintaining its inherent mechanical properties, further work is mandatory to determine whether these residual DNA and cellular remnants would lead to any immune reaction, or if the mechanical properties of the ACM are preserved upon implantation and cellularization.

A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: The two-person CPR study.

Science.gov (United States)

Roppolo, Lynn P; Heymann, Rahm; Pepe, Paul; Wagner, James; Commons, Bradford; Miller, Ronna; Allen, Emilie; Horne, Leyla; Wainscott, Michael P; Idris, Ahamed H

2011-03-01

The primary purpose of this study was to compare two, shorter, self-directed methods of cardiopulmonary resuscitation (CPR) education for healthcare professionals (HCP) to traditional training with a focus on the trainee's ability to perform two-person CPR. First-year medical students with either no prior CPR for HCP experience or prior training greater than 5 years were randomized to complete one of three courses: 1) HeartCode BLS System, 2) BLS Anytime, or 3) Traditional training. Only data from the adult CPR skills testing station was reviewed via video recording by certified CPR instructors and the Laerdal PC Skill Reporter software program (Laerdal Medical, Stavanger, Norway). There were 180 first-year medical students who met inclusion criteria: 68 were HeartCode BLS System, 53 BLS Anytime group, and 59 traditional group Regarding two-person CPR, 57 (84%) of Heartcode BLS students and 43 (81%) of BLS Anytime students were able to initiate the switch compared to 39 (66%) of traditional course students (p = 0.04). There were no significant differences in the quality of chest compressions or ventilations between the three groups. There was a trend for a much higher CPR skills testing pass rate for the traditional course students. However, failure to "clear to analyze or shock" while using the AED was the most common reason for failure in all groups. The self-directed learning groups not only had a high level of success in initiating the "switch" to two-person CPR, but were not significantly different from students who completed traditional training. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

PyCPR - a python-based implementation of the Conjugate Peak Refinement (CPR) algorithm for finding transition state structures.

Science.gov (United States)

Gisdon, Florian J; Culka, Martin; Ullmann, G Matthias

2016-10-01

Conjugate peak refinement (CPR) is a powerful and robust method to search transition states on a molecular potential energy surface. Nevertheless, the method was to the best of our knowledge so far only implemented in CHARMM. In this paper, we present PyCPR, a new Python-based implementation of the CPR algorithm within the pDynamo framework. We provide a detailed description of the theory underlying our implementation and discuss the different parts of the implementation. The method is applied to two different problems. First, we illustrate the method by analyzing the gauche to anti-periplanar transition of butane using a semiempirical QM method. Second, we reanalyze the mechanism of a glycyl-radical enzyme, namely of 4-hydroxyphenylacetate decarboxylase (HPD) using QM/MM calculations. In the end, we suggest a strategy how to use our implementation of the CPR algorithm. The integration of PyCPR into the framework pDynamo allows the combination of CPR with the large variety of methods implemented in pDynamo. PyCPR can be used in combination with quantum mechanical and molecular mechanical methods (and hybrid methods) implemented directly in pDynamo, but also in combination with external programs such as ORCA using pDynamo as interface. PyCPR is distributed as free, open source software and can be downloaded from http://www.bisb.uni-bayreuth.de/index.php?page=downloads . Graphical Abstract PyCPR is a search tool for finding saddle points on the potential energy landscape of a molecular system.

AcmD, a homolog of the major autolysin AcmA of Lactococcus lactis, binds to the cell wall and contributes to cell separation and autolysis

NARCIS (Netherlands)

Visweswaran, Ganesh Ram R; Steen, Anton; Leenhouts, Kees; Szeliga, Monika; Ruban, Beata; Hesseling-Meinders, Anne; Dijkstra, Bauke W; Kuipers, Oscar P; Kok, Jan; Buist, Girbe

2013-01-01

Lactococcus lactis expresses the homologous glucosaminidases AcmB, AcmC, AcmA and AcmD. The latter two have three C-terminal LysM repeats for peptidoglycan binding. AcmD has much shorter intervening sequences separating the LysM repeats and a lower iso-electric point (4.3) than AcmA (10.3). Under

Acemetacin cocrystals and salts: structure solution from powder X-ray data and form selection of the piperazine salt.

Science.gov (United States)

Sanphui, Palash; Bolla, Geetha; Nangia, Ashwini; Chernyshev, Vladimir

2014-03-01

Acemetacin (ACM) is a non-steroidal anti-inflammatory drug (NSAID), which causes reduced gastric damage compared with indomethacin. However, acemetacin has a tendency to form a less soluble hydrate in the aqueous medium. We noted difficulties in the preparation of cocrystals and salts of acemetacin by mechanochemical methods, because this drug tends to form a hydrate during any kind of solution-based processing. With the objective to discover a solid form of acemetacin that is stable in the aqueous medium, binary adducts were prepared by the melt method to avoid hydration. The coformers/salt formers reported are pyridine carboxamides [nicotinamide (NAM), isonicotinamide (INA), and picolinamide (PAM)], caprolactam (CPR), p-aminobenzoic acid (PABA), and piperazine (PPZ). The structures of an ACM-INA cocrystal and a binary adduct ACM-PABA were solved using single-crystal X-ray diffraction. Other ACM cocrystals, ACM-PAM and ACM-CPR, and the piperazine salt ACM-PPZ were solved from high-resolution powder X-ray diffraction data. The ACM-INA cocrystal is sustained by the acid⋯pyridine heterosynthon and N-H⋯O catemer hydrogen bonds involving the amide group. The acid⋯amide heterosynthon is present in the ACM-PAM cocrystal, while ACM-CPR contains carboxamide dimers of caprolactam along with acid-carbonyl (ACM) hydrogen bonds. The cocrystals ACM-INA, ACM-PAM and ACM-CPR are three-dimensional isostructural. The carboxyl⋯carboxyl synthon in ACM-PABA posed difficulty in assigning the position of the H atom, which may indicate proton disorder. In terms of stability, the salts were found to be relatively stable in pH 7 buffer medium over 24 h, but the cocrystals dissociated to give ACM hydrate during the same time period. The ACM-PPZ salt and ACM-nicotinamide cocrystal dissolve five times faster than the stable hydrate form, whereas the ACM-PABA adduct has 2.5 times faster dissolution rate. The pharmaceutically acceptable piperazine salt of acemetacin exhibits superior

A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study.

Science.gov (United States)

Rasmussen, Stinne Eika; Nebsbjerg, Mette Amalie; Krogh, Lise Qvirin; Bjørnshave, Katrine; Krogh, Kristian; Povlsen, Jonas Agerlund; Riddervold, Ingunn Skogstad; Grøfte, Thorbjørn; Kirkegaard, Hans; Løfgren, Bo

2017-01-01

Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, pCPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Quark ACM with topologically generated gluon mass

Science.gov (United States)

Choudhury, Ishita Dutta; Lahiri, Amitabha

2016-03-01

We investigate the effect of a small, gauge-invariant mass of the gluon on the anomalous chromomagnetic moment (ACM) of quarks by perturbative calculations at one-loop level. The mass of the gluon is taken to have been generated via a topological mass generation mechanism, in which the gluon acquires a mass through its interaction with an antisymmetric tensor field Bμν. For a small gluon mass ( ACM at momentum transfer q2 = -M Z2. We compare those with the ACM calculated for the gluon mass arising from a Proca mass term. We find that the ACM of up, down, strange and charm quarks vary significantly with the gluon mass, while the ACM of top and bottom quarks show negligible gluon mass dependence. The mechanism of gluon mass generation is most important for the strange quarks ACM, but not so much for the other quarks. We also show the results at q2 = -m t2. We find that the dependence on gluon mass at q2 = -m t2 is much less than at q2 = -M Z2 for all quarks.

Cardiopulmonary resuscitation (CPR)-related posterior rib fractures in neonates and infants following recommended changes in CPR techniques.

Science.gov (United States)

Franke, I; Pingen, A; Schiffmann, H; Vogel, M; Vlajnic, D; Ganschow, R; Born, M

2014-07-01

Posterior rib fractures are highly indicative of non-accidental trauma (NAT) in infants. Since 2000, the "two-thumbs" technique for cardiopulmonary resuscitation (CPR) of newborns and infants has been recommended by the American Heart Association (AHA). This technique is similar to the grip on an infant's thorax while shaking. Is it possible that posterior rib fractures in newborns and infants could be caused by the "two-thumbs" technique? Using computerized databases from three German children's hospitals, we identified all infants less than 12 months old who underwent professional CPR within a 10-year period. We included all infants with anterior-posterior chest radiographs taken after CPR. Exclusion criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest radiographs were identified, and 50 of those infants underwent CPR immediately after birth. Data concerning the length of CPR was available for 41 infants. The mean length of CPR was 11min (range: 1-180min, median: 3min). On average, there were seven radiographs per infant. A total of 39 infants had a follow-up radiograph after at least 10 days. No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture after the use of the "two-thumbs" CPR technique is uncommon. Thus, there should be careful consideration of abuse when these fractures are identified, regardless of whether CPR was performed and what technique used. The discovery of rib fractures in an infant who has undergone CPR without underlying bone disease or major trauma warrants a full child protection investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cardiopulmonary Resuscitation (CPR): First Aid

Science.gov (United States)

... learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator ( ... and Research. © 1998-2018 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

Porosity of porcine bladder acellular matrix: impact of ACM thickness.

Science.gov (United States)

Farhat, Walid; Chen, Jun; Erdeljan, Petar; Shemtov, Oren; Courtman, David; Khoury, Antoine; Yeger, Herman

2003-12-01

The objectives of this study are to examine the porosity of bladder acellular matrix (ACM) using deionized (DI) water as the model fluid and dextran as the indicator macromolecule, and to correlate the porosity to the ACM thickness. Porcine urinary bladders from pigs weighing 20-50 kg were sequentially extracted in detergent containing solutions, and to modify the ACM thickness, stretched bladders were acellularized in the same manner. Luminal and abluminal ACM specimens were subjected to fixed static DI water pressure (10 cm); and water passing through the specimens was collected at specific time interval. While for the macromolecule porosity testing, the diffusion rate and direction of 10,000 MW fluoroescein-labeled dextrans across the ACM specimens mounted in Ussing's chambers were measured. Both experiments were repeated on the thin stretched ACM. In both ACM types, the fluid porosity in both directions did not decrease with increased test duration (3 h); in addition, the abluminal surface was more porous to fluid than the luminal surface. On the other hand, when comparing thin to thick ACM, the porosity in either direction was higher in the thick ACM. Macromolecule porosity, as measured by absorbance, was higher for the abluminal thick ACM than the luminal side, but this characteristic was reversed in the thin ACM. Comparing thin to thick ACM, the luminal side in the thin ACM was more porous to dextran than in the thick ACM, but this characteristic was reversed for the abluminal side. The porcine bladder ACM possesses directional porosity and acellularizing stretched urinary bladders may increase structural density and alter fluid and macromolecule porosity. Copyright 2003 Wiley Periodicals, Inc. J Biomed Mater Res 67A: 970-974, 2003

Prevalence and hemodynamic effects of leaning during CPR

Science.gov (United States)

Niles, Dana E.; Sutton, Robert M.; Nadkarni, Vinay M.; Glatz, Andrew; Zuercher, Mathias; Maltese, Matthew R.; Eilevstjønn, Joar; Abella, Benjamin S.; Becker, Lance B.; Berg, Robert A.

2013-01-01

Background Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). Objective Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR. Results In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/ force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥2.5 kg and 89% had residual leaning ≥0.5 kg. Conclusions Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR. PMID:22208173

The development of CPR.

Science.gov (United States)

McLennan, Stuart

2008-10-17

Cardiopulmonary resuscitation (CPR) is now the standard treatment for someone having a cardiac arrest. It is, however, a procedure that has emerged only relatively recently. For a number of scientific and religious reasons, it was long considered impossible, even blasphemous, to attempt to reverse 'death'. Because of these factors, the area of resuscitation failed to progress until the Enlightenment in the 18th Century. The main elements of resuscitation were then developed over the next 200 years, and eventually brought together to create CPR in the early 1960s. The increased demands that morality was seen to place on the medical profession to combat sudden cardiac death subsequent to this development may have been an important factor in why CPR has come to be used in the widespread manner it currently is.

Distribution of the ACME-arcA gene among meticillin-resistant Staphylococcus haemolyticus and identification of a novel ccr allotype in ACME-arcA-positive isolates.

Science.gov (United States)

Pi, Borui; Yu, Meihong; Chen, Yagang; Yu, Yunsong; Li, Lanjuan

2009-06-01

The aim of this study was to investigate the prevalence and characteristics of ACME (arginine catabolic mobile element)-arcA-positive isolates among meticillin-resistant Staphylococcus haemolyticus (MRSH). ACME-arcA, native arcA and SCCmec elements were detected by PCR. Susceptibilities to 10 antimicrobial agents were compared between ACME-arcA-positive and -negative isolates by chi-square test. PFGE was used to investigate the clonal relatedness of ACME-arcA-positive isolates. The phylogenetic relationships of ACME-arcA and native arcA were analysed using the neighbour-joining methods of mega software. A total of 42 (47.7 %) of 88 isolates distributed in 13 PFGE types were positive for the ACME-arcA gene. There were no significant differences in antimicrobial susceptibility between ACME-arcA-positive and -negative isolates. A novel ccr allotype (ccrAB(SHP)) was identified in ACME-arcA-positive isolates. Among 42 ACME-arcA-positive isolates: 8 isolates harboured SCCmec V, 8 isolates harboured class C1 mec complex and ccrAB(SHP); 22 isolates harbouring class C1 mec complex and 4 isolates harbouring class C2 mec complex were negative for all known ccr allotypes. The ACME-arcA-positive isolates were first found in MRSH with high prevalence and clonal diversity, which suggests a mobility of ACME within MRSH. The results from this study revealed that MRSH is likely to be one of the potential reservoirs of ACME for Staphylococcus aureus.

Medical students and physical education students as CPR instructors: an appropriate solution to the CPR-instructor shortage in secondary schools?

OpenAIRE

Cuijpers, P. J. P. M.; Bookelman, G.; Kicken, W.; de Vries, W.; Gorgels, A. P. M.

2016-01-01

Background Integrating cardiopulmonary resuscitation (CPR) training in secondary schools will increase the number of potential CPR providers. However, currently too few certified instructors are available for this purpose. Training medical students and physical education student teachers to become CPR instructors could decrease this shortage. Aim Examine whether medical students and physical education student teachers can provide CPR training for secondary school pupils as well as (i.?e., non...

Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial.

Science.gov (United States)

Cheng, Adam; Brown, Linda L; Duff, Jonathan P; Davidson, Jennifer; Overly, Frank; Tofil, Nancy M; Peterson, Dawn T; White, Marjorie L; Bhanji, Farhan; Bank, Ilana; Gottesman, Ronald; Adler, Mark; Zhong, John; Grant, Vincent; Grant, David J; Sudikoff, Stephanie N; Marohn, Kimberly; Charnovich, Alex; Hunt, Elizabeth A; Kessler, David O; Wong, Hubert; Robertson, Nicola; Lin, Yiqun; Doan, Quynh; Duval-Arnould, Jordan M; Nadkarni, Vinay M

2015-02-01

The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P 89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation. The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes. clinicaltrials.gov Identifier: NCT02075450.

CPR - adult

Science.gov (United States)

... heartbeat has stopped. This may happen after an electric shock , drowning, or heart attack. CPR involves: Rescue ... to swim. Teach your child to watch for cars and ride bikes safely. Teach your child firearm ...

Report on the Southern Ocean Continuous Plankton Recorder (SO-CPR Standards Workshop 2016: SCAR SO-CPR Database Expert Group

Directory of Open Access Journals (Sweden)

Kunio T. Takahashi

2017-07-01

Full Text Available The“Southern Ocean Continuous Plankton Recorder (SO-CPR Survey Standards Workshop”was held at the Australian Antarctic Division on 12−16December 2016. The purposes of the workshop were to confirm that consistent and high standards of species identification, methodology, and data quality were being maintained amongst the main analysts in the SO-CPR Survey, and to discuss future training methods, including a SO-CPR manual that will include a counting rule book, and a future road map for the SO-CPR program. During the workshop we discussed a range of topics including: taxonomic resolution issues (particularly for Foraminifera and euphausiid larval identification and staging; laboratory methods (preservation and storage, with emphasis on maintaining correct pH; shipboard techniques; training methods; data handling (metadata, database, data sharing; gap analysis (spatial, temporal, data, quantitative; and future workshops/conferences, including comprehensive training workshops for emerging SO-CPR survey partners (India. We agreed that there should be a larger workshop every two years to ensure that the high standards of the SO-CPR program are maintained.

Additive Construction with Mobile Emplacement (ACME)

Science.gov (United States)

Vickers, John

2015-01-01

The Additive Construction with Mobile Emplacement (ACME) project is developing technology to build structures on planetary surfaces using in-situ resources. The project focuses on the construction of both 2D (landing pads, roads, and structure foundations) and 3D (habitats, garages, radiation shelters, and other structures) infrastructure needs for planetary surface missions. The ACME project seeks to raise the Technology Readiness Level (TRL) of two components needed for planetary surface habitation and exploration: 3D additive construction (e.g., contour crafting), and excavation and handling technologies (to effectively and continuously produce in-situ feedstock). Additionally, the ACME project supports the research and development of new materials for planetary surface construction, with the goal of reducing the amount of material to be launched from Earth.

Learn CPR You Can Do It!

Science.gov (United States)

... first aid training. Please try to attend a CPR training course in your community and help save a life. Francais Español ... Life Sciences Discovery Fund © 1998 - 2010 Learn CPR . All Rights Reserved. Replication of any of the ...

CPR: A Real Lifesaver (For Kids)

Science.gov (United States)

... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... English Español CPR: A Real Lifesaver KidsHealth / For Kids / CPR: A Real Lifesaver What's in this article? ...

CPR: Adult

Medline Plus

Full Text Available Refresher Center Home FIRST AID, CPR and AED LIFEGUARDING Refresher Putting It All Together: CPR—Adult (2:03) Refresher videos only utilize this player QUICK LINKS Home RedCross.org Purchase Course Materials Shop Our Store ...

CPR: Infant

Medline Plus

Full Text Available Refresher Center Home FIRST AID, CPR and AED LIFEGUARDING Refresher Putting It All Together: CPR—Infant (1:52) Refresher videos only utilize this player QUICK LINKS Home RedCross.org Purchase Course Materials Shop Our Store ...

Pharmacotherapy In Cardiopulmonary Resuscitation (CPR)

OpenAIRE

GÜNAYDIN, Berrin

2014-01-01

Cardiac arrest is defined as cessation of cardiac mechanical activity. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through several maneuvers and techniques. Although the two interventions, which are competent basic life support and prompt defibrillation, improve the survival rate, several adjuvant cardiac medication drugs are advocated to treat cardiac arrest during advanced cardiac life support. Since the introduction of modern CPR there have been man...

Applying CPR to a gas utility

International Nuclear Information System (INIS)

Lowe, R.

1995-01-01

The latest management tool to hit the United States over the past five years is Core Process Re-engineering (CPR). Though not as radical a procedure as the well-known rescue method it shares an abbreviation with, it is viewed as the radical thinking of a business process. CPR has helped breathe new life into gas and electric utilities in recent years, which have been using it to find ways to increase customer satisfaction, decrease operating costs, reduce process time and/or increase quality. The first phase of a typical project identifies and reviews current processes and obtains information that can point out re-engineering opportunities. The second phase involves the actual redesign of the current process. In this phase new teams may be formed, since the skill requirements are different (creative thinking becomes very important, for instance). Once alternatives are finalized and approved, the actual change process begins. Implementing all the recommendations can take several years, primarily because of labor and regulatory implications; therefore, planning the implementation is the most important part of the project. First, develop an overall implementation strategy. This overall strategy should address four major questions: What to implement? Who will implement? When to implement? How to implement? CPR is not an automatic solution to a problem. Any company wanting to expedite a CPR effort should consider the following factors: Align the CPR objectives to the overall company objectives; Ensure that senior management is actively involved and supports the CPR activities; Select the right team of people and ensure they are committed to the project; Develop a case for change and instill a sense of urgency in all the stakeholders; Focus on business results and not on specific activities; and Communicate, communicate, communicate

CLIC-ACM: Acquisition and Control System

CERN Document Server

Bielawski, B; Magnoni, S

2014-01-01

CLIC [1] (Compact Linear Collider) is a world-wide collaboration to study the next terascale lepton collider, relying upon a very innovative concept of two-beamacceleration. In this scheme, the power is transported to the main accelerating structures by a primary electron beam. The Two Beam Module (TBM) is a compact integration with a high filling factor of all components: RF, Magnets, Instrumentation, Vacuum, Alignment and Stabilization. This paper describes the very challenging aspects of designing the compact system to serve as a dedicated Acquisition & Control Module (ACM) for all signals of the TBM. Very delicate conditions must be considered, in particular radiation doses that could reach several kGy in the tunnel. In such severe conditions shielding and hardened electronics will have to be taken into consideration. In addition, with more than 300 ADC&DAC channels per ACM and about 21000 ACMs in total, it appears clearly that power consumption will be an important issue. It is also obvious that...

A mixed-methods study exploring student nurses’ understanding of futile CPR

OpenAIRE

Batty, Emma

2014-01-01

Abstract Background: Futile CPR has the potential to inflict significant, avoidable harms on dying patients. Futile CPR is widely debated in the literature, but there is little research into futile CPR in the context of nursing. There are no published studies exploring student nurses’ understanding of futile CPR. Aim: To explore student nurses’ understanding of futile CPR Methods: A mixed methods study, using questionnaires to establish background data and identify prominent issues. ...

Barriers and Facilitators to Community CPR Education in San José, Costa Rica.

Science.gov (United States)

Schmid, Kristin M; Mould-Millman, Nee-Kofi; Hammes, Andrew; Kroehl, Miranda; García, Raquel Quiros; McDermott, Manrique Umaña; Lowenstein, Steven R

2016-10-01

Bystander cardiopulmonary resuscitation (CPR) improves survival after prehospital cardiac arrest. While community CPR training programs have been implemented across the US, little is known about their acceptability in non-US Latino populations. The purpose of this study was to identify barriers to enrolling in CPR training classes and performing CPR in San José, Costa Rica. After consulting 10 San José residents, a survey was created, pilot-tested, and distributed to a convenience sample of community members in public gathering places in San José. Questions included demographics, CPR knowledge and beliefs, prior CPR training, having a family member with heart disease, and prior witnessing of a cardiac arrest. Questions also addressed barriers to enrolling in CPR classes (cost/competing priorities). The analysis focused on two main outcomes: likelihood of registering for a CPR class and willingness to perform CPR on an adult stranger. Odds ratios and 95% CIs were calculated to test for associations between patient characteristics and these outcomes. Among 371 participants, most were male (60%) and education (OR: 1.9; 95% CI, 1.1-3.2). Believing that CPR does not work was associated with a higher likelihood of not attending a CPR class (OR: 2.4; 95% CI, 1.7-7.9). Fear of performing mouth-mouth, believing CPR is against God's will, and fear of legal risk were associated with a likelihood of not attending a CPR class and not performing CPR on a stranger (range of ORs: 2.4-3.9). Most San José residents are willing to take CPR classes and perform CPR on a stranger. To implement a community CPR program, barriers must be considered, including misgivings about CPR efficacy and legal risk. Hands-only CPR programs may alleviate hesitancy to perform mouth-to-mouth. Schmid KM , Mould-Millman NK , Hammes A , Kroehl M , Quiros García R , Umaña McDermott M , Lowenstein SR . Barriers and facilitators to community CPR education in San José, Costa Rica. Prehosp Disaster Med

Bioinformatics analysis for structure and function of CPR of Plasmodium falciparum.

Science.gov (United States)

Fan, Zhigang; Zhang, Lingmin; Yan, Guogang; Wu, Qiang; Gan, Xiufeng; Zhong, Saifeng; Lin, Guifen

2011-02-01

To analyse the structure and function of NADPH-cytochrome p450 reductase (CYPOR or CPR) from Plasmodium falciparum (Pf), and to predict its' drug target and vaccine target. The structure, function, drug target and vaccine target of CPR from Plasmodium falciparum were analyzed and predicted by bioinformatics methods. PfCPR, which was older CPR, had close relationship with the CPR from other Plasmodium species, but it was distant from its hosts, such as Homo sapiens and Anopheles. PfCPR was located in the cellular nucleus of Plasmodium falciparum. 335aa-352aa and 591aa - 608aa were inserted the interior side of the nuclear membrane, while 151aa-265aa was located in the nucleolus organizer regions. PfCPR had 40 function sites and 44 protein-protein binding sites in amino acid sequence. The teriary structure of 1aa-700aa was forcep-shaped with wings. 15 segments of PfCPR had no homology with Homo sapien CPR and most were exposed on the surface of the protein. These segments had 25 protein-protein binding sites. While 13 other segments all possessed function sites. The evolution or genesis of Plasmodium falciparum is earlier than those of Homo sapiens. PfCPR is a possible resistance site of antimalarial drug and may involve immune evasion, which is associated with parasite of sporozoite in hepatocytes. PfCPR is unsuitable as vaccine target, but it has at least 13 ideal drug targets. Copyright © 2011 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Timely bystander CPR improves outcomes despite longer EMS times.

Science.gov (United States)

Park, Gwan Jin; Song, Kyoung Jun; Shin, Sang Do; Lee, Kyung Won; Ahn, Ki Ok; Lee, Eui Jung; Hong, Ki Jeong; Ro, Young Sun

2017-08-01

This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response. A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (bystander CPR and the time interval from collapse to CPR by EMS providers. A total of 15,354 OHCAs were analyzed. Bystander CPR was performed in 8591 (56.0%). Survival to hospital discharge occurred in 1632 (10.6%) and favorable neurological outcome in 996 (6.5%). In an interaction model of bystander CPR, compared to the fastest group, adjusted odds ratios (AORs) (95% CIs) for survival to discharge were 0.89 (0.66-1.20) in the fast group, 0.76 (0.57-1.02) in the late group, and 0.52 (0.37-0.73) in the latest group. For favorable neurological outcome, AORs were 1.12 (0.77-1.62) in the fast group, 0.90 (0.62-1.30) in the late group, 0.59 (0.38-0.91) in the latest group. The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR. Copyright © 2017 Elsevier Inc. All rights reserved.

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 1: Evidence analysis and consensus process: collaborative path toward small animal CPR guidelines.

Science.gov (United States)

Boller, Manuel; Fletcher, Daniel J

2012-06-01

To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to evaluate the scientific evidence relevant to small animal CPR and to compose consensus-based clinical CPR guidelines for dogs and cats. This report is part of a series of 7 articles on the RECOVER evidence and knowledge gap analysis and consensus-based small animal CPR guidelines. It describes the organizational structure of RECOVER, the evaluation process employed, consisting of standardized literature searches, the analysis of relevant articles according to study design, species and predefined quality markers, and the drafting of clinical CPR guidelines based on these data. Therefore, this article serves as the methodology section for the subsequent 6 RECOVER articles. Academia, referral practice. RECOVER is a collaborative initiative that systematically evaluated the evidence on 74 topics relevant to small animal CPR and generated 101 clinical CPR guidelines from this analysis. All primary contributors were veterinary specialists, approximately evenly split between academic institutions and private referral practices. The evidence evaluation and guideline drafting processes were conducted according to a predefined sequence of steps designed to reduce bias and increase the repeatability of the findings, including multiple levels of review, culminating in a consensus process. Many knowledge gaps were identified that will allow prioritization of research efforts in veterinary CPR. Collaborative systematic evidence review is organizationally challenging but feasible and effective in veterinary medicine. More experience is needed to refine the process. © Veterinary Emergency and Critical Care Society 2012.

Design of ACM system based on non-greedy punctured LDPC codes

Science.gov (United States)

Lu, Zijun; Jiang, Zihong; Zhou, Lin; He, Yucheng

2017-08-01

In this paper, an adaptive coded modulation (ACM) scheme based on rate-compatible LDPC (RC-LDPC) codes was designed. The RC-LDPC codes were constructed by a non-greedy puncturing method which showed good performance in high code rate region. Moreover, the incremental redundancy scheme of LDPC-based ACM system over AWGN channel was proposed. By this scheme, code rates vary from 2/3 to 5/6 and the complication of the ACM system is lowered. Simulations show that more and more obvious coding gain can be obtained by the proposed ACM system with higher throughput.

Effect of mobile application-based versus DVD-based CPR training on students’ practical CPR skills and willingness to act: a cluster randomised study

Science.gov (United States)

Nord, Anette; Svensson, Leif; Hult, Håkan; Kreitz-Sandberg, Susanne; Nilsson, Lennart

2016-01-01

Objectives The aim was to compare students’ practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training. Settings Seventh grade students in two Swedish municipalities. Design A cluster randomised trial. The classes were randomised to receive app-based or DVD-based training. Willingness to act and practical CPR skills were assessed, directly after training and at 6 months, by using a questionnaire and a PC Skill Reporting System. Data on CPR skills were registered in a modified version of the Cardiff test, where scores were given in 12 different categories, adding up to a total score of 12–48 points. Training and measurements were performed from December 2013 to October 2014. Participants 63 classes or 1232 seventh grade students (13-year-old) were included in the study. Primary and secondary outcome measures Primary end point was the total score of the modified Cardiff test. The individual variables of the test and self-reported willingness to make a life-saving intervention were secondary end points. Results The DVD-based group was superior to the app-based group in CPR skills; a total score of 36 (33–38) vs 33 (30–36) directly after training (pCPR skill components. Both groups improved compression depth from baseline to follow-up. If a friend suffered cardiac arrest, 78% (DVD) versus 75% (app) would do compressions and ventilations, whereas only 31% (DVD) versus 32% (app) would perform standard CPR if the victim was a stranger. Conclusions At 6 months follow-up, the 50 min DVD-based group showed superior CPR skills compared with the 30 min app-based group. The groups did not differ in regard to willingness to make a life-saving effort. PMID:27130166

Barriers and Facilitators to Learning and Performing Cardiopulmonary Resuscitation (CPR) in Neighborhoods with Low Bystander CPR Prevalence and High Rates of Cardiac Arrest in Columbus, Ohio

Science.gov (United States)

Sasson, Comilla; Haukoos, Jason S.; Bond, Cindy; Rabe, Marilyn; Colbert, Susan H.; King, Renee; Sayre, Michael; Heisler, Michele

2013-01-01

Background Residents who live in neighborhoods that are primarily African-American, Latino, or poor are more likely to have an out-of-hospital cardiac arrest (OHCA), less likely to receive cardiopulmonary resuscitation (CPR), and less likely to survive. No prior studies have been conducted to understand the contributing factors that may decrease the likelihood of residents learning and performing CPR in these neighborhoods. The goal of this study was to identify barriers and facilitators to learning and performing CPR in three low-income, “high-risk” predominantly African American, neighborhoods in Columbus, Ohio. Methods and Results Community-Based Participatory Research (CBPR) approaches were used to develop and conduct six focus groups in conjunction with community partners in three target high-risk neighborhoods in Columbus, Ohio in January-February 2011. Snowball and purposeful sampling, done by community liaisons, was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Three major barriers to learning CPR were identified and included financial, informational, and motivational factors. Four major barriers were identified for performing CPR and included fear of legal consequences, emotional issues, knowledge, and situational concerns. Participants suggested that family/self-preservation, emotional, and economic factors may serve as potential facilitators in increasing the provision of bystander CPR. Conclusion The financial cost of CPR training, lack of information, and the fear of risking one's own life must be addressed when designing a community-based CPR educational program. Using data from the community can facilitate improved design and implementation of CPR programs. PMID:24021699

Dissemination of CPR video self-instruction materials to secondary trainees: results from a hospital-based CPR education trial

Science.gov (United States)

Ikeda, Daniel J.; Buckler, David G.; Li, Jiaqi; Agarwal, Amit K.; Di Taranti, Laura J.; Kurtz, James; dos Reis, Ryan; Leary, Marion; Abella, Benjamin S.; Blewer, Audrey L.

2016-01-01

Background Cardiopulmonary resuscitation (CPR) video self-instruction (VSI) materials have been promoted as a scalable approach to increase the prevalence of CPR skills among the lay public, in part due to the opportunity for secondary training (i.e., sharing of training materials). However, the motivations for, and barriers to, disseminating VSI materials to secondary trainees is poorly understood. Methods This work represents an ancillary investigation of a prospective hospital-based CPR education trial in which family members of cardiac patients were trained using VSI. Mixed-methods surveys were administered to primary trainees six months after initial enrollment. Surveys were designed to capture motivations for, and barriers to, sharing VSI materials, the number of secondary trainees with whom materials were shared, and the settings, timing, and recipients of trainings. Results Between 07/2012–05/2015, 653 study participants completed a six-month follow-up interview. Of those, 345 reported sharing VSI materials with 1455 secondary trainees. Materials were shared most commonly with family members. In a logistic regression analysis, participants in the oldest quartile (age > 63 years) were less likely to share materials compared to those in the youngest quartile (age ≤ 44 years, OR 0.58, CI 0.37–0.90, p=0.02). Among the 308 participants who did not share their materials, time constraints was the most commonly cited barrier for not sharing. Conclusions VSI materials represent a strategy for secondary dissemination of CPR training, yet older individuals have a lower likelihood of sharing relative to younger individuals. Further work is warranted to remedy perceived barriers to CPR dissemination among the lay public using VSI approaches. PMID:26776900

An analytical framework for common-pool resource–large technical system (CPR-LTS constellations

Directory of Open Access Journals (Sweden)

Pär Blomkvist

2013-02-01

Full Text Available This paper introduces an analytical framework for a special phenomenon: when a common-pool resource (CPR institution and a large technical system (LTS are connected and mutually interdependent. The CPR in this case is a node managed by its appropriators within a centrally planned and managed system; here named CPR-LTS constellations. Our framework is empirically derived from two historical investigations of CPR institutions within two LTSs, the agricultural-technical system and the road transport system of Sweden. By comparing similarities and differences it is possible to identify paths to successes and failures. To understand why one survived and the other disappeared we connect Elinor Ostrom’s theories about management of CPRs with Thomas P. Hughes’s theories about LTSs. We are proposing a framework that can bridge the gap between theories about management of CPRs and LTSs. By combining the two theories it should be possible to better understand how small-scale producers using bottom-up CPRs can be linked to top-down LTSs.We will argue that to fit within an LTS, a CPR needs alignment between different parts or components within the constellation/system and alignment with other systems and institutions in society. We propose three analytical levels to deal with the phenomenon of aligning a CPR project to an existing, large sociotechnical system:Local alignment (CPR: How are CPRs organized and managed at local sites?Sociotechnical alignment (CPR-LTS: How are CPRs connected to the sociotechnical system?Contextual alignment: How are CPR-LTS constellations aligned with neighboring institutions and systems in society?Our work indicates that for successful management of a CPR-LTS constellation it is important that the CPR be included in legislation and that government agencies support the CPR in alignment with the LTS. Legislators must recognize the CPR-part in the CPR-LTS constellation so that its institutional body is firmly established in

Analysis on working pressure selection of ACME integral test facility

International Nuclear Information System (INIS)

Chen Lian; Chang Huajian; Li Yuquan; Ye Zishen; Qin Benke

2011-01-01

An integral effects test facility, advanced core cooling mechanism experiment facility (ACME) was designed to verify the performance of the passive safety system and validate its safety analysis codes of a pressurized water reactor power plant. Three test facilities for AP1000 design were introduced and review was given. The problems resulted from the different working pressures of its test facilities were analyzed. Then a detailed description was presented on the working pressure selection of ACME facility as well as its characteristics. And the approach of establishing desired testing initial condition was discussed. The selected 9.3 MPa working pressure covered almost all important passive safety system enables the ACME to simulate the LOCAs with the same pressure and property similitude as the prototype. It's expected that the ACME design would be an advanced core cooling integral test facility design. (authors)

News from the Library: A one-stop-shop for computing literature: ACM Digital Library

CERN Multimedia

CERN Library

2011-01-01

The Association for Computing Machinery, ACM, is the world’s largest educational and scientific computing society. Among others, the ACM provides the computing field's premier Digital Library and serves its members and the computing profession with leading-edge publications, conferences, and career resources.   ACM Digital Library is available to the CERN community. The most popular journal here at CERN is Communications of the ACM. However, the collection offers access to a series of other valuable important academic journals such as Journal of the ACM and even fulltext of a series of classical books. In addition, users have access to the ACM Guide to Computing Literature, the most comprehensive bibliographic database focusing on computing, integrated with ACM’s full-text articles and including features such as ACM Author Profile Pages - which provides bibliographic and bibliometric data for over 1,000,000 authors in the field. ACM Digital Library is an excellent com...

Characterization of a Novel Arginine Catabolic Mobile Element (ACME) and Staphylococcal Chromosomal Cassette mec Composite Island with Significant Homology to Staphylococcus epidermidis ACME type II in Methicillin-Resistant Staphylococcus aureus Genotype ST22-MRSA-IV.

LENUS (Irish Health Repository)

Shore, Anna C

2011-02-22

The arginine catabolic mobile element (ACME) is prevalent among ST8-MRSA-IVa (USA300) isolates and evidence suggests that ACME enhances the ability of ST8-MRSA-IVa to grow and survive on its host. ACME has been identified in a small number of isolates belonging to other MRSA clones but is widespread among coagulase-negative staphylococci (CoNS). This study reports the first description of ACME in two distinct strains of the pandemic ST22-MRSA-IV clone. A total of 238 MRSA isolates recovered in Ireland between 1971 and 2008 were investigated for ACME using a DNA microarray. Twenty-three isolates (9.7%) were ACME-positive, all were either MRSA genotype ST8-MRSA-IVa (7\\/23, 30%) or ST22-MRSA-IV (16\\/23, 70%). Whole-genome sequencing and comprehensive molecular characterization revealed the presence of a novel 46-kb ACME and SCCmec composite island (ACME\\/SCCmec-CI) in ST22-MRSA-IVh isolates (n = 15). This ACME\\/SCCmec-CI consists of a 12-kb DNA region previously identified in ACME type II in S. epidermidis ATCC 12228, a truncated copy of the J1 region of SCCmec I and a complete SCCmec IVh element. The composite island has a novel genetic organization with ACME located within orfX and SCCmec located downstream of ACME. One pvl-positive ST22-MRSA-IVa isolate carried ACME located downstream of SCCmec IVa as previously described in ST8-MRSA-IVa. These results suggest that ACME has been acquired by ST22-MRSA-IV on two independent occasions. At least one of these instances may have involved horizontal transfer and recombination events between MRSA and CoNS. The presence of ACME may enhance dissemination of ST22-MRSA-IV, an already successful MRSA clone.

Contribution of the collagen adhesin Acm to pathogenesis of Enterococcus faecium in experimental endocarditis.

Science.gov (United States)

Nallapareddy, Sreedhar R; Singh, Kavindra V; Murray, Barbara E

2008-09-01

Enterococcus faecium is a multidrug-resistant opportunist causing difficult-to-treat nosocomial infections, including endocarditis, but there are no reports experimentally demonstrating E. faecium virulence determinants. Our previous studies showed that some clinical E. faecium isolates produce a cell wall-anchored collagen adhesin, Acm, and that an isogenic acm deletion mutant of the endocarditis-derived strain TX0082 lost collagen adherence. In this study, we show with a rat endocarditis model that TX0082 Deltaacm::cat is highly attenuated versus wild-type TX0082, both in established (72 h) vegetations (P Acm the first factor shown to be important for E. faecium pathogenesis. In contrast, no mortality differences were observed in a mouse peritonitis model. While 5 of 17 endocarditis isolates were Acm nonproducers and failed to adhere to collagen in vitro, all had an intact, highly conserved acm locus. Highly reduced acm mRNA levels (>or=50-fold reduction relative to an Acm producer) were found in three of these five nonadherent isolates, including the sequenced strain TX0016, by quantitative reverse transcription-PCR, indicating that acm transcription is downregulated in vitro in these isolates. However, examination of TX0016 cells obtained directly from infected rat vegetations by flow cytometry showed that Acm was present on 40% of cells grown during infection. Finally, we demonstrated a significant reduction in E. faecium collagen adherence by affinity-purified anti-Acm antibodies from E. faecium endocarditis patient sera, suggesting that Acm may be a potential immunotarget for strategies to control this emerging pathogen.

The use of CPR data in fisheries research [review article

Science.gov (United States)

Corten, A.; Lindley, J. A.

2003-08-01

The Continuous Plankton Recorder (CPR) survey was initiated partly to contribute to our understanding of the variability of fish stocks and as a potential method for predicting fish distributions from the abundance and composition of the plankton. The latter objective has been superseded by technological developments in fish detection, but the former has been the subject of continuing, and in recent years expanding use of the CPR data. Examples are presented of application of the data to studies on North Sea herring, cod, mackerel, blue whiting and redfish as well as more general plankton studies relevant to fisheries research. Variations in the migration patterns of herring as well as recruitment have been related to abundances and species composition of the plankton in the CPR survey. Extensive use has been made of the CPR data in relation to cod, particularly in the development and testing of the ‘match-mismatch’ hypothesis. Advection of sufficient numbers of Calanus from the core oceanic areas of its distribution into the areas where the cod stocks occur may partly determine the success of those stocks. The analysis of the distribution and abundances of mackerel larvae in the CPR survey have shown contrasting variations between the North Sea and Celtic Sea. The expansion of the horse mackerel fishery in the north-eastern North Sea since 1987 has been related to physical events and a ‘regime shift’ in the plankton, described from CPR data. The oceanic spawning areas of the blue whiting and redfish were highlighted by the expansion of the CPR survey into the north-eastern and north-western Atlantic respectively. These results helped to focus the attention of fisheries scientists on stocks that have subsequently become the targets for commercial exploitation. The results of the CPR survey, particularly those on Calanusfinmarchicus, the phytoplankton standing stock as measured by the CPR colour index, the overall patterns of trends in plankton abundance and

Asbestos-Containing Materials (ACM) and Demolition

Science.gov (United States)

There are specific federal regulatory requirements that require the identification of asbestos-containing materials (ACM) in many of the residential buildings that are being demolished or renovated by a municipality.

Proceedings of the 2nd ACM SIGSPATIAL International Workshop on Indoor Spatial Awareness

DEFF Research Database (Denmark)

These proceedings contain the papers selected for presentation at the Second International Workshop on Indoor Spatial Awareness, hosted by ACM SIGSPATIAL and held in conjunction with the18th ACM SIGSPATIAL International Conference on Advances in Geographic Information Systems (ACM SIGSPATIAL GIS...

De afschaffing van de bezwaarfase bij boetebesluiten van de ACM

NARCIS (Netherlands)

Jans, J.H.; Outhuijse, A.

Per 1 maart 2013 ontstaat door samenvoeging van de NMa, de OPTA en de Consumentenautoriteit, de Autoriteit Consument en Markt. Om de ACM slagvaardig te laten functioneren, wordt voorgesteld het handhavingsinstrumentarium m.b.t. het markttoezicht van de ACM te vereenvoudigen. Eén van de voorstellen

ACME: A Basis for Architecture Exchange

National Research Council Canada - National Science Library

Wile, David

2003-01-01

.... It remains useful in that role, but since the project's inception the Acme language and its support toolkit have grown into a solid foundation upon which new software architecture design and analysis...

Characterization of a novel arginine catabolic mobile element (ACME) and staphylococcal chromosomal cassette mec composite island with significant homology to Staphylococcus epidermidis ACME type II in methicillin-resistant Staphylococcus aureus genotype ST22-MRSA-IV.

LENUS (Irish Health Repository)

Shore, Anna C

2011-05-01

The arginine catabolic mobile element (ACME) is prevalent among methicillin-resistant Staphylococcus aureus (MRSA) isolates of sequence type 8 (ST8) and staphylococcal chromosomal cassette mec (SCCmec) type IVa (USA300) (ST8-MRSA-IVa isolates), and evidence suggests that ACME enhances the ability of ST8-MRSA-IVa to grow and survive on its host. ACME has been identified in a small number of isolates belonging to other MRSA clones but is widespread among coagulase-negative staphylococci (CoNS). This study reports the first description of ACME in two distinct strains of the pandemic ST22-MRSA-IV clone. A total of 238 MRSA isolates recovered in Ireland between 1971 and 2008 were investigated for ACME using a DNA microarray. Twenty-three isolates (9.7%) were ACME positive, and all were either MRSA genotype ST8-MRSA-IVa (7\\/23, 30%) or MRSA genotype ST22-MRSA-IV (16\\/23, 70%). Whole-genome sequencing and comprehensive molecular characterization revealed the presence of a novel 46-kb ACME and staphylococcal chromosomal cassette mec (SCCmec) composite island (ACME\\/SCCmec-CI) in ST22-MRSA-IVh isolates (n=15). This ACME\\/SCCmec-CI consists of a 12-kb DNA region previously identified in ACME type II in S. epidermidis ATCC 12228, a truncated copy of the J1 region of SCCmec type I, and a complete SCCmec type IVh element. The composite island has a novel genetic organization, with ACME located within orfX and SCCmec located downstream of ACME. One PVL locus-positive ST22-MRSA-IVa isolate carried ACME located downstream of SCCmec type IVa, as previously described in ST8-MRSA-IVa. These results suggest that ACME has been acquired by ST22-MRSA-IV on two independent occasions. At least one of these instances may have involved horizontal transfer and recombination events between MRSA and CoNS. The presence of ACME may enhance dissemination of ST22-MRSA-IV, an already successful MRSA clone.

Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.

Science.gov (United States)

Pearson, David A; Darrell Nelson, R; Monk, Lisa; Tyson, Clark; Jollis, James G; Granger, Christopher B; Corbett, Claire; Garvey, Lee; Runyon, Michael S

2016-08-01

Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown. To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR. This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1-2. Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50-81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7-8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2-5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR

Highlights from ACM SIGSPATIAL GIS 2011: the 19th ACM SIGSPATIAL International Conference on Advances in Geographic Information Systems: (Chicago, Illinois - November 1 - 4, 2011)

DEFF Research Database (Denmark)

Jensen, Christian S.; Ofek, Eyal; Tanin, Egemen

2012-01-01

ACM SIGSPATIAL GIS 2011 was the 19th gathering of the premier event on spatial information and Geographic Information Systems (GIS). It is also the fourth year that the conference was held under the auspices of ACM's most recent special interest group, SIGSPATIAL. Since its start in 1993, the con...

CPR in the nursing home: fool's errand or looming dilemma?

LENUS (Irish Health Repository)

Lyons, D

2011-09-01

The indications for CPR (cardiopulmonary resuscitation) have expanded greatly since the technique was introduced and theoretically it can be attempted on all prior to death. Policy initiatives (such as the British Medical Association\\/Royal College of Nursing guidelines) have attempted to provide a clinical rationale for the withholding of inappropriate CPR. Traditionally a care home was felt to be an inappropriate environment to attempt CPR but increased use of advance directives may bring the issue to the fore in this setting.

Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance.

Science.gov (United States)

Choa, Minhong; Cho, Junho; Choi, Young Hwan; Kim, Seungho; Sung, Ji Min; Chung, Hyun Soo

2009-06-01

The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training. This study was a single blind randomized controlled trial. The participants' last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n=42) and the control group (n=38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the ResusciAnne SkillReporter. Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (pCPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR.

CPR Instruction in U.S. High Schools: What Is the State in the Nation?

Science.gov (United States)

Brown, Lorrel E; Lynes, Carlos; Carroll, Travis; Halperin, Henry

2017-11-28

Cardiopulmonary resuscitation (CPR) training in high schools is required by law in the majority of U.S. states. However, laws differ from state to state, and it is unknown how this legislation is being enacted. The authors sent a cross-sectional, closed survey to educational superintendents in 32 states with CPR laws in June 2016. The authors subsequently performed direct examination and categorization of CPR legislation in 39 states (several states passed legislation as of September 2017). Survey results indicated differing practices with regard to CPR instruction in areas such as course content (63% perform automated external defibrillator training), instructor (47% used CPR-certified teachers/coaches, 30% used other CPR-certified instructors, 11% used noncertified teachers/coaches), and method (7% followed American Red Cross methods, 55% followed American Heart Association methods). CPR laws differ, although almost all (97%) require hands-on training. Although hands-on practice during CPR instruction in high school is required by law in the majority of U.S. states, there is currently no standardized method of implementation. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods

Science.gov (United States)

Han, Josiah; Cano, Alejandra; Ramirez, Victor; Morales, Gabriel; Campbell, Teri L.; Hoek, Terry Vanden

2018-01-01

Introduction The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. Methods We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. Results Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision. PMID:29560076

Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: a randomised simulation study.

Science.gov (United States)

Zapletal, Bernhard; Greif, Robert; Stumpf, Dominik; Nierscher, Franz Josef; Frantal, Sophie; Haugk, Moritz; Ruetzler, Kurt; Schlimp, Christoph; Fischer, Henrik

2014-04-01

Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers' performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality. In this open, prospective, randomised, controlled trial we compared three CPR feedback devices (PocketCPR, CPRmeter, iPhone app PocketCPR) with standard BLS without feedback in a simulated scenario. 240 trained medical students performed single rescuer BLS on a manikin for 8min. Effective compression (compressions with correct depth, pressure point and sufficient decompression) as well as compression rate, flow time fraction and ventilation parameters were compared between the four groups. Study participants using the PocketCPR performed 17±19% effective compressions compared to 32±28% with CPRmeter, 25±27% with the iPhone app PocketCPR, and 35±30% applying standard BLS (PocketCPR vs. CPRmeter p=0.007, PocketCPR vs. standard BLS p=0.001, others: ns). PocketCPR and CPRmeter prevented a decline in effective compression over time, but overall performance in the PocketCPR group was considerably inferior to standard BLS. Compression depth and rate were within the range recommended in the guidelines in all groups. While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Keep pushing! Limiting interruptions to CPR; bag-valve mask versus ...

African Journals Online (AJOL)

This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications ...

Proceedings of the 2014 ACM international conference on Interactive experiences for TV and online video

NARCIS (Netherlands)

P. Olivier (Patrick); P. Wright; T. Bartindale; M. Obrist (Marianna); P.S. Cesar Garcia (Pablo Santiago); S. Basapur

2014-01-01

htmlabstractIt is our great pleasure to introduce the 2014 ACM International Conference on Interactive Experiences for Television and Online Video -- ACM TVX 2014. ACM TVX is a leading annual conference that brings together international researchers and practitioners from a wide range of

Inhibition of Enterococcus faecium adherence to collagen by antibodies against high-affinity binding subdomains of Acm.

Science.gov (United States)

Nallapareddy, Sreedhar R; Sillanpää, Jouko; Ganesh, Vannakambadi K; Höök, Magnus; Murray, Barbara E

2007-06-01

Strains of Enterococcus faecium express a cell wall-anchored protein, Acm, which mediates adherence to collagen. Here, we (i) identify the minimal and high-affinity binding subsegments of Acm and (ii) show that anti-Acm immunoglobulin Gs (IgGs) purified against these subsegments reduced E. faecium TX2535 strain collagen adherence up to 73 and 50%, respectively, significantly more than the total IgGs against the full-length Acm A domain (28%) (P Acm adherence with functional subsegment-specific antibodies raises the possibility of their use as therapeutic or prophylactic agents.

Effects of diaspirin cross-linked hemoglobin (DCLHb) during and post-CPR in swine.

Science.gov (United States)

Chow, M S; Fan, C; Tran, H; Zhao, H; Zhou, L

2001-04-01

The purpose of the study was to test the hypothesis that diaspirin cross-linked hemoglobin (DCLHb) can produce improved resuscitation during cardiac arrest. DCLHb, a derivative of human hemoglobin, has previously been demonstrated to produce a vasopressor response that is associated with increased blood flow to vital organs. In addition, it is an oxygen carrier. These effects may be beneficial to extreme low flow states, such as that during cardiac arrest and cardiopulmonary resuscitation (CPR). Experimental cardiac arrest and CPR were carried out in 32 anesthetized immature pigs. In each animal, ventricular fibrillation was induced for 5 min, followed by 10 min of standard CPR with a pneumatic device and room air ventilation. High (15 ml/kg) and low (5 ml/kg) doses of DCLHb or equivalent volume of normal saline were infused at the beginning of CPR in a random and blind manner. Cardiac output, organ blood flow, aortic pressure, coronary perfusion pressure, blood gases, and lactate concentrations were obtained before and during CPR. Following the 10-min CPR, the animals were defibrillated and the return of spontaneous circulation (ROSC) determined. DCLHb treatment achieved 75% ROSC compared with 25% in the saline group (p CPR significantly improves ROSC. This is most likely related to its improvement in coronary perfusion and myocardial oxygen delivery.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods.

Science.gov (United States)

Del Rios, Marina; Han, Josiah; Cano, Alejandra; Ramirez, Victor; Morales, Gabriel; Campbell, Teri L; Hoek, Terry Vanden

2018-03-01

The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a "pay-it-forward" component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to "pay it forward" and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and "pay-it-forward" participants. Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p pay-it-forward cohort saw an increase from 58% to 82% (p pay-it-forward" component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods

Directory of Open Access Journals (Sweden)

Josiah Han

2018-02-01

Full Text Available Introduction: The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. Methods: We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. Results: Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001. The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001. Conclusion: A high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.

Comparison of CPR1000 and AP1000 rod position indication systems

International Nuclear Information System (INIS)

Lei Qing

2009-01-01

This paper introduces the structure, the function, the digital detection principle of reactor control rod position and monitoring systems in CPR1000 and AP1000, comparing with the characteristics of the system design. The results show that the operation mode and function of AP1000 Rod position indication system are similar to that of CPR1000, but AP1000 rod position system provides higher reliability, and reduces the numbers of containment electrical penetrations and is with better characteristics than that of CPR1000, since it incorporated the redundancy design and data communication. (authors)

76 FR 64943 - Proposed Cercla Administrative Cost Recovery Settlement; ACM Smelter and Refinery Site, Located...

Science.gov (United States)

2011-10-19

... Settlement; ACM Smelter and Refinery Site, Located in Cascade County, MT AGENCY: Environmental Protection... projected future response costs concerning the ACM Smelter and Refinery NPL Site (Site), Operable Unit 1..., Helena, MT 59626. Mr. Sturn can be reached at (406) 457-5027. Comments should reference the ACM Smelter...

Guidelines for CPR Training in Louisiana Schools. Bulletin No. 1638.

Science.gov (United States)

Louisiana State Dept. of Education, Baton Rouge.

Completion of a course in cardiopulmonary resuscitation (CPR) is required for graduation from high school in Louisiana. This bulletin presents the guidelines for a course in CPR and was prepared with the cooperation of the American Red Cross (ARC) and the American Heart Association (AHA). At the conclusion of the course, students will be prepared…

Study on the percent of frequency of ACME-Arca in clinical isolates ...

African Journals Online (AJOL)

ACME is a mobile element of Arginine catabolic in Staphylococcus epidermidis that codes specific virulence factors. The purpose of this study was to examine the specific features and prevalence of ACME-arcA in the isolates of Staphylococcus epidermidis resistant to Methicillin isolated by clinical samples in Isfahan.

On-resin conversion of Cys(Acm)-containing peptides to their corresponding Cys(Scm) congeners.

Science.gov (United States)

Mullen, Daniel G; Weigel, Benjamin; Barany, George; Distefano, Mark D

2010-05-01

The Acm protecting group for the thiol functionality of cysteine is removed under conditions (Hg(2+)) that are orthogonal to the acidic milieu used for global deprotection in Fmoc-based solid-phase peptide synthesis. This use of a toxic heavy metal for deprotection has limited the usefulness of Acm in peptide synthesis. The Acm group may be converted to the Scm derivative that can then be used as a reactive intermediate for unsymmetrical disulfide formation. It may also be removed by mild reductive conditions to generate unprotected cysteine. Conversion of Cys(Acm)-containing peptides to their corresponding Cys(Scm) derivatives in solution is often problematic because the sulfenyl chloride reagent used for this conversion may react with the sensitive amino acids tyrosine and tryptophan. In this protocol, we report a method for on-resin Acm to Scm conversion that allows the preparation of Cys(Scm)-containing peptides under conditions that do not modify other amino acids. (c) 2010 European Peptide Society and John Wiley & Sons, Ltd.

CNTF-ACM promotes mitochondrial respiration and oxidative stress in cortical neurons through upregulating L-type calcium channel activity.

Science.gov (United States)

Sun, Meiqun; Liu, Hongli; Xu, Huanbai; Wang, Hongtao; Wang, Xiaojing

2016-09-01

A specialized culture medium termed ciliary neurotrophic factor-treated astrocyte-conditioned medium (CNTF-ACM) allows investigators to assess the peripheral effects of CNTF-induced activated astrocytes upon cultured neurons. CNTF-ACM has been shown to upregulate neuronal L-type calcium channel current activity, which has been previously linked to changes in mitochondrial respiration and oxidative stress. Therefore, the aim of this study was to evaluate CNTF-ACM's effects upon mitochondrial respiration and oxidative stress in rat cortical neurons. Cortical neurons, CNTF-ACM, and untreated control astrocyte-conditioned medium (UC-ACM) were prepared from neonatal Sprague-Dawley rat cortical tissue. Neurons were cultured in either CNTF-ACM or UC-ACM for a 48-h period. Changes in the following parameters before and after treatment with the L-type calcium channel blocker isradipine were assessed: (i) intracellular calcium levels, (ii) mitochondrial membrane potential (ΔΨm), (iii) oxygen consumption rate (OCR) and adenosine triphosphate (ATP) formation, (iv) intracellular nitric oxide (NO) levels, (v) mitochondrial reactive oxygen species (ROS) production, and (vi) susceptibility to the mitochondrial complex I toxin rotenone. CNTF-ACM neurons displayed the following significant changes relative to UC-ACM neurons: (i) increased intracellular calcium levels (p ACM (p ACM promotes mitochondrial respiration and oxidative stress in cortical neurons through elevating L-type calcium channel activity.

The acellular matrix (ACM) for bladder tissue engineering: A quantitative magnetic resonance imaging study.

Science.gov (United States)

Cheng, Hai-Ling Margaret; Loai, Yasir; Beaumont, Marine; Farhat, Walid A

2010-08-01

Bladder acellular matrices (ACMs) derived from natural tissue are gaining increasing attention for their role in tissue engineering and regeneration. Unlike conventional scaffolds based on biodegradable polymers or gels, ACMs possess native biomechanical and many acquired biologic properties. Efforts to optimize ACM-based scaffolds are ongoing and would be greatly assisted by a noninvasive means to characterize scaffold properties and monitor interaction with cells. MRI is well suited to this role, but research with MRI for scaffold characterization has been limited. This study presents initial results from quantitative MRI measurements for bladder ACM characterization and investigates the effects of incorporating hyaluronic acid, a natural biomaterial useful in tissue-engineering and regeneration. Measured MR relaxation times (T(1), T(2)) and diffusion coefficient were consistent with increased water uptake and glycosaminoglycan content observed on biochemistry in hyaluronic acid ACMs. Multicomponent MRI provided greater specificity, with diffusion data showing an acellular environment and T(2) components distinguishing the separate effects of increased glycosaminoglycans and hydration. These results suggest that quantitative MRI may provide useful information on matrix composition and structure, which is valuable in guiding further development using bladder ACMs for organ regeneration and in strategies involving the use of hyaluronic acid.

Arabidopsis CPR5 regulates ethylene signaling via molecular association with the ETR1 receptor.

Science.gov (United States)

Wang, Feifei; Wang, Lijuan; Qiao, Longfei; Chen, Jiacai; Pappa, Maria Belen; Pei, Haixia; Zhang, Tao; Chang, Caren; Dong, Chun-Hai

2017-11-01

The plant hormone ethylene plays various functions in plant growth, development and response to environmental stress. Ethylene is perceived by membrane-bound ethylene receptors, and among the homologous receptors in Arabidopsis, the ETR1 ethylene receptor plays a major role. The present study provides evidence demonstrating that Arabidopsis CPR5 functions as a novel ETR1 receptor-interacting protein in regulating ethylene response and signaling. Yeast split ubiquitin assays and bi-fluorescence complementation studies in plant cells indicated that CPR5 directly interacts with the ETR1 receptor. Genetic analyses indicated that mutant alleles of cpr5 can suppress ethylene insensitivity in both etr1-1 and etr1-2, but not in other dominant ethylene receptor mutants. Overexpression of Arabidopsis CPR5 either in transgenic Arabidopsis plants, or ectopically in tobacco, significantly enhanced ethylene sensitivity. These findings indicate that CPR5 plays a critical role in regulating ethylene signaling. CPR5 is localized to endomembrane structures and the nucleus, and is involved in various regulatory pathways, including pathogenesis, leaf senescence, and spontaneous cell death. This study provides evidence for a novel regulatory function played by CPR5 in the ethylene receptor signaling pathway in Arabidopsis. © 2017 Institute of Botany, Chinese Academy of Sciences.

Assessment of in-vessel corium retention in CPR1000

International Nuclear Information System (INIS)

Chen Xing; Zhang Shishun; Lin Jiming

2011-01-01

The In-Vessel corium Retention (IVR) strategy of Chinese 1000 MW class commercial pressurized water reactor (CPR1000) is assessed by Risk-Oriented Accident Analysis Methodology (ROAAM). Four representative severe accident scenarios are selected for the IVR assessment in this paper. According to four representative severe accident scenarios consequence calculated by the deterministic code combined with engineering judgment, the input probability distribution of the assessment is determined. Success probability of IVR from the viewpoint of thermal failure is then predicted using MOPOL code. MOPOL is a code developed basing on the well known ROAAM frame and heat transfer model of corium. It is demonstrated that the success probability of IVR by Reactor Cavity Flooding in CPR1000 is potentially higher than 99%. Application of IVR strategy in CPR1000 is envisioned probable if a further more comprehensive risk-benefit evaluation conclusion is positive. (authors)

VANET '13: Proceeding of the Tenth ACM International Workshop on Vehicular Inter-networking, Systems, and Applications

NARCIS (Netherlands)

Gozalvez, J.; Kargl, Frank; Mittag, J.; Kravets, R.; Tsai, M.; Unknown, [Unknown

This year marks a very important date for the ACM international workshop on Vehicular inter-networking, systems, and applications as ACM VANET celebrates now its 10th edition. Starting in 2004 as "ACM international workshop on Vehicular ad hoc networks" already the change in title indicates that

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills.

Science.gov (United States)

Wanner, Gregory K; Osborne, Arayel; Greene, Charlotte H

2016-11-29

Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt). Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills (compression rate, depth, hand position, release), and hands-off time (time without compressions). CPR skills were evaluated using a sensor-equipped mannequin and two blinded CPR experts observed testing of participants. Twenty-four participants were included: 12 never-trained and 12 currently certified in CPR. Comparing pre and post training, the never-trained group had improvements in average compression rate per minute (64.3 to 103.9, p = 0.006), compressions with correct hand position in 1 min (8.3 to 54.3, p = 0.002), and correct compression release in 1 min (21.2 to 76.3, p 100/min), but an improved number of compressions with correct release (53.5 to 94.7, p 50 mm) remained problematic in both groups. Comparisons made between groups indicated significant improvements in compression depth, hand position, and hands-off time in never-trained compared to CPR-certified participants. Inter-rater agreement values were also calculated between the CPR experts and sensor-equipped mannequin. A brief internet-based video coupled with skill practice on a homemade mannequin improved compression-only CPR skills, especially in the previously untrained participants. This training method allows for widespread compression-only CPR

Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics

Directory of Open Access Journals (Sweden)

Nina Thakkar Rivera

2016-01-01

Full Text Available The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (p=0.05, with a stronger disparity between low- and high-income neighborhoods (p=0.01 and p=0.03, resp.. Survival with bystander CPR was statistically greater in white- versus black-predominant neighborhoods (p=0.04. Increased survival, overall and with bystander CPR, was seen with high- versus low-education neighborhoods (p=0.03. Neighborhoods with more high school age persons displayed the lowest survival. We discovered a significant disparity in OHCA survival within neighborhoods of low-income, black-predominance, and low-education. Reduced survival was seen in neighborhoods with larger populations of high school students. This group is a potential target for training, and instruction can conceivably change survival outcomes in these neighborhoods, closing the gap, thus improving survival for all.

Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial.

Science.gov (United States)

Kern, Karl B; Stickney, Ronald E; Gallison, Leanne; Smith, Robert E

2010-02-01

We hypothesized that a unique tock and voice metronome could prevent both suboptimal chest compression rates and hyperventilation. A prospective, randomized, parallel design study involving 34 pairs of paid firefighter/emergency medical technicians (EMTs) performing two-rescuer CPR using a Laerdal SkillReporter Resusci Anne manikin with and without metronome guidance was performed. Each CPR session consisted of 2 min of 30:2 CPR with an unsecured airway, then 4 min of CPR with a secured airway (continuous compressions at 100 min(-1) with 8-10 ventilations/min), repeated after the rescuers switched roles. The metronome provided "tock" prompts for compressions, transition prompts between compressions and ventilations, and a spoken "ventilate" prompt. During CPR with a bag/valve/mask the target compression rate of 90-110 min(-1) was achieved in 5/34 CPR sessions (15%) for the control group and 34/34 sessions (100%) for the metronome group (pmetronome or control group during CPR with a bag/valve/mask. During CPR with a bag/endotracheal tube, the target of both a compression rate of 90-110 min(-1) and a ventilation rate of 8-11 min(-1) was achieved in 3/34 CPR sessions (9%) for the control group and 33/34 sessions (97%) for the metronome group (pMetronome use with the secured airway scenario significantly decreased the incidence of over-ventilation (11/34 EMT pairs vs. 0/34 EMT pairs; pmetronome was effective at directing correct chest compression and ventilation rates both before and after intubation. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

CPR - child (1 to 8 years old)

Science.gov (United States)

Rescue breathing and chest compressions - child; Resuscitation - cardiopulmonary - child; Cardiopulmonary resuscitation - child ... take care of children should learn infant and child CPR if they have not already. See www. ...

Clinical isolates of Enterococcus faecium exhibit strain-specific collagen binding mediated by Acm, a new member of the MSCRAMM family.

Science.gov (United States)

Nallapareddy, Sreedhar R; Weinstock, George M; Murray, Barbara E

2003-03-01

A collagen-binding adhesin of Enterococcus faecium, Acm, was identified. Acm shows 62% similarity to the Staphylococcus aureus collagen adhesin Cna over the entire protein and is more similar to Cna (60% and 75% similarity with Cna A and B domains respectively) than to the Enterococcus faecalis collagen-binding adhesin, Ace, which shares homology with Acm only in the A domain. Despite the detection of acm in 32 out of 32 E. faecium isolates, only 11 of these (all clinical isolates, including four vancomycin-resistant endocarditis isolates and seven other isolates) exhibited binding to collagen type I (CI). Although acm from three CI-binding vancomycin-resistant E. faecium clinical isolates showed 100% identity, analysis of acm genes and their promoter regions from six non-CI-binding strains identified deletions or mutations that introduced stop codons and/or IS elements within the gene or the promoter region in five out of six strains, suggesting that the presence of an intact functional acm gene is necessary for binding of E. faecium strains to CI. Recombinant Acm A domain showed specific and concentration-dependent binding to collagen, and this protein competed with E. faecium binding to immobilized CI. Consistent with the adherence phenotype and sequence data, probing with Acm-specific IgGs purified from anti-recombinant Acm A polyclonal rabbit serum confirmed the surface expression of Acm in three out of three collagen-binding clinical isolates of E. faecium tested, but in none of the strains with a non-functional pseudo acm gene. Introduction of a functional acm gene into two non-CI-binding natural acm mutant strains conferred a CI-binding phenotype, further confirming that native Acm is sufficient for the binding of E. faecium to CI. These results demonstrate that acm, which encodes a potential virulence factor, is functional only in certain infection-derived clinical isolates of E. faecium, and suggest that Acm is the primary adhesin responsible for the

Formation of personality’s acme-qualities as a component of physical education specialists’ acmeological competence

Directory of Open Access Journals (Sweden)

T.Hr. Dereka

2016-10-01

Full Text Available Purpose: to determine characteristics of acme-qualities’ formation in physical education specialists and determine correlations between components. Material: in the research students of “Physical education” specialty (n=194 participated. For assessment personality’s qualities special tests were used. Organization abilities, communicative abilities, creative potential, demand in achievement, emotional information level, control of emotions and etc. were assessed. Results: we determined components of personality’s acme-competence component in physical education specialists. We found density and orientation of correlation and influence of acme-qualities on personality’s component. By the results of factorial analysis we grouped, classified components by four factors and created their visual picture. The accumulated percentage of the studied factors’ dispersion was determined. Conclusions: continuous professional training of physical education specialists on acme-principles resulted in formation of personality’s acme-qualities. They facilitate manifestation of personality’s activity in the process of professional formation and constant self-perfection.

Human c-peptide immunoreactivity (CPR) in blood and urine - evaluation of a radioimmunoassay method and its clinical applications

Energy Technology Data Exchange (ETDEWEB)

Kuzuya, T; Matsuda, A; Saito, T; Yoshida, S

1976-01-01

A double-antibody radioimmunoassay method, using synthetic human connecting peptide as an immunizing antigen and standard, was evaluated for clinical assay of blood and urine samples. Normal fasting blood connecting peptide immunoreacivity (CPR) was 2.45 +- 0.96 ng/ml, increasing promptly after a 50 g oral glucose load, but somewhat slower than insulin. Molar concentration of CPR exceeded that of insulin. CPR responses to glucose were subnormal in diabetics, very low in juvenile-type cases, and often poor in patients on insulin treatment. Fasting CPR levels were elevated in patients on corticosteroid treatment and with uraemia. A patient with insulin 'auto-antibody' had high serum CPR. A considerable amount of CPR appeared in urine. Normal daily excretion of CPR was 1.52 +- 0.55 ..mu..g/kg or 55.1 +- 18.2 ng/mg creatinine. Urine CPR was very low in juvenile-type diabetics, and elevated in patients on corticosteroid treatment. The results confirm that blood and urine CPR are useful measures of the endocrine pancreatic function.

Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.

Science.gov (United States)

Ringh, Mattias; Rosenqvist, Mårten; Hollenberg, Jacob; Jonsson, Martin; Fredman, David; Nordberg, Per; Järnbert-Pettersson, Hans; Hasselqvist-Ax, Ingela; Riva, Gabriel; Svensson, Leif

2015-06-11

Cardiopulmonary resuscitation (CPR) performed by bystanders is associated with increased survival rates among persons with out-of-hospital cardiac arrest. We investigated whether rates of bystander-initiated CPR could be increased with the use of a mobile-phone positioning system that could instantly locate mobile-phone users and dispatch lay volunteers who were trained in CPR to a patient nearby with out-of-hospital cardiac arrest. We conducted a blinded, randomized, controlled trial in Stockholm from April 2012 through December 2013. A mobile-phone positioning system that was activated when ambulance, fire, and police services were dispatched was used to locate trained volunteers who were within 500 m of patients with out-of-hospital cardiac arrest; volunteers were then dispatched to the patients (the intervention group) or not dispatched to them (the control group). The primary outcome was bystander-initiated CPR before the arrival of ambulance, fire, and police services. A total of 5989 lay volunteers who were trained in CPR were recruited initially, and overall 9828 were recruited during the study. The mobile-phone positioning system was activated in 667 out-of-hospital cardiac arrests: 46% (306 patients) in the intervention group and 54% (361 patients) in the control group. The rate of bystander-initiated CPR was 62% (188 of 305 patients) in the intervention group and 48% (172 of 360 patients) in the control group (absolute difference for intervention vs. control, 14 percentage points; 95% confidence interval, 6 to 21; PCPR was associated with significantly increased rates of bystander-initiated CPR among persons with out-of-hospital cardiac arrest. (Funded by the Swedish Heart-Lung Foundation and Stockholm County; ClinicalTrials.gov number, NCT01789554.).

Simple CPR: A randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation.

Science.gov (United States)

Todd, K H; Heron, S L; Thompson, M; Dennis, R; O'Connor, J; Kellermann, A L

1999-12-01

Despite the proven efficacy of cardiopulmonary resuscitation (CPR), only a small fraction of the population knows how to perform it. As a result, rates of bystander CPR and rates of survival from cardiac arrest are low. Bystander CPR is particularly uncommon in the African American community. Successful development of a simplified approach to CPR training could boost rates of bystander CPR and save lives. We conducted the following randomized, controlled study to determine whether video self-instruction (VSI) in CPR results in comparable or better performance than traditional CPR training. This randomized, controlled trial was conducted among congregational volunteers in an African American church in Atlanta, GA. Subjects were randomly assigned to receive either 34 minutes of VSI or the 4-hour American Heart Association "Heartsaver" CPR course. Two months after training, blinded observers used explicit criteria to assess CPR performance in a simulated cardiac arrest setting. A recording manikin was used to measure ventilation and chest compression characteristics. Participants also completed a written test of CPR-related knowledge and attitudes. VSI trainees displayed a comparable level of performance to that achieved by traditional trainees. Observers scored 40% of VSI trainees competent or better in performing CPR, compared with only 16% of traditional trainees (absolute difference 24%, 95% confidence interval 8% to 40%). Data from the recording manikin confirmed these observations. VSI trainees and traditional trainees achieved comparable scores on tests of CPR-related knowledge and attitudes. Thirty-four minutes of VSI can produce CPR of comparable quality to that achieved by traditional training methods. VSI provides a simple, quick, consistent, and inexpensive alternative to traditional CPR instruction, and may be used to extend CPR training to historically underserved populations.

Prediction of Recovery from Coma After CPR

Science.gov (United States)

... to pain. There is good evidence* that myoclonus status epilepticus within the first day after CPR accurately predicts poor recovery from coma. Myoclonus status epilepticus is a constant twitching of muscles, including the ...

Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.

Science.gov (United States)

McDonald, Catherine H; Heggie, James; Jones, Christopher M; Thorne, Christopher J; Hulme, Jonathan

2013-08-01

Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance. 62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. 49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue. Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.

Two-thumb technique is superior to two-finger technique during lone rescuer infant manikin CPR.

Science.gov (United States)

Udassi, Sharda; Udassi, Jai P; Lamb, Melissa A; Theriaque, Douglas W; Shuster, Jonathan J; Zaritsky, Arno L; Haque, Ikram U

2010-06-01

Infant CPR guidelines recommend two-finger chest compression with a lone rescuer and two-thumb with two rescuers. Two-thumb provides better chest compression but is perceived to be associated with increased ventilation hands-off time. We hypothesized that lone rescuer two-thumb CPR is associated with increased ventilation cycle time, decreased ventilation quality and fewer chest compressions compared to two-finger CPR in an infant manikin model. Crossover observational study randomizing 34 healthcare providers to perform 2 min CPR at a compression rate of 100 min(-1) using a 30:2 compression:ventilation ratio comparing two-thumb vs. two-finger techniques. A Laerdal Baby ALS Trainer manikin was modified to digitally record compression rate, compression depth and compression pressure and ventilation cycle time (two mouth-to-mouth breaths). Manikin chest rise with breaths was video recorded and later reviewed by two blinded CPR instructors for percent effective breaths. Data (mean+/-SD) were analyzed using a two-tailed paired t-test. Significance was defined qualitatively as pCPR, but there was no significant difference in percent effective breaths delivered between the two techniques. Two-thumb CPR had 4 fewer delivered compressions per minute, which may be offset by far more effective compression depth and compression pressure compared to two-finger technique. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Does the sex of a simulated patient affect CPR?

Science.gov (United States)

Kramer, Chelsea E; Wilkins, Matthew S; Davies, Jan M; Caird, Jeff K; Hallihan, Gregory M

2015-01-01

While males and females are equally at risk of sudden cardiac arrest (SCA), females are less likely to be resuscitated. Cardiopulmonary Resuscitation (CPR) may be inhibited by socio-cultural norms about exposing female victims' chests. Empirically confirming this hypothesis is limited by lack of patient simulators modeling realistic female physiques. A commercially-available patient simulator was transformed to evaluate how physical attributes of a patient's sex might influence lay participants who were asked to resuscitate a female versus a male during simulated cardiac arrest. Sixty-nine participants consented to be in the study. Participants were randomly assigned to provide CPR and defibrillation as instructed by a commercially-available automated external defibrillator on a patient simulator presented as either a male or female experiencing cardiac arrest. Rescuers removed significantly more clothing from the male than the female, with men removing less clothing from the female. More rescuers' initial hand placements for CPR were centered between the female's breasts compared to the male, on which placement was distributed across the chest towards the nipples. While rescuers had better hand placement for CPR on the female, both men and women rescuers were reluctant to remove the female's clothing, with men significantly more hesitant. Reticence to remove clothing was often articulated relative to social norms during structured interviews. We suggest that using only male simulators will not allow trainees to experience social differences associated with the care of a female simulated patient. Realistic female patient simulators are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls.

Science.gov (United States)

Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette; Folke, Fredrik; Lippert, Freddy

2017-02-01

This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPR prior ) versus during the emergency call following dispatcher-assisted CPR (CPR during ) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPR prior . This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPR prior . The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPR prior group and 65.1% (n=357) in the CPR during group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPR prior and CPR during . Predictors positively associated with CPR prior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPR prior included residential location, solitary bystanders, and bystanders related to the patient. The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Hypofractionated stereotactic radiotherapy (HFSRT) for who grade I anterior clinoid meningiomas (ACM).

Science.gov (United States)

Demiral, Selcuk; Dincoglan, Ferrat; Sager, Omer; Gamsiz, Hakan; Uysal, Bora; Gundem, Esin; Elcim, Yelda; Dirican, Bahar; Beyzadeoglu, Murat

2016-11-01

While microsurgical resection plays a central role in the management of ACMs, extensive surgery may be associated with substantial morbidity particularly for tumors in intimate association with critical structures. In this study, we evaluated the use of HFSRT in the management of ACM. A total of 22 patients with ACM were treated using HFSRT. Frameless image guided volumetric modulated arc therapy (VMAT) was performed with a 6 MV linear accelerator (LINAC). The total dose was 25 Gy delivered in five fractions over five consecutive treatment days. Local control (LC) and progression free survival (PFS) rates were calculated using the Kaplan-Meier method. Common Terminology Criteria for Adverse Events, version 4.0 was used in toxicity grading. Out of the total 22 patients, outcomes of 19 patients with at least 36 months of periodic follow-up were assessed. Median patient age was 40 years old (range 24-77 years old). Median follow-up time was 53 months (range 36-63 months). LC and PFS rates were 100 and 89.4 % at 1 and 3 years, respectively. Only two patients (10.5 %) experienced clinical deterioration during the follow-up period. LINAC-based HFSRT offers high rates of LC and PFS for patients with ACMs.

Training hospital providers in basic CPR skills in Botswana: Acquisition, retention and impact of novel training techniques☆

Science.gov (United States)

Meaney, Peter A.; Sutton, Robert M.; Tsima, Billy; Steenhoff, Andrew P.; Shilkofski, Nicole; Boulet, John R.; Davis, Amanda; Kestler, Andrew M.; Church, Kasey K.; Niles, Dana E.; Irving, Sharon Y.; Mazhani, Loeto; Nadkarni, Vinay M.

2013-01-01

Objective Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p CPR skill retention was significant at 3 (39% vs. 70%, p CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction. PMID:22561463

Representation of deforestation impacts on climate, water, and nutrient cycles in the ACME earth system model

Science.gov (United States)

Cai, X.; Riley, W. J.; Zhu, Q.

2017-12-01

Deforestation causes a series of changes to the climate, water, and nutrient cycles. Employing a state-of-the-art earth system model—ACME (Accelerated Climate Modeling for Energy), we comprehensively investigate the impacts of deforestation on these processes. We first assess the performance of the ACME Land Model (ALM) in simulating runoff, evapotranspiration, albedo, and plant productivity at 42 FLUXNET sites. The single column mode of ACME is then used to examine climate effects (temperature cooling/warming) and responses of runoff, evapotranspiration, and nutrient fluxes to deforestation. This approach separates local effects of deforestation from global circulation effects. To better understand the deforestation effects in a global context, we use the coupled (atmosphere, land, and slab ocean) mode of ACME to demonstrate the impacts of deforestation on global climate, water, and nutrient fluxes. Preliminary results showed that the land component of ACME has advantages in simulating these processes and that local deforestation has potentially large impacts on runoff and atmospheric processes.

Implementation of a mechanical CPR device in a physician staffed HEMS - a prospective observational study.

Science.gov (United States)

Rauch, Simon; Strapazzon, Giacomo; Brodmann, Monika; Fop, Ernst; Masoner, Christian; Rauch, Lydia; Forti, Alessandro; Pietsch, Urs; Mair, Peter; Brugger, Hermann

2018-04-28

In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. Two (11.1%) of the 18 patients survived long term with full neurologic recovery. In seven of eight patients transferred to hospital with ongoing CPR, CPR was ceased in the emergency room without further intervention. Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.

It isn't like this on TV: Revisiting CPR survival rates depicted on popular TV shows.

Science.gov (United States)

Portanova, Jaclyn; Irvine, Krystle; Yi, Jae Yoon; Enguidanos, Susan

2015-11-01

Public perceptions of cardiopulmonary resuscitation (CPR) can be influenced by the media. Nearly two decades ago, a study found that the rates of survival following CPR were far higher in popular TV shows than actual rates. In recent years, major strides toward enhanced education and communication around life sustaining interventions have been made. This study aimed to reassess the accuracy of CPR portrayed by popular medical TV shows. Additionally, we sought to determine whether these shows depicted discussions of care preferences and referenced advance directives. Three trained research assistants independently coded two leading medical dramas airing between 2010 and 2011, Grey's Anatomy and House. Patient characteristics, CPR survival rates, and goals of care discussions were recorded. CPR was depicted 46 times in the 91 episodes, with a survival rate of 69.6%. Among those immediately surviving following CPR, the majority (71.9%) survived to hospital discharge and 15.6% died before discharge. Advance directive discussions only occurred for two patients, and preferences regarding code status (8.7%), intubation (6.5%) and feeding (4.3%) rarely occurred. Both popular TV shows portrayed CPR as more effective than actual rates. Overall, the shows portrayed an immediate survival rate nearly twice that of actual survival rates. Inaccurate TV portrayal of CPR survival rates may misinform viewers and influence care decisions made during serious illness and at end of life. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Transient Inverse Calibration of the Site-Wide Groundwater Flow Model (ACM-2): FY03 Progress Report

International Nuclear Information System (INIS)

Vermeul, Vince R.; Bergeron, Marcel P.; Cole, C R.; Murray, Christopher J.; Nichols, William E.; Scheibe, Timothy D.; Thorne, Paul D.; Waichler, Scott R.; Xie, YuLong

2003-01-01

DOE and PNNL are working to strengthen the technical defensibility of the groundwater flow and transport model at the Hanford Site and to incorporate uncertainty into the model. One aspect of the initiative is developing and using a three-dimensional transient inverse model to estimate the hydraulic conductivities, specific yields, and other parameters using data from Hanford since 1943. The focus of the alternative conceptual model (ACM-2) inverse modeling initiative documented in this report was to address limitations identified in the ACM-1 model, complete the facies-based approach for representing the hydraulic conductivity distribution in the Hanford and middle Ringold Formations, develop the approach and implementation methodology for generating multiple ACMs based on geostatistical data analysis, and develop an approach for inverse modeling of these stochastic ACMs. The primary modifications to ACM-2 transient inverse model include facies-based zonation of Units 1 (Hanford ) and 5 (middle Ringold); an improved approach for handling run-on recharge from upland areas based on watershed modeling results; an improved approach for representing artificial discharges from site operations; and minor changes to the geologic conceptual model. ACM-2 is the first attempt to fully incorporate the facies-based approach to represent the hydrogeologic structure. Further refinement and additional improvements to overall model fit will be realized during future inverse simulations of groundwater flow and transport. In addition, preliminary work was completed on an approach and implementation for generating an inverse modeling of stochastic ACMs. These techniques were applied to assess the uncertainty in the facies-based zonation of the Hanford formation and the geological structure of Ringold mud units. The geostatistical analysis used a preliminary interpretation of the facies-based zonation that was not consistent with that used in ACM-2. Although the overall objective of

Arabidopsis CPR5 independently regulates seed germination and postgermination arrest of development through LOX pathway and ABA signaling.

Directory of Open Access Journals (Sweden)

Guilan Gao

Full Text Available The phytohormone abscisic acid (ABA and the lipoxygenases (LOXs pathway play important roles in seed germination and seedling growth and development. Here, we reported on the functional characterization of Arabidopsis CPR5 in the ABA signaling and LOX pathways. The cpr5 mutant was hypersensitive to ABA in the seed germination, cotyledon greening and root growth, whereas transgenic plants overexpressing CPR5 were insensitive. Genetic analysis demonstrated that CPR5 gene may be located downstream of the ABI1 in the ABA signaling pathway. However, the cpr5 mutant showed an ABA independent drought-resistant phenotype. It was also found that the cpr5 mutant was hypersensitive to NDGA and NDGA treatment aggravated the ABA-induced delay in the seed germination and cotyledon greening. Taken together, these results suggest that the CPR5 plays a regulatory role in the regulation of seed germination and early seedling growth through ABA and LOX pathways independently.

Autolysis of Lactococcus lactis caused by induced overproduction of its major autolysin, AcmA

NARCIS (Netherlands)

Buist, Girbe; Karsens, H; Nauta, A; van Sinderen, D; Venema, G; Kok, J

The optical density of a culture of Lactococcus lactis MG1363 was reduced more than 60% during prolonged stationary phase, Reduction in optical density (autolysis) was almost absent in a culture of an isogenic mutant containing a deletion in the major autolysin gene, acmA. An acmA mutant carrying

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills

OpenAIRE

Wanner, Gregory K.; Osborne, Arayel; Greene, Charlotte H.

2016-01-01

Background Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, r...

Using a serious game to complement CPR instruction in a nurse faculty.

Science.gov (United States)

Boada, Imma; Rodriguez-Benitez, Antonio; Garcia-Gonzalez, Juan Manuel; Olivet, Josep; Carreras, Vicenç; Sbert, Mateu

2015-11-01

Cardiopulmonary resuscitation (CPR) is a first aid key survival technique used to stimulate breathing and keep blood flowing to the heart. Its effective administration can significantly increase the chances of survival for victims of cardiac arrest. LISSA is a serious game designed to complement CPR teaching and also to refresh CPR skills in an enjoyable way. The game presents an emergency situation in a 3D virtual environment and the player has to save the victim applying the CPR actions. In this paper, we describe LISSA and its evaluation in a population composed of 109 nursing undergraduate students enrolled in the Nursing degree of our university. To evaluate LISSA we performed a randomized controlled trial that compares the classical teaching methodology, composed of self-directed learning for theory plus laboratory sessions with a mannequin for practice, with the one that uses LISSA after self-directed learning for theory and before laboratory sessions with a mannequin. From our evaluation we observed that students using LISSA (Group 2 and 3) gave significantly better learning acquisition scores than those following traditional classes (Group 1). To evaluate the differences between students of these groups we performed a paired samples t-test between Group 1 and 2 (μ1=35, 67, μ2=47, 50 and pevaluated student performance of main steps of CPR protocol. Students that use LISSA performed better than the ones that did not use it. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR.

Science.gov (United States)

Stroobants, Jan; Monsieurs, Koenraad; Devriendt, Bart; Dreezen, Christa; Vets, Philippe; Mols, Pierre

2014-12-01

We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR. In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children. A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P attitude towards BCPR positively. Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren.

How to provide around-the-clock CPR certification without losing any sleep.

Science.gov (United States)

Umlauf, M G

1990-01-01

Teaching and reviewing cardiopulmonary resuscitation (CPR) to employees is an important part of the role and responsibilities of hospital nurse educators. The new teaching technologies of computer-assisted instruction and interactive video have been merged into a teaching/learning system that was tested by a rural federal hospital. Over a 2-month period, more than one third of the hospital's staff members were certified in CPR by the standards of the American Heart Association with the learning system. Ease of operation, employee enthusiasm, and easy access to the equipment were identified as important factors that contributed to the successful implementation of this innovative CPR training/review program. Additional evaluation of the system confirmed that the system was efficient, cost effective, and time-saving.

Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators.

Science.gov (United States)

Fernando, Shannon M; Vaillancourt, Christian; Morrow, Stanley; Stiell, Ian G

2018-07-01

Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute. Copyright © 2018 Elsevier B.V. All rights reserved.

Timely activation of budding yeast APCCdh1 involves degradation of its inhibitor, Acm1, by an unconventional proteolytic mechanism.

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Michael Melesse

Full Text Available Regulated proteolysis mediated by the ubiquitin proteasome system is a fundamental and essential feature of the eukaryotic cell division cycle. Most proteins with cell cycle-regulated stability are targeted for degradation by one of two related ubiquitin ligases, the Skp1-cullin-F box protein (SCF complex or the anaphase-promoting complex (APC. Here we describe an unconventional cell cycle-regulated proteolytic mechanism that acts on the Acm1 protein, an inhibitor of the APC activator Cdh1 in budding yeast. Although Acm1 can be recognized as a substrate by the Cdc20-activated APC (APCCdc20 in anaphase, APCCdc20 is neither necessary nor sufficient for complete Acm1 degradation at the end of mitosis. An APC-independent, but 26S proteasome-dependent, mechanism is sufficient for complete Acm1 clearance from late mitotic and G1 cells. Surprisingly, this mechanism appears distinct from the canonical ubiquitin targeting pathway, exhibiting several features of ubiquitin-independent proteasomal degradation. For example, Acm1 degradation in G1 requires neither lysine residues in Acm1 nor assembly of polyubiquitin chains. Acm1 was stabilized though by conditional inactivation of the ubiquitin activating enzyme Uba1, implying some requirement for the ubiquitin pathway, either direct or indirect. We identified an amino terminal predicted disordered region in Acm1 that contributes to its proteolysis in G1. Although ubiquitin-independent proteasome substrates have been described, Acm1 appears unique in that its sensitivity to this mechanism is strictly cell cycle-regulated via cyclin-dependent kinase (Cdk phosphorylation. As a result, Acm1 expression is limited to the cell cycle window in which Cdk is active. We provide evidence that failure to eliminate Acm1 impairs activation of APCCdh1 at mitotic exit, justifying its strict regulation by cell cycle-dependent transcription and proteolytic mechanisms. Importantly, our results reveal that strict cell

Timely Activation of Budding Yeast APCCdh1 Involves Degradation of Its Inhibitor, Acm1, by an Unconventional Proteolytic Mechanism

Science.gov (United States)

Melesse, Michael; Choi, Eunyoung; Hall, Hana; Walsh, Michael J.; Geer, M. Ariel; Hall, Mark C.

2014-01-01

Regulated proteolysis mediated by the ubiquitin proteasome system is a fundamental and essential feature of the eukaryotic cell division cycle. Most proteins with cell cycle-regulated stability are targeted for degradation by one of two related ubiquitin ligases, the Skp1-cullin-F box protein (SCF) complex or the anaphase-promoting complex (APC). Here we describe an unconventional cell cycle-regulated proteolytic mechanism that acts on the Acm1 protein, an inhibitor of the APC activator Cdh1 in budding yeast. Although Acm1 can be recognized as a substrate by the Cdc20-activated APC (APCCdc20) in anaphase, APCCdc20 is neither necessary nor sufficient for complete Acm1 degradation at the end of mitosis. An APC-independent, but 26S proteasome-dependent, mechanism is sufficient for complete Acm1 clearance from late mitotic and G1 cells. Surprisingly, this mechanism appears distinct from the canonical ubiquitin targeting pathway, exhibiting several features of ubiquitin-independent proteasomal degradation. For example, Acm1 degradation in G1 requires neither lysine residues in Acm1 nor assembly of polyubiquitin chains. Acm1 was stabilized though by conditional inactivation of the ubiquitin activating enzyme Uba1, implying some requirement for the ubiquitin pathway, either direct or indirect. We identified an amino terminal predicted disordered region in Acm1 that contributes to its proteolysis in G1. Although ubiquitin-independent proteasome substrates have been described, Acm1 appears unique in that its sensitivity to this mechanism is strictly cell cycle-regulated via cyclin-dependent kinase (Cdk) phosphorylation. As a result, Acm1 expression is limited to the cell cycle window in which Cdk is active. We provide evidence that failure to eliminate Acm1 impairs activation of APCCdh1 at mitotic exit, justifying its strict regulation by cell cycle-dependent transcription and proteolytic mechanisms. Importantly, our results reveal that strict cell-cycle expression profiles

The Plant Immunity Regulating F-Box Protein CPR1 Supports Plastid Function in Absence of Pathogens

Directory of Open Access Journals (Sweden)

Christiane Hedtmann

2017-09-01

Full Text Available The redox imbalanced 6 mutant (rimb6 of Arabidopsis thaliana was isolated in a genetic screening approach for mutants with defects in chloroplast-to-nucleus redox signaling. It has an atypically low activation status of the 2-Cys peroxiredoxin-A promoter in the seedling stage. rimb6 shows wildtype-like germination, seedling development and greening, but slower growth and reduced biomass in the rosette stage. Mapping of the casual mutation revealed that rimb6 carries a single nucleotide polymorphism in the gene encoding CONSTITUTIVE EXPRESSER OF PATHOGENESIS RELATED (PR GENES 1, CPR1 (At4g12560, leading to a premature stop codon. CPR1 is known as a repressor of pathogen signaling and regulator of microtubule organization. Allelism of rimb6 and cpr1 revealed a function of CPR1 in chloroplast stress protection. Expression studies in pathogen signaling mutants demonstrated that CPR1-mediated activation of genes for photosynthesis and chloroplast antioxidant protection is, in contrast to activation of pathogen responses, regulated independently from PAD4-controlled salicylic acid (SA accumulation. We conclude that the support of plastid function is a basic, SA-independent function of CPR1.

Comparative study of numerical schemes of TVD3, UNO3-ACM and optimized compact scheme

Science.gov (United States)

Lee, Duck-Joo; Hwang, Chang-Jeon; Ko, Duck-Kon; Kim, Jae-Wook

1995-01-01

Three different schemes are employed to solve the benchmark problem. The first one is a conventional TVD-MUSCL (Monotone Upwind Schemes for Conservation Laws) scheme. The second scheme is a UNO3-ACM (Uniformly Non-Oscillatory Artificial Compression Method) scheme. The third scheme is an optimized compact finite difference scheme modified by us: the 4th order Runge Kutta time stepping, the 4th order pentadiagonal compact spatial discretization with the maximum resolution characteristics. The problems of category 1 are solved by using the second (UNO3-ACM) and third (Optimized Compact) schemes. The problems of category 2 are solved by using the first (TVD3) and second (UNO3-ACM) schemes. The problem of category 5 is solved by using the first (TVD3) scheme. It can be concluded from the present calculations that the Optimized Compact scheme and the UN03-ACM show good resolutions for category 1 and category 2 respectively.

Metronome Use for Coordination of Breaths and Cardiac Compressions Delivered by Minimally-Trained Caregivers During Two-Person CPR

Science.gov (United States)

Hurst, Victor, IV; West, Sarah; Austin, Paul; Branson, Richard; Beck, George

2005-01-01

Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training over 18 months before each mission, including two-person cardiopulmonary resuscitation (2CPR) as recommended by the American Heart Association (AHA). Recent studies have concluded that the use of metronomic tones improves the coordination of 2CPR by trained clinicians. 2CPR performance data for minimally-trained caregivers has been limited. The goal of this study was to determine whether use of a metronome by minimally-trained caregivers (CMO analogues) would improve 2CPR performance. 20 pairs of minimally-trained caregivers certified in 2CPR via AHA guidelines performed 2CPR for 4 minutes on an instrumented manikin using 3 interventions: 1) Standard 2CPR without a metronome [NONE], 2) Standard 2CPR plus a metronome for coordinating compression rate only [MET], 3) Standard 2CPR plus a metronome for coordinating both the compression rate and ventilation rate [BOTH]. Caregivers were evaluated for their ability to meet the AHA guideline of 32 breaths-240 compressions in 4 minutes. All (100%) caregivers using the BOTH intervention provided the required number of ventilation breaths as compared with the NONE caregivers (10%) and MET caregivers (0%). For compressions, 97.5% of the BOTH caregivers were not successful in meeting the AHA compression guideline; however, an average of 238 compressions of the desired 240 were completed. None of the caregivers were successful in meeting the compression guideline using the NONE and MET interventions. This study demonstrates that use of metronomic tones by minimally-trained caregivers for coordinating both compressions and breaths improves 2CPR performance. Meeting the breath guideline is important to minimize air entering the stomach, thus decreasing the likelihood of gastric aspiration. These results suggest that manifesting a metronome for the ISS may augment the performance of 2CPR on orbit and thus may

Use of whole body CT to detect patterns of CPR-related injuries after sudden cardiac arrest.

Science.gov (United States)

Dunham, Gregor M; Perez-Girbes, Alexandre; Bolster, Ferdia; Sheehan, Kellie; Linnau, Ken F

2017-11-09

We have recently implemented a dedicated sudden cardiac arrest (SCA) - whole-body computed tomography (WBCT) protocol to evaluate SCA patients with return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR). The aim of this study is to evaluate the number and pattern of CPR-related injuries in ROSC patients with SCA-WBCT. Single-centre retrospective review of 39 patients (13 female; 20 male, mean age 51.8 years) with non-traumatic, out-of-hospital SCA and ROSC and evaluation with dedicated SCA-WBCT over a 10-month period. In-hospital mortality was 54%. CPR-related injuries were detected in 85% (33/39). Chest injuries were most common on WBCT: 85% (33) subjects had rib fractures (mean of 8.5 fractures/subject); 31% (12) sternal fractures; 13% (5) mediastinal haematoma; 10% (4) pneumothorax; 8% (3) pneumomediastinum and 3% (1) haemothorax. Three subjects (8%) had abdominal injuries on WBCT, including one hepatic haematoma with active haemorrhage. CPR-related injuries on WBCT after ROSC are common, with serial rib fractures detected most commonly. An unexpectedly high rate of abdominal injuries was detected on SCA-WBCT. Radiologists need to be attuned to the spectrum of CPR-related injuries in WBCT, including abdominal injuries and subtle rib fractures. • CPR frequently causes injuries. • Radiologists should be aware of the spectrum of CPR related injuries. • Rib fractures are frequent and radiologic findings often subtle. • Clinically unexpected abdominal injuries may be present.

77 FR 74278 - Proposed Information Collection (Internet Student CPR Web Registration Application); Comment Request

Science.gov (United States)

2012-12-13

... (Internet Student CPR Web Registration Application); Comment Request AGENCY: Veterans Health Administration.... Title: Internet Student CPR Web Registration Application, VA Form 10-0468. OMB Control Number: 2900-0746... Minneapolis VA Medical Center Education Service. Students will be able to identify and register for a training...

Use of impedance threshold device in conjunction with our novel adhesive glove device for ACD-CPR does not result in additional chest decompression.

Science.gov (United States)

Shih, Andre; Udassi, Sharda; Porvasnik, Stacy L; Lamb, Melissa A; Badugu, Srinivasarao; Venkata, Giridhar Kaliki; Lopez-Colon, Dalia; Haque, Ikram U; Zaritsky, Arno L; Udassi, Jai P

2013-10-01

To evaluate the hemodynamic effects of using an adhesive glove device (AGD) to perform active compression-decompression CPR (AGD-CPR) in conjunction with an impedance threshold device (ITD) in a pediatric cardiac arrest model. Controlled, randomized animal study. In this study, 18 piglets were anesthetized, ventilated, and continuously monitored. After 3min of untreated ventricular fibrillation, animals were randomized (6/group) to receive either standard CPR (S-CPR), active compression-decompression CPR via adhesive glove device (AGD-CPR) or AGD-CPR along with an ITD (AGD-CPR+ITD) for 2min at 100-120compressions/min. AGD is delivered using a fingerless leather glove with a Velcro patch on the palmer aspect and the counter Velcro patch adhered to the pig's chest. Data (mean±SD) were analyzed using one-way ANOVA with pair wise multiple comparisons to assess differences between groups. p-Value≤0.05 was considered significant. Both AGD-CPR and AGD-CPR+ITD groups produced lower intrathoracic pressure (IttP, mmHg) during decompression phase (-13.4±6.7, p=0.01 and -11.9±6.5, p=0.01, respectively) in comparison to S-CPR (-0.3±4.2). Carotid blood flow (CBF, % of baseline mL/min) was higher in AGD-CPR and AGD-CPR+ITD (respectively 64.3±47.3%, p=0.03 and 67.5±33.1%, p=0.04) as compared with S-CPR (29.1±12.5%). Coronary perfusion pressure (CPP, mmHg) was higher in AGD-CPR and AGD-CPR+ITD (respectively 19.7±4.6, p=0.04 and 25.6±12.1, p=0.02) when compared to S-CPR (9.6±9.1). There was no statistically significant difference between AGD-CPR and AGD-CPR+ITD groups with reference to intra-thoracic pressure, carotid blood flow and coronary perfusion pressure. Active compression decompression delivered by this simple and inexpensive adhesive glove device resulted in improved cerebral blood flow and coronary perfusion pressure. There was no statistically significant added effect of ITD use along with AGD-CPR on the decompression of the chest. Copyright © 2013 Elsevier

Hospital implementation of resuscitation guidelines and review of CPR training programmes: a nationwide study.

Science.gov (United States)

Schmidt, Anders S; Lauridsen, Kasper G; Adelborg, Kasper; Løfgren, Bo

2016-06-01

This study aimed to investigate cardiopulmonary resuscitation (CPR) guideline implementation and CPR training in hospitals. This nationwide study included mandatory resuscitation protocols from each Danish hospital. Protocols were systematically reviewed for adherence to the European Resuscitation Council (ERC) 2010 guidelines and CPR training in each hospital. Data were included from 45 of 47 hospitals. Adherence to the ERC basic life support (BLS) algorithm was 49%, whereas 63 and 58% of hospitals adhered to the recommended chest compression depth and rate. Adherence to the ERC advanced life support (ALS) algorithm was 81%. Hospital BLS course duration was [median (interquartile range)] 2.3 (1.5-2.5) h, whereas ALS course duration was 4.0 (2.5-8.0) h. Implementation of ERC 2010 guidelines on BLS is limited in Danish hospitals 2 years after guideline publication, whereas the majority of hospitals adhere to the ALS algorithm. CPR training differs among hospitals.

An Unexpected Location of the Arginine Catabolic Mobile Element (ACME) in a USA300-Related MRSA Strain

DEFF Research Database (Denmark)

Damkjær Bartels, Mette; Hansen, Lars H.; Boye, Kit

2011-01-01

In methicillin resistant Staphylococcus aureus (MRSA), the arginine catabolic mobile element (ACME) was initially described in USA300 (t008-ST8) where it is located downstream of the staphylococcal cassette chromosome mec (SCCmec). A common health-care associated MRSA in Copenhagen, Denmark (t024......-ST8) is clonally related to USA300 and is frequently PCR positive for the ACME specific arcA-gene. This study is the first to describe an ACME element upstream of the SCCmec in MRSA. By traditional SCCmec typing schemes, the SCCmec of t024-ST8 strain M1 carries SCCmec IVa, but full sequencing...... of SCCmec, M1 had two new DR between the orfX gene and the J3 region of the SCCmec. The region between the orfX DR (DR1) and DR2 contained the ccrAB4 genes. An ACME II-like element was located between DR2 and DR3. The entire 26,468 bp sequence between DR1 and DR3 was highly similar to parts of the ACME...

Production of a highly active, soluble form of the cytochrome P450 reductase (CPR A) from Candida tropicalis

Science.gov (United States)

Donnelly, Mark

2006-08-01

The present invention provides soluble cytochrome p450 reductase (CPR) proteins from Candida sp. having an altered N-terminal region which results in reduced hydrophobicity of the N-terminal region. Also provided are host cells comprising the subject soluble CPR proteins. In addition, the present invention provides nucleotide and corresponding amino acid sequences for soluble CPR proteins and vectors comprising the nucleotide sequences. Methods for producing a soluble CPR, for increasing production of a dicarboxylic acid, and for detecting a cytochrome P450 are also provided.

The impact of CPR and AED training on healthcare professionals' self-perceived attitudes to performing resuscitation

Directory of Open Access Journals (Sweden)

Källestedt Marie-Louise

2012-04-01

Full Text Available Abstract Background Healthcare professionals have shown concern about performing mouth-to-mouth ventilation due to the risks to themselves with the procedure. However, little is known about healthcare professionals' fears and attitudes to start CPR and the impact of training. Objective To examine whether there were any changes in the attitudes among healthcare professionals to performing CPR from before to after training. Methods Healthcare professionals from two Swedish hospitals were asked to answer a questionnaire before and after training. The questions were relating to physical and mental discomfort and attitudes to CPR. Statistical analysis used was generalized McNemar's test. Results Overall, there was significant improvement in 10 of 11 items, reflecting various aspects of attitudes to CPR. All groups of health care professionals (physicians, nurses, assistant nurses, and "others" = physiotherapists, occupational therapists, social welfare officers, psychologists, biomedical analysts felt more secure in CPR knowledge after education. In other aspects, such as anxiety prior to a possible cardiac arrest, only nurses and assistant nurses improved. The concern about being infected, when performing mouth to mouth ventilation, was reduced with the most marked reduction in physicians (75%; P Conclusion In this hospital-based setting, we found a positive outcome of education and training in CPR concerning healthcare professionals' attitudes to perform CPR. They felt more secure in their knowledge of cardiopulmonary resuscitation. In some aspects of attitudes to resuscitation nurses and assistant nurses appeared to be the groups that were most markedly influenced. The concern of being infected by a disease was low.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

Science.gov (United States)

Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

2009-05-01

Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Preliminary proceedings of the 2001 ACM SIGPLAN Haskell workshop

NARCIS (Netherlands)

Hinze, R.

2001-01-01

This volume contains the preliminary proceedings of the 2001 ACM SIGPLAN Haskell Workshop, which was held on 2nd September 2001 in Firenze, Italy. The final proceedings will published by Elsevier Science as an issue of Electronic Notes in Theoretical Computer Science (Volume 59). The

Decarbonylated cyclophilin A Cpr1 protein protects Saccharomyces cerevisiae KNU5377Y when exposed to stress induced by menadione.

Science.gov (United States)

Kim, Il-Sup; Jin, Ingnyol; Yoon, Ho-Sung

2011-01-01

Cyclophilins are conserved cis-trans peptidyl-prolyl isomerase that are implicated in protein folding and function as molecular chaperones. The accumulation of Cpr1 protein to menadione in Saccharomyces cerevisiae KNU5377Y suggests a possibility that this protein may participate in the mechanism of stress tolerance. Stress response of S. cerevisiae KNU5377Y cpr1Δ mutant strain was investigated in the presence of menadione (MD). The growth ability of the strain was confirmed in an oxidant-supplemented medium, and a relationship was established between diminishing levels of cell rescue enzymes and MD sensitivity. The results demonstrate the significant effect of CPR1 disruption in the cellular growth rate, cell viability and morphology, and redox state in the presence of MD and suggest the possible role of Cpr1p in acquiring sensitivity to MD and its physiological role in cellular stress tolerance. The in vivo importance of Cpr1p for antioxidant-mediated reactive oxygen species (ROS) neutralization and chaperone-mediated protein folding was confirmed by analyzing the expression changes of a variety of cell rescue proteins in a CPR1-disrupted strain. The cpr1Δ to the exogenous MD showed reduced expression level of antioxidant enzymes, molecular chaperones, and metabolic enzymes such as nicotinamide adenine dinucleotide phosphate (NADPH)- or adenosine triphosphate (ATP)-generating systems. More importantly, it was shown that cpr1Δ mutant caused imbalance in the cellular redox homeostasis and increased ROS levels in the cytosol as well as mitochondria and elevated iron concentrations. As a result of excess ROS production, the cpr1Δ mutant provoked an increase in oxidative damage and a reduction in antioxidant activity and free radical scavenger ability. However, there was no difference in the stress responses between the wild-type and the cpr1Δ mutant strains derived from S. cerevisiae BY4741 as a control strain under the same stress. Unlike BY4741, KNU5377Y Cpr1

Functions of standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival.

Science.gov (United States)

Fanshan, Meng; Lin, Zhao; Wenqing, Liu; Chunlei, Lu; Yongqiang, Liu; Naiyi, Li

2013-01-01

Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel training in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. As one of the most important skills mastered by medical volunteers serving for Mt. Taishan International Mounting Festival, we randomly selected some of them to evaluate the quality of CPR operation and compared the result with that of the untrained doctors and nurses. In order to evaluate the functions of repeating standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival, their performance qualities of CPR were compared with those of the untrained medical workers working in emergency departments of hospitals in Taian. The CPR performance qualities of 52 medical volunteers (Standard Training Group), who had continually taken part in standard CPR technical training for six months, were tested at random and were compared with those of 68 medical workers (Compared Group) working in emergency departments of hospitals in Taian who hadn't attended CPR training within a year. The QCPR 3535 monitor (provided by Philips Company) was used to measure the standard degree of single simulated CPR performance, including the chest compression depth, frequency, released pressure between compressions and performance time of compression and ventilation, the results of which were recorded in the table and the number of practical compression per minute was calculated. The data were analyzed by x2 Test and t Test. The factors which would influence CPR performance, including gender, age, placement, hand skill, posture of compression and frequency of training, were classified and given parameters, and were put to Logistic repression analysis. The CPR performance qualities of volunteers were much higher than those of the compared group. The overall pass rates

Acemetacin cocrystals and salts: structure solution from powder X-ray data and form selection of the piperazine salt

Directory of Open Access Journals (Sweden)

Palash Sanphui

2014-03-01

Full Text Available Acemetacin (ACM is a non-steroidal anti-inflammatory drug (NSAID, which causes reduced gastric damage compared with indomethacin. However, acemetacin has a tendency to form a less soluble hydrate in the aqueous medium. We noted difficulties in the preparation of cocrystals and salts of acemetacin by mechanochemical methods, because this drug tends to form a hydrate during any kind of solution-based processing. With the objective to discover a solid form of acemetacin that is stable in the aqueous medium, binary adducts were prepared by the melt method to avoid hydration. The coformers/salt formers reported are pyridine carboxamides [nicotinamide (NAM, isonicotinamide (INA, and picolinamide (PAM], caprolactam (CPR, p-aminobenzoic acid (PABA, and piperazine (PPZ. The structures of an ACM–INA cocrystal and a binary adduct ACM–PABA were solved using single-crystal X-ray diffraction. Other ACM cocrystals, ACM–PAM and ACM–CPR, and the piperazine salt ACM–PPZ were solved from high-resolution powder X-ray diffraction data. The ACM–INA cocrystal is sustained by the acid...pyridine heterosynthon and N—H...O catemer hydrogen bonds involving the amide group. The acid...amide heterosynthon is present in the ACM–PAM cocrystal, while ACM–CPR contains carboxamide dimers of caprolactam along with acid–carbonyl (ACM hydrogen bonds. The cocrystals ACM–INA, ACM–PAM and ACM–CPR are three-dimensional isostructural. The carboxyl...carboxyl synthon in ACM–PABA posed difficulty in assigning the position of the H atom, which may indicate proton disorder. In terms of stability, the salts were found to be relatively stable in pH 7 buffer medium over 24 h, but the cocrystals dissociated to give ACM hydrate during the same time period. The ACM–PPZ salt and ACM–nicotinamide cocrystal dissolve five times faster than the stable hydrate form, whereas the ACM–PABA adduct has 2.5 times faster dissolution rate. The pharmaceutically acceptable

The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based multicentre study.

Science.gov (United States)

Cheng, Adam; Lin, Yiqun; Nadkarni, Vinay; Wan, Brandi; Duff, Jonathan; Brown, Linda; Bhanji, Farhan; Kessler, David; Tofil, Nancy; Hecker, Kent; Hunt, Elizabeth A

2018-01-01

We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality. We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use. One hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, pstep stool use (pStep stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.

Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

Science.gov (United States)

Straney, Lahn D; Bray, Janet E; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

2015-01-01

Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia. We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

ACME: A scalable parallel system for extracting frequent patterns from a very long sequence

KAUST Repository

Sahli, Majed

2014-10-02

Modern applications, including bioinformatics, time series, and web log analysis, require the extraction of frequent patterns, called motifs, from one very long (i.e., several gigabytes) sequence. Existing approaches are either heuristics that are error-prone, or exact (also called combinatorial) methods that are extremely slow, therefore, applicable only to very small sequences (i.e., in the order of megabytes). This paper presents ACME, a combinatorial approach that scales to gigabyte-long sequences and is the first to support supermaximal motifs. ACME is a versatile parallel system that can be deployed on desktop multi-core systems, or on thousands of CPUs in the cloud. However, merely using more compute nodes does not guarantee efficiency, because of the related overheads. To this end, ACME introduces an automatic tuning mechanism that suggests the appropriate number of CPUs to utilize, in order to meet the user constraints in terms of run time, while minimizing the financial cost of cloud resources. Our experiments show that, compared to the state of the art, ACME supports three orders of magnitude longer sequences (e.g., DNA for the entire human genome); handles large alphabets (e.g., English alphabet for Wikipedia); scales out to 16,384 CPUs on a supercomputer; and supports elastic deployment in the cloud.

Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR.

Science.gov (United States)

Spiro, J R; White, S; Quinn, N; Gubran, C J; Ludman, P F; Townend, J N; Doshi, S N

2015-02-01

Poor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Firstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). Scenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15-96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, pCPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. A-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The use of CPR data in fisheries research

NARCIS (Netherlands)

Corten, A.A.H.M.; Lindley, J.A.

2003-01-01

The Continuous Plankton Recorder (CPR) survey was initiated partly to contribute to our understanding of the variability of fish stocks and as a potential method for predicting fish distributions from the abundance and composition of the plankton. The latter objective has been superseded by

Communication for Policy Research (CPR) South-South | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

... of telecom researchers : measures and messages relevant to CPRsouth. Download PDF. Reports. CPRafrica 2010-2012 : a comparative analysis vis-í -vis TPRC, EuroCPR, and CPRsouth/africa. Download PDF. Reports. Communication for Policy Research Africa (CPRafrica) (South-South in contract) : final technical and ...

Evaluation of Cardiopulmonary Resuscitation (CPR) for Patient Outcomes and their Predictors

Science.gov (United States)

Singh, Swati; Grewal, Anju; Gautam, Parshotam L; Luthra, Neeru; Tanwar, Gayatri; Kaur, Amarpreet

2016-01-01

Introduction Cardiac arrest continues to be a common cause of in-hospital deaths. Even small improvements in survival can translate into thousands of lives saved every year. Aim The aim of our prospective observational study was to elicit the outcomes and predictors of in-hospital cardiopulmonary resuscitation among adult patients. Settings and Design All in-hospital adult patients (age >14) who suffered cardiac arrest & were attended by a Code Blue Team between 1st January 2012 & 30th April 2013 were part of the study. Materials and Methods The cardiopulmonary resuscitation (CPR) was assessed in terms of: Response time, Presenting initial rhythm, Time to first defibrillation, Duration of CPR and Outcome (Return of spontaneous circulation (ROSC), Glasgow outcome scale (GOS) at discharge). Statistical Analysis Age, GOS and mean response time were analysed using t-test and ANOVA. Logistic regression was applied to determine the significance of the various factors in determining mortality. Results ROSC was achieved in 44% of a total of 127 patients included in our study. Asystole/Pulseless electrical activity (PEA) was the most common presenting rhythm (87.5%). The survival to discharge was seen in 7.1% patients of whom only 3.9% patients had good neurological outcome. Regression and survival analysis depicted achievement of ROSC during CPR, absence of co-morbidities and shorter response time of code blue team as predictors of good outcome. Conclusion We found poor outcome of CPR after in-hospital cardiac arrest. This was mainly attributed to an initial presenting rhythm of Asystole/PEA in most cases and delayed response times. PMID:26894150

Accident Analysis of Chinese CPR1000 in Response to Station Blackout

Energy Technology Data Exchange (ETDEWEB)

Kim, Juyoul [FNC Technology Co., Yongin (Korea, Republic of); Cilliers, Anthonie [North-West University, Potchefstroom (South Africa)

2016-10-15

Stress tests required evaluation of the consequences of loss of safety functions from any initiating event (e.g., earthquake or flooding) causing loss of electrical power, including station blackout (SBO). The SBO scenario involves a loss of offsite power, failure of the redundant emergency diesel generators, failure of alternate current (AC) power restoration and the eventual degradation of the reactor coolant pump (RCP) seals resulting in a long term loss of coolant. Using PCTRAN/CPR1000, this study analyses the station blackout on a Chinese CPR1000 which is the most representative type reactor in terms of number of reactors, operating period, power capacity and geological distance from Korean Peninsula. Both the physical effects of the accidents as well as the releases of radioisotopes are calculated and discussed. Station blackout simulation was conducted in this study. The resulting effects seen are consistent with other stress test station blackout tests used utilizing licensed simulation codes. An exact comparison is however not possible as the plants on which the simulations was done vary greatly and the limitations of availability to Chinese FSAR. PCTRAN/CPR1000 is an extremely useful simulation package that provides engineers and scientists very accurate feedback to how a nuclear power plant would react as a whole under various plant conditions. It is able to do this extremely fast as well. As a training tool PCTRAN/CPR1000 provides hands-on experience with many of the primary plant operations and develops an intuitive understanding of the plant.

Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.

Science.gov (United States)

Geri, Guillaume; Fahrenbruch, Carol; Meischke, Hendrika; Painter, Ian; White, Lindsay; Rea, Thomas D; Weaver, Marcia R

2017-06-01

Bystander cardiopulmonary resuscitation (CPR) is associated with a greater likelihood of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA). However the long-term survival benefits in relationship to cost have not been well-studied. We evaluated bystander CPR, hospital-based costs, and long-term survival following OHCA in order to assess the potential cost-effectiveness of bystander CPR. We conducted a retrospective cohort study of consecutive EMS-treated OHCA patients >=12years who arrested prior to EMS arrival and outside a nursing facility between 2001 and 2010 in greater King County, WA. Utstein-style information was obtained from the EMS registry, including 5-year survival. Costs from the OHCA hospitalization were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Cost effectiveness was based on hospital costs divided by quality-adjusted life years (QALYs) for a 5-year follow-up window. Of the 4448 eligible patients, 18.5% (n=824) were discharged alive from hospital and 12.1% (n=539) were alive at 5 years. Five-year survival was higher in patients who received bystander CPR (14.3% vs. 8.7%, pbystander CPR. The average (SD) total cost of the initial acute care hospitalization was USD 19,961 (40,498) for all admitted patients and USD 75,175 (52,276) for patients alive at year 5. The incremental cost-effectiveness ratio associated with bystander CPR was USD 48,044 per QALY. Based on this population-based investigation, bystander CPR was positively associated with long-term survival and appears cost-effective. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival

DEFF Research Database (Denmark)

Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette

2017-01-01

BACKGROUND: This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC...... and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS: The study...... included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPRpriorgroup and 65.1% (n=357) in the CPRduringgroup. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPRpriorand CPRduring...

Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR randomized trial in primary care

Directory of Open Access Journals (Sweden)

Wisnivesky Juan

2011-09-01

Full Text Available Abstract Background Clinical prediction rules (CPRs represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149 were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters and chest x-rays (pneumonia iCPR only between intervention and control providers. Discussion Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative

Proceedings of the ACM SIGIR Workshop ''Searching Spontaneous Conversational Speech''

NARCIS (Netherlands)

de Jong, Franciska M.G.; Oard, Douglas; Ordelman, Roeland J.F.; Raaijmakers, Stephan

2007-01-01

The Proceedings contain the contributions to the workshop on Searching Spontaneous Conversational Speech organized in conjunction with the 30th ACM SIGIR, Amsterdam 2007. The papers reflect some of the emerging focus areas and cross-cutting research topics, together addressing evaluation metrics,

Automated software system for checking the structure and format of ACM SIG documents

Science.gov (United States)

Mirza, Arsalan Rahman; Sah, Melike

2017-04-01

Microsoft (MS) Office Word is one of the most commonly used software tools for creating documents. MS Word 2007 and above uses XML to represent the structure of MS Word documents. Metadata about the documents are automatically created using Office Open XML (OOXML) syntax. We develop a new framework, which is called ADFCS (Automated Document Format Checking System) that takes the advantage of the OOXML metadata, in order to extract semantic information from MS Office Word documents. In particular, we develop a new ontology for Association for Computing Machinery (ACM) Special Interested Group (SIG) documents for representing the structure and format of these documents by using OWL (Web Ontology Language). Then, the metadata is extracted automatically in RDF (Resource Description Framework) according to this ontology using the developed software. Finally, we generate extensive rules in order to infer whether the documents are formatted according to ACM SIG standards. This paper, introduces ACM SIG ontology, metadata extraction process, inference engine, ADFCS online user interface, system evaluation and user study evaluations.

Difference of reactor core nuclear instrument between AP1000 and CPR1000

International Nuclear Information System (INIS)

Zhang Shidong; Zhou Can; Deng Tian

2014-01-01

As a typical generation Ⅲ reactor technique, the AP1000 applies many advanced design concepts, simplifies the design, reduces equipment quantities, and thus enhances systematic reliability. The comparison of reactor core measurement instrument differences between AP1000 and CPR1000 from several aspects was involved in the paper. Through analysis and comparison of these differences, passive design concepts and characteristics of AP1000 are familiarized, and conveniences for staffs engaged in CPR1000 to learn and grasp AP1000 technique are provided. It is useful in reactor start up, operation and maintenance. (authors)

Molecular characteristics of clinical methicillin-resistant Staphylococcus pseudintermedius harboring arginine catabolic mobile element (ACME) from dogs and cats.

Science.gov (United States)

Yang, Ching; Wan, Min-Tao; Lauderdale, Tsai-Ling; Yeh, Kuang-Sheng; Chen, Charles; Hsiao, Yun-Hsia; Chou, Chin-Cheng

2017-06-01

This study aimed to investigate the presence of arginine catabolic mobile element (ACME) and its associated molecular characteristics in methicillin-resistant Staphylococcus pseudintermedius (MRSP). Among the 72 S. pseudintermedius recovered from various infection sites of dogs and cats, 52 (72.2%) were MRSP. ACME-arcA was detected commonly (69.2%) in these MRSP isolates, and was more frequently detected in those from the skin than from other body sites (P=0.047). There was a wide genetic diversity among the ACME-arcA-positive MRSP isolates, which comprised three SCCmec types (II-III, III and V) and 15 dru types with two predominant clusters (9a and 11a). Most MRSP isolates were multidrug-resistant. Since S. pseudintermedius could serve as a reservoir of ACME, further research on this putative virulence factor is recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cardiopulmonary Re-Immonation (CPR: How Long Should A Person Insist On Performing The Maneuvers?

Directory of Open Access Journals (Sweden)

Henrique José Bandeira Formiga

2017-04-01

Full Text Available Objetive: The study had the aim to describe the exact moment of interrupting CPR maneuvers in patients in CRP situations. Method: This is an exploratory and descriptive research, with quantitative character and approach. It was performed with 67 (seventy-seven nurses from a Regional Hospital, who were informed about the objectives of the same. There were included those who act in direct patient care; of effective position and contracted in the service; And with more than one (1 year of training. The instrument used for data collection was a questionnaire, previously elaborated, containing objective, subjective and non-inductive questions, which allowed the informant to answer the data pertinent to the study. It was found that the majority of the interviewees were women, aged between 31 and 35 years, specialists, with more than 4 years of training and 3 years of service, medical / surgical clinic attendees, and without reports of training. Results: They demonstrated they know the exact timing of CPR maneuvers but reported that they would not apply CPR in situations in which the patient had cadaveric stiffness, decomposition, crushing of the skull and thorax, or a CPA report of more than 20 minutes. Faced with conditions in which the team could decide not to perform CPR, they reported not applying CPR in the vegetative state, in terminal or chronic patients. Conclusion: Therefore, they conclude that the said moment of interrupting the protocol is determined in a personal and ethical way, that is, by the individuality of each situation. Keywords: Nurses. Cardiovascular Stop. Cardiopulmonary resuscitation.

Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients: A prospective observational study.

Science.gov (United States)

Yücel, Hasan; Türkdoğan, Kenan Ahmet; Zorlu, Ali; Aydın, Hüseyin; Kurt, Recep; Yılmaz, Mehmet Birhan

2015-09-01

Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest (CA). Many clinical and laboratory parameters, such as the presence of asystole, out-of-hospital CPR, and duration of cardiac arrest, are associated with failed CPR in patients with CA. Asystole is a state of no cardiac electrical activity, along with the absence of contractions of the myocardium and absence of cardiac output. Oxidative stress index (OSI), which is the ratio of total oxidative status to total antioxidant status, increases by ischemia-reperfusion injury. We investigated whether OSI levels in patients with CA could predict early mortality after CPR. This study has a prospective observational cohort design. Five patients with a history of cancer, four patients who developed hemolysis in their blood, six patients who were transferred to our hospital from other hospitals, and six patients in whom blood samples for OSI could not be stored properly were excluded. Finally, a total of 90 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n=46) and a failed group (n=44). Comparisons between groups were performed using one-way ANOVA with post hoc analysis by Tukey's HSD or independent samples t-test and the Kruskal-Wallis tests or Mann- Whitney U test for normally and abnormally distributed data, respectively. Also, we used chi-square test, Spearman's correlation test, univariate and multible logistic regression analyses, and receiver operator characteristic curve analysis. OSI was 3.0±4.0, 5.6±4.3, and 8.7±3.8 in the control group, the successful CPR group, and the failed CPR group, respectively (pOSI on admission, ischemia-modified albumin, presence of asystole, mean duration of cardiac arrest, out-of-hospital CPR, pH, and potassium and sodium levels were

AcmB Is an S-Layer-Associated β-N-Acetylglucosaminidase and Functional Autolysin in Lactobacillus acidophilus NCFM.

Science.gov (United States)

Johnson, Brant R; Klaenhammer, Todd R

2016-09-15

Autolysins, also known as peptidoglycan hydrolases, are enzymes that hydrolyze specific bonds within bacterial cell wall peptidoglycan during cell division and daughter cell separation. Within the genome of Lactobacillus acidophilus NCFM, there are 11 genes encoding proteins with peptidoglycan hydrolase catalytic domains, 9 of which are predicted to be functional. Notably, 5 of the 9 putative autolysins in L. acidophilus NCFM are S-layer-associated proteins (SLAPs) noncovalently colocalized along with the surface (S)-layer at the cell surface. One of these SLAPs, AcmB, a β-N-acetylglucosaminidase encoded by the gene lba0176 (acmB), was selected for functional analysis. In silico analysis revealed that acmB orthologs are found exclusively in S-layer- forming species of Lactobacillus Chromosomal deletion of acmB resulted in aberrant cell division, autolysis, and autoaggregation. Complementation of acmB in the ΔacmB mutant restored the wild-type phenotype, confirming the role of this SLAP in cell division. The absence of AcmB within the exoproteome had a pleiotropic effect on the extracellular proteins covalently and noncovalently bound to the peptidoglycan, which likely led to the observed decrease in the binding capacity of the ΔacmB strain for mucin and extracellular matrices fibronectin, laminin, and collagen in vitro These data suggest a functional association between the S-layer and the multiple autolysins noncovalently colocalized at the cell surface of L. acidophilus NCFM and other S-layer-producing Lactobacillus species. Lactobacillus acidophilus is one of the most widely used probiotic microbes incorporated in many dairy foods and dietary supplements. This organism produces a surface (S)-layer, which is a self-assembling crystalline array found as the outermost layer of the cell wall. The S-layer, along with colocalized associated proteins, is an important mediator of probiotic activity through intestinal adhesion and modulation of the mucosal immune

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study.

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Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Braut, Geir Sverre; Søreide, Eldar

2016-05-25

Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers. Published by the BMJ Publishing Group

A functional collagen adhesin gene, acm, in clinical isolates of Enterococcus faecium correlates with the recent success of this emerging nosocomial pathogen.

Science.gov (United States)

Nallapareddy, Sreedhar R; Singh, Kavindra V; Okhuysen, Pablo C; Murray, Barbara E

2008-09-01

Enterococcus faecium recently evolved from a generally avirulent commensal into a multidrug-resistant health care-associated pathogen causing difficult-to-treat infections, but little is known about the factors responsible for this change. We previously showed that some E. faecium strains express a cell wall-anchored collagen adhesin, Acm. Here we analyzed 90 E. faecium isolates (99% acm(+)) and found that the Acm protein was detected predominantly in clinically derived isolates, while the acm gene was present as a transposon-interrupted pseudogene in 12 of 47 isolates of nonclinical origin. A highly significant association between clinical (versus fecal or food) origin and collagen adherence (P Acm detected by whole-cell enzyme-linked immunosorbent assay and flow cytometry. Thirty-seven of 41 sera from patients with E. faecium infections showed reactivity with recombinant Acm, while only 4 of 30 community and hospitalized patient control group sera reacted (P Acm were present in all 14 E. faecium endocarditis patient sera. Although pulsed-field gel electrophoresis indicated that multiple strains expressed collagen adherence, multilocus sequence typing demonstrated that the majority of collagen-adhering isolates, as well as 16 of 17 endocarditis isolates, are part of the hospital-associated E. faecium genogroup referred to as clonal complex 17 (CC17), which has emerged globally. Taken together, our findings support the hypothesis that Acm has contributed to the emergence of E. faecium and CC17 in nosocomial infections.

Application of Calibrated Peer Review (CPR) Writing Assignments to Enhance Experiments with an Environmental Chemistry Focus

Science.gov (United States)

Margerum, Lawrence D.; Gulsrud, Maren; Manlapez, Ronald; Rebong, Rachelle; Love, Austin

2007-01-01

The browser-based software program, Calibrated Peer Review (CPR) developed by the Molecular Science Project enables instructors to create structured writing assignments in which students learn by writing and reading for content. Though the CPR project covers only one experiment in general chemistry, it might provide lab instructors with a method…

Corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model.

Science.gov (United States)

Eichhorn, S; Mendoza Garcia, A; Polski, M; Spindler, J; Stroh, A; Heller, M; Lange, R; Krane, M

2017-06-01

The provision of sufficient chest compression is among the most important factors influencing patient survival during cardiopulmonary resuscitation (CPR). One approach to optimize the quality of chest compressions is to use mechanical-resuscitation devices. The aim of this study was to compare a new device for chest compression (corpuls cpr) with an established device (LUCAS II). We used a mechanical thorax model consisting of a chest with variable stiffness and an integrated heart chamber which generated blood flow dependent on the compression depth and waveform. The method of blood-flow generation could be changed between direct cardiac-compression mode and thoracic-pump mode. Different chest-stiffness settings and compression modes were tested to generate various blood-flow profiles. Additionally, an endurance test at high stiffness was performed to measure overall performance and compression consistency. Both resuscitation machines were able to compress the model thorax with a frequency of 100/min and a depth of 5 cm, independent of the chosen chest stiffness. Both devices passed the endurance test without difficulty. The corpuls cpr device was able to generate about 10-40% more blood flow than the LUCAS II device, depending on the model settings. In most scenarios, the corpuls cpr device also generated a higher blood pressure than the LUCAS II. The peak compression forces during CPR were about 30% higher using the corpuls cpr device than with the LUCAS II. In this study, the corpuls cpr device had improved blood flow and pressure outcomes than the LUCAS II device. Further examination in an animal model is required to prove the findings of this preliminary study.

CPR performance in the presence of audiovisual feedback or football shoulder pads.

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Tanaka, Shota; Rodrigues, Wayne; Sotir, Susan; Sagisaka, Ryo; Tanaka, Hideharu

2017-01-01

The initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions. Six basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP. CPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4-6.1) cm, 114(96-131) cpm; BLS-EMS: 5.4 (4.1-6.4) cm, 112(99-131) cpm; ACLS-EMS: 6.4 (5.7-6.7) cm, 138(113-140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9-49.2)% vs 69.6 (32.3-85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0-80.7)% without feedback to 59.2 (17.3-74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the

Comparison of the chemical behaviour of humanized ACMS VS. Human IGG radiolabeled with 99mTc

International Nuclear Information System (INIS)

Rivero Santamaria, Alejandro; Zayas Crespo, Francisco; Mesa Duennas, Niurka; Castillo Vitloch, Adolfo J.

2003-01-01

The purpose of this work is to compare the chemical behaviour of humanized AcMs vs. human IgG radiolabeled with 99 mTc. to this end, 3 immunoglobulins were analyzed, the IgG (human), the humanized monoclonal antibody R3 (Acm-R3h) and the humanized monoclonal antibody T1. The results obtained reveal slight differences as regards the behaviour of theses immunoglobulins before the labelling with 99T c, which shows differences in the chemical behaviour of these proteins. Although in theory the modifications that are made to the AcMs in order to humanize them must not affect their chemical behaviour, the obtained data indicate that the conditions for their radiolabelling should not be extrapolated from other proteins; on the contrary, particular procedures should be elaborated for each AcM-h

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

Science.gov (United States)

Dami, Fabrice; Fuchs, Vincent; Praz, Laurent; Vader, John-Paul

2010-07-01

In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery

Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study.

Science.gov (United States)

Casadio, Maria Chiara; Coppo, Anna; Vargiolu, Alessia; Villa, Jacopo; Rota, Matteo; Avalli, Leonello; Citerio, Giuseppe

2017-09-01

In a consecutive cohort of cardiac arrest (CA) treated with extracorporeal cardiopulmonary resuscitation (eCPR), we describe the incidence of brain death (BD), the eligibility for organ donation and the short-term follow-up of the transplanted organs. All refractory in- and out-of-hospital CA admitted to our Cardiac Intensive Care Unit between January 2011 and September 2016 treated with eCPR were enrolled in the study. 112 CA patients received eCPR. 82 (73.2%) died in hospital, 25 BD (22.3%) and 57 for other causes (50.9%). At the time of first neurological evaluation after rewarming, variables related to evolution to BD were a lower GCS (3 [3-3] vs. 8 [3-11], pdonation in BD patients was 56%, with 39 donated organs: 23 kidneys, 12 livers, and 4 lungs. 89.74% of the transplanted organs reached an early good functional recovery. In refractory CA patients treated with eCPR, the prevalence of BD is high. This population has a high potential for considering organ donation. Donated organs have a good outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

Edaravone improves survival and neurological outcomes after CPR in a ventricular fibrillation model of rats.

Science.gov (United States)

Qin, Tao; Lei, Ling-Yan; Li, Nuo; Shi, Fangying Ruan; Chen, Meng-Hua; Xie, Lu

2016-10-01

Overproduction of free radicals is a main factor contributing to cerebral injury after cardiac arrest (CA)/cardiopulmonary resuscitation (CPR). We sought to evaluate the impact of edaravone on the survival and neurological outcomes after CA/CPR in rats. Rats were subjected to CA following CPR. For survival study, the rats with restoration of spontaneous circulation (ROSC) were randomly allocated to one of the two groups (edaravone and saline group, n=20/each group) to received Edaravone (3 mg/kg) or normal saline. Another 10 rats without experiencing CA and CPR served as the sham group. Survival was observed for 72 hours and the neurological deficit score (NDS) was calculated at 12, 24, 48, and 72 hours after ROSC. For the neurological biochemical analysis study, rats were subjected to the same experimental procedures. Then, edaravone group (n=24), saline group (n=24) and sham group (n=16) were further divided into 4 subgroups according to the different time intervals (12, 24, 48, and 72 hours following ROSC). Brain tissues were harvested at relative time intervals for evaluation of oxidative stress, TUNEL staining and apoptotic gene expression. Edaravone improved postresuscitative survival time and neurological deficit, decreased brain malonylaldehyde level, increased superoxide dismutase activities, decreased proapoptotic gene expression of capase-8, capase-3, and Bax, and increased antiapoptotic Bcl-2 expression at 12, 24, 48, and 72 hours after ROSC. Edaravone improves survival and neurological outcomes following CPR via antioxidative and antiapoptotic effects in rats. Copyright © 2016 Elsevier Inc. All rights reserved.

Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations.

Science.gov (United States)

Liu, Shawn; Vaillancourt, Christian; Kasaboski, Ann; Taljaard, Monica

2016-11-01

This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims. This randomized crossover trial took place at three tertiary care hospitals and a seniors' center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7). They completed two 5-minute CPR sessions (using 30:2 and CCC) on manikins; sessions were separated by a rest period. We used concealed block randomization to determine CPR method order. Metronome feedback maintained a compression rate of 100/minute. We measured heart rate (HR), mean arterial pressure (MAP), and Borg Exertion Scale. CPR quality measures included total number of compressions and number of adequate compressions (depth ≥5 cm). Sixty-three participants were enrolled: mean age 70.8 years, female 66.7%, past CPR training 60.3%. Bystander fatigue was similar between CPR methods: mean difference in HR -0.59 (95% CI -3.51-2.33), MAP 1.64 (95% CI -0.23-3.50), and Borg 0.46 (95% CI 0.07-0.84). Compared to 30:2, participants using CCC performed more chest compressions (480.0 v. 376.3, mean difference 107.7; pCPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.

Effect of a reminder video using a mobile phone on the retention of CPR and AED skills in lay responders.

Science.gov (United States)

Ahn, Ji Yun; Cho, Gyu Chong; Shon, You Dong; Park, Seung Min; Kang, Ku Hyun

2011-12-01

Skills related to cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by lay responders decay rapidly after training, and efforts are required to maintain competence among trainees. We examined whether repeated viewing of a reminder video on a mobile phone would be an effective means of maintaining CPR and AED skills in lay responders. In a single-blind case-control study, 75 male students received training in CPR and AED use. They were allocated either to the control or to the video-reminded group, who received a memory card containing a video clip about CPR and AED use for their mobile phone, which they were repeatedly encouraged to watch by SMS text message. CPR and AED skills were assessed in scenario format by examiners immediately and 3 months after initial training. Three months after initial training, the video-reminded group showed more accurate airway opening (PCPR after defibrillation (PCPR confidence scores and increased willingness to perform bystander CPR in cardiac arrest than the controls at 3 months (PCPR and AED skills in lay responders. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Nurses' behaviour regarding CPR and the theories of reasoned action and planned behaviour.

Science.gov (United States)

Dwyer, Trudy; Mosel Williams, Leonie

2002-01-01

Cardiopulmonary resuscitation (CPR) has been used in hospitals for approximately 40 years. Nurses are generally the first responders to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive. Speed and competence of the first responder are factors contributing to the initial survival of a person following a cardiac arrest. Attitudes of individual nurses may influence the speed and level of involvement in true emergency situations. This paper uses the theories of reasoned action and planned behaviour to examine some behavioural issues with CPR involvement.

Computer-Based CPR Simulation Towards Validation of AHA/ERC Guidelines.

Science.gov (United States)

John, Alka Rachel; Manivannan, M; Ramakrishnan, T V

2017-06-01

As per the AHA 2015 and ERC 2015 guidelines for resuscitation, chest compression depth should be between 5 and 6 cm with a rate of 100-120 compressions per minute. Theoretical validation of these guidelines is still elusive. We developed a computer model of the cardiopulmonary resuscitation (CPR) system to validate these guidelines. A lumped element computer model of the cardiovascular system was developed to simulate cardiac arrest and CPR. Cardiac output was compared for a range of compression pressures and frequencies. It was observed from our investigation that there is an optimum compression pressure and rate. The maximum cardiac output occurred at 100 mmHg, which is approximately 5.7 cm, and in the range of 100 to 120 compressions per minute with an optimum value at 110 compressions per minute, validating the guidelines. Increasing the pressure or the depth of compression beyond the optimum, limits the blood flow by depleting the volume in the cardiac chambers and not allowing for an effective stroke volume. Similarly increasing the compression rate beyond the optimum degrades the ability of the chambers to pump blood. The results also bring out the importance of complete recoil of the chest after each compression with more than 400% increase in cardiac output from 90% recoil to 100% recoil. Our simulation predicts that the recommendation to compress harder and faster is not the best counsel as there is an optimum compression pressure and rate for high-quality CPR.

Considering the CPR Decision Through the Lens of Prospect Theory in the Context of Advanced Chronic Illness.

Science.gov (United States)

Bern-Klug, Mercedes

2017-02-01

It is common for people with advanced chronic illness to have many health care providers and many health care-related visits. It is also common, during those visits, to be asked whether attempts at cardiopulmonary resuscitation (CPR) are desired, in the event of cardiac arrest. Although the question is common, the implications of a "yes" or a "no" may not be well understood. Although CPR can be a life-saving procedure, it is not always in the patient's best interest. This article discusses experiences with CPR of 2 older women (and their adult children) during their last years of life, and uses concepts from prospect theory to make suggestions for changes in the way health care providers and patients approach advance care planning including the CPR decision. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The effectiveness of CPR training during anesthesia internship rotation on improvement of interns, knowledge and clinical skills of Lorestan university of medical sciences

Directory of Open Access Journals (Sweden)

sepideh Vahabi

2015-09-01

Full Text Available Background : Since only the correct and effective Cardiopulmonary Resuscitation (CPR can increase the survival of patients with cardiopulmonary arrest, the aim of this study is to determine the effects of CPR training in the anesthetioligy ward to improve CPR knowledge and clinical skills of interns of Lorestan university of medical sciences. Materials and Methods : A 10-month Educational experimental study was done on 31 undergraduate medical students at Lorestan university of medical sciences in 2013. During a period of 15 days of anesthesiology internship course, all these students underwent CPR training including Basic Life Support ( BLS , Advanced Cardiac Life Support ( ACLS and practical skills. Data were collected via a questionnaire with 4 parts including demographic, pre and post knowledge and skills as standpoint of interns and ward,s professor. Results: After training the mean of score about knowledge of CPR and its practical skills significantly increased from 5.68 to 7.94 and 10.65 to 23.45 respectivly (PV=0.0001 . A significant relationship between preinternship exam score and knowledge of CPR before anesthesiology internship course was shown (PV=0.001, but there was no significant relationship with practical skills score pre and post CPR training in anesthesilogy ward.(PV=0.38 Conclusion: The CPR training course in anesthetiology ward leads to significant increase in CPR skills and Knowledge of medical interns. Adding this course to undergraduated medical students is essential

Listening to professional voices: draft 2 of the ACM code of ethics and professional conduct

OpenAIRE

Flick, Catherine; Brinkman, Bo; Gotterbarn, D. W.; Miller, Keith; Vazansky, Kate; Wolf, Marty J.

2017-01-01

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. For the first time since 1992, the ACM Code of Ethics and Professional Conduct (the Code) is being updated. The Code Update Task Force in conjunction with the Committee on Professional Ethics is seeking advice from ACM members on the update. We indicated many of the motivations for changing the Code when we shared Draft 1 of Code 2018 with the ...

The combined use of mechanical CPR and a carry sheet to maintain quality resuscitation in out-of-hospital cardiac arrest patients during extrication and transport.

Science.gov (United States)

Lyon, Richard M; Crawford, Anna; Crookston, Colin; Short, Steven; Clegg, Gareth R

2015-08-01

Quality of manual cardiopulmonary resuscitation (CPR) during extrication and transport of out-of-hospital cardiac arrest victims is known to be poor. Performing manual CPR during ambulance transport poses significant risk to the attending emergency medical services crew. We sought to use pre-hospital video recording to objectively analyse the impact of introducing mechanical CPR with an extrication sheet (Autopulse, Zoll) to an advanced, second-tier cardiac arrest response team. The study was conducted prospectively using defibrillator downloads and analysis of pre-hospital video recording to measure the quality of CPR during extrication from scene and ambulance transport of the OHCA patient. Adult patients with non-traumatic OHCA were included. The interruption to manual CPR to during extrication and to deploy the mechanical CPR device was analysed. In the manual CPR group, 53 OHCA cases were analysed for quality of CPR during extrication. The median time that chest compression was interrupted to allow the patient to be carried from scene to the ambulance was 270 s (IQR 201-387 s). 119 mechanical CPR cases were analysed. The median time interruption from last manual compression to first Autopulse compression was 39 s (IQR 29-47 s). The range from last manual compression to first Autopulse compression was 14-118 s. Mechanical CPR used in combination with an extrication sheet can be effectively used to improve the quality of resuscitation during extrication and ambulance transport of the refractory OHCA patient. The time interval to deploy the mechanical CPR device can be shortened with regular simulation training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Crystal structure of conjugated polyketone reductase (CPR-C1) from Candida parapsilosis IFO 0708 complexed with NADPH.

Science.gov (United States)

Qin, Hui-Min; Yamamura, Akihiro; Miyakawa, Takuya; Kataoka, Michihiko; Maruoka, Shintaro; Ohtsuka, Jun; Nagata, Koji; Shimizu, Sakayu; Tanokura, Masaru

2013-11-01

Conjugated polyketone reductase (CPR-C1) from Candida parapsilosis IFO 0708 is a member of the aldo-keto reductase (AKR) superfamily and reduces ketopantoyl lactone to d-pantoyl lactone in a NADPH-dependent and stereospecific manner. We determined the crystal structure of CPR-C1.NADPH complex at 2.20 Å resolution. CPR-C1 adopted a triose-phosphate isomerase (TIM) barrel fold at the core of the structure in which Thr25 and Lys26 of the GXGTX motif bind uniquely to the adenosine 2'-phosphate group of NADPH. This finding provides a novel structural basis for NADPH binding of the AKR superfamily. Copyright © 2013 Wiley Periodicals, Inc.

Effects of head-up vs. supine CPR on cerebral oxygenation and cerebral metabolism - a prospective, randomized porcine study.

Science.gov (United States)

Putzer, Gabriel; Braun, Patrick; Martini, Judith; Niederstätter, Ines; Abram, Julia; Lindner, Andrea Katharina; Neururer, Sabrina; Mulino, Miriam; Glodny, Bernhard; Helbok, Raimund; Mair, Peter

2018-05-01

Recent studies have shown that during cardiopulmonary resuscitation (CPR) head-up position (HUP) as compared to standard supine position (SUP) decreases intracranial pressure (ICP) and increases cerebral perfusion pressure (CPP). The impact of this manoeuvre on brain oxygenation and metabolism is not clear. We therefore investigated HUP as compared to SUP during basic life support (BLS) CPR for their effect on brain oxygenation and metabolism. Twenty pigs were anaesthetized and instrumented. After 8 min of cardiac arrest (CA) pigs were randomized to either HUP or SUP and resuscitated mechanically for 20 min. Mean arterial pressure (MAP), ICP, CPP, cerebral regional oxygen saturation (rSO 2 ) and brain tissue oxygen tension (P bt O 2 ) were measured at baseline, after CA and every 5 min during CPR. Cerebral venous oxygen saturation (S cv O 2 ) was measured at baseline, after CA and after 20 min of CPR. Cerebral microdialysis parameters, e.g. lactate/pyruvate ratio (L/P ratio) were taken at baseline and the end of the experiment. ICP was significantly lower in HUP compared to SUP animals after 5 min (18.0 ± 4.5 vs. 24.1 ± 5.2 mmHg; p = 0.033) and 20 min (12.0 ± 3.4 vs. 17.8 ± 4.3 mmHg; p = 0.023) of CPR. Accordingly, CPP was significantly higher in the HUP group after 5 min (11.2 ± 9.5 vs. 1.0 ± 9.2 mmHg; p = 0.045) and 20 min (3.4 ± 6.4 vs. -3.8 ± 2.8 mmHg; p = 0.023) of CPR. However, no difference was found in rSO 2 , P bt O 2 , S cv O 2 and L/P ratio between groups after 20 min of CPR. In this animal model of BLS CPR, HUP as compared to SUP did not improve cerebral oxygenation or metabolism. Copyright © 2018. Published by Elsevier B.V.

Development of a smart backboard system for real-time feedback during CPR chest compression on a soft back support surface.

Science.gov (United States)

Gohier, Francis; Dellimore, Kiran; Scheffer, Cornie

2013-01-01

The quality of cardiopulmonary resuscitation (CPR) is often inconsistent and frequently fails to meet recommended guidelines. One promising approach to address this problem is for clinicians to use an active feedback device during CPR. However, one major deficiency of existing feedback systems is that they fail to account for the displacement of the back support surface during chest compression (CC), which can be important when CPR is performed on a soft surface. In this study we present the development of a real-time CPR feedback system based on an algorithm which uses force and dual-accelerometer measurements to provide accurate estimation of the CC depth on a soft surface, without assuming full chest decompression. Based on adult CPR manikin tests it was found that the accuracy of the estimated CC depth for a dual accelerometer feedback system is significantly better (7.3% vs. 24.4%) than for a single accelerometer system on soft back support surfaces, in the absence or presence of a backboard. In conclusion, the algorithm used was found to be suitable for a real-time, dual accelerometer CPR feedback application since it yielded reasonable accuracy in terms of CC depth estimation, even when used on a soft back support surface.

Searching Spontaneous Conversational Speech. Proceedings of ACM SIGIR Workshop (SSCS2008)

NARCIS (Netherlands)

Köhler, J.; Larson, M; de Jong, Franciska M.G.; Ordelman, Roeland J.F.; Kraaij, W.

2008-01-01

The second workshop on Searching Spontaneous Conversational Speech (SSCS 2008) was held in Singapore on July 24, 2008 in conjunction with the 31st Annual International ACM SIGIR Conference. The goal of the workshop was to bring the speech community and the information retrieval community together.

Model Diagnostics for the Department of Energy's Accelerated Climate Modeling for Energy (ACME) Project

Science.gov (United States)

Smith, B.

2015-12-01

In 2014, eight Department of Energy (DOE) national laboratories, four academic institutions, one company, and the National Centre for Atmospheric Research combined forces in a project called Accelerated Climate Modeling for Energy (ACME) with the goal to speed Earth system model development for climate and energy. Over the planned 10-year span, the project will conduct simulations and modeling on DOE's most powerful high-performance computing systems at Oak Ridge, Argonne, and Lawrence Berkeley Leadership Compute Facilities. A key component of the ACME project is the development of an interactive test bed for the advanced Earth system model. Its execution infrastructure will accelerate model development and testing cycles. The ACME Workflow Group is leading the efforts to automate labor-intensive tasks, provide intelligent support for complex tasks and reduce duplication of effort through collaboration support. As part of this new workflow environment, we have created a diagnostic, metric, and intercomparison Python framework, called UVCMetrics, to aid in the testing-to-production execution of the ACME model. The framework exploits similarities among different diagnostics to compactly support diagnosis of new models. It presently focuses on atmosphere and land but is designed to support ocean and sea ice model components as well. This framework is built on top of the existing open-source software framework known as the Ultrascale Visualization Climate Data Analysis Tools (UV-CDAT). Because of its flexible framework design, scientists and modelers now can generate thousands of possible diagnostic outputs. These diagnostics can compare model runs, compare model vs. observation, or simply verify a model is physically realistic. Additional diagnostics are easily integrated into the framework, and our users have already added several. Diagnostics can be generated, viewed, and manipulated from the UV-CDAT graphical user interface, Python command line scripts and programs

Extra-Margins in ACM's Adjusted NMa ‘Mortgage-Rate-Calculation Method

NARCIS (Netherlands)

Dijkstra, M.; Schinkel, M.P.

2013-01-01

We analyse the development since 2004 of our concept of extra-margins on Dutch mortgages (Dijkstra & Schinkel, 2012), based on funding cost estimations in ACM (2013), which are an update of those in NMa (2011). Neither costs related to increased mortgage-specific risks, nor the inclusion of Basel

Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR

Directory of Open Access Journals (Sweden)

Jacobs Ian

2011-10-01

Full Text Available Abstract Background The International Liaison Committee on Resuscitation (ILCOR now recommends therapeutic hypothermia (TH (33°C for 12-24 hours as soon as possible for patients who remain comatose after resuscitation from shockable rhythm in out-of-hospital cardiac arrest and that it be considered for non shockable rhythms. The optimal timing of TH is still uncertain. Laboratory data have suggested that there is significantly decreased neurological injury if cooling is initiated during CPR. In addition, peri-arrest cooling may increase the rate of successful defibrillation. This study aims to determine whether paramedic cooling during CPR improves outcome compared standard treatment in patients who are being resuscitated from out-of-hospital cardiac arrest. Methods/Design This paper describes the methodology for a definitive multi-centre, randomised, controlled trial of paramedic cooling during CPR compared with standard treatment. Paramedic cooling during CPR will be achieved using a rapid infusion of large volume (20-40 mL/kg to a maximum of 2 litres ice-cold (4°C normal saline. The primary outcome measure is survival at hospital discharge. Secondary outcome measures are rates of return of spontaneous circulation, rate of survival to hospital admission, temperature on arrival at hospital, and 12 month quality of life of survivors. Discussion This trial will test the effect of the administration of ice cold saline during CPR on survival outcomes. If this simple treatment is found to improve outcomes, it will have generalisability to prehospital services globally. Trial Registration ClinicalTrials.gov: NCT01172678

CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors – a promising strategy for medical students?

Directory of Open Access Journals (Sweden)

Herkner Harald

2006-04-01

Full Text Available Abstract Background Cardiopulmonary resuscitation (CPR training is gaining more importance for medical students. There were many attempts to improve the basic life support (BLS skills in medical students, some being rather successful, some less. We developed a new problem based learning curriculum, where students had to teach CPR to cardiac arrest survivors in order to improve the knowledge about life support skills of trainers and trainees. Methods Medical students who enrolled in our curriculum had to pass a 2 semester problem based learning session about the principles of cardiac arrest, CPR, BLS and defibrillation (CPR-D. Then the students taught cardiac arrest survivors who were randomly chosen out of a cardiac arrest database of our emergency department. Both, the student and the Sudden Cardiac Death (SCD survivor were asked about their skills and knowledge via questionnaires immediately after the course. The questionnaires were then used to evaluate if this new teaching strategy is useful for learning CPR via a problem-based-learning course. The survey was grouped into three categories, namely "Use of AED", "CPR-D" and "Training". In addition, there was space for free answers where the participants could state their opinion in their own words, which provided some useful hints for upcoming programs. Results This new learning-by-teaching strategy was highly accepted by all participants, the students and the SCD survivors. Most SCD survivors would use their skills in case one of their relatives goes into cardiac arrest (96%. Furthermore, 86% of the trainees were able to deal with failures and/or disturbances by themselves. On the trainer's side, 96% of the students felt to be well prepared for the course and were considered to be competent by 96% of their trainees. Conclusion We could prove that learning by teaching CPR is possible and is highly accepted by the students. By offering a compelling appreciation of what CPR can achieve in using

An appropriate compression pace is important for securing the quality of hands-only CPR--a manikin study.

Science.gov (United States)

Shimizu, Yoshitaka; Tanigawa, Koichi; Ishikawa, Masami; Ouhara, Kazuhisa; Oue, Kana; Yoshinaka, Taiga; Kurihara, Hidemi; Irifune, Masahiro

2014-09-01

It is important to implement good quality chest compressions for cardiopulmonary resuscitation (CPR). This manikin study examined the effects of different compression rates on chest compression depth variables using a metronome sound guide. Fifty sixth-year dentistry students participated in the study. Each participant performed CPR at 3 different compression rates, 110, 100, and 90 compressions per min (pace-110-g, pace-100-g, and pace-90-g) for 2 consecutive one-minute sets with a ten-second break between the sets. The percentage of compressions deeper than 5 cm at pace-110-g decreased significantly from 22.1 ± 4.7% in the first set to 16.7 ± 4.4%* in the second set (*p CPR.

Analysis of small break loss of coolant accident for Chinese CPR1000

Energy Technology Data Exchange (ETDEWEB)

Kim, Ju Youl [FNC Technology Co., Yongin (Korea, Republic of); Cilier, Anthonie [North-West University, Mahikeng (South Africa); Poc, Li-chi Cliff [Micro-Simulation Technology, Montville (United States)

2016-05-15

This research analyses the small break loss of coolant accident (LOCA) on a Chinese CPR1000 type reactor. LOCA accident is used as benchmark for the PCTRAN/CPR1000 code by comparing the effects and results to the Manshaan FSAR accident analysis. LOCA is a design basis accident in which a guillotine break is postulated to occur in one of the cold legs of a pressurized water reactor (PWR). Consequently, the primary system pressure would drop and almost all the reactor coolant would be discharged into the reactor containment. The drop in pressure would activate the reactor protection system and the reactor would trip. The simulation of a 3-inch small break loss of coolant accident using the PCTRAN/CPR1000 has revealed this code's effectiveness as well as weaknesses in specific simulation applications. The code has the ability to run at 16 times real time and produce very accurate results. The results are consistently producing the same trends as licensed codes used in Safety Assessment Reports. It is however able to produce these results in a fraction of the time and also provides a whole plant simulation coupling the various thermal, hydraulic, chemical and neutronic systems together with a plant specific control system.

Progress Towards a Global Understanding of Plankton Dynamics: The Global Alliance of CPR Surveys (GACS)

Science.gov (United States)

Batten, S.; Richardson, A.; Melrose, C.; Muxagata, E.; Hosie, G.; Verheye, H.; Hall, J.; Edwards, M.; Koubbi, P.; Abu-Alhaija, R.; Chiba, S.; Wilson, W.; Nagappa, R.; Takahashi, K.

2016-02-01

The Continuous Plankton Recorder (CPR) was first used in 1931 to routinely sample plankton and its continued deployment now sustains the longest-running, and spatially most extensive marine biological sampling programme in the world. Towed behind, for the most part commercial, ships it collects plankton samples from the surface waters that are subsequently analysed to provide taxonomically-resolved abundance data on a broad range of planktonic organisms from the size of coccolithophores to euphausiids. Plankton appear to integrate changes in the physical environment and by underpinning most marine food-webs, pass on this variability to higher trophic levels which have societal value. CPRs are deployed increasingly around the globe in discrete regional surveys that until recently interacted in an informal way. In 2011 the Global Alliance of CPR Surveys (GACS) was launched to bring these surveys together to collaborate more productively and address issues such as: methodological standardization, data integration, capacity building, and data analysis. Early products include a combined global database and regularly-released global marine ecological status reports. There are, of course, limitations to the exploitation of CPR data as well as the current geographic coverage. A current focus of GACS is integration of the data with models to meaningfully extrapolate across time and space. In this way the output could be used to provide more robust synoptic representations of key plankton variables. Recent years have also seen the CPR used as a platform in itself with the inclusion of additional sensors and water samplers that can sample the microplankton. The archive of samples has already been used for some molecular investigations and curation of samples is maintained for future studies. Thus the CPR is a key element of any regional to global ocean observing system of biodiversity.

Presentation of the CPR ISMIR (Insulators: IRradiation Modelling); Presentation du CPR ISMIR (ISolants: modelisation de l'IRradiation)

Energy Technology Data Exchange (ETDEWEB)

Lozes, G. [CEA Saclay, Dir. de l' Energie Nucleaire (DEN/DSOE), 91 - Gif sur Yvette (France)

2007-07-01

The CPR ISMIR is a CEA-CNRS program on the behaviour of materials submitted to irradiation; it has been begun to support the applied current research programs on the aging of nuclear fuels, the storage and incineration matrices and the future reactors. Its aim is to contribute to scientifically set up the methods for anticipating the behaviour of ceramic materials under irradiation in using the important development of calculation means. Thus have been developed the basic knowledge and the interactions physics and calculation models at pertinent scales have been elaborated. (O.M.)

A Prediction of the Damping Properties of Hindered Phenol AO-60/polyacrylate Rubber (AO-60/ACM) Composites through Molecular Dynamics Simulation

Science.gov (United States)

Yang, Da-Wei; Zhao, Xiu-Ying; Zhang, Geng; Li, Qiang-Guo; Wu, Si-Zhu

2016-05-01

Molecule dynamics (MD) simulation, a molecular-level method, was applied to predict the damping properties of AO-60/polyacrylate rubber (AO-60/ACM) composites before experimental measures were performed. MD simulation results revealed that two types of hydrogen bond, namely, type A (AO-60) -OH•••O=C- (ACM), type B (AO-60) - OH•••O=C- (AO-60) were formed. Then, the AO-60/ACM composites were fabricated and tested to verify the accuracy of the MD simulation through dynamic mechanical thermal analysis (DMTA). DMTA results showed that the introduction of AO-60 could remarkably improve the damping properties of the composites, including the increase of glass transition temperature (Tg) alongside with the loss factor (tan δ), also indicating the AO-60/ACM(98/100) had the best damping performance amongst the composites which verified by the experimental.

Does real-time objective feedback and competition improve performance and quality in manikin CPR training--a prospective observational study from several European EMS.

Science.gov (United States)

Smart, J R; Kranz, K; Carmona, F; Lindner, T W; Newton, A

2015-10-15

Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train. Ten European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0. The results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.

A study assessing the impact of different teaching modalities for pharmacy students in a Cardio-Pulmonary Resuscitation (CPR) course.

Science.gov (United States)

Khan, Tahir Mehmood; Hassali, Mohamed Azmi; Rasool, Sahibzada Tasleem

2013-10-01

The current study aims to assess the effectiveness of different teaching methods adopted for the practical session of Cardio-Pulmonary Resuscitation (CPR). CPR training is one of the compulsory modules of the Public Health Pharmacy (PHP) course at Universiti Sains Malaysia. CPR training comprises of 10% of total marks of the PHP course. To test the effectiveness of the different teaching strategies, three groups were defined using a two-stage cohort distribution-i.e. based on grade point average (GPA) and different teaching modalities. Group One was instructed using images and PowerPoint lecture slides. Group Two was instructed using videos and PowerPoint lecture slides. Group Three was instructed using PowerPoint slides with white boards and videos. Students in Group Three were not provided with a hard/soft copy of the PowerPoint slides and were encouraged to write down all the information on their personal notebooks. A 20-item questionnaire was used to assess the students' understanding toward the CPR session. Data were analyzed using the Statistical Package for Social Science Students, SPSS version 13®. Based on the response attained, the comparison of the final score among the groups was undertaken using one way ANOVA. Twenty-seven students have participated in this study. Final evaluation using the questionnaire revealed that student's in Group Three had a better understanding of CPR (18.1 ± 1.5, p lecture and use of traditional chalkboard teaching were found significant to improve the students' understanding and learning in the CPR session.

ACM-based automatic liver segmentation from 3-D CT images by combining multiple atlases and improved mean-shift techniques.

Science.gov (United States)

Ji, Hongwei; He, Jiangping; Yang, Xin; Deklerck, Rudi; Cornelis, Jan

2013-05-01

In this paper, we present an autocontext model(ACM)-based automatic liver segmentation algorithm, which combines ACM, multiatlases, and mean-shift techniques to segment liver from 3-D CT images. Our algorithm is a learning-based method and can be divided into two stages. At the first stage, i.e., the training stage, ACM is performed to learn a sequence of classifiers in each atlas space (based on each atlas and other aligned atlases). With the use of multiple atlases, multiple sequences of ACM-based classifiers are obtained. At the second stage, i.e., the segmentation stage, the test image will be segmented in each atlas space by applying each sequence of ACM-based classifiers. The final segmentation result will be obtained by fusing segmentation results from all atlas spaces via a multiclassifier fusion technique. Specially, in order to speed up segmentation, given a test image, we first use an improved mean-shift algorithm to perform over-segmentation and then implement the region-based image labeling instead of the original inefficient pixel-based image labeling. The proposed method is evaluated on the datasets of MICCAI 2007 liver segmentation challenge. The experimental results show that the average volume overlap error and the average surface distance achieved by our method are 8.3% and 1.5 m, respectively, which are comparable to the results reported in the existing state-of-the-art work on liver segmentation.

A Novel Observation-Guided Approach for Evaluating Mesoscale Convective Systems Simulated by the DOE ACME Model

Science.gov (United States)

Feng, Z.; Ma, P. L.; Hardin, J. C.; Houze, R.

2017-12-01

Mesoscale convective systems (MCSs) are the largest type of convective storms that develop when convection aggregates and induces mesoscale circulation features. Over North America, MCSs contribute over 60% of the total warm-season precipitation and over half of the extreme daily precipitation in the central U.S. Our recent study (Feng et al. 2016) found that the observed increases in springtime total and extreme rainfall in this region are dominated by increased frequency and intensity of long-lived MCSs*. To date, global climate models typically do not run at a resolution high enough to explicitly simulate individual convective elements and may not have adequate process representations for MCSs, resulting in a large deficiency in projecting changes of the frequency of extreme precipitation events in future climate. In this study, we developed a novel observation-guided approach specifically designed to evaluate simulated MCSs in the Department of Energy's climate model, Accelerated Climate Modeling for Energy (ACME). The ACME model has advanced treatments for convection and subgrid variability and for this study is run at 25 km and 100 km grid spacings. We constructed a robust MCS database consisting of over 500 MCSs from 3 warm-season observations by applying a feature-tracking algorithm to 4-km resolution merged geostationary satellite and 3-D NEXRAD radar network data over the Continental US. This high-resolution MCS database is then down-sampled to the 25 and 100 km ACME grids to re-characterize key MCS properties. The feature-tracking algorithm is adapted with the adjusted characteristics to identify MCSs from ACME model simulations. We demonstrate that this new analysis framework is useful for evaluating ACME's warm-season precipitation statistics associated with MCSs, and provides insights into the model process representations related to extreme precipitation events for future improvement. *Feng, Z., L. R. Leung, S. Hagos, R. A. Houze, C. D. Burleyson

HT 2011 : Proceedings of the 22nd ACM Conference on Hypertext and Hypermedia, Eindhoven, The Netherlands, June 6-9, 2011

NARCIS (Netherlands)

De Bra, P.M.E.; Gronbak, K.

2011-01-01

Foreword. It is our great pleasure to welcome you to ACM Hypertext 2011, the 22nd ACM Conference on Hypertext and Hypermedia, and to the "Land of the Innovator", the campus of the Eindhoven University of Technology, located in the "city of light" Eindhoven, the Netherlands. Hypertext is an exciting

ADAPTIF CONSERVATION (ACM MODEL IN INCREASING FAMILY SUPPORT AND COMPLIANCE TREATMENT IN PATIENT WITH PULONARY TUBERCULOSIS IN SURABAYA CITY REGION

Directory of Open Access Journals (Sweden)

Siti Nur Kholifah

2017-04-01

Full Text Available Introduction: Tuberculosis (TB in Indonesia is still health problem and the prevalence rate is high. Discontinuing medication and lack of family support are the causalities. Numbers of strategies to overcome are seemingly not succeeded. Roles and responsibilities of family nursing are crucial to improve participation, motivation of individual, family and community in prevention, including pulmonary tuberculosis. Unfortunately, models of pulmonary tuberculosis currently unavailable. The combination of adaptation and conservation in complementarily improving family support and compliance in medication is introduced in this study. Method: This research intended to analyze Adaptive Conservation Model (ACM in extending family support and treatment compliance. Modeling steps including model analysis, expert validation, field trial, implementation and recommending the output model. Research subject involves 15 families who implement family Assistance and supervision in Medication (ASM and other 15 families with ACM. Result: The study revealed ACM is better than ASM on the case of family support and medication compliances. It supports the role of environment as influential factor on individual health belief, values and decision making. Therefore, it is advised to apply ACM in enhancing family support and compliance of pulmonary TB patients. Discussion: Social and family supports to ACM group obtained by developing interaction through communication. Family interaction necessary to improve family support to pulmonary tuberculosis patients. And social support plays as motivator to maintain compliance on medication

Simulation of advanced accumulator and its application in CPR1000 LBLOCA analysis

International Nuclear Information System (INIS)

Hu, Hongwei; Shan, Jianqiang; Gou, Junli; Cao, Jianhua; Shen, Yonggang; Fu, Xiangang

2014-01-01

Highlights: • The analysis model was developed for advanced accumulator. • The sensitivity analysis of each key parameter was performed. • The LBLOCA was analyzed for the CPR1000 with advanced accumulator. • The analysis shows that advanced accumulator can improve CPR1000 safety performance. - Abstract: The advanced accumulator is designed to improve the safety and reliability of CPR1000 by providing a small injection flow to keep the reactor core in flooded condition. Thus, the core still stays in a cooling state without the intervention of low pressure safety injection and the startup grace time of the low pressure safety injection pump can be greatly extended. A new model for the advanced accumulator, which is based on the basic conservation equations, is developed and incorporated into RELAP5/MOD 3.3. The simulation of the advanced accumulator can be carried out and results show that the behavior of the advanced accumulator satisfied its primary design target. There is a large flow in the advanced accumulator at the initial stage. When the accumulator water level is lower than the stand pipe, a vortex appears in the damper, which results in a large pressure drop and a small flow. And then the sensitivity analysis is performed and the major factors which affected the flow rate of the advanced accumulator were obtained, including the damper diameter, the initial volume ratio of the water and the nitrogen and the diameter ratio of the standpipe and the small pipe. Additionally, the primary coolant loop cold leg double-ended guillotine break LBLOCA in CPR1000 with advanced accumulator is analyzed. The results show that the criterion for maximum cladding temperature limit (1477 K) (NRC, 1992) can be met ever with 200 s after the startup of the low pressure safety injection. From this point of view, passive advanced accumulator can strive a longer grace time for LPSI. Thus the reliability, safety and economy of the reactor system can be improved

An evaluation of designed passive Core Makeup Tank (CMT) for China pressurized reactor (CPR1000)

International Nuclear Information System (INIS)

Wang, Mingjun; Tian, Wenxi; Qiu, Suizheng; Su, Guanghui; Zhang, Yapei

2013-01-01

Highlights: ► Only PRHRS is not sufficient to maintain reactor safety in case of SGTR accident. ► The Core Makeup Tank (CMT) is designed for CPR1000. ► Joint operation of PRHRS and CMT can keep reactor safety during the SGTR transient. ► CMT is a vital supplement for CPR1000 passive safety system design. - Abstract: Emergency Passive Safety System (EPSS) is an innovative design to improve reliability of nuclear power plants. In this work, the EPSS consists of secondary passive residual heat removal system (PRHRS) and the reactor Core Makeup Tank (CMT) system. The PRHRS, which has been studied in our previous paper, can effectively remove the core residual heat and passively improve the inherent safety by passive methods. The designed CMT, representing the safety improvement for CPR1000, is used to inject cool boron-containing water into the primary system during the loss of coolant accident. In this study, the behaviors of EPSS and transient characteristics of the primary loop system during the Steam Generator Tube Rupture (SGTR) accident are investigated using the nuclear reactor thermal hydraulic code RELAP5/MOD3.4. The results show that the designed CMT can protect the reactor primary loop from boiling and maintain primary loop coolant in single phase state. Both PRHRS and CMT operation ensures reactor safety during the SGTR accident. Results reported in this paper show that the designed CMT is a further safety improvement for CPR1000

CPR in the Schools: Training Students to Save Heart Attack Victims.

Science.gov (United States)

Britton, Royce J.

1978-01-01

A community cardiac emergency medical plan should include training of family and co-workers of high risk patients, including teenage students. The American Heart Association lists ways to introduce cardiopulmonary resuscitation (CPR) into school curricula and describes the plan implemented in Pennsylvania. (MF)

The silkworm Bombyx mori cuticular protein CPR55 gene is regulated by the transcription factor βFTZ-F1

Directory of Open Access Journals (Sweden)

Md. Saheb Ali

2016-01-01

Full Text Available The insect cuticle is composed of various proteins and formed during the moult under a complex biological process that depends on the cross talk between hormone levels and gene expression. In the present study, we aimed to clarify the ecdysone-dependent temporal regulation mechanisms of cuticular proteins expression and the underlying control of Bombyx mori metamorphosis. The expression of CPR55 was observed from the W3 early stage and peaked at pupation when the ecdysteroid titre declined. CPR55 was induced by the ecdysone pulse, and their expression peaked at 24 h after transfer to a hormone free medium. Transcripts of CPR55 were neither observed after the 20E pulse treatment in the presence of cycloheximide nor after the addition of 20E in V4 wing discs. We analysed the upstream region of the CPR55 gene using a transient reporter assay with a gene gun system which identified only one βFTZ-F1 binding site important for cis-acting elements for the transcription activation of the luciferase reporter gene by an ecdysone pulse. Site-directed mutagenesis of this element in the context of the 589-bp promoter fragment drastically decreased the reporter activity. The nuclear protein bound to βFTZ-F1 sites was identified by an electrophoretic mobility shift assay suggesting that CPR55 expression was regulated by βFTZ-F1 through the ecdysone pulse. The results confirmed that transcription factor, BmβFTZ-F1, binds to the cis-regulatory elements in the promoter of the gene coding for cuticle protein, CPR55, and regulates its expression during B. mori metamorphosis.

Development and first application of an Aerosol Collection Module (ACM) for quasi online compound specific aerosol measurements

Science.gov (United States)

Hohaus, Thorsten; Kiendler-Scharr, Astrid; Trimborn, Dagmar; Jayne, John; Wahner, Andreas; Worsnop, Doug

2010-05-01

Atmospheric aerosols influence climate and human health on regional and global scales (IPCC, 2007). In many environments organics are a major fraction of the aerosol influencing its properties. Due to the huge variety of organic compounds present in atmospheric aerosol current measurement techniques are far from providing a full speciation of organic aerosol (Hallquist et al., 2009). The development of new techniques for compound specific measurements with high time resolution is a timely issue in organic aerosol research. Here we present first laboratory characterisations of an aerosol collection module (ACM) which was developed to allow for the sampling and transfer of atmospheric PM1 aerosol. The system consists of an aerodynamic lens system focussing particles on a beam. This beam is directed to a 3.4 mm in diameter surface which is cooled to -30 °C with liquid nitrogen. After collection the aerosol sample can be evaporated from the surface by heating it to up to 270 °C. The sample is transferred through a 60cm long line with a carrier gas. In order to test the ACM for linearity and sensitivity we combined it with a GC-MS system. The tests were performed with octadecane aerosol. The octadecane mass as measured with the ACM-GC-MS was compared versus the mass as calculated from SMPS derived total volume. The data correlate well (R2 0.99, slope of linear fit 1.1) indicating 100 % collection efficiency. From 150 °C to 270 °C no effect of desorption temperature on transfer efficiency could be observed. The ACM-GC-MS system was proven to be linear over the mass range 2-100 ng and has a detection limit of ~ 2 ng. First experiments applying the ACM-GC-MS system were conducted at the Jülich Aerosol Chamber. Secondary organic aerosol (SOA) was formed from ozonolysis of 600 ppbv of b-pinene. The major oxidation product nopinone was detected in the aerosol and could be shown to decrease from 2 % of the total aerosol to 0.5 % of the aerosol over the 48 hours of

Responses of Mixed-Phase Cloud Condensates and Cloud Radiative Effects to Ice Nucleating Particle Concentrations in NCAR CAM5 and DOE ACME Climate Models

Science.gov (United States)

Liu, X.; Shi, Y.; Wu, M.; Zhang, K.

2017-12-01

Mixed-phase clouds frequently observed in the Arctic and mid-latitude storm tracks have the substantial impacts on the surface energy budget, precipitation and climate. In this study, we first implement the two empirical parameterizations (Niemand et al. 2012 and DeMott et al. 2015) of heterogeneous ice nucleation for mixed-phase clouds in the NCAR Community Atmosphere Model Version 5 (CAM5) and DOE Accelerated Climate Model for Energy Version 1 (ACME1). Model simulated ice nucleating particle (INP) concentrations based on Niemand et al. and DeMott et al. are compared with those from the default ice nucleation parameterization based on the classical nucleation theory (CNT) in CAM5 and ACME, and with in situ observations. Significantly higher INP concentrations (by up to a factor of 5) are simulated from Niemand et al. than DeMott et al. and CNT especially over the dust source regions in both CAM5 and ACME. Interestingly the ACME model simulates higher INP concentrations than CAM5, especially in the Polar regions. This is also the case when we nudge the two models' winds and temperature towards the same reanalysis, indicating more efficient transport of aerosols (dust) to the Polar regions in ACME. Next, we examine the responses of model simulated cloud liquid water and ice water contents to different INP concentrations from three ice nucleation parameterizations (Niemand et al., DeMott et al., and CNT) in CAM5 and ACME. Changes in liquid water path (LWP) reach as much as 20% in the Arctic regions in ACME between the three parameterizations while the LWP changes are smaller and limited in the Northern Hemispheric mid-latitudes in CAM5. Finally, the impacts on cloud radiative forcing and dust indirect effects on mixed-phase clouds are quantified with the three ice nucleation parameterizations in CAM5 and ACME.

A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

Directory of Open Access Journals (Sweden)

Brehaut Jamie C

2008-11-01

Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

Proceedings of the 16th ACM SIGPLAN international conference on Functional programming

DEFF Research Database (Denmark)

Danvy, Olivier

Welcome to the 16th ACM SIGPLAN International Conference on Functional Programming -- ICFP'11. The picture, on the front cover, is of Mount Fuji, seen from the 20th floor of the National Institute of Informatics (NII). It was taken by Sebastian Fischer in January 2011. In Japanese, the characters...

The effect of formal training of cardiopulmonary resuscitation (CPR skills on medical students perceived self-sufficiency

Directory of Open Access Journals (Sweden)

Shaghaghi A

2004-07-01

Full Text Available Background: Experience of cardiopulmonary resuscitation (CPR in real clinical setting is not easily possible for all medical students. Purpose: To assess medical student perceived self-sufficiency on three procedural skill on internship courses after they had taken a training course in clerkship period. Methods: Forty three medical students who had attended a workshop on CPR, tracheal intubations and venopuncture answered the questionnaires on their perceived self-sufficiency in performing these procedures after serving a few months as interns. Results: The mean score for perceived self-sufficiency (PSS was 75.84 (±18.63.Thre were a high correlation between the score given for the applicability of training in real life situation and the stress reduction scores on first time performing the procedure. Conclusion: The high degree of correlation between PSS scores and applicability scores, may warrant the consideration of new methods in procedural skills. Keywords: SKILL TRAINING, CPR TRAINING, PERCEIVED SELF-SUFFICIENCY

The Two-Component System CprRS Senses Cationic Peptides and Triggers Adaptive Resistance in Pseudomonas aeruginosa Independently of ParRS

DEFF Research Database (Denmark)

Fernandez, Luca; Jenssen, Håvard; Bains, Manjeet

2012-01-01

dependency on the CprRS and ParRS systems in a concentration-dependent manner. It was further demonstrated that, following exposure to inducing antimicrobial peptides, cprRS mutants did not become adaptively resistant to polymyxins as was observed for wild-type cells. Our microarray studies demonstrated...

Protocol of a Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for laypeople (MANI-CPR).

Science.gov (United States)

Baldi, Enrico; Contri, Enrico; Burkart, Roman; Borrelli, Paola; Ferraro, Ottavia Eleonora; Tonani, Michela; Cutuli, Amedeo; Bertaia, Daniele; Iozzo, Pasquale; Tinguely, Caroline; Lopez, Daniel; Boldarin, Susi; Deiuri, Claudio; Dénéréaz, Sandrine; Dénéréaz, Yves; Terrapon, Michael; Tami, Christian; Cereda, Cinzia; Somaschini, Alberto; Cornara, Stefano; Cortegiani, Andrea

2018-04-19

Out-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR. This is a prospective randomised trial performed in eight training centres. Laypeople who passed a basic life support course will be randomised to one of the four CPR protocols in an 8 min simulated cardiac arrest scenario on a manikin: (1) 30 compressions and 2 s pause; (2) 50 compressions and 5 s pause; (3) 100 compressions and 10 s pause; (4) hands-only. The calculated sample size is 552 people. The primary outcome is the percentage of chest compression performed with correct depth evaluated by a computerised feedback system (Laerdal QCPR). ETHICS AND DISSEMINATION: . Due to the nature of the study, we obtained a waiver from the Ethics Committee (IRCCS Policlinico San Matteo, Pavia, Italy). All participants will sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journal. The data collected will also be made available in a public data repository. NCT02632500. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study

Directory of Open Access Journals (Sweden)

Creutzfeldt Johan

2012-12-01

Full Text Available Abstract Background Multiplayer virtual world (MVW technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students’ retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR team training. Methods Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance. Results The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11% compared to 65 (±28% (p  At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5, 1.5 (±1.0 and 4.5 (±1.0 for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44% in the control group (p  Conclusions This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

How well does the Continuous Plankton Recorder (CPR) sample zooplankton? A comparison with the Longhurst Hardy Plankton Recorder (LHPR) in the northeast Atlantic

Science.gov (United States)

Richardson, Anthony J.; John, Eurgain H.; Irigoien, Xabier; Harris, Roger P.; Hays, Graeme C.

2004-09-01

The Continuous Plankton Recorder (CPR) survey has collected data on basin-scale zooplankton abundance in the North Atlantic since the 1930s. These data have been used in many studies to elucidate seasonal patterns and long-term change in plankton populations, as well as more recently to validate ecosystem models. There has, however, been relatively little comparison of the data from the CPR with that from other samplers. In this study we compare zooplankton abundance estimated from the CPR in the northeast Atlantic with near-surface samples collected by a Longhurst-Hardy Plankton Recorder (LHPR) at Ocean Weather Station India (59°N, 19°W) between 1971 and 1975. Comparisons were made for six common copepods in the region: Acartia clausi, Calanus finmarchicus, Euchaeta norvegica, Metridia lucens, Oithona sp., and Pleuromamma robusta. Seasonal cycles based on CPR data were similar to those recorded by the LHPR. Differences in absolute abundances were apparent, however, with the CPR underestimating abundances by a factor of between 5 and 40, with the exception of A. clausi. Active avoidance by zooplankton is thought to be responsible. This avoidance is species specific, so that care must be taken describing communities, as the CPR emphasises those species that are preferentially caught, a problem common to many plankton samplers.

Microstructure and chemical bonding of DLC films deposited on ACM rubber by PACVD

NARCIS (Netherlands)

Martinez-Martinez, D.; Schenkel, M.; Pei, Y.T.; Sánchez-López, J.C.; Hosson, J.Th.M. De

2011-01-01

The microstructure and chemical bonding of DLC films prepared by plasma assisted chemical vapor deposition on acrylic rubber (ACM) are studied in this paper. The temperature variation produced by the ion impingement during plasma cleaning and subsequent film deposition was used to modify the film

Theoretical interpretation of the nuclear structure of 88Se within the ACM and the QPM models.

Science.gov (United States)

Gratchev, I. N.; Thiamova, G.; Alexa, P.; Simpson, G. S.; Ramdhane, M.

2018-02-01

The four-parameter algebraic collective model (ACM) Hamiltonian is used to describe the nuclear structure of 88Se. It is shown that the ACM is capable of providing a reasonable description of the excitation energies and relative positions of the ground-state band and γ band. The most probable interpretation of the nuclear structure of 88Se is that of a transitional nucleus. The Quasiparticle-plus-Phonon Model (QPM) was also applied to describe the nuclear motion in 88Se. Preliminarily calculations show that the collectivity of second excited state {2}2+ is weak and that this state contains a strong two-quasiparticle component.

An Appropriate Compression Pace is Important for Securing the Quality of Hands-only CPR : A manikin study

OpenAIRE

Shimizu, Yoshitaka; Tanigawa, Koichi; Ishikawa, Masami; Ouhara, Kazuhisa; Oue, Kana; Yoshinaka, Taiga; Kurihara, Hidemi; Irifune, Masahiro

2014-01-01

It is important to implement good quality chest compressions for cardiopulmonary resuscitation (CPR). This manikin study examined the effects of different compression rates on chest compression depth variables using a metronome sound guide. Fifty sixth-year dentistry students participated in the study. Each participant performed CPR at 3 different compression rates, 110, 100, and 90 compressions per min (pace-110-g, pace-100-g, and pace-90-g) for 2 consecutive one-minute sets with a ten-secon...

Abstract 20854: A Tale of Self-Fulfilling Prophecies in Out-of-Hospital Cardiac Arrest: Emergency Medical Technicians Deliberately Perform Substandard CPR When Anticipating Poor Prognosis

DEFF Research Database (Denmark)

Bødtker, Henrik; Klausen, Troels M; Lauridsen, Kasper G

2017-01-01

) if they believe resuscitation to be futile. Furthermore, to investigate if different patient and resuscitation attempt characteristics result in EMTs deliberately performing substandard CPR.Methods: This was a cross-sectional questionnaire survey study conducted in 2016 through 2017 including EMTs from a Danish...... and compressions). Overall, 22% and 51% would perform substandard CPR if the patient were 80 or 90 years old respectively, 46% if the patient was living in a nursing home and up to 31% due to comorbidity such as cancer. EMTs (51%) would deliberately perform substandard CPR in case of on-going bystander CPR >20...... minutes. EMTs (72%) felt competent to terminate resuscitation, but only 9% knew international termination guidelines.Conclusion: EMTs delay start of resuscitation if they anticipate resuscitation to be futile. Furthermore, they deliberately perform substandard CPR based on controversial patient...

Prevention of oral bacterial flora transmission by using mouth-to-mask ventilation during CPR.

Science.gov (United States)

Cydulka, R K; Connor, P J; Myers, T F; Pavza, G; Parker, M

1991-01-01

The Emergency Cardiac Care Committee of the American Heart Association has recently recommended utilizing protective barrier precautions during CPR (1,2). We assessed 17 mask and faceshield resuscitation devices for adequacy of barrier protection. Eight of the devices were faceshields (CPR Microshield, Hygenic, MedCare Mask, Resusci, Samaritan, Sealeasy, Portex); 8 were mask devices (Laerdal, Dyna Med, MTM Emergency Lung Ventilator, MTM Emergency Resuscitator, Res-Q-Flo, Rightway Mouth-to-Mask Resuscitation, Trufit), and one of the devices did not meet the criteria for either faceshield or mask (Lifesaver). All masks were disinfected, applied to the investigator's face as directed by the manufacturers' instructions, and then cultured for oral aerobic bacterial flora on the rescuer side. No mask devices cultured positive for oral aerobic bacterial flora, while 6 of 8 faceshield devices cultured positive for oral aerobic bacterial flora (P less than 0.007). The CPR Microshield and the Portex faceshield were the only devices that did not develop a positive culture. We conclude that all ventilation devices with a one-way valve, except the Sealeasy device, provide adequate barrier type protection from oral aerobic bacterial flora when simulating mouth-to-barrier type protection when performing mouth-to-mouth ventilation.

Keep pushing! Limiting interruptions to CPR; bag-valve mask versus i-gel® airway ventilation

Directory of Open Access Journals (Sweden)

Craig Vincent-Lambert

2016-10-01

Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR. Method: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared. Results: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT. Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.

Air Traffic Complexity Measurement Environment (ACME): Software User's Guide

Science.gov (United States)

1996-01-01

A user's guide for the Air Traffic Complexity Measurement Environment (ACME) software is presented. The ACME consists of two major components, a complexity analysis tool and user interface. The Complexity Analysis Tool (CAT) analyzes complexity off-line, producing data files which may be examined interactively via the Complexity Data Analysis Tool (CDAT). The Complexity Analysis Tool is composed of three independently executing processes that communicate via PVM (Parallel Virtual Machine) and Unix sockets. The Runtime Data Management and Control process (RUNDMC) extracts flight plan and track information from a SAR input file, and sends the information to GARP (Generate Aircraft Routes Process) and CAT (Complexity Analysis Task). GARP in turn generates aircraft trajectories, which are utilized by CAT to calculate sector complexity. CAT writes flight plan, track and complexity data to an output file, which can be examined interactively. The Complexity Data Analysis Tool (CDAT) provides an interactive graphic environment for examining the complexity data produced by the Complexity Analysis Tool (CAT). CDAT can also play back track data extracted from System Analysis Recording (SAR) tapes. The CDAT user interface consists of a primary window, a controls window, and miscellaneous pop-ups. Aircraft track and position data is displayed in the main viewing area of the primary window. The controls window contains miscellaneous control and display items. Complexity data is displayed in pop-up windows. CDAT plays back sector complexity and aircraft track and position data as a function of time. Controls are provided to start and stop playback, adjust the playback rate, and reposition the display to a specified time.

The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time interval among bystanders in a shopping mall.

Science.gov (United States)

Panchal, Ashish R; Meziab, Omar; Stolz, Uwe; Anderson, Wes; Bartlett, Mitchell; Spaite, Daniel W; Bobrow, Bentley J; Kern, Karl B

2014-09-01

Recent studies have demonstrated higher-quality chest compressions (CCs) following a 60 s ultra-brief video (UBV) on compression-only CPR (CO-CPR). However, the effectiveness of UBVs as a CPR-teaching tool for lay bystanders in public venues remains unknown. Determine whether an UBV is effective in teaching laypersons CO-CPR in a public setting and if viewing leads to superior responsiveness and CPR skills. Adult lay bystanders were enrolled in a public shopping mall and randomized to: (1) Control (CTR): sat idle for 60 s; (2) UBV: watched a 60 s UBV on CO-CPR. Subjects were read a scenario detailing a sudden collapse in the mall and asked to do what they "thought was best" on a mannequin. Performance measures were recorded for 2 min: responsiveness (time to call 911 and first CCs) and CPR quality [CC depth, rate, hands-off interval (time without CC after first CC)]. One hundred subjects were enrolled. Demographics were similar between groups. UBV subjects called 911 more frequently (percent difference: 31%) and initiated CCs sooner in the arrest scenario (median difference (MD): 5 s). UBV cohort had increased CC rate (MD: 19 cpm) and decreased hands-off interval (MD: 27 s). There was no difference in CC depth. Bystanders with UBV training in a shopping mall had significantly improved responsiveness, CC rate, and decreased hands-off interval. Given the short length of training, UBV may have potential as a ubiquitous intervention for public venues to help improve bystander reaction to arrest and CO-CPR performance. Published by Elsevier Ireland Ltd.

ACME: A scalable parallel system for extracting frequent patterns from a very long sequence

KAUST Repository

Sahli, Majed; Mansour, Essam; Kalnis, Panos

2014-01-01

-long sequences and is the first to support supermaximal motifs. ACME is a versatile parallel system that can be deployed on desktop multi-core systems, or on thousands of CPUs in the cloud. However, merely using more compute nodes does not guarantee efficiency

ACME - Algorithms for Contact in a Multiphysics Environment API Version 1.0

International Nuclear Information System (INIS)

BROWN, KEVIN H.; SUMMERS, RANDALL M.; GLASS, MICHEAL W.; GULLERUD, ARNE S.; HEINSTEIN, MARTIN W.; JONES, REESE E.

2001-01-01

An effort is underway at Sandia National Laboratories to develop a library of algorithms to search for potential interactions between surfaces represented by analytic and discretized topological entities. This effort is also developing algorithms to determine forces due to these interactions for transient dynamics applications. This document describes the Application Programming Interface (API) for the ACME (Algorithms for Contact in a Multiphysics Environment) library

The Effects of Visual Feedback on CPR Skill Retention in Graduate Student Athletic Trainers

Directory of Open Access Journals (Sweden)

Michael G. Miller

2015-09-01

Full Text Available Context: Studies examining the effectiveness of cardiopulmonary resuscitation (CPR chest compressions have found compression depth and rate to be less than optimal and recoil to full release to be incomplete. Objective: To determine if visual feedback affects the rate and depth of chest compressions and chest recoil values during CPR training of athletic trainers and to determine retention of proficiency over time. Design: Pre-test, post-test. Setting: Medical simulation laboratory. Participants: Eleven females and one male (23.08+.51 years old, from an Athletic Training Graduate Program. All participants were Certified Athletic Trainers (1.12+.46 years of experience and certified in CPR for the Professional Rescuer. Interventions: Participants completed a pre-test, practice sessions, and a post-test on a SimMan® (Laerdal Medical manikin with visual feedback of skills in real time. After the pre-test, participants received feedback by the investigators. Participants completed practice sessions as needed (range=1-4 sessions, until they reached 100% skill proficiency. After achieving proficiency, participants returned 8 weeks later to perform the CPR skills. Main Outcome Measures: The average of all compression outcome measures (rate, depth, recoil was captured every 10 seconds (6x per min. All participants performed 5 cycles of 30 compressions. A two-tailed paired samples t-test (pre to post was used to compare rate of chest compressions, depth of chest compressions, and recoil of the chest. Significance was set a priori at pResults: There was a significant difference between pre and post-test compression depth average, p=.002. The pre-depth average was 41mm + 9.83mm compared to the post-depth average of 52.26mm + 5mm. There were no significant differences between pre and post-test chest compression rates and recoil. Conclusions: The use of a simulated manikin with visual feedback facilitated participants to reach the recommended compression

Design and transient analyses of emergency passive residual heat removal system of CPR1000

International Nuclear Information System (INIS)

Zhang, Y.P.; Qiu, S.Z.; Su, G.H.; Tian, W.X.

2012-01-01

Highlights: ► Designing an EPRHRs for CPR1000. ► Developing a RELAP model of the EPRHRs. ► The EPRHRs could take away the decay heat effectively. - Abstract: The steam generator secondary emergency passive residual heat removal system (EPRHRs) is a new design for traditional generation II + reactor CPR1000. The EPRHRs is designed to improve the safety and reliability of CPR1000 by completely or partially replacing traditional emergency water cooling system in the event of the station blackout or loss of heat sink accident. The EPRHRs consists of steam generator (SG), heat exchanger (HX), emergency makeup tank (EMT), cooling water tank (CWT), and corresponding pipes and valves. In order to improve the safety and reliability of CPR1000, the model of the primary loop and the EPRHRs was developed to investigate residual heat removal capability of the EPRHRs and the transient characteristics of the primary loop affected by the EPRHRs using RELAP5/MOD3.4. The transient characteristics of the primary loop and the EPRHRs were calculated in the event of station blackout accident. Sensitivity studies of the EPRHRs were also conducted to investigate the response of the primary loop and the EPRHRs on the main parameters of the EPRHRs. The EPRHRs could supply water to the SG shell side from the EMT successfully. The calculation results showed that the EPRHRs could take away the decay heat from the primary loop effectively, and that the single-phase and two-phase natural circulations were established in the primary loop and EPRHRs loop, respectively. The results also indicated that the effect of isolation valve open time on the transient characteristics of the primary loop was little. However, the effect of isolation valve open time on the EPRHRs condensate flow was relatively greater. The isolation valves should not be opened too rapidly during the isolation valve opening process, and the isolation valve opening time should be greater than 10 s, which could avoid the

Effects of activated ACM on expression of signal transducers in cerebral cortical neurons of rats.

Science.gov (United States)

Wang, Xiaojing; Li, Zhengli; Zhu, Changgeng; Li, Zhongyu

2007-06-01

To explore the roles of astrocytes in the epileptogenesis, astrocytes and neurons were isolated, purified and cultured in vitro from cerebral cortex of rats. The astrocytes were activated by ciliary neurotrophic factor (CNTF) and astrocytic conditioned medium (ACM) was collected to treat neurons for 4, 8 and 12 h. By using Western blot, the expression of calmodulin dependent protein kinase II (CaMK II), inducible nitric oxide synthase (iNOS) and adenylate cyclase (AC) was detected in neurons. The results showed that the expression of CaMK II, iNOS and AC was increased significantly in the neurons treated with ACM from 4 h to 12 h (PACM and such signal pathways as NOS-NO-cGMP, Ca2+/CaM-CaMK II and AC-cAMP-PKA might take part in the signal transduction of epileptogenesis.

A third-order gas-kinetic CPR method for the Euler and Navier-Stokes equations on triangular meshes

Science.gov (United States)

Zhang, Chao; Li, Qibing; Fu, Song; Wang, Z. J.

2018-06-01

A third-order accurate gas-kinetic scheme based on the correction procedure via reconstruction (CPR) framework is developed for the Euler and Navier-Stokes equations on triangular meshes. The scheme combines the accuracy and efficiency of the CPR formulation with the multidimensional characteristics and robustness of the gas-kinetic flux solver. Comparing with high-order finite volume gas-kinetic methods, the current scheme is more compact and efficient by avoiding wide stencils on unstructured meshes. Unlike the traditional CPR method where the inviscid and viscous terms are treated differently, the inviscid and viscous fluxes in the current scheme are coupled and computed uniformly through the kinetic evolution model. In addition, the present scheme adopts a fully coupled spatial and temporal gas distribution function for the flux evaluation, achieving high-order accuracy in both space and time within a single step. Numerical tests with a wide range of flow problems, from nearly incompressible to supersonic flows with strong shocks, for both inviscid and viscous problems, demonstrate the high accuracy and efficiency of the present scheme.

Segmentation of solid subregion of high grade gliomas in MRI images based on active contour model (ACM)

Science.gov (United States)

Seow, P.; Win, M. T.; Wong, J. H. D.; Abdullah, N. A.; Ramli, N.

2016-03-01

Gliomas are tumours arising from the interstitial tissue of the brain which are heterogeneous, infiltrative and possess ill-defined borders. Tumour subregions (e.g. solid enhancing part, edema and necrosis) are often used for tumour characterisation. Tumour demarcation into substructures facilitates glioma staging and provides essential information. Manual segmentation had several drawbacks that include laborious, time consuming, subjected to intra and inter-rater variability and hindered by diversity in the appearance of tumour tissues. In this work, active contour model (ACM) was used to segment the solid enhancing subregion of the tumour. 2D brain image acquisition data using 3T MRI fast spoiled gradient echo sequence in post gadolinium of four histologically proven high-grade glioma patients were obtained. Preprocessing of the images which includes subtraction and skull stripping were performed and then followed by ACM segmentation. The results of the automatic segmentation method were compared against the manual delineation of the tumour by a trainee radiologist. Both results were further validated by an experienced neuroradiologist and a brief quantitative evaluations (pixel area and difference ratio) were performed. Preliminary results of the clinical data showed the potential of ACM model in the application of fast and large scale tumour segmentation in medical imaging.

Segmentation of solid subregion of high grade gliomas in MRI images based on active contour model (ACM)

International Nuclear Information System (INIS)

Seow, P; Win, M T; Wong, J H D; Ramli, N; Abdullah, N A

2016-01-01

Gliomas are tumours arising from the interstitial tissue of the brain which are heterogeneous, infiltrative and possess ill-defined borders. Tumour subregions (e.g. solid enhancing part, edema and necrosis) are often used for tumour characterisation. Tumour demarcation into substructures facilitates glioma staging and provides essential information. Manual segmentation had several drawbacks that include laborious, time consuming, subjected to intra and inter-rater variability and hindered by diversity in the appearance of tumour tissues. In this work, active contour model (ACM) was used to segment the solid enhancing subregion of the tumour. 2D brain image acquisition data using 3T MRI fast spoiled gradient echo sequence in post gadolinium of four histologically proven high-grade glioma patients were obtained. Preprocessing of the images which includes subtraction and skull stripping were performed and then followed by ACM segmentation. The results of the automatic segmentation method were compared against the manual delineation of the tumour by a trainee radiologist. Both results were further validated by an experienced neuroradiologist and a brief quantitative evaluations (pixel area and difference ratio) were performed. Preliminary results of the clinical data showed the potential of ACM model in the application of fast and large scale tumour segmentation in medical imaging. (paper)

Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: a randomized double-blind crossover study.

Science.gov (United States)

Nikandish, Reza; Shahbazi, Sharbanoo; Golabi, Sedigheh; Beygi, Najimeh

2008-02-01

Previous research has suggested improved quality of chest compressions when the dominant hand was in contact with the sternum. However, the study was in health care professionals and during conventional chest compression-ventilation CPR. The aim of this study was to test the hypothesis, in null form, that the quality of external chest compressions (ECC) in novice rescuers during 5min of uninterrupted chest compression CPR (UCC-CPR) is independent of the hand in contact with the sternum. Confirmation of the hypothesis would allow the use of either hand by the novice rescuers during UCC-CPR. Fifty-nine first year public heath students participated in this randomised double-blind crossover study. After completion of a standard adult BLS course, they performed single rescuer adult UCC-CPR for 5 min on a recording Resusci Anne. One week later they changed the hand of contact with the sternum while performing ECC. The quality of ECC was recorded by the skill meter for the dominant and non-dominant hand during 5 min ECC. The total number of correct chest compressions in the dominant hand group (DH), mean 183+/-152, was not statistically different from the non-dominant hand group (NH), mean 152+/-135 (P=0.09). The number of ECC with inadequate depth in the DH group, mean 197+/-174 and NH group, mean 196+/-173 were comparable (P=0.1). The incidence of ECC exceeding the recommended depth in the DH group, mean 51+/-110 and NH group, mean 32+/-75 were comparable (P=0.1). Although there is a trend to increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min.

Validation of the Adolescent Concerns Measure (ACM): Evidence from Exploratory and Confirmatory Factor Analysis

Science.gov (United States)

Ang, Rebecca P.; Chong, Wan Har; Huan, Vivien S.; Yeo, Lay See

2007-01-01

This article reports the development and initial validation of scores obtained from the Adolescent Concerns Measure (ACM), a scale which assesses concerns of Asian adolescent students. In Study 1, findings from exploratory factor analysis using 619 adolescents suggested a 24-item scale with four correlated factors--Family Concerns (9 items), Peer…

A new method to detect cerebral blood flow waveform in synchrony with chest compression by near-infrared spectroscopy during CPR.

Science.gov (United States)

Koyama, Yasuaki; Wada, Takafumi; Lohman, Brandon D; Takamatsu, Yuka; Matsumoto, Junichi; Fujitani, Shigeki; Taira, Yasuhiko

2013-10-01

The objective of the study is to demonstrate the utility of near-infrared spectroscopy (NIRS) in evaluating chest compression (CC) quality in cardiac arrest (CA) patients as well as determine its prognosis predictive value. We present a nonconsecutive case series of adult patients with CA whose cardiopulmonary resuscitation (CPR) was monitored with NIRS and collected the total hemoglobin concentration change (ΔcHb), the tissue oxygen index (TOI), and the ΔTOI to assess CC quality in a noninvasive fashion. During CPR, ΔcHb displayed waveforms monitor, which we regarded as a surrogate for CC quality. Total hemoglobin concentration change waveforms responded accurately to variations or cessations of CCs. In addition, a TOI greater than 40% measured upon admission appears to be significant in predicting patient's outcome. Of 15 patients, 6 had a TOI greater than 40% measured upon admission, and 67% of the latter were in return of spontaneous circulation after CPR and were found to be significantly different between return of spontaneous circulation and death (P = .047; P < .05). Near-infrared spectroscopy reliably assesses the quality of CCs in patients with CA demonstrated by synchronous waveforms during CPR and possible prognostic predictive value, although further investigation is warranted. © 2013 Elsevier Inc. All rights reserved.

Importance of basic CPR techniques. A study in the Region of Murcia

Directory of Open Access Journals (Sweden)

J. Arturo Abraldes Valeiras

2011-01-01

Full Text Available Annually in Spain many people die from diseases related to heart. Heart attack is the main cause of such deaths. Know and control the basic techniques of basic Cardiopulmonary resuscitation (CPR are essential to help a person away from these features. This study examined 1 the importance of knowing these techniques in the general population, and 2 the perception of the difficulty of understanding and application of techniques. We used a questionnaire designed "ad hoc" as a tool for collecting information. The instrument was subjected to validation and reliability for the study. The questionnaire was completed by 235 volunteers aged between 10 and 65. We performed a descriptive analysis, based on gender and the variables importance of knowledge and learning / apply techniques. Among the most relevant results, we emphasize an interest of society to improve training in this type of knowledge. Training would be ideal in most age groups of people (teens to seniors. Likewise, CPR techniques are easy to understand and execute a lesser extent, relevant perception among people who acknowledge and application these techniques

"Utstein style" spreadsheet and database programs based on Microsoft Excel and Microsoft Access software for CPR data management of in-hospital resuscitation.

Science.gov (United States)

Adams, Bruce D; Whitlock, Warren L

2004-04-01

In 1997, The American Heart Association in association with representatives of the International Committee on Resuscitation (ILCOR) published recommended guidelines for reviewing, reporting and conducting in-hospital cardiopulmonary resuscitation (CPR) outcomes using the "Utstein style". Using these guidelines, we developed two Microsoft Office based database management programs that may be useful to the resuscitation community. We developed a user-friendly spreadsheet based on MS Office Excel. The user enters patient variables such as name, age, and diagnosis. Then, event resuscitation variables such as time of collapse and CPR team arrival are entered from a "code flow sheet". Finally, outcome variables such as patient condition at different time points are recorded. The program then makes automatic calculations of average response times, survival rates and other important outcome measurements. Also using the Utstein style, we developed a database program based on MS Office Access. To promote free public access to these programs, we established at a website. These programs will help hospitals track, analyze, and present their CPR outcomes data. Clinical CPR researchers might also find the programs useful because they are easily modified and have statistical functions.

Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

Directory of Open Access Journals (Sweden)

Siriphuwanun V

2014-10-01

Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

Bench evaluation: three face-shield CPR barrier devices.

Science.gov (United States)

Simmons, M; Deao, D; Moon, L; Peters, K; Cavanaugh, S

1995-06-01

Due to the fear of disease transmission, the practice of mouth-to-mouth (M-M) rescue breathing is rarely performed; to address this concern, many types of CPR barrier devices have been developed. These include bag-valve-mask devices, mouth-to-mask devices, and face shields (FS). The purpose of this study was to measure the volumes delivered during mouth-to-face shield (M-FS) breathing, to measure the back pressure and calculate the resistance to flow through their 1-way valves, and to test for backward leak of gas through the valves. Three FS brands were evaluated: Kiss of Life (KOL), MicroSHIELD (Micro) and Res-Cue Key (RCK). Volume delivered during M-M and M-FS breathing was evaluated by 10 rescuers who used the devices while performing rescue breathing on a CPR mannequin. Back pressure was measured and resistance calculated by directing airflow through the 1-way valves. Backward leak was evaluated by measuring the O2 concentration at the rescuer side of the valve while 100% O2 was directed toward the patient side of the valve. Differences among the brands were evaluated using analysis of variance. The mean (SD) values for volumes in L were: M-M 1.00 (0.25), Micro 0.77 (0.20), RCK 0.64 (0.10), and KOL 0.24 (0.11). Mean values for back pressure in cm H2O at 50 L/min were Micro 16.7 (1.29), KOL 7.22 (0.13), and RCK 2.15 (0.16). Significant backward leak only occurred with RCK. Not one of the FSs tested met all of the requirements suggested by the American Heart Association and by the International Standards Organization.

Expression, purification, crystallization and preliminary X-ray analysis of conjugated polyketone reductase C2 (CPR-C2) from Candida parapsilosis IFO 0708.

Science.gov (United States)

Yamamura, Akihiro; Maruoka, Shintaro; Ohtsuka, Jun; Miyakawa, Takuya; Nagata, Koji; Kataoka, Michihiko; Kitamura, Nahoko; Shimizu, Sakayu; Tanokura, Masaru

2009-11-01

Conjugated polyketone reductase C2 (CPR-C2) from Candida parapsilosis IFO 0708 is a member of the NADPH-dependent aldo-keto reductase (AKR) superfamily and catalyzes the stereospecific reduction of ketopantoyl lactone to d-pantoyl lactone. A diffraction-quality crystal of recombinant CPR-C2 was obtained by the sitting-drop vapour-diffusion method using PEG 3350 as the precipitant. The crystal diffracted X-rays to 1.7 angstrom resolution on beamline NW12A of the Photon Factory-Advanced Ring (Tsukuba, Japan). The crystal belonged to space group P2(1)2(1)2(1), with unit-cell parameters a = 55.02, b = 68.30, c = 68.93 angstrom. The Matthews coefficient (V(M) = 1.76 angstrom(3) Da(-1)) indicated that the crystal contained one CPR-C2 molecule per asymmetric unit.

Corpuls CPR Generates Higher Mean Arterial Pressure Than LUCAS II in a Pig Model of Cardiac Arrest

Directory of Open Access Journals (Sweden)

S. Eichhorn

2017-01-01

Full Text Available According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recently developed chest compression device (Corpuls CPR with an established system (LUCAS II in a pig model. Methods. Pigs (n = 5/group in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO2, regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Results. Animals treated with Corpuls CPR had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. Conclusion. Chest compressions with the Corpuls CPR device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device.

Evaluation of a Brief Intervention Designed to Increase CPR Training among Pregnant Pool Owners

Science.gov (United States)

Girasek, Deborah C.

2011-01-01

This study evaluated whether a brief videotape could motivate pregnant pool owners to be trained in infant/child cardiopulmonary resuscitation (CPR). Women were recruited from prenatal classes in South Florida. Eligible volunteers were randomized to view a video or receive standard treatment, after completing a questionnaire. The video explained…

Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country

Directory of Open Access Journals (Sweden)

Desalu Ibironke

2008-01-01

There is low confidence among junior anaesthetists in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythm and little practice in defibrillation. The establishment of a Resuscitation council would ensure adequate and frequent training which would improve knowledge, boost confidence and result in better patient care.

When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.

Science.gov (United States)

Giberson, Brandon; Uber, Amy; F Gaieski, David; Miller, Joseph B; Wira, Charles; Berg, Katherine; Giberson, Tyler; Cocchi, Michael N; S Abella, Benjamin; Donnino, Michael W

2016-09-01

Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest. We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States. The survey consisted of 5 multiple-choice, scenario-based ACLS questions, including our question of interest. Adult staff members with a valid ACLS certification were included. A total of 347 surveys were analyzed. The response rate was 28.1%. The majority (53.6%) of responders were between 18 and 32 years old, and 59.9% were female. The majority (54.2%) of responders incorrectly stated that they would continue CPR and possibly administer additional therapies when a team member detects a pulse immediately following defibrillation. Secondarily, only 51.9% of respondents correctly chose to perform a rhythm check following 2 minutes of CPR. The other 3 survey questions were correctly answered an average of 89.1% of the time. Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected. © The Author(s) 2014.

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

Science.gov (United States)

Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

2017-01-01

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and

Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

NARCIS (Netherlands)

Kalz, Marco

2013-01-01

Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

Out-of-hospital cardiac arrest: the prospect of E-CPR in the Maastricht region.

Science.gov (United States)

Sharma, A S; Pijls, R W M; Weerwind, P W; Delnoij, T S R; de Jong, W C; Gorgels, A P M; Maessen, J G

2016-02-01

The current outcome of out-of-hospital cardiac arrest (OHCA) patients in the Maastricht region was analysed with the prospect of implementing extracorporeal cardiopulmonary resuscitation (E-CPR). A retrospective analysis of adult patients who were resuscitated for OHCA during a 24-month period was performed. 195 patients (age 66 [57-75] years, 82 % male) were resuscitated for OHCA by the emergency medical services and survived to admission at the emergency department. Survival to hospital discharge was 46.2 %. Notable differences between non-survivors and survivors were observed and included: age (70 [58-79] years) vs. (63 [55-72] years, p = 0.01), chronic heart failure (18 vs. 7 %, p = 0.02), shockable rhythm (67 vs. 99 %, p < 0.01), and return of spontaneous circulation (ROSC) at departure from the site of the arrest (46 vs. 99 %, p < 0.01) and on arrival to the emergency department (43 vs. 98 %, p < 0.01), respectively. Acute coronary syndrome was diagnosed in 32 % of non-survivors vs. 59 % among survivors, p < 0.01. Therapeutic hypothermia was provided in non-survivors (20 %) vs. survivors (43 %), p < 0.01. Percutaneous coronary intervention (PCI) was performed in 14 % of non-survivors while 52 % of survivors received PCI (p < 0.01). No statistical significance was observed in terms of gender, witnessed arrest, bystander CPR, or automated external defibrillator deployed among the cohort. At hospital discharge, moderately severe neurological disability was present in six survivors. These observations are compatible with the notion that a shockable rhythm, ROSC, and post-arrest care improve survival outcome. Potentially, initiating E-CPR in the resuscitation phase in patients with a shockable rhythm and no ROSC might serve as a bridge to definite treatment and improve survival outcome.

Augmented survival of out-of-hospital cardiac arrest victims with the use of mobile phones for emergency communication under the DA-CPR protocol getting information from callers beside the victim.

Science.gov (United States)

Maeda, Tetsuo; Yamashita, Akira; Myojo, Yasuhiro; Wato, Yukihiro; Inaba, Hideo

2016-10-01

To investigate the impacts of emergency calls made using mobile phones on the quality of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) and survival from out-of-hospital cardiac arrests (OHCAs) that were not witnessed by emergency medical service (EMS). In this prospective study, we collected data for 2530 DA-CPR-attempted medical emergency cases (517 using mobile phones and 2013 using landline phones) and 2980 non-EMS-witnessed OHCAs (600 using mobile phones and 2380 using landline phones). Time factors and quality of DA-CPR, backgrounds of callers and outcomes of OHCAs were compared between mobile and landline phone groups. Emergency calls are much more frequently placed beside the arrest victim in mobile phone group (52.7% vs. 17.2%). The positive predictive value and acceptance rate of DA-CPR in mobile phone group (84.7% and 80.6%, respectively) were significantly higher than those in landline group (79.2% and 70.9%). The proportion of good-quality bystander CPR in mobile phone group was significantly higher than that in landline group (53.5% vs. 45.0%). When analysed for all non-EMS-witnessed OHCAs, rates of 1-month survival and 1-year neurologically favourable survival in mobile phone group (7.8% and 3.5%, respectively) were higher than those in landline phone group (4.6% and 1.9%; pmobile phone calls were associated with increased 1-month survival in the subgroup of OHCAs receiving bystander CPR (adjusted odds ratio, 1.84; 95% CI, 1.15-2.92). Emergency calls made using mobile phones are likely to augment the survival from OHCAs by improving DA-CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Emergency nurses' current practices and understanding of family presence during CPR.

LENUS (Irish Health Repository)

Madden, Eilis

2012-02-03

PURPOSE: To examine emergency nurses\\' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland. METHOD: A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months\\' emergency nursing experience. RESULTS: Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development. CONCLUSION: The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.

Preliminary assessment of a combined passive safety system for typical 3-loop PWR CPR1000

Energy Technology Data Exchange (ETDEWEB)

Yang, Zijiang; Shan, Jianqiang, E-mail: jqshan@mail.xjtu.edu.cn; Gou, Junli

2017-03-15

Highlights: • A combined passive safety system was placed on a typical 3-loop PWR CPR1000. • Three accident analyses show the three different accident mitigation methods of the passive safety system. • The three mitigation methods were proved to be useful. - Abstract: As the development of the nuclear industry, passive technology turns out to be a remarkable characteristic of advanced nuclear power plants. Since the 20th century, much effort has been given to the passive technology, and a number of evolutionary passive systems have developed. Thoughts have been given to upgrade the existing reactors with passive systems to meet stricter safety demands. In this paper, the CPR1000 plant, which is one kind of mature pressurized water reactor plants in China, is improved with some passive systems to enhance safety. The passive systems selected are as follows: (1) the reactor makeup tank (RMT); (2) the advanced accumulator (A-ACC); (3) the in-containment refueling water storage tank (IRWST); (4) the passive emergency feed water system (PEFS), which is installed on the secondary side of SGs; (5) the passive depressurization system (PDS). Although these passive components is based on the passive technology of some advanced reactors, their structural and trip designs are adjusted specifically so that it could be able to mitigate accidents of the CPR1000. Utilizing the RELAP5/MOD3.3 code, accident analyses (small break loss of coolant accident, large break loss of coolant accident, main feed water line break accident) of this improved CPR1000 plant were presented to demonstrate three different accident mitigation methods of the safety system and to test whether the passive safety system preformed its function well. In the SBLOCA, all components of the passive safety system were put into work sequentially, which prevented the core uncover. The LBLOCA analysis illustrates the contribution of the A-ACCs whose small-flow-rate injection can control the maximum cladding

Classroom versus Computer-Based CPR Training: A Comparison of the Effectiveness of Two Instructional Methods

Science.gov (United States)

Rehberg, Robb S.; Gazzillo Diaz, Linda; Middlemas, David A.

2009-01-01

Objective: The objective of this study was to determine whether computer-based CPR training is comparable to traditional classroom training. Design and Setting: This study was quantitative in design. Data was gathered from a standardized examination and skill performance evaluation which yielded numerical scores. Subjects: The subjects were 64…

TWO NOVEL ACM (ACTIVE CONTOUR MODEL) METHODS FOR INTRAVASCULAR ULTRASOUND IMAGE SEGMENTATION

International Nuclear Information System (INIS)

Chen, Chi Hau; Potdat, Labhesh; Chittineni, Rakesh

2010-01-01

One of the attractive image segmentation methods is the Active Contour Model (ACM) which has been widely used in medical imaging as it always produces sub-regions with continuous boundaries. Intravascular ultrasound (IVUS) is a catheter based medical imaging technique which is used for quantitative assessment of atherosclerotic disease. Two methods of ACM realizations are presented in this paper. The gradient descent flow based on minimizing energy functional can be used for segmentation of IVUS images. However this local operation alone may not be adequate to work with the complex IVUS images. The first method presented consists of basically combining the local geodesic active contours and global region-based active contours. The advantage of combining the local and global operations is to allow curves deforming under the energy to find only significant local minima and delineate object borders despite noise, poor edge information and heterogeneous intensity profiles. Results for this algorithm are compared to standard techniques to demonstrate the method's robustness and accuracy. In the second method, the energy function is appropriately modified and minimized using a Hopfield neural network. Proper modifications in the definition of the bias of the neurons have been introduced to incorporate image characteristics. The method overcomes distortions in the expected image pattern, such as due to the presence of calcium, and employs a specialized structure of the neural network and boundary correction schemes which are based on a priori knowledge about the vessel geometry. The presented method is very fast and has been evaluated using sequences of IVUS frames.

Long-term retrospective analysis of mackerel spawning in the North Sea: a new time series and modeling approach to CPR data.

Science.gov (United States)

Jansen, Teunis; Kristensen, Kasper; Payne, Mark; Edwards, Martin; Schrum, Corinna; Pitois, Sophie

2012-01-01

We present a unique view of mackerel (Scomber scombrus) in the North Sea based on a new time series of larvae caught by the Continuous Plankton Recorder (CPR) survey from 1948-2005, covering the period both before and after the collapse of the North Sea stock. Hydrographic backtrack modelling suggested that the effect of advection is very limited between spawning and larvae capture in the CPR survey. Using a statistical technique not previously applied to CPR data, we then generated a larval index that accounts for both catchability as well as spatial and temporal autocorrelation. The resulting time series documents the significant decrease of spawning from before 1970 to recent depleted levels. Spatial distributions of the larvae, and thus the spawning area, showed a shift from early to recent decades, suggesting that the central North Sea is no longer as important as the areas further west and south. These results provide a consistent and unique perspective on the dynamics of mackerel in this region and can potentially resolve many of the unresolved questions about this stock.

Long-term retrospective analysis of mackerel spawning in the North Sea: a new time series and modeling approach to CPR data.

Directory of Open Access Journals (Sweden)

Teunis Jansen

Full Text Available We present a unique view of mackerel (Scomber scombrus in the North Sea based on a new time series of larvae caught by the Continuous Plankton Recorder (CPR survey from 1948-2005, covering the period both before and after the collapse of the North Sea stock. Hydrographic backtrack modelling suggested that the effect of advection is very limited between spawning and larvae capture in the CPR survey. Using a statistical technique not previously applied to CPR data, we then generated a larval index that accounts for both catchability as well as spatial and temporal autocorrelation. The resulting time series documents the significant decrease of spawning from before 1970 to recent depleted levels. Spatial distributions of the larvae, and thus the spawning area, showed a shift from early to recent decades, suggesting that the central North Sea is no longer as important as the areas further west and south. These results provide a consistent and unique perspective on the dynamics of mackerel in this region and can potentially resolve many of the unresolved questions about this stock.

Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study

OpenAIRE

Page, Ann-Sophie; Page, Geert; Dehaene, Isabelle; Roets, Ellen; Roelens, Kristien

2017-01-01

Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies. Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were ...

Enabling Chemistry of Gases and Aerosols for Assessment of Short-Lived Climate Forcers: Improving Solar Radiation Modeling in the DOE-ACME and CESM models

Energy Technology Data Exchange (ETDEWEB)

Prather, Michael [Univ. of California, Irvine, CA (United States)

2018-01-12

This proposal seeks to maintain the DOE-ACME (offshoot of CESM) as one of the leading CCMs to evaluate near-term climate mitigation. It will implement, test, and optimize the new UCI photolysis codes within CESM CAM5 and new CAM versions in ACME. Fast-J is a high-order-accuracy (8 stream) code for calculating solar scattering and absorption in a single column atmosphere containing clouds, aerosols, and gases that was developed at UCI and implemented in CAM5 under the previous BER/SciDAC grant.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

Science.gov (United States)

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

Construction of improved temperature-sensitive and mobilizable vectors and their use for constructing mutations in the adhesin-encoding acm gene of poorly transformable clinical Enterococcus faecium strains.

Science.gov (United States)

Nallapareddy, Sreedhar R; Singh, Kavindra V; Murray, Barbara E

2006-01-01

Inactivation by allelic exchange in clinical isolates of the emerging nosocomial pathogen Enterococcus faecium has been hindered by lack of efficient tools, and, in this study, transformation of clinical isolates was found to be particularly problematic. For this reason, a vector for allelic replacement (pTEX5500ts) was constructed that includes (i) the pWV01-based gram-positive repAts replication region, which is known to confer a high degree of temperature intolerance, (ii) Escherichia coli oriR from pUC18, (iii) two extended multiple-cloning sites located upstream and downstream of one of the marker genes for efficient cloning of flanking regions for double-crossover mutagenesis, (iv) transcriptional terminator sites to terminate undesired readthrough, and (v) a synthetic extended promoter region containing the cat gene for allelic exchange and a high-level gentamicin resistance gene, aph(2'')-Id, to distinguish double-crossover recombination, both of which are functional in gram-positive and gram-negative backgrounds. To demonstrate the functionality of this vector, the vector was used to construct an acm (encoding an adhesin to collagen from E. faecium) deletion mutant of a poorly transformable multidrug-resistant E. faecium endocarditis isolate, TX0082. The acm-deleted strain, TX6051 (TX0082Deltaacm), was shown to lack Acm on its surface, which resulted in the abolishment of the collagen adherence phenotype observed in TX0082. A mobilizable derivative (pTEX5501ts) that contains oriT of Tn916 to facilitate conjugative transfer from the transformable E. faecalis strain JH2Sm::Tn916 to E. faecium was also constructed. Using this vector, the acm gene of a nonelectroporable E. faecium wound isolate was successfully interrupted. Thus, pTEX5500ts and its mobilizable derivative demonstrated their roles as important tools by helping to create the first reported allelic replacement in E. faecium; the constructed this acm deletion mutant will be useful for assessing the

Expression, purification, crystallization and preliminary X-ray analysis of conjugated polyketone reductase C2 (CPR-C2) from Candida parapsilosis IFO 0708

International Nuclear Information System (INIS)

Yamamura, Akihiro; Maruoka, Shintaro; Ohtsuka, Jun; Miyakawa, Takuya; Nagata, Koji; Kataoka, Michihiko; Kitamura, Nahoko; Shimizu, Sakayu; Tanokura, Masaru

2009-01-01

Conjugated polyketone reductase C2 from C. parapsilosis IFO 0708 was expressed, purified and crystallized by the sitting-drop vapour-diffusion method. The crystal belonged to space group P2 1 2 1 2 1 and diffracted X-rays to 1.7 Å resolution. Conjugated polyketone reductase C2 (CPR-C2) from Candida parapsilosis IFO 0708 is a member of the NADPH-dependent aldo-keto reductase (AKR) superfamily and catalyzes the stereospecific reduction of ketopantoyl lactone to d-pantoyl lactone. A diffraction-quality crystal of recombinant CPR-C2 was obtained by the sitting-drop vapour-diffusion method using PEG 3350 as the precipitant. The crystal diffracted X-rays to 1.7 Å resolution on beamline NW12A of the Photon Factory-Advanced Ring (Tsukuba, Japan). The crystal belonged to space group P2 1 2 1 2 1 , with unit-cell parameters a = 55.02, b = 68.30, c = 68.93 Å. The Matthews coefficient (V M = 1.76 Å 3 Da −1 ) indicated that the crystal contained one CPR-C2 molecule per asymmetric unit

[11C]PR04.MZ, a promising DAT ligand for low concentration imaging: synthesis, efficient 11C-O-methylation and initial small animal PET studies

International Nuclear Information System (INIS)

Riss, P.J.; Hooker, J.; Alexoff, D.; Kim, Sung-Won; Fowler, J.S.; Roesch, F.

2009-01-01

PR04.MZ was designed as a highly selective dopamine transporter inhibitor, derived from natural cocaine. Its binding profile indicates that [ 11 C]PR04.MZ may be suited as a PET radioligand for the non-invasive exploration of striatal and extrastriatal DAT populations. As a key feature, its structural design facilitates both, labelling with fluorine-18 at its terminally fluorinated butynyl moiety and carbon-11 at its methyl ester function. The present report concerns the efficient [ 11 C]MeI mediated synthesis of [ 11 C]PR04.MZ from an O-desmethyl precursor trifluoroacetic acid salt with Rb 2 CO 3 in DMF in up to 95 ± 5% labelling yield. A preliminary μPET-experiment demonstrates the reversible, highly specific binding of [ 11 C]PR04.MZ in the brain of a male Sprague-Dawley rat.

A comparison between the two methods of chest compression in infant and neonatal resuscitation. A review according to 2010 CPR guidelines.

Science.gov (United States)

Douvanas, Alexandros; Koulouglioti, Christina; Kalafati, Maria

2018-03-01

The quality of chest compression (CC) delivered during neonatal and infant cardiopulmonary resuscitation (CPR) is identified as the most important factor to achieve the increase of survival rate without major neurological deficit to the patients. The objective of the study was to systematically review all the available studies that have compared the two different techniques of hand placement on infants and neonatal resuscitation, from 2010 to 2015 and to highlight which method is more effective. A review of the literature using a variety of medical databases, including Cochrane, MEDLINE, and SCOPUS electronic databases. The following MeSH terms were used in the search: infant, neonatal, CPR, CC, two-thumb (TT) technique/method, two-finger (TF) technique/method, rescuer fatigue, thumb/finger position/placement, as well as combinations of these. Ten studies met the inclusion criteria; nine observational studies and a randomized controlled trial. All providers performed either continuous TF or TT technique CCs and the majority of CPR performance was taken place in infant trainer manikin. The majority of the studies suggest the TT method as the more useful for infants and neonatal resuscitation than the TF.

Mutation of a cuticular protein, BmorCPR2, alters larval body shape and adaptability in silkworm, Bombyx mori.

Science.gov (United States)

Qiao, Liang; Xiong, Gao; Wang, Ri-xin; He, Song-zhen; Chen, Jie; Tong, Xiao-ling; Hu, Hai; Li, Chun-lin; Gai, Ting-ting; Xin, Ya-qun; Liu, Xiao-fan; Chen, Bin; Xiang, Zhong-huai; Lu, Cheng; Dai, Fang-yin

2014-04-01

Cuticular proteins (CPs) are crucial components of the insect cuticle. Although numerous genes encoding cuticular proteins have been identified in known insect genomes to date, their functions in maintaining insect body shape and adaptability remain largely unknown. In the current study, positional cloning led to the identification of a gene encoding an RR1-type cuticular protein, BmorCPR2, highly expressed in larval chitin-rich tissues and at the mulberry leaf-eating stages, which is responsible for the silkworm stony mutant. In the Dazao-stony strain, the BmorCPR2 allele is a deletion mutation with significantly lower expression, compared to the wild-type Dazao strain. Dysfunctional BmorCPR2 in the stony mutant lost chitin binding ability, leading to reduced chitin content in larval cuticle, limitation of cuticle extension, abatement of cuticle tensile properties, and aberrant ratio between internodes and intersegmental folds. These variations induce a significant decrease in cuticle capacity to hold the growing internal organs in the larval development process, resulting in whole-body stiffness, tightness, and hardness, bulging intersegmental folds, and serious defects in larval adaptability. To our knowledge, this is the first study to report the corresponding phenotype of stony in insects caused by mutation of RR1-type cuticular protein. Our findings collectively shed light on the specific role of cuticular proteins in maintaining normal larval body shape and will aid in the development of pest control strategies for the management of Lepidoptera.

Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country

OpenAIRE

Desalu Ibironke; O Oyedepo Olanrewaju; J Olatosi Olutola

2008-01-01

Training in resuscitation is done worldwide by a dedicated council who is responsible for training and frequent recertification. Nigeria has no Resuscitation council and training is the responsibility of individual health institutions. There is no mandatory law on resuscitation training or recertification. This study sought to investigate how much training in CPR occurs, how effective this training is and how confident our anaesthetic trainees are in implementing present guidelines. A deta...

A Comparison of Internet-Based Learning and Traditional Classroom Lecture to Learn CPR for Continuing Medical Education

Science.gov (United States)

Hemmati, Nima; Omrani, Soghra; Hemmati, Naser

2013-01-01

The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL) and traditional classroom lecture (TCL) for continuing medical education (CME) programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR) curriculum guidelines training…

Proceeding of the ACM/IEEE-CS Joint Conference on Digital Libraries (1st, Roanoke, Virginia, June 24-28, 2001).

Science.gov (United States)

Association for Computing Machinery, New York, NY.

Papers in this Proceedings of the ACM/IEEE-CS Joint Conference on Digital Libraries (Roanoke, Virginia, June 24-28, 2001) discuss: automatic genre analysis; text categorization; automated name authority control; automatic event generation; linked active content; designing e-books for legal research; metadata harvesting; mapping the…

acme: The Amendable Coal-Fire Modeling Exercise. A C++ Class Library for the Numerical Simulation of Coal-Fires

Science.gov (United States)

Wuttke, Manfred W.

2017-04-01

At LIAG, we use numerical models to develop and enhance understanding of coupled transport processes and to predict the dynamics of the system under consideration. Topics include geothermal heat utilization, subrosion processes, and spontaneous underground coal fires. Although the details make it inconvenient if not impossible to apply a single code implementation to all systems, their investigations go along similar paths: They all depend on the solution of coupled transport equations. We thus saw a need for a modular code system with open access for the various communities to maximize the shared synergistic effects. To this purpose we develop the oops! ( open object-oriented parallel solutions) - toolkit, a C++ class library for the numerical solution of mathematical models of coupled thermal, hydraulic and chemical processes. This is used to develop problem-specific libraries like acme( amendable coal-fire modeling exercise), a class library for the numerical simulation of coal-fires and applications like kobra (Kohlebrand, german for coal-fire), a numerical simulation code for standard coal-fire models. Basic principle of the oops!-code system is the provision of data types for the description of space and time dependent data fields, description of terms of partial differential equations (pde), their discretisation and solving methods. Coupling of different processes, described by their particular pde is modeled by an automatic timescale-ordered operator-splitting technique. acme is a derived coal-fire specific application library, depending on oops!. If specific functionalities of general interest are implemented and have been tested they will be assimilated into the main oops!-library. Interfaces to external pre- and post-processing tools are easily implemented. Thus a construction kit which can be arbitrarily amended is formed. With the kobra-application constructed with acme we study the processes and propagation of shallow coal seam fires in particular in

Keep pushing! Limiting interruptions to CPR; bag-valve mask versus i-gel® airway ventilation

Directory of Open Access Journals (Sweden)

Craig Vincent-Lambert

2016-12-01

Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.

Design and transient analyses of passive emergency feedwater system of CPR1000. Part 1. Air cooling condition

International Nuclear Information System (INIS)

Zhang Yapei; Qiu Suizheng; Su Guanghui; Tian Wenxi; Cao Jianhua; Lu Donghua; Fu Xiangang

2011-01-01

The steam generator secondary passive emergency feedwater system is a new design for traditional generation Ⅱ + reactor CPR1000. The passive emergency feedwater system is designed to supply water to the SG shell side and improve the safety and reliability of CPR1000 by completely or partially replacing traditional emergency water cooling system in the event of the feed line break (FLB) or loss of heat sink accident. The passive emergency feedwater system consists of steam generator (SG), heat exchanger (HX), air cooling tower, emergency makeup tank (EMT), and corresponding pipes and valves for air cooling condition. In order to improve the safety and reliability of CPR1000, the model of the primary loop system and the passive emergency feedwater system was developed to investigate residual heat removal capability of the passive emergency feedwater system and the transient characteristics of the primary loop system affected by the passive emergency feedwater system using RELAP5/MOD3.4. The transient characteristics of the primary loop system and the passive emergency feedwater system were calculated in the event of feed line break accident. Sensitivity studies of the passive emergency feedwater system were also conducted to investigate the response of the primary loop and the passive emergency feedwater system on the main parameters of the passive emergency feedwater system. The passive emergency feedwater system could supply water to the SG shell side from the EMT successfully. The calculation results showed that the passive emergency feedwater system could take away the decay heat from the primary loop effectively for air cooling condition, and that the single-phase and two-phase natural circulations were established in the primary loop and passive emergency feedwater system loop, respectively. (author)

Autonomic Cluster Management System (ACMS): A Demonstration of Autonomic Principles at Work

Science.gov (United States)

Baldassari, James D.; Kopec, Christopher L.; Leshay, Eric S.; Truszkowski, Walt; Finkel, David

2005-01-01

Cluster computing, whereby a large number of simple processors or nodes are combined together to apparently function as a single powerful computer, has emerged as a research area in its own right. The approach offers a relatively inexpensive means of achieving significant computational capabilities for high-performance computing applications, while simultaneously affording the ability to. increase that capability simply by adding more (inexpensive) processors. However, the task of manually managing and con.guring a cluster quickly becomes impossible as the cluster grows in size. Autonomic computing is a relatively new approach to managing complex systems that can potentially solve many of the problems inherent in cluster management. We describe the development of a prototype Automatic Cluster Management System (ACMS) that exploits autonomic properties in automating cluster management.

The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest--a prospective, randomized trial.

Science.gov (United States)

Bohn, Andreas; Weber, Thomas P; Wecker, Sascha; Harding, Ulf; Osada, Nani; Van Aken, Hugo; Lukas, Roman P

2011-03-01

Chest compression quality is a determinant of survival from out-of-hospital cardiac arrest (OHCA). ERC 2005 guidelines recommend the use of technical devices to support rescuers giving compressions. This prospective randomized study reviewed influence of different feedback configurations on survival and compression quality. 312 patients suffering an OHCA were randomly allocated to two different feedback configurations. In the limited feedback group a metronome and visual feedback was used. In the extended feedback group voice prompts were added. A training program was completed prior to implementation, performance debriefing was conducted throughout the study. Survival did not differ between the extended and limited feedback groups (47.8% vs 43.9%, p = 0.49). Average compression depth (mean ± SD: 4.74 ± 0.86 cm vs 4.84 ± 0.93 cm, p = 0.31) was similar in both groups. There were no differences in compression rate (103 ± 7 vs 102 ± 5 min(-1), p=0.74) or hands-off fraction (16.16% ± 0.07 to 17.04% ± 0.07, p = 0.38). Bystander CPR, public arrest location, presenting rhythm and chest compression depth were predictors of short term survival (ROSC to ED). Even limited CPR-feedback combined with training and ongoing debriefing leads to high chest compression quality. Bystander CPR, location, rhythm and chest compression depth are determinants of survival from out of hospital cardiac arrest. Addition of voice prompts does neither modify CPR quality nor outcome in OHCA. CC depth significantly influences survival and therefore more focus should be put on correct delivery. Further studies are needed to examine the best configuration of feedback to improve CPR quality and survival. ClinicalTrials.gov (NCT00449969), http://www.clinicalTrials.gov. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival.

Science.gov (United States)

Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob

2011-12-01

In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), pMobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Analysis of Residual Nuclide in a ACM and ACCT of 100-MeV proton beamline By measurement X-ray Spectrum

Energy Technology Data Exchange (ETDEWEB)

Park, Jeong-Min; Yun, Sang-Pil; Kim, Han-Sung; Kwon, Hyeok-Jung; Cho, Yong-Sub [Korea Atomic Energy Research Institute, Gyeongju (Korea, Republic of)

2015-10-15

The proton beam is provides to users as various energy range from 20 MeV to 100 MeV. After protons generated from the ion source are accelerated to 100 MeV and irradiated to target through bending magnet and AC magnet. At this time, relatively high dose X-ray is emitted due to collision of proton and components of beamline. The generated X-ray is remaining after the accelerator is turned off and analyzing residual nuclides through the measurement of X-ray spectrum. Then identify the components that are the primary cause of residual nuclides are detected form the AC magnet(ACM) and associated components (ACCT). Analysis of the X-ray spectrum generated form the AC magnet(ACM) and AC current transformer(ACCT) of 100 MeV beamline according to the proton beam irradiation, most of the residual nuclides are identified it can be seen that emission in the stainless steel by beam loss.

Updated teaching techniques improve CPR performance measures: a cluster randomized, controlled trial.

Science.gov (United States)

Ettl, Florian; Testori, Christoph; Weiser, Christoph; Fleischhackl, Sabine; Mayer-Stickler, Monika; Herkner, Harald; Schreiber, Wolfgang; Fleischhackl, Roman

2011-06-01

The first-aid training necessary for obtaining a drivers license in Austria has a regulated and predefined curriculum but has been targeted for the implementation of a new course structure with less theoretical input, repetitive training in cardiopulmonary resuscitation (CPR) and structured presentations using innovative media. The standard and a new course design were compared with a prospective, participant- and observer-blinded, cluster-randomized controlled study. Six months after the initial training, we evaluated the confidence of the 66 participants in their skills, CPR effectiveness parameters and correctness of their actions. The median self-confidence was significantly higher in the interventional group [IG, visual analogue scale (VAS:"0" not-confident at all,"100" highly confident):57] than in the control group (CG, VAS:41). The mean chest compression rate in the IG (98/min) was closer to the recommended 100 bpm than in the CG (110/min). The time to the first chest compression (IG:25s, CG:36s) and time to first defibrillator shock (IG:86s, CG:92s) were significantly shorter in the IG. Furthermore, the IG participants were safer in their handling of the defibrillator and started with countermeasures against developing shock more often. The management of an unconscious person and of heavy bleeding did not show a difference between the two groups even after shortening the lecture time. Motivation and self-confidence as well as skill retention after six months were shown to be dependent on the teaching methods and the time for practical training. Courses may be reorganized and content rescheduled, even within predefined curricula, to improve course outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

ARM Airborne Carbon Measurements VI (ARM-ACME VI) Field Campaign Report

Energy Technology Data Exchange (ETDEWEB)

Biraud, Sebastien [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2017-05-01

From October 1, 2015 through September 30, 2016, AAF deployed a Cessna 206 aircraft over the Southern Great Plains, collecting observations of trace gas mixing ratios over the ARM/SGP Central Facility. The aircraft payload included two Atmospheric Observing Systems (AOS Inc.) analyzers for continuous measurements of CO2, and a 12-flask sampler for analysis of carbon cycle gases (CO2, CO, CH4, N2O, 13CO2). The aircraft payload also includes solar/infrared radiation measurements. This research (supported by DOE ARM and TES programs) builds upon previous ARM-ACME missions. The goal of these measurements is to improve understanding of: (a) the carbon exchange of the ARM region; (b) how CO2 and associated water and energy fluxes influence radiative forcing, convective processes, and CO2 concentrations over the ARM region, and (c) how greenhouse gases are transported on continental scales.

Design optimization on structure of blowdown in CPR1000 steam generator

International Nuclear Information System (INIS)

Wang Guoxian; Ren Hongbing; Zuo Chaoping; Zhu Yong; Mo Shaojia

2014-01-01

The structure of blowdown in CPR1000 steam generator has been optimized by eliminating the blowdown pipe and tube lane blocking, drilling holes in the peripheral tube lane, which can improve the accessibility of the central tube lane and facilitate inspecting and lancing. This paper detailed compares and analyzes the thermal hydraulic characteristic before and after optimization using GENEPI code which a special software for SG thermal hydraulic analysis. The results showed that the thermal hydraulic characteristic of steam generator meets the design requirements compared with the original design. Structure optimization can improve lancing effects, although the change of flow field distribution above the tubesheet leads to increase the number of tube subjected to sludge deposit. The analysis results proved the feasibility of the optimization. (authors)

Arabidopsis CPR5 is a senescence-regulatory gene with pleiotropic functions as predicted by the evolutionary theory of senescence

NARCIS (Netherlands)

Jing, Hai-Chun; Anderson, Lisa; Sturre, Marcel J. G.; Hille, Jacques; Dijkwel, Paul P.

2007-01-01

Arabidopsis CPR5 is a senescence-regulatory gene with pleiotropic functions as predicted by the evolutionary theory of senescence Hai-Chun Jing1,2, Lisa Anderson3, Marcel J.G. Sturre1, Jacques Hille1 and Paul P. Dijkwel1,* 1Molecular Biology of Plants, Groningen Biomolecular Sciences and

Selective desulfurization of cysteine in the presence of Cys(Acm) in polypeptides obtained by native chemical ligation.

Science.gov (United States)

Pentelute, Brad L; Kent, Stephen B H

2007-02-15

Increased versatility for the synthesis of proteins and peptides by native chemical ligation requires the ability to ligate at positions other than Cys. Here, we report that Raney nickel can be used under standard conditions for the selective desulfurization of Cys in the presence of Cys(Acm). This simple and practical tactic enables the more common Xaa-Ala junctions to be used as ligation sites for the chemical synthesis of Cys-containing peptides and proteins. [reaction: see text].

Strain measurement in and analysis for hydraulic test of CPR1000 reactor pressure vessel

International Nuclear Information System (INIS)

Zhou Dan; Zhuang Dongzhen

2013-01-01

The strain measurement in hydraulic test of CPR1000 reactor pressure vessel performed in Dongfang Heavy Machinery Co., Ltd. is introduced. The detail test scheme and method was introduced and the measurement results of strain and stress was given. Meanwhile the finite element analysis was performed for the pressure vessel, which was generally matched with the measurement results. The reliability of strain measurement was verified and the high strength margin of vessel was shown, which would give a good reference value for the follow-up hydraulic tests and strength analysis of reactor pressure vessel. (authors)

Preventive maintenance plan of the air-conditioning duct using the ACM-sensor

International Nuclear Information System (INIS)

Fukuba, Kazushi; Ito, Takanobu; Kojima, Akiko; Tanji, Kazuhiro; Sato, Yuki

2013-01-01

Air-conditioning duct is difficult to predict the date to occur of corrosion such as affect the function. Therefore, the current conservation method is mostly corrective maintenance. Therefore, we used the test pieces of six types and ACM-sensor in order to solve the corrosion speed from corrosion environment and relationship of corrosion quantity of test pieces. In addition, was used the duct molded articles various in order to check the corrosion degree of when processed the duct. As a result, we were selected crust body constituting a duct and optimal combination of the flange by solve the corrosion speed of the test pieces various. Thus, it performs preventive disposal before to occur of corrosion such as affect the function by predicting the duct life from corrosion speed, and lead to stability and safe operating by appropriate maintenance of equipment. (author)

Design of ET(B) receptor agonists: NMR spectroscopic and conformational studies of ET7-21[Leu7, Aib11, Cys(Acm)15].

Science.gov (United States)

Hewage, Chandralal M; Jiang, Lu; Parkinson, John A; Ramage, Robert; Sadler, Ian H

2002-03-01

In a previous report we have shown that the endothelin-B receptor-selective linear endothelin peptide, ET-1[Cys (Acm)1,15, Ala3, Leu7, Aib11], folds into an alpha-helical conformation in a methanol-d3/water co-solvent [Hewage et al. (1998) FEBS Lett., 425, 234-238]. To study the requirements for the structure-activity relationships, truncated analogues of this peptide were subjected to further studies. Here we report the solution conformation of ET7-21[Leu7, Aib11, Cys(Acm)15], in a methanol-d3/water co-solvent at pH 3.6, by NMR spectroscopic and molecular modelling studies. Further truncation of this short peptide results in it displaying poor agonist activity. The modelled structure shows that the peptide folds into an alpha-helical conformation between residues Lys9-His16, whereas the C-terminus prefers no fixed conformation. This truncated linear endothelin analogue is pivotal for designing endothelin-B receptor agonists.

The process and risk of the CPR1000 cold function test in the cold area

International Nuclear Information System (INIS)

Liu Tinghao; Zhang Jian; Ji Dapeng; Shi Quanjian; Tian Kuo

2014-01-01

Hong yanhe nuclear power station is the first CPR1000 reactor which is under construction in the cold area of north China. It is also the first time to carry out the cold functional test (CFT) in the winter of north China. The preparation and process of CFT are described in the paper. According to the experience feedback of CFT of Unit 1, the risk and solution which are significance for the CFT of the other NPS in the cold area are analysed. (authors)

A Comparison Of Internet-Based Learning And Traditional Classroom Lecture To Learn Cpr For Continuing Medical Education

OpenAIRE

HEMMATI, Nima; OMRANI, Soghra; HEMMATI, Naser

2013-01-01

The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL) and traditional classroom lecture (TCL) for continuing medical education (CME) programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR) curriculum guidelines training either by traditional or by an Internet-based CME. A randomized two-group pretest-posttest quasi-experimental design was used. Postgraduate general ...

Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study.

Science.gov (United States)

Nitzschke, Rainer; Doehn, Christoph; Kersten, Jan F; Blanz, Julian; Kalwa, Tobias J; Scotti, Norman A; Kubitz, Jens C

2017-04-04

The present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linked to a ventilator and provides synchronised visual and acoustic instructions for guidance through the ALS algorithm and assistance for face-mask ventilations. We compared the cardiopulmonary resuscitation (CPR) quality of emergency medical system (EMS) staff members using the study device or standard equipment in a mannequin simulation study with a prospective, controlled, randomised cross-over study design. Main outcome was the effect of the study device compared to the standard equipment and the effect of the number of prior ALS trainings of the EMS staff on the CPR quality. Data were analysed using analyses of covariance (ANCOVA) and binary logistic regression, accounting for the study design. In 106 simulations of 56 two-person rescuer teams, the mean hands-off time was 24.5% with study equipment and 23.5% with standard equipment (Difference 1.0% (95% CI: -0.4 to 2.5%); p = 0.156). With both types of equipment, the hands-off time decreased with an increasing cumulative number of previous CPR trainings (p = 0.042). The study equipment reduced the mean time until administration of adrenaline (epinephrine) by 23 s (p = 0.003) and that of amiodarone by 17 s (p = 0.016). It also increased the mean number of changes in the person doing chest compressions (0.6 per simulation; p < 0.001) and decreased the mean number of chest compressions (2.8 per minute; p = 0.022) and the mean number of ventilations (1.8 per minute; p < 0.001). The chance of administering amiodarone at the appropriate time was higher, with an odds ratio of 4.15, with the use of the study equipment CPR.com compared to the standard equipment (p = 0.004). With an increasing number of prior CPR trainings, the time intervals in the ALS algorithm until the

Pomegranate MR images analysis using ACM and FCM algorithms

Science.gov (United States)

Morad, Ghobad; Shamsi, Mousa; Sedaaghi, M. H.; Alsharif, M. R.

2011-10-01

Segmentation of an image plays an important role in image processing applications. In this paper segmentation of pomegranate magnetic resonance (MR) images has been explored. Pomegranate has healthy nutritional and medicinal properties for which the maturity indices and quality of internal tissues play an important role in the sorting process in which the admissible determination of features mentioned above cannot be easily achieved by human operator. Seeds and soft tissues are the main internal components of pomegranate. For research purposes, such as non-destructive investigation, in order to determine the ripening index and the percentage of seeds in growth period, segmentation of the internal structures should be performed as exactly as possible. In this paper, we present an automatic algorithm to segment the internal structure of pomegranate. Since its intensity of stem and calyx is close to the internal tissues, the stem and calyx pixels are usually labeled to the internal tissues by segmentation algorithm. To solve this problem, first, the fruit shape is extracted from its background using active contour model (ACM). Then stem and calyx are removed using morphological filters. Finally the image is segmented by fuzzy c-means (FCM). The experimental results represent an accuracy of 95.91% in the presence of stem and calyx, while the accuracy of segmentation increases to 97.53% when stem and calyx are first removed by morphological filters.

Early leaf senescence is associated with an altered cellular redox balance in Arabidopsis cpr5/old1 mutants

OpenAIRE

Jing, H. -C.; Hebeler, R.; Oeljeklaus, S.; Sitek, B.; Stuehler, K.; Meyer, H. E.; Sturre, M. J. G.; Hille, J.; Warscheid, B.; Dijkwel, P. P.; Stühler, K.

2008-01-01

Reactive oxygen species (ROS) are the inevitable by-products of essential cellular metabolic and physiological activities. Plants have developed sophisticated gene networks of ROS generation and scavenging systems. However, ROS regulation is still poorly understood. Here, we report that mutations in the Arabidopsis CPR5/OLD1 gene may cause early senescence through deregulation of the cellular redox balance. Genetic analysis showed that blocking stress-related hormonal signalling pathways, suc...

Neonatal CPR: room at the top—a mathematical study of optimal chest compression frequency versus body size

OpenAIRE

Babbs, Charles F; Meyer, Andrew; Nadkarni, Vinay

2009-01-01

Objective: To explore in detail the expected magnitude of systemic perfusion pressure during standard CPR as a function of compression frequency for different sized people from neonate to adult. Method: A 7-compartment mathematical model of the human cardiopulmonary system—upgraded to include inertance of blood columns in the aorta and vena cavae—was exercised with parameters scaled to reflect changes in body weight from 1 to 70 kg. Results: Maximal systemic perfusion pressure occurs at chest...

Basic-CPR and AIDS: are volunteer life-savers prepared for a storm?

Science.gov (United States)

Bierens, J J; Berden, H J

1996-10-01

Professional health care workers have access to guidelines, equipment and techniques to reduce the exposure to infectious material in case of resuscitation. The current official content of national courses for volunteer life-savers do not address this issue, as far as we know. Concern about the risks of infection due to resuscitation is increasing in this group. This article describes a rational approach of the problem, that includes data on the infection risk of basic-CPR, and an approach that accepts that the concern can not be controlled by objective data. In such an emotional approach, direct contact has to be minimised by using devices. Requirements for resuscitation devices with a barrier function are listed. Although both approaches will reduce the fear of infection, we advice a rational approach.

Full vessel CFD analysis on thermal-hydraulic characteristics of CPR1000 PWR

International Nuclear Information System (INIS)

Chao Yanmeng; Yang Lixin; Zhang Mingqian

2014-01-01

To obtain flow distributions and thermal-hydraulic properties in a full vessel PWR under limited computation ability and time, a full vessel simulation model of CPR1000 was built based on two simplification methods. One simplified the inner geometry of the control rod guide tubes using equivalent flow area. Another substituted the core by a porous domain to maintain the pressure drop and temperature rise. After the computation, global and localized flow distributions, hydraulic loads of some main assemblies were obtained, as well as other thermal-hydraulic properties. The results indicate the flow distribution in the full vessel is asymmetrical. Therefore it is essential to use the full vessel model to simulate. The calculated thermal-hydraulic characteristics agree well with the operation statistics, providing the reference data for the reactor safety operation. (authors)

CLIC-ACM: generic modular rad-hard data acquisition system based on CERN GBT versatile link

International Nuclear Information System (INIS)

Bielawski, B.; Locci, F.; Magnoni, S.

2015-01-01

CLIC is a world-wide collaboration to study the next ''terascale'' lepton collider, relying upon a very innovative concept of two-beam-acceleration. This accelerator, currently under study, will be composed of the subsequence of 21000 two-beam-modules. Each module requires more than 300 analogue and digital signals which need to be acquired and controlled in a synchronous way. CLIC-ACM (Acquisition and Control Module) is the 'generic' control and acquisition module developed to accommodate the controls of all these signals for various sub-systems and related specification in term of data bandwidth, triggering and timing synchronization. This paper describes the system architecture with respect to its radiation-tolerance, power consumption and scalability

A COMPARISON OF INTERNET-BASED LEARNING AND TRADITIONAL CLASSROOM LECTURE TO LEARN CPR FOR CONTINUING MEDICAL EDUCATION

Directory of Open Access Journals (Sweden)

Naser HEMMATI

2013-01-01

Full Text Available The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL and traditional classroom lecture (TCL for continuing medical education (CME programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR curriculum guidelines training either by traditional or by an Internet-based CME. A randomized two-group pretest-posttest quasi-experimental design was used. Postgraduate general physician trainees of Iran medical schools were participated. Two methods were compared for teaching the newest curriculum guidelines of the American Heart Association: lecture method in which the teacher follows a Power point presentation with linear layout, and with interactive self-assessment and Scenario-based learning, feedback, multimedia with linear and nonlinear layout with the same power point presentation as lecture in terms of text and photography. The data on final CPR exam grades, collected both groups trained physicians, were obtained for a total of 80 physicians in 2011. An independent sample t-test analysis indicated that participants in the IBL format reported significantly higher mean ratings for this format (62.5 ±2.32 than TCL format (54.6±2.18 (p=.001. There were no significant differences between the two groups in cognitive gains (p<0.05. well-designed IBL content can be effective or a supplement component to CME.

75 FR 10026 - Proposed Collection; Comment Request for Forms W-2, W-2c, W-2AS, W-2GU, W-2VI, W-3, W-3c, W-3cPR...

Science.gov (United States)

2010-03-04

... W-2, W-2c, W-2AS, W-2GU, W-2VI, W-3, W-3c, W-3cPR, W-3PR, and W-3SS AGENCY: Internal Revenue Service....C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Forms W-2, W-2c, W-2AS, W-2GU, W-2VI, W-3, W-3c, W- 3cPR, W-3PR, and W-3SS. DATES: Written comments should be received on or...

HPDC ´12 : proceedings of the 21st ACM symposium on high-performance parallel and distributed computing, June 18-22, 2012, Delft, The Netherlands

NARCIS (Netherlands)

Epema, D.H.J.; Kielmann, T.; Ripeanu, M.

2012-01-01

Welcome to ACM HPDC 2012! This is the twenty-first year of HPDC and we are pleased to report that our community continues to grow in size, quality and reputation. The program consists of three days packed with presentations on the latest developments in high-performance parallel and distributed

Intercomparison of Vertical Structure of Storms Revealed by Ground-Based (NMQ and Spaceborne Radars (CloudSat-CPR and TRMM-PR

Directory of Open Access Journals (Sweden)

Veronica M. Fall

2013-01-01

Full Text Available Spaceborne radars provide great opportunities to investigate the vertical structure of clouds and precipitation. Two typical spaceborne radars for such a study are the W-band Cloud Profiling Radar (CPR and Ku-band Precipitation Radar (PR, which are onboard NASA’s CloudSat and TRMM satellites, respectively. Compared to S-band ground-based radars, they have distinct scattering characteristics for different hydrometeors in clouds and precipitation. The combination of spaceborne and ground-based radar observations can help in the identification of hydrometeors and improve the radar-based quantitative precipitation estimation (QPE. This study analyzes the vertical structure of the 18 January, 2009 storm using data from the CloudSat CPR, TRMM PR, and a NEXRAD-based National Mosaic and Multisensor QPE (NMQ system. Microphysics above, within, and below the melting layer are studied through an intercomparison of multifrequency measurements. Hydrometeors’ type and their radar scattering characteristics are analyzed. Additionally, the study of the vertical profile of reflectivity (VPR reveals the brightband properties in the cold-season precipitation and its effect on the radar-based QPE. In all, the joint analysis of spaceborne and ground-based radar data increases the understanding of the vertical structure of storm systems and provides a good insight into the microphysical modeling for weather forecasts.

First physical volcanological description of a Miocene, silicic, phreatomagmatic fall complex in the Carpatho-Pannonian Region (CPR)

Science.gov (United States)

Biró, Tamás; Hencz, Mátyás; Karátson, Dávid; Márton, Emő; Bradák-Hayashi, Balázs; Szalai, Zoltán

2017-04-01

The study reports the basic physical volcanological and stratigraphical features of a hitherto unrecognized silicic phreatomagmatic fall succession from the Bükk Foreland Volcanic Area (Hungary), known as part of the extensive Miocene ignimbrite volcanism of the northern CPR. The complex have been identified at two sites, in the vicinity of Bogács and Tibolddaróc villages. Tens of mm to several dm thick layers make up the 20 m thick entire succession. The complex could be subdivided into three eruption cycles by two, intercalated well-developed paleosoil horizons, which indicate longer repose periods. The eruption cycles consist of several individual eruptive events. The volcano-sedimentological field approach was completed by granulometrical and low field anisotropy of magnetic susceptibility (AMS) studies. Combined dry sieving and laser diffraction particle size analysis were performed to get information on median grain size (MdΦ) and sorting (σΦ) of friable layers. AMS was used to infer the emplacement processes. Based on the following features the succession is proposed to record a large-scale, silicic, phreatomagmatic fall activity: i) Presence of very fine ash and abundant ash aggregates, ii) General poor sorting, and often bimodal grain-size distributions; ii) Extremely weak magnetic fabric compared to dilute, thin pyroclastic density current deposits. On the basis of comparison of the recorded grain size characteristics with data from other silicic phretomagmatic fall deposits worldwide, several units in the succession can be considered as phreatoplinian fall deposit (sensu lato), described for the first time in the CPR.

Experimental determination of the partitioning coefficient and volatility of important BVOC oxidation products using the Aerosol Collection Module (ACM) coupled to a PTR-ToF-MS

Science.gov (United States)

Gkatzelis, G.; Hohaus, T.; Tillmann, R.; Schmitt, S. H.; Yu, Z.; Schlag, P.; Wegener, R.; Kaminski, M.; Kiendler-Scharr, A.

2015-12-01

Atmospheric aerosol can alter the Earth's radiative budget and global climate but can also affect human health. A dominant contributor to the submicrometer particulate matter (PM) is organic aerosol (OA). OA can be either directly emitted through e.g. combustion processes (primary OA) or formed through the oxidation of organic gases (secondary organic aerosol, SOA). A detailed understanding of SOA formation is of importance as it constitutes a major contribution to the total OA. The partitioning between the gas and particle phase as well as the volatility of individual components of SOA is yet poorly understood adding uncertainties and thus complicating climate modelling. In this work, a new experimental methodology was used for compound-specific analysis of organic aerosol. The Aerosol Collection Module (ACM) is a newly developed instrument that deploys an aerodynamic lens to separate the gas and particle phase of an aerosol. The particle phase is directed to a cooled sampling surface. After collection particles are thermally desorbed and transferred to a detector for further analysis. In the present work, the ACM was coupled to a Proton Transfer Reaction-Time of Flight-Mass Spectrometer (PTR-ToF-MS) to detect and quantify organic compounds partitioning between the gas and particle phase. This experimental approach was used in a set of experiments at the atmosphere simulation chamber SAPHIR to investigate SOA formation. Ozone oxidation with subsequent photochemical aging of β-pinene, limonene and real plant emissions from Pinus sylvestris (Scots pine) were studied. Simultaneous measurement of the gas and particle phase using the ACM-PTR-ToF-MS allows to report partitioning coefficients of important BVOC oxidation products. Additionally, volatility trends and changes of the SOA with photochemical aging are investigated and compared for all systems studied.

Fabrication of 93.7 m long PLD-EuBCO + BaHfO_3 coated conductors with 103 A/cm W at 77 K under 3 T

International Nuclear Information System (INIS)

Yoshida, T.; Ibi, A.; Takahashi, T.; Yoshizumi, M.; Izumi, T.; Shiohara, Y.

2015-01-01

Highlights: • A 93.7 m long EuBCO + BHO CC with 103 A/cm W at 77 K under 3 T was obtained. • The 93.7 m long CC showed high I_c values and high n-values with high uniformity. • The average I_c value at 77 K under 3 T was estimated by that at 77 K under 0.3 T. - Abstract: Introduction of artificial pinning centers such as BaHfO_3 (BHO), BaZrO_3 (BZO) and BaSnO_3 (BSO) into REBa_2Cu_3O_7_−_δ (REBCO) coated conductor (CC) layers could improve the in-field critical currents (I_c) in wide ranges of temperatures and magnetic fields. In particular, a combination of EuBCO + BHO has been found to be effective for attaining high in-field I_c performance by means of IBAD/PLD process in short length samples. In this work, we have successfully fabricated a 93.7 m long EuBCO + BHO CC with 103 A/cm W at 77 K under a magnet field (B) of 3 T applied perpendicular to the CC (B//c). The 93.7 m long EuBCO + BHO CC had high uniformity of I_c values and n-values without any trend of fluctuations, independent of the external field up to 0.3 T. I_c–B–applied angle (θ) profiles of the 93.7 m long EuBCO + BHO CC sample showed the high in-field I_c values in all directions of applied magnetic fields especially B//c (at θ ∼ 180°, I_c = 157 A/cm W) at 77 K under 3 T. The profiles were about the same as those in a short length sample.

Evidence for heterogeneity of astrocyte de-differentiation in vitro: astrocytes transform into intermediate precursor cells following induction of ACM from scratch-insulted astrocytes.

Science.gov (United States)

Yang, Hao; Qian, Xin-Hong; Cong, Rui; Li, Jing-wen; Yao, Qin; Jiao, Xi-Ying; Ju, Gong; You, Si-Wei

2010-04-01

Our previous study definitely demonstrated that the mature astrocytes could undergo a de-differentiation process and further transform into pluripotential neural stem cells (NSCs), which might well arise from the effect of diffusible factors released from scratch-insulted astrocytes. However, these neurospheres passaged from one neurosphere-derived from de-differentiated astrocytes possessed a completely distinct characteristic in the differentiation behavior, namely heterogeneity of differentiation. The heterogeneity in cell differentiation has become a crucial but elusive issue. In this study, we show that purified astrocytes could de-differentiate into intermediate precursor cells (IPCs) with addition of scratch-insulted astrocyte-conditioned medium (ACM) to the culture, which can express NG2 and A2B5, the IPCs markers. Apart from the number of NG2(+) and A2B5(+) cells, the percentage of proliferative cells as labeled with BrdU progressively increased with prolonged culture period ranging from 1 to 10 days. Meanwhile, the protein level of A2B5 in cells also increased significantly. These results revealed that not all astrocytes could de-differentiate fully into NSCs directly when induced by ACM, rather they generated intermediate or more restricted precursor cells that might undergo progressive de-differentiation to generate NSCs.

An audiovisual feedback device for compression depth, rate and complete chest recoil can improve the CPR performance of lay persons during self-training on a manikin

International Nuclear Information System (INIS)

Krasteva, Vessela; Jekova, Irena; Didon, Jean-Philippe

2011-01-01

This study aims to contribute to the scarce data available about the abilities of untrained lay persons to perform hands-only cardio-pulmonary resuscitation (CPR) on a manikin and the improvement of their skills during training with an autonomous CPR feedback device. The study focuses on the following questions: (i) Is there a need for such a CPR training device? (ii) How adequate are the embedded visual feedback and audio guidance for training of lay persons who learn and correct themselves in real time without instructor guidance? (iii) What is the achieved effect of only 3 min of training? This is a prospective study in which 63 lay persons (volunteers) received a debriefing to basic life support and then performed two consecutive 3 min trials of hands-only CPR on a manikin. The pre-training skills of the lay persons were tested in trial 1. The training process with audio guidance and visual feedback from a cardio compression control device (CC-Device) was recorded in trial 2. After initial debriefing for correct chest compressions (CC) with rate 85–115 min −1 , depth 3.8–5.4 cm and complete recoil, in trial 1 the lay persons were able to perform CC without feedback at mean rate 95.9 ± 18.9 min −1 , mean depth 4.13 ± 1.5 cm, with low proportions of 'correct depth', 'correct rate' and 'correct recoil' at 33%, 43%, 87%, resulting in the scarce proportion of 14% for compressions, which simultaneously fulfill the three quality criteria ('correct all'). In trial 2, the training process by the CC-Device was established by the significant improvement of the CC skills until the 60th second of training, when 'correct depth', 'correct rate' and 'correct recoil' attained the plateau of the highest quality at 82%, 90%, 96%, respectively, resulting in 73% 'correct all' compressions within 3 min of training. The training was associated with reduced variance of the mean rate 102.4 ± 4

Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.

Science.gov (United States)

Mäkinen, M; Aune, S; Niemi-Murola, L; Herlitz, J; Varpula, T; Nurmi, J; Axelsson, A B; Thorén, A-B; Castrén, M

2007-02-01

Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (Pskills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

Improving simulated spatial distribution of productivity and biomass in Amazon forests using the ACME land model

Science.gov (United States)

Yang, X.; Thornton, P. E.; Ricciuto, D. M.; Shi, X.; Xu, M.; Hoffman, F. M.; Norby, R. J.

2017-12-01

Tropical forests play a crucial role in the global carbon cycle, accounting for one third of the global NPP and containing about 25% of global vegetation biomass and soil carbon. This is particularly true for tropical forests in the Amazon region, as it comprises approximately 50% of the world's tropical forests. It is therefore important for us to understand and represent the processes that determine the fluxes and storage of carbon in these forests. In this study, we show that the implementation of phosphorus (P) cycle and P limitation in the ACME Land Model (ALM) improves simulated spatial pattern of NPP. The P-enabled ALM is able to capture the west-to-east gradient of productivity, consistent with field observations. We also show that by improving the representation of mortality processes, ALM is able to reproduce the observed spatial pattern of above ground biomass across the Amazon region.

Can Pearlite form Outside of the Hultgren Extrapolation of the Ae3 and Acm Phase Boundaries?

Science.gov (United States)

Aranda, M. M.; Rementeria, R.; Capdevila, C.; Hackenberg, R. E.

2016-02-01

It is usually assumed that ferrous pearlite can form only when the average austenite carbon concentration C 0 lies between the extrapolated Ae3 ( γ/ α) and Acm ( γ/ θ) phase boundaries (the "Hultgren extrapolation"). This "mutual supersaturation" criterion for cooperative lamellar nucleation and growth is critically examined from a historical perspective and in light of recent experiments on coarse-grained hypoeutectoid steels which show pearlite formation outside the Hultgren extrapolation. This criterion, at least as interpreted in terms of the average austenite composition, is shown to be unnecessarily restrictive. The carbon fluxes evaluated from Brandt's solution are sufficient to allow pearlite growth both inside and outside the Hultgren Extrapolation. As for the feasibility of the nucleation events leading to pearlite, the only criterion is that there are some local regions of austenite inside the Hultgren Extrapolation, even if the average austenite composition is outside.

Enterococcus faecium biofilm formation: identification of major autolysin AtlAEfm, associated Acm surface localization, and AtlAEfm-independent extracellular DNA Release.

Science.gov (United States)

Paganelli, Fernanda L; Willems, Rob J L; Jansen, Pamela; Hendrickx, Antoni; Zhang, Xinglin; Bonten, Marc J M; Leavis, Helen L

2013-04-16

Enterococcus faecium is an important multidrug-resistant nosocomial pathogen causing biofilm-mediated infections in patients with medical devices. Insight into E. faecium biofilm pathogenesis is pivotal for the development of new strategies to prevent and treat these infections. In several bacteria, a major autolysin is essential for extracellular DNA (eDNA) release in the biofilm matrix, contributing to biofilm attachment and stability. In this study, we identified and functionally characterized the major autolysin of E. faecium E1162 by a bioinformatic genome screen followed by insertional gene disruption of six putative autolysin genes. Insertional inactivation of locus tag EfmE1162_2692 resulted in resistance to lysis, reduced eDNA release, deficient cell attachment, decreased biofilm, decreased cell wall hydrolysis, and significant chaining compared to that of the wild type. Therefore, locus tag EfmE1162_2692 was considered the major autolysin in E. faecium and renamed atlAEfm. In addition, AtlAEfm was implicated in cell surface exposure of Acm, a virulence factor in E. faecium, and thereby facilitates binding to collagen types I and IV. This is a novel feature of enterococcal autolysins not described previously. Furthermore, we identified (and localized) autolysin-independent DNA release in E. faecium that contributes to cell-cell interactions in the atlAEfm mutant and is important for cell separation. In conclusion, AtlAEfm is the major autolysin in E. faecium and contributes to biofilm stability and Acm localization, making AtlAEfm a promising target for treatment of E. faecium biofilm-mediated infections. IMPORTANCE Nosocomial infections caused by Enterococcus faecium have rapidly increased, and treatment options have become more limited. This is due not only to increasing resistance to antibiotics but also to biofilm-associated infections. DNA is released in biofilm matrix via cell lysis, caused by autolysin, and acts as a matrix stabilizer. In this study

Additive Construction with Mobile Emplacement (ACME) / Automated Construction of Expeditionary Structures (ACES) Materials Delivery System (MDS)

Science.gov (United States)

Mueller, R. P.; Townsend, I. I.; Tamasy, G. J.; Evers, C. J.; Sibille, L. J.; Edmunson, J. E.; Fiske, M. R.; Fikes, J. C.; Case, M.

2018-01-01

The purpose of the Automated Construction of Expeditionary Structures, Phase 3 (ACES 3) project is to incorporate the Liquid Goods Delivery System (LGDS) into the Dry Goods Delivery System (DGDS) structure to create an integrated and automated Materials Delivery System (MDS) for 3D printing structures with ordinary Portland cement (OPC) concrete. ACES 3 is a prototype for 3-D printing barracks for soldiers in forward bases, here on Earth. The LGDS supports ACES 3 by storing liquid materials, mixing recipe batches of liquid materials, and working with the Dry Goods Feed System (DGFS) previously developed for ACES 2, combining the materials that are eventually extruded out of the print nozzle. Automated Construction of Expeditionary Structures, Phase 3 (ACES 3) is a project led by the US Army Corps of Engineers (USACE) and supported by NASA. The equivalent 3D printing system for construction in space is designated Additive Construction with Mobile Emplacement (ACME) by NASA.

80 A/cm2 electron beams from metal targets irradiated by KrCl and XeCl excimer lasers

Science.gov (United States)

Beloglazov, A.; Martino, M.; Nassisi, V.

1996-05-01

Due to the growing demand for high-current and long-duration electron-beam devices, laser electron sources were investigated in our laboratory. Experiments on electron-beam generation and propagation from aluminium and copper targets illuminated by XeCl (308 nm) and KrCl (222 nm) excimer lasers, were carried out under plasma ignition due to laser irradiation. This plasma supplied a spontaneous accelerating electric field of about 370 kV/m without an external accelerating voltage. By applying the modified one-dimensional Poisson equation, we computed the expected current and we also estimated the plasma concentration during the accelerating process. At 40 kV of accelerating voltage, an output current pulse of about 80 A/cm2 was detected from an Al target irradiated by the shorter wavelength laser.

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: a randomised crossover mannequin pilot study.

Science.gov (United States)

Semeraro, Federico; Frisoli, Antonio; Loconsole, Claudio; Bannò, Filippo; Tammaro, Gaetano; Imbriaco, Guglielmo; Marchetti, Luca; Cerchiari, Erga L

2013-04-01

Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. Mini-VREM system consists of a Kinect(®) (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1h pause and a second 2 min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min(-1) and compression depth between 50 and 60mm); compressions rate within 100-120 min(-1); compressions depth within 50-60mm. When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p<0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p<0.001) and target depth (FB 47.34% vs. 24.87%, p=0.002). The participants perceived the system to be easy to use with effective feedback. The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and depth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Comparison of Knowledge of Medical and Paramedical Intern about of CPR, 2015

Directory of Open Access Journals (Sweden)

Nastoor Bekhradian

2016-09-01

Full Text Available Every day a number of people from the heart stops beating for most of them that this early cessation of heartbeat. With operations of CPR in 4 to 6 minutes of cardiopulmonary arrest and before the onset of brain death can be established circulation and survival for patients with the death of 2 to 4 folds. The aim of this study was to Comparison of knowledge of medical and paramedical intern about of CPCR, 2015. This descriptive analytical and sampling method was census. Restore their data using a standard questionnaire with Cronbach's alpha coefficient was 0.82 .Spss20 data using statistical software analysis and descriptive statistics and Chi-square test was used. The mean score of 3/6 students that showed poor knowledge of students participating in the study. The lowest score of zero and the highest score was 12. Was found between gender and level of knowledge (p=0/05. Between education and the knowledge of the relationship was not statistically significant (p=0/764. The knowledge of medical and paramedical students groups scheduled for next semester as part of the treatment system personnel are working poor and require special attention in order to provide guidelines for planning authorities to increase the awareness of students.

The design of instructional tools affects secondary school students' learning of cardiopulmonary resuscitation (CPR) in reciprocal peer learning: a randomized controlled trial.

Science.gov (United States)

Iserbyt, Peter; Byra, Mark

2013-11-01

Research investigating design effects of instructional tools for learning Basic Life Support (BLS) is almost non-existent. To demonstrate the design of instructional tools matter. The effect of spatial contiguity, a design principle stating that people learn more deeply when words and corresponding pictures are placed close (i.e., integrated) rather than far from each other on a page was investigated on task cards for learning Cardiopulmonary Resuscitation (CPR) during reciprocal peer learning. A randomized controlled trial. A total of 111 students (mean age: 13 years) constituting six intact classes learned BLS through reciprocal learning with task cards. Task cards combine a picture of the skill with written instructions about how to perform it. In each class, students were randomly assigned to the experimental group or the control. In the control, written instructions were placed under the picture on the task cards. In the experimental group, written instructions were placed close to the corresponding part of the picture on the task cards reflecting application of the spatial contiguity principle. One-way analysis of variance found significantly better performances in the experimental group for ventilation volumes (P=.03, ηp2=.10) and flow rates (P=.02, ηp2=.10). For chest compression depth, compression frequency, compressions with correct hand placement, and duty cycles no significant differences were found. This study shows that the design of instructional tools (i.e., task cards) affects student learning. Research-based design of learning tools can enhance BLS and CPR education. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Temperature profiles from mechanical bathythermograph (MBT) casts from the USS ACME in the North Pacific Ocean in support of the Fleet Observations of Oceanographic Data (FLOOD) project from 1968-04-05 to 1968-04-25 (NODC Accession 6800642)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — MBT data were collected from the USS ACME in support of the Fleet Observations of Oceanographic Data (FLOOD) project. Data were collected by US Navy; Ships of...

Financement agricole par l’échange grains / intrants : l’impact de la NPR à Sapezal–MT entre 2004 et 2009 Financiamento agrícola através da troca de grãos por insumos: o impacto da CPR em Sapezal-MT no período de 2004–2009 Agricultural financing through grain exchange for raw materials: the impact of CPR in Sapezal-MT in the 2004-2009 period

Directory of Open Access Journals (Sweden)

Wylmor Constantino Tives Dalfovo

2011-11-01

Full Text Available La NPR (Note de Produit Rural apparaît comme un instrument régulé par le Gouvernement Fédéral, grâce à laquelle le producteur anticipe sa recette de production en ayant comme contrepartie la remise aux entreprises privées d’une certaine quantité venue de sa production de soja. Ce système a pris de l'ampleur pendant la spirale inflationnaire et la crise fiscale brésilienne, durant les années 1980, qui a restreint le crédit. On a cherché dans cet article, ayant comme réference des entreprises de la commune de Sapezal – MT, à décrire les coûts d’acquisition des intrants à travers deux mécanismes distincts. Le premier, le mécanisme d’achat au comptant avec les prix des intrants obtenu en Reais, et le deuxième, le mécanisme à longue échéance connu comme NPR, où les prix ont été analysés sous le système d’échange contre des paquets d’intrants. Parmi les résultats, on a eu que la principale variable responsable du succès de la NPR est la variation du prix de la denrée à la période de réalisation du contrat et de son échéance. Autre résultat important, le fait que la majorité des producteurs que cherchent la NPR à Sapezal – MT ce sont les moyens producteurs. Enfin, quant aux agents financiers, les plus grandes entreprises occupent un pourcentage élevé de participation dans l’émission de ce type de négociation rurale.A CPR (Cédula de Produto Rural surge como um instrumento regulamentado pelo Governo Federal, em que o produtor antecipa sua receita de produção tendo como contrapartida a entrega para as empresas privadas de uma quantidade estipulada da sua produção de soja. Esse sistema ganhou força através da espiral inflacionária e da crise fiscal brasileira da década de 1980, que restringiu o crédito. Buscou-se nesse artigo, através de uma abordagem nas empresas do município de Sapezal-MT, descrever os custos de aquisição dos insumos através de dois mecanismos distintos. O

A multicopper oxidase is essential for manganese oxidation and laccase-like activity in Pedomicrobium sp. ACM 3067.

Science.gov (United States)

Ridge, Justin P; Lin, Marianne; Larsen, Eloise I; Fegan, Mark; McEwan, Alastair G; Sly, Lindsay I

2007-04-01

Pedomicrobium sp. ACM 3067 is a budding-hyphal bacterium belonging to the alpha-Proteobacteria which is able to oxidize soluble Mn2+ to insoluble manganese oxide. A cosmid, from a whole-genome library, containing the putative genes responsible for manganese oxidation was identified and a primer-walking approach yielded 4350 bp of novel sequence. Analysis of this sequence showed the presence of a predicted three-gene operon, moxCBA. The moxA gene product showed homology to multicopper oxidases (MCOs) and contained the characteristic four copper-binding motifs (A, B, C and D) common to MCOs. An insertion mutation of moxA showed that this gene was essential for both manganese oxidation and laccase-like activity. The moxB gene product showed homology to a family of outer membrane proteins which are essential for Type I secretion in Gram-negative bacteria. moxBA has not been observed in other manganese-oxidizing bacteria but homologues were identified in the genomes of several bacteria including Sinorhizobium meliloti 1021 and Agrobacterium tumefaciens C58. These results suggest that moxBA and its homologues constitute a family of genes encoding an MCO and a predicted component of the Type I secretion system.

Human factors in computing systems: focus on patient-centered health communication at the ACM SIGCHI conference.

Science.gov (United States)

Wilcox, Lauren; Patel, Rupa; Chen, Yunan; Shachak, Aviv

2013-12-01

Health Information Technologies, such as electronic health records (EHR) and secure messaging, have already transformed interactions among patients and clinicians. In addition, technologies supporting asynchronous communication outside of clinical encounters, such as email, SMS, and patient portals, are being increasingly used for follow-up, education, and data reporting. Meanwhile, patients are increasingly adopting personal tools to track various aspects of health status and therapeutic progress, wishing to review these data with clinicians during consultations. These issues have drawn increasing interest from the human-computer interaction (HCI) community, with special focus on critical challenges in patient-centered interactions and design opportunities that can address these challenges. We saw this community presenting and interacting at the ACM SIGCHI 2013, Conference on Human Factors in Computing Systems, (also known as CHI), held April 27-May 2nd, 2013 at the Palais de Congrès de Paris in France. CHI 2013 featured many formal avenues to pursue patient-centered health communication: a well-attended workshop, tracks of original research, and a lively panel discussion. In this report, we highlight these events and the main themes we identified. We hope that it will help bring the health care communication and the HCI communities closer together. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Three different CPR management models for riverine nitrogen polluters in Sweden

Energy Technology Data Exchange (ETDEWEB)

Arheimer, B

1998-12-31

Sweden has failed in the environmental goal of reducing the nitrogen transport to the Baltic Sea by 50 per cent in ten years, mainly because of the large amounts of nitrogen still leaching from arable land. The riverine nitrogen problem can be formulated in terms of a CPR problem, as the property rights of the river water are undefined and it is possible to free-ride in the maintenance of the resource by polluting it for personal aim. Swedish water management at present is dominated by a command-and-control policy. However, to master the situation, various propositions of changed institutional arrangements for better management of water resources have been presented recently. This chapter describes and discusses three models that have been proposed for water management in the Swedish environmental policy debate: the community model, the negotiation model and the market model. To be economically efficient and ecologically sustainable, all of these models must be in accordance with local environmental, socio-economic and cultural conditions. According to the analysis, the proposed management models have about the same institutional requirements, although the sensitivity to various requirements may differ among the models. In the chapter it is argued that new policy implementation in Sweden should include regional water administration boards, where monitoring and problem analysis are kept within single catchments. Problem solution should be decentralized so that sub basins are managed according to the model most in accordance with local conditions. As long as the various requests for model success are met, different management models may be used in different parts of the same watershed. This may be possible since the overwhelming need of institutional arrangements is about the same for the three proposed management models and, consequently, they do not exclude each other 42 refs, 3 figs, 1 tab

Three different CPR management models for riverine nitrogen polluters in Sweden

Energy Technology Data Exchange (ETDEWEB)

Arheimer, B.

1997-12-31

Sweden has failed in the environmental goal of reducing the nitrogen transport to the Baltic Sea by 50 per cent in ten years, mainly because of the large amounts of nitrogen still leaching from arable land. The riverine nitrogen problem can be formulated in terms of a CPR problem, as the property rights of the river water are undefined and it is possible to free-ride in the maintenance of the resource by polluting it for personal aim. Swedish water management at present is dominated by a command-and-control policy. However, to master the situation, various propositions of changed institutional arrangements for better management of water resources have been presented recently. This chapter describes and discusses three models that have been proposed for water management in the Swedish environmental policy debate: the community model, the negotiation model and the market model. To be economically efficient and ecologically sustainable, all of these models must be in accordance with local environmental, socio-economic and cultural conditions. According to the analysis, the proposed management models have about the same institutional requirements, although the sensitivity to various requirements may differ among the models. In the chapter it is argued that new policy implementation in Sweden should include regional water administration boards, where monitoring and problem analysis are kept within single catchments. Problem solution should be decentralized so that sub basins are managed according to the model most in accordance with local conditions. As long as the various requests for model success are met, different management models may be used in different parts of the same watershed. This may be possible since the overwhelming need of institutional arrangements is about the same for the three proposed management models and, consequently, they do not exclude each other 42 refs, 3 figs, 1 tab

CFD simulation analysis and validation for CPR1000 pressurized water reactor

International Nuclear Information System (INIS)

Zhang Mingqian; Ran Xiaobing; Liu Yanwu; Yu Xiaolei; Zhu Mingli

2013-01-01

Background: With the rapid growth in the non-nuclear area for industrial use of Computational fluid dynamics (CFD) which has been accompanied by dramatically enhanced computing power, the application of CFD methods to problems relating to Nuclear Reactor Safety (NRS) is rapidly accelerating. Existing research data have shown that CFD methods could predict accurately the pressure field and the flow repartition in reactor lower plenum. But simulations for the full domain of the reactor have not been reported so far. Purpose: The aim is to determine the capabilities of the codes to model accurately the physical phenomena which occur in the full reactor vessel. Methods: The flow field of the CPR1000 reactor which is associated with a typical pressurized water reactor (PWR) is simulated by using ANSYS CFX. The pressure loss in reactor pressure vessel, the hydraulic loads of guide tubes and support columns, and the bypass flow of head dome were obtained by calculations for the full domain of the reactor. The results were validated by comparing with the determined reference value of the operating nuclear plant (LingAo nuclear plant), and the transient simulation was conducted in order to better understand the flow in reactor pressure vessel. Results: It was shown that the predicted pressure loss with CFD code was slightly different with the determined value (10% relative deviation for the total pressure loss), the hydraulic loads were less than the determined value with maximum relative deviation 50%, and bypass flow of head dome was approximately the same with determined value. Conclusion: This analysis practice predicts accurately the physical phenomena which occur in the full reactor vessel, and can be taken as a guidance for the nuclear plant design development and improve our understanding of reactor flow phenomena. (authors)

Institutional property rights structure, common pool resource (CPR), tragedy of the urban commons: A Review

Science.gov (United States)

Ling, G.; Ho, C. S.; Ali, H. M.

2014-02-01

There have been a plethora of researches on the significance of public open space (POS) in contributing to societies' sustainability. However, by virtue of identified maladaptive policy-based-property rights structure, such a shared good becomes vulnerable to tragedy of the urban commons (overexploitation) that subsequently leads to burgeoning number of mismanaged POS e.g., degraded and unkempt urban public spaces. By scrutinising the literatures within property rights domain and commons resources, an objective is highlighted in this paper which is to insightfully discourse institutional property rights structure pertaining to the mechanism, roles and interrelationship between property-rights regimes, bundle of property rights and resource domains; types of goods on how they act upon and tie in the POS with the social quandary. In summary, urban POS tragedy can potentially be triggered by the institutional structure especially if the ownership is left under open-access resource regime and ill-defined property rights which both successively constitute the natures of Common Pool Resource (CPR) within the commons, POS. Therefore, this paper sparks an idea to policy makers that property rights structure is a determinant in sustainably governing the POS in which adaptive assignment of property regimes and property rights are impelled.

Aseismic safety analysis of a prestressed concrete containment vessel for CPR1000 nuclear power plant

Science.gov (United States)

Yi, Ping; Wang, Qingkang; Kong, Xianjing

2017-01-01

The containment vessel of a nuclear power plant is the last barrier to prevent nuclear reactor radiation. Aseismic safety analysis is the key to appropriate containment vessel design. A prestressed concrete containment vessel (PCCV) model with a semi-infinite elastic foundation and practical arrangement of tendons has been established to analyze the aseismic ability of the CPR1000 PCCV structure under seismic loads and internal pressure. A method to model the prestressing tendon and its interaction with concrete was proposed and the axial force of the prestressing tendons showed that the simulation was reasonable and accurate. The numerical results show that for the concrete structure, the location of the cylinder wall bottom around the equipment hatch and near the ring beam are critical locations with large principal stress. The concrete cracks occurred at the bottom of the PCCV cylinder wall under the peak earthquake motion of 0.50 g, however the PCCV was still basically in an elastic state. Furthermore, the concrete cracks occurred around the equipment hatch under the design internal pressure of 0.4MPa, but the steel liner was still in the elastic stage and its leak-proof function soundness was verified. The results provide the basis for analysis and design of containment vessels.

Institutional property rights structure, common pool resource (CPR), tragedy of the urban commons: A Review

International Nuclear Information System (INIS)

Ling, G; Ho, C S; Ali, H M

2014-01-01

There have been a plethora of researches on the significance of public open space (POS) in contributing to societies' sustainability. However, by virtue of identified maladaptive policy-based-property rights structure, such a shared good becomes vulnerable to tragedy of the urban commons (overexploitation) that subsequently leads to burgeoning number of mismanaged POS e.g., degraded and unkempt urban public spaces. By scrutinising the literatures within property rights domain and commons resources, an objective is highlighted in this paper which is to insightfully discourse institutional property rights structure pertaining to the mechanism, roles and interrelationship between property-rights regimes, bundle of property rights and resource domains; types of goods on how they act upon and tie in the POS with the social quandary. In summary, urban POS tragedy can potentially be triggered by the institutional structure especially if the ownership is left under open-access resource regime and ill-defined property rights which both successively constitute the natures of Common Pool Resource (CPR) within the commons, POS. Therefore, this paper sparks an idea to policy makers that property rights structure is a determinant in sustainably governing the POS in which adaptive assignment of property regimes and property rights are impelled

Improving simulated long-term responses of vegetation to temperature and precipitation extremes using the ACME land model

Science.gov (United States)

Ricciuto, D. M.; Warren, J.; Guha, A.

2017-12-01

While carbon and energy fluxes in current Earth system models generally have reasonable instantaneous responses to extreme temperature and precipitation events, they often do not adequately represent the long-term impacts of these events. For example, simulated net primary productivity (NPP) may decrease during an extreme heat wave or drought, but may recover rapidly to pre-event levels following the conclusion of the extreme event. However, field measurements indicate that long-lasting damage to leaves and other plant components often occur, potentially affecting the carbon and energy balance for months after the extreme event. The duration and frequency of such extreme conditions is likely to shift in the future, and therefore it is critical for Earth system models to better represent these processes for more accurate predictions of future vegetation productivity and land-atmosphere feedbacks. Here we modify the structure of the Accelerated Climate Model for Energy (ACME) land surface model to represent long-term impacts and test the improved model against observations from experiments that applied extreme conditions in growth chambers. Additionally, we test the model against eddy covariance measurements that followed extreme conditions at selected locations in North America, and against satellite-measured vegetation indices following regional extreme events.

Recent changes in flood damage in the United States from observations and ACME model

Science.gov (United States)

Leng, G.; Leung, L. R.

2017-12-01

Despite efforts to mitigate flood hazards in flood-prone areas, survey- and report-based flood databases show that flood damage has increased and emerged as one of the most costly disaster in the United States since the 1990s. Understanding the mechanism driving the changes in flood damage is therefore critical for reducing flood risk. In this study, we first conduct a comprehensive analysis of the changing characteristics of flood damage at local, state and country level. Results show a significant increasing trend in the number of flood hazards, causing economic losses of up to $7 billion per year. The ratio of flood events that caused tangible economical cost to the total flood events has exhibited a non-significant increasing trend before 2007 followed by a significant decrease, indicating a changing vulnerability to floods. Analysis also reveals distinct spatial and temporal patterns in the threshold intensity of flood hazards with tangible economical cost. To understand the mechanism behind the increasing flood damage, we develop a flood damage economic model coupled with the integrated hydrological modeling system of ACME that features a river routing model with an inundation parameterization and a water use and regulation model. The model is evaluated over the country against historical records. Several numerical experiments are then designed to explore the mechanisms behind the recent changes in flood damage from the perspective of flood hazard, exposure and vulnerability, which constitute flood damage. The role of human activities such as reservoir operations and water use in modifying regional floods are also explored using the new tool, with the goal of improving understanding and modeling of vulnerability to flood hazards.

Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry

Directory of Open Access Journals (Sweden)

Anjala Chelvanathan

2016-01-01

Full Text Available Objective. Out of hospital cardiac arrest (OHCA patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C and without catheterization (MTH + NC between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C and 110 patients did not undergo cardiac catheterization (MTH + NC. Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009. Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.

Study of ex-vessel steam explosion risk of Reactor Pit Flooding System and structural response of containment for CPR1000"+ Unit

International Nuclear Information System (INIS)

Zhang Juanhua; Chen Peng

2015-01-01

Reactor Pit Flooding System is one of the special mitigation measures for severe accident for CPR1000"+ Unit. If the In-Vessel Relocation function of Reactor Pit Flooding System is failed, there is the steam explosion risk in reactor cavity. This paper firstly adopts MC3D code to build steam explosion model in order to calculate the pressure load and impulses of steam explosion that are as the input data of containment structural response analysis. The next step is to model the containment structure and analyze the structural response by ABAQUS code. The analysis results show that the integral damage induced by steam explosion to the external containment wall is shallow, and the containment structural integrity can be maintained. The risk and damage to the containment integrity reduced by steam explosion of RPF is small, and it does not influence the design and implementation of RPF. (author)

Reduced hands-off-time and time to first shock in CPR according to the ERC Guidelines 2005.

Science.gov (United States)

Roessler, B; Fleischhackl, R; Losert, H; Arrich, J; Mittlboeck, M; Domanovits, H; Hoerauf, K

2009-01-01

Chest compressions and early defibrillation are crucial in cardiopulmonary resuscitation (CPR). The Guidelines 2005 brought major changes to the basic life support and automated external defibrillator (BLS-AED) algorithm. We compared the European Resuscitation Council's Guidelines 2000 (group '00) and 2005 (group '05) on hands-off-time (HOT) and time to first shock (TTFS) in an experimental model. In a randomised, cross-over design, volunteers were assessed in performing BLS-AED over a period of 5min on a manikin in a simulated ventricular fibrillation cardiac arrest situation. Ten minutes of standardised teaching and 10min of training including corrective feedback were allocated for each of the guidelines before evaluation. HOT was chosen as the primary and TTFS as the secondary outcome parameter. Forty participants were enrolled; one participant dropped out after group allocation. During the 5-min evaluation period of adult BLS-AED, HOT was significantly (p<0.001) longer in group '00 [273+/-3s (mean+/-standard error)] than in group '05 (188+/-3s). The TTFS was significantly (p<0.001) longer in group '00 (91+/-3s) than in group '05 (71+/-3s). In this manikin setting, HOT and TTFS improved with BLS-AED performed according to Guidelines 2005.

Immature osteoblastic MG63 cells possess two calcitonin gene-related peptide receptor subtypes that respond differently to [Cys(Acm)(2,7)] calcitonin gene-related peptide and CGRP(8-37).

Science.gov (United States)

Kawase, Tomoyuki; Okuda, Kazuhiro; Burns, Douglas M

2005-10-01

Calcitonin gene-related peptide (CGRP) is clearly an anabolic factor in skeletal tissue, but the distribution of CGRP receptor (CGRPR) subtypes in osteoblastic cells is poorly understood. We previously demonstrated that the CGRPR expressed in osteoblastic MG63 cells does not match exactly the known characteristics of the classic subtype 1 receptor (CGRPR1). The aim of the present study was to further characterize the MG63 CGRPR using a selective agonist of the putative CGRPR2, [Cys(Acm)(2,7)]CGRP, and a relatively specific antagonist of CGRPR1, CGRP(8-37). [Cys(Acm)(2,7)]CGRP acted as a significant agonist only upon ERK dephosphorylation, whereas this analog effectively antagonized CGRP-induced cAMP production and phosphorylation of cAMP response element-binding protein (CREB) and p38 MAPK. Although it had no agonistic action when used alone, CGRP(8-37) potently blocked CGRP actions on cAMP, CREB, and p38 MAPK but had less of an effect on ERK. Schild plot analysis of the latter data revealed that the apparent pA2 value for ERK is clearly distinguishable from those of the other three plots as judged using the 95% confidence intervals. Additional assays using 3-isobutyl-1-methylxanthine or the PKA inhibitor N-(2-[p-bromocinnamylamino]ethyl)-5-isoquinolinesulfonamide hydrochloride (H-89) indicated that the cAMP-dependent pathway was predominantly responsible for CREB phosphorylation, partially involved in ERK dephosphorylation, and not involved in p38 MAPK phosphorylation. Considering previous data from Scatchard analysis of [125I]CGRP binding in connection with these results, these findings suggest that MG63 cells possess two functionally distinct CGRPR subtypes that show almost identical affinity for CGRP but different sensitivity to CGRP analogs: one is best characterized as a variation of CGRPR1, and the second may be a novel variant of CGRPR2.

A mechanistic diagnosis of the simulation of soil CO2 efflux of the ACME Land Model

Science.gov (United States)

Liang, J.; Ricciuto, D. M.; Wang, G.; Gu, L.; Hanson, P. J.; Mayes, M. A.

2017-12-01

Accurate simulation of the CO2 efflux from soils (i.e., soil respiration) to the atmosphere is critical to project global biogeochemical cycles and the magnitude of climate change in Earth system models (ESMs). Currently, the simulated soil respiration by ESMs still have a large uncertainty. In this study, a mechanistic diagnosis of soil respiration in the Accelerated Climate Model for Energy (ACME) Land Model (ALM) was conducted using long-term observations at the Missouri Ozark AmeriFlux (MOFLUX) forest site in the central U.S. The results showed that the ALM default run significantly underestimated annual soil respiration and gross primary production (GPP), while incorrectly estimating soil water potential. Improved simulations of soil water potential with site-specific data significantly improved the modeled annual soil respiration, primarily because annual GPP was simultaneously improved. Therefore, accurate simulations of soil water potential must be carefully calibrated in ESMs. Despite improved annual soil respiration, the ALM continued to underestimate soil respiration during peak growing seasons, and to overestimate soil respiration during non-peak growing seasons. Simulations involving increased GPP during peak growing seasons increased soil respiration, while neither improved plant phenology nor increased temperature sensitivity affected the simulation of soil respiration during non-peak growing seasons. One potential reason for the overestimation of the soil respiration during non-peak growing seasons may be that the current model structure is substrate-limited, while microbial dormancy under stress may cause the system to become decomposer-limited. Further studies with more microbial data are required to provide adequate representation of soil respiration and to understand the underlying reasons for inaccurate model simulations.

Public awareness and self-efficacy of cardiopulmonary resuscitation in communities and outcomes of out-of-hospital cardiac arrest: A multi-level analysis.

Science.gov (United States)

Ro, Young Sun; Shin, Sang Do; Song, Kyoung Jun; Hong, Sung Ok; Kim, Young Taek; Lee, Dong-Woo; Cho, Sung-Il

2016-05-01

This study aims to test the association between capacity of cardiopulmonary resuscitation (CPR) at community level and survival after out-of-hospital cardiac arrest (OHCA). Emergency medical service (EMS)-treated OHCAs with cardiac etiology in Korea between 2012 and 2013 were analyzed, excluding cases witnessed by EMS providers. Exposure variables were five indexes of community CPR capacity: awareness of CPR (CPR-Awareness), any training experience of CPR (CPR-Any-Training), recent CPR training within the last 2 years (CPR-Recent-Training), CPR training with a manikin (CPR-Manikin-Training), and CPR self-efficacy (CPR-Self-Efficacy). All measures of capacity were calculated as aggregated values for each county level using the national Korean Community Health Survey database of 228,921 responders sampled representatively from 253 counties in 2012. Endpoints were bystander CPR (BCPR) and survival to discharge. We calculated adjusted odds ratios (AORs) per 10% increment in community CPR capacity using multi-level logistic regression models, adjusting for potential confounders at individual levels. Of 29,052 eligible OHCAs, 11,079 (38.1%) received BCPR. Patients were more likely to receive BCPR in communities with higher proportions of residents with CPR-Awareness, CPR-Any-Training, CPR-Recent-Training, CPR-Manikin-Training, and CPR-Self-Efficacy (all pCPR-Awareness, 1.10 (1.04-1.15) for CPR-Any-Training, and 1.08 (1.03-1.13) for CPR-Self-Efficacy. For survival to discharge, AORs (95% CIs) were 1.34 (1.23-1.47) per 10% increment in CPR-Awareness, 1.36 (1.20-1.54) for CPR-Any-Training, and 1.29 (1.15-1.45) for CPR-Self-Efficacy. Higher CPR capacity at community level was associated with higher bystander CPR and survival to discharge rates after OHCA. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.

Science.gov (United States)

2006-05-01

This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced

Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.

Directory of Open Access Journals (Sweden)

Philipp Schuerner

Full Text Available Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR. Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany in a randomized, cross-over manikin study.Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary.The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group.As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.

Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.

Science.gov (United States)

Schuerner, Philipp; Grande, Bastian; Piegeler, Tobias; Schlaepfer, Martin; Saager, Leif; Hutcherson, Matthew T; Spahn, Donat R; Ruetzler, Kurt

2016-01-01

Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.

Dispatcher-assisted compression-only cardiopulmonary resuscitation provides best quality cardiopulmonary resuscitation by laypersons: A randomised controlled single-blinded manikin trial.

Science.gov (United States)

Spelten, Oliver; Warnecke, Tobias; Wetsch, Wolfgang A; Schier, Robert; Böttiger, Bernd W; Hinkelbein, Jochen

2016-08-01

High-quality cardiopulmonary resuscitation (CPR) by laypersons is a key determinant of both outcome and survival for out-of-hospital cardiac arrest. Dispatcher-assisted CPR (telephone-CPR, T-CPR) increases the frequency and correctness of bystander-CPR but results in prolonged time to first chest compressions. However, it remains unclear whether instructions for rescue ventilation and/or chest compressions should be recommended for dispatcher-assisted CPR. The aim of this study was to evaluate both principles of T-CPR with respect to CPR quality. Randomised controlled single-blinded manikin trial. University Hospital of Cologne, Germany, 1 July 2012 to 30 September 2012. Sixty laypersons between 18 and 65 years. Medically educated individuals, medical professionals and pregnant women were excluded. Participants were asked to resuscitate a manikin and were randomised into three groups: not dispatcher-assisted (uninstructed) CPR (group 1; U-CPR; n = 20), dispatcher-assisted compression-only CPR (group 2; DACO-CPR; n = 19) and full dispatcher-assisted CPR with rescue ventilation (group 3; DAF-CPR; n = 19). Specific parameters of CPR quality [i.e. no-flow-time (NFT) as well as compression and ventilation parameters] were analysed. To compare different groups we used Student's t test and P less than 0.05 was considered significant. Initial NFT was lowest in the DACO-CPR group (mean 21.3 ± 14.4%), followed by dispatcher-assisted full CPR (mean 49.1 ± 8.5%) and by unassisted CPR (mean 55.0 ± 12.9%). Initial NFT covering the time of instruction was lower in DACO-CPR (12.1 ± 5.4%) as compared to dispatcher-assisted full CPR (20.7 ± 8.1%). Compression depth was similar in all three groups: 40.6 ± 13.0 mm (unassisted CPR), 41.0 ± 12.2 mm (DACO-CPR) and 38.8 ± 15.8 mm (dispatcher-assisted full CPR). Average compression frequency was highest in the DACO-CPR group (65.2 ± 22.4 min) compared with the unassisted CPR

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople’s resuscitation performance

Science.gov (United States)

Ko, Rachel Jia Min; Lim, Swee Han; Wu, Vivien Xi; Leong, Tak Yam; Liaw, Sok Ying

2018-01-01

INTRODUCTION Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers’ CPR performance as compared to standard CPR. METHODS A total of 85 laypeople (aged 21–60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants’ performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins. RESULTS The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p CPR group than in the standard CPR group (p CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR. PMID:29167910

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople's resuscitation performance.

Science.gov (United States)

Ko, Rachel Jia Min; Lim, Swee Han; Wu, Vivien Xi; Leong, Tak Yam; Liaw, Sok Ying

2018-04-01

Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers' CPR performance as compared to standard CPR. A total of 85 laypeople (aged 21-60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants' performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins. The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p CPR group than in the standard CPR group (p CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR. Copyright: © Singapore Medical Association.

ACMS-Data

Data.gov (United States)

Department of Homeland Security — The Records of CBP training activities in the academies and in-service field training. This data is for processing by COTS Application Acadis Readiness Suite and is...

High-quality cardiopulmonary resuscitation: current and future directions.

Science.gov (United States)

Abella, Benjamin S

2016-06-01

Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

Diffusion of Cardiopulmonary Resuscitation Training to Chinese Immigrants with Limited English Proficiency

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Mei Po Yip

2011-01-01

Full Text Available Cardiopulmonary resuscitation (CPR is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP. A bilingual facilitator conducted all the sessions. All discussions were taped, recorded, translated, and transcribed. Transcripts were analyzed by content analysis guided by the theory of diffusion. The majority of participants did not know of CPR and did not know where to get trained. Complexity of CPR procedure, advantages of calling 9-1-1, lack of confidence, and possible liability discourage LEP individuals to learn CPR. LEP individuals welcome simplified Hands-Only CPR and are willing to perform CPR with instruction from 9-1-1 operators. Expanding the current training to include Hands-Only CPR and dispatcher-assisted CPR may motivate Chinese LEP individuals to get trained for CPR.

Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator.

Science.gov (United States)

Kim, Tae Han; Hong, Ki Jeong; Sang Do, Shin; Kim, Chu Hyun; Song, Sung Wook; Song, Kyoung Jun; Ro, Young Sun; Ahn, Ki Ok; Jang, Dayea Beatrice

2016-08-01

Manual cardiopulmonary resuscitation (CPR) during vertical transport in small elevators using standard stretcher for out-of-hospital cardiac arrest can raise concerns with diminishing quality. Mechanical CPR on a reducible stretcher (RS-CPR) that can be shortened in the length was tested to compare the CPR quality with manual CPR on a standard stretcher (SS-CPR). A randomized crossover manikin simulation was designed. Three teams of emergency medical technicians were recruited to perform serial CPR simulations using two different protocols (RS-CPR and SS-CPR) according to a randomization; the first 6 minutes of manual CPR at the scene was identical for both scenarios and two different protocols during vertical transport in a small elevator followed on a basis of cross-over assignment. The LUCAS-2 Chest Compression System (Zolife AB, Lund, Sweden) was used for RS-CPR. CPR quality was measured using a resuscitation manikin (Resusci Anne QCPR, Laerdal Medical, Stavanger, Norway) in terms of no flow fraction, compression depth, and rate (median and IQR). A total of 42 simulations were analyzed. CPR quality did not differ significantly at the scene. No flow fraction (%) was significantly lower when the stretcher was moving in RS-CPR then SS-CPR (36.0 (33.8-38.7) vs 44.0 (36.8-54.4), P< .01). RS-CPR showed significantly better quality than SS-CPR; 93.2 (50.6-95.6) vs 14.8 (0-20.8) for adequate depth (P< 0.01), and 97.5 (96.6-98.2) vs 68.9(43.4-78.5) for adequate rate (P< .01). Mechanical CPR on a reducible stretcher during vertical transport showed significant improvement in CPR quality in terms of no-flow fraction, compression depth, and rate compared with manual CPR on a standard stretcher. Copyright © 2016 Elsevier Inc. All rights reserved.

Retention of cardiopulmonary resuscitation skills after hands-only training versus conventional training in novices: a randomized controlled trial.

Science.gov (United States)

Kim, Young Joon; Cho, Youngsuk; Cho, Gyu Chong; Ji, Hyun Kyung; Han, Song Yi; Lee, Jin Hyuck

2017-06-01

Cardiopulmonary resuscitation (CPR) training can improve performance during simulated cardiac arrest; however, retention of skills after training remains uncertain. Recently, hands-only CPR has been shown to be as effective as conventional CPR. The purpose of this study is to compare the retention rate of CPR skills in laypersons after hands-only or conventional CPR training. Participants were randomly assigned to 1 of 2 CPR training methods: 80 minutes of hands-only CPR training or 180 minutes of conventional CPR training. Each participant's CPR skills were evaluated at the end of training and 3 months thereafter using the Resusci Anne manikin with a skill-reporting software. In total, 252 participants completed training; there were 125 in the hands-only CPR group and 127 in the conventional CPR group. After 3 months, 118 participants were randomly selected to complete a post-training test. The hands-only CPR group showed a significant decrease in average compression rate (P=0.015), average compression depth (P=0.031), and proportion of adequate compression depth (P=0.011). In contrast, there was no difference in the skills of the conventional CPR group after 3 months. Conventional CPR training appears to be more effective for the retention of chest compression skills than hands-only CPR training; however, the retention of artificial ventilation skills after conventional CPR training is poor.

Community involvement in out of hospital cardiac arrest

Science.gov (United States)

Shams, Ali; Raad, Mohamad; Chams, Nour; Chams, Sana; Bachir, Rana; El Sayed, Mazen J.

2016-01-01

Abstract Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival. This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR. A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR. A total of 948 students completed the survey. Participants’ mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR. University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of

The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone.

Science.gov (United States)

Choa, Minhong; Park, Incheol; Chung, Hyun Soo; Yoo, Sun K; Shim, Hoshik; Kim, Seungho

2008-04-01

We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci Anne SkillReporter Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering. The AA-CPR group had a significantly better checklist score (pCPR cycle (pCPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8+/-3.6%, p=0.033) and compression rate (72.4+/-3.7%, p=0.015) than DA-CPR group. However, the accuracy of compression depth (p=0.400), ventilation volume (p=0.977) and flow rate (p=0.627) were below 30% in both groups. Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Public Knowledge and Attitudes towards Bystander Cardiopulmonary Resuscitation in China

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Meng Chen

2017-01-01

Full Text Available The rate of bystander CPR is much lower in China than in developed countries. This survey was implemented to assess the current status of layperson CPR training, to analyze the willingness of bystanders to perform CPR, and to identify barriers to improving bystander CPR rates. The questionnaire included individual information, current status of bystander CPR training, and individual’s willingness and attitude towards performing CPR. There were 25.6% laypersons who took CPR training. The majority (98.6% of laypersons would perform CPR on their family members, but fewer laypersons (76.3% were willing to perform CPR on strangers. Most respondents (53.2% were worried about legal issues. If laws were implemented to protect bystanders who give aid, the number of laypersons who were not willing to perform CPR on strangers dropped from 23.7% to 2.4%. An increasing number of people in China know CPR compared with the situation in the past. CPR training in China is much less common than in many developed countries. The barriers are that laypersons are not well-trained and they fear being prosecuted for unsuccessful CPR. More accredited CPR training courses are needed in China. The laws should be passed to protect bystanders who provide assistance.

Molecular cloning and functional characterization of multiple NADPH-cytochrome P450 reductases from Andrographis paniculata.

Science.gov (United States)

Lin, Huixin; Wang, Jian; Qi, Mengdie; Guo, Juan; Rong, Qixian; Tang, Jinfu; Wu, Yisheng; Ma, Xiaojing; Huang, Luqi

2017-09-01

Andrographis paniculata (Burm.f.) Wall. ex Nees is widely used as medicinal herb in Southern and Southeastern Asia and andrographolide is its main medicinal constituent. Based on the structure of andrographolide, it has been proposed that cytochrome P450 enzymes play vital roles on its biosynthesis. NADPH:cytochrome P450 reductase (CPR) is the most important redox partner of multiple P450s. In this study, three CPRs were identified in the genomic data of A. paniculata (namely ApCPR1, ApCPR2, and ApCPR3), and their coding regions were cloned. They varied from 62% to 70% identities to each other at the amino acid sequence level. ApCPR1 belongs to Class I of dicotyledonous CPR while both ApCPR2 and ApCPR3 are grouped to Class II. The recombinant enzymes ApCPR1 and ApCPR2 reduced cytochrome c and ferricyanide in an NADPH-dependent manner. In yeast, they supported the activity of CYP76AH1, a ferruginol-forming enzyme. However, ApCPR3 did not show any enzymatic activities either in vitro or in vivo. Quantitative real-time PCR analysis showed that both ApCPR1 and ApCPR2 expressed in all tissues examined, but ApCPR2 showed higher expression in leaves. Expression of ApCPR2 was inducible by MeJA and its pattern matched with andrographolide accumulation. Present investigation suggested ApCPR2 involves in the biosynthesis of secondary metabolites including andrographolide. Copyright © 2017. Published by Elsevier B.V.

Retention of cardiopulmonary resuscitation skills after hands-only training versus conventional training in novices: a randomized controlled trial

OpenAIRE

Kim, Young Joon; Cho, Youngsuk; Cho, Gyu Chong; Ji, Hyun Kyung; Han, Song Yi; Lee, Jin Hyuck

2017-01-01

Objective Cardiopulmonary resuscitation (CPR) training can improve performance during simulated cardiac arrest; however, retention of skills after training remains uncertain. Recently, hands-only CPR has been shown to be as effective as conventional CPR. The purpose of this study is to compare the retention rate of CPR skills in laypersons after hands-only or conventional CPR training. Methods Participants were randomly assigned to 1 of 2 CPR training methods: 80 minutes of hands-only CPR tra...

Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

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Lakshmi Rajeswaran

2013-05-01

Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources.The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts.

Bystander-witnessed cardiac arrest is associated with reported agonal breathing and leads to less frequent bystander CPR.

Science.gov (United States)

Brinkrolf, P; Metelmann, B; Scharte, C; Zarbock, A; Hahnenkamp, K; Bohn, A

2018-04-18

Although the importance of bystander cardiopulmonary resuscitation has been shown in multiple studies, the rate of bystander cardiopulmonary resuscitation is still relatively low in many countries. Little is known on bystanders' perceptions influencing the decision to start cardiopulmonary resuscitation. Our study aims to determine such factors. Semi-structured telephone interviews with bystanders of out-of-hospital cardiac arrests between December 2014 and April 2016 were performed in a prospective manner. This single-center survey was conducted in the city of Münster, Germany. The bystander's sex and age, the perception of the victim's breathing and initial condition were correlated with the share of bystander cardiopulmonary resuscitation in the corresponding group. 101 telephone interviews were performed with 57 male and 44 female participants showing a mean age of 52.7 (SD ± 16.3). In case of apnoea 38 out of 46 bystanders (82.6%) started cardiopulmonary resuscitation; while in case of descriptions indicating agonal breathing 19 out of 35 bystanders (54.3%) started cardiopulmonary resuscitation (p = .007). If the patient was found unconscious 47 out of 63 bystanders (74.7%) performed cardiopulmonary resuscitation, while in cases of witnessed cardiac arrest 19 out of 38 bystanders (50%) attempted cardiopulmonary resuscitation (p = .012). Witnessed change of consciousness is an independent factor significantly lowering the probability of starting cardiopulmonary resuscitation (regression coefficient -1.489, p bystander-CPR was started. These data reinforce the importance of teaching the recognition of early cardiac arrest. Copyright © 2018 Elsevier B.V. All rights reserved.

Bystander cardiopulmonary resuscitation training experience and self-efficacy of age and gender group: a nationwide community survey.

Science.gov (United States)

Ro, Young Sun; Shin, Sang Do; Song, Kyoung Jun; Hong, Sung Ok; Kim, Young Taek; Cho, Sung-Il

2016-08-01

We hypothesized that recent hands-on practice for cardiopulmonary resuscitation (CPR) would be strongly associated with a higher likelihood of self-efficacy in bystander CPR among laypersons according to age and gender group. We used the National Korean Community Health Survey database of 228921 representatively sampled responders from 253 counties in 2012. Laypersons who had previous CPR training were eligible. Exposure variables were having had CPR training with hands-on practice session with a manikin (Practical-CPR-Training) and CPR training within the last 2 years (Recent-CPR-Training). Primary outcome was self-efficacy in bystander CPR. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects of CPR training across different age and gender groups. Of 62425 eligible respondents who have had CPR training, 20213 (32.4%) had Practical-CPR-Training. Adjusted odds ratios (AORs) for self-efficacy were 4.08 (3.78-4.41) in Practical-CPR-Training, 2.61 (2.50-2.73) in male, 1.26 (1.16-1.36) in good self-rated health, 1.19 (1.10-1.29) in high school graduate, 1.19 (1.01-1.39) in persons living with stroke patients in household, and 1.17 (1.10-1.24) in Recent-CPR-Training. In interaction models, Practical-CPR-Training showed higher self-efficacy in all age and gender groups, whereas Recent-CPR-Training was not associated with better self-efficacy in elderly group, male (AOR, 0.90 [0.69-1.18]) and female (AOR, 0.94 [0.72-1.23]). Self-efficacy in bystander CPR was higher in person with recent CPR training with hands-on practice with a manikin. Copyright © 2015 Elsevier Inc. All rights reserved.

Differentially regulated NADPH:cytochrome P450 oxidoreductases in parsley

Science.gov (United States)

Koopmann, Edda; Hahlbrock, Klaus

1997-01-01

Two NADPH:cytochrome P450 oxidoreductases (CPRs) from parsley (Petroselinum crispum) were cloned, and the complete proteins were expressed and functionally identified in yeast. The two enzymes, designated CPR1 and CPR2, are 80% identical in amino acid sequence with one another and about 75% identical with CPRs from several other plant species. The mRNA accumulation patterns for CPR1 and CPR2 in fungal elicitor-treated or UV-irradiated cultured parsley cells and in developing or infected parsley plants were compared with those for cinnamate 4-hydroxylase (C4H), one of the most abundant CPR-dependent P450 enzymes in plants. All treatments strongly induced the mRNAs for C4H and CPR1 but not for CPR2, suggesting distinct metabolic roles of CPR1 and CPR2 and a functional relationship between CPR1 and C4H. PMID:9405720

Differentially regulated NADPH: cytochrome p450 oxidoreductases in parsely

International Nuclear Information System (INIS)

Koopmann, E.; Hahlbrock, K.

1997-01-01

Two NADPH:cytochrome P450 oxidoreductases (CPRs) from parsley (Petroselinum crispum) were cloned, and the complete proteins were expressed and functionally identified in yeast. The two enzymes, designated CPR1 and CPR2, are 80% identical in amino acid sequence with one another and about 75% identical with CPRs from several other plant species. The mRNA accumulation patterns for CPR1 and CPR2 in fungal elicitor-treated or UV-irradiated cultured parsley cells and in developing or infected parsley plants were compared with those for cinnamate 4-hydroxylase (C4H), one of the most abundant CPR-dependent P450 enzymes in plants. All treatments strongly induced the mRNAs for C4H and CPR1 but not for CPR2, suggesting distinct metabolic roles of CPR1 and CPR2 and a functional relationship between CPR1 and C4H

Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation.

Science.gov (United States)

Shultz, J J; Mianulli, M J; Gisch, T M; Coffeen, P R; Haidet, G C; Lurie, K G

1995-02-01

Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) utilizes a hand-held suction device with a pressure gauge that enables the operator to compress as well as actively decompress the chest. This new CPR method improves hemodynamic and ventilatory parameters when compared with standard CPR. ACD-CPR is easy to perform but may be more labor intensive. The purpose of this study was to quantify and compare the work required to perform ACD and standard CPR. Cardiopulmonary testing was performed on six basic cardiac life support- and ACD-trained St. Paul, MN fire-fighter personnel during performance of 10 min each of ACD and standard CPR on a mannequin equipped with a compression gauge. The order of CPR techniques was determined randomly with > 1 h between each study. Each CPR method was performed at 80 compressions/min (timed with a metronome), to a depth of 1.5-2 inches, and with a 50% duty cycle. Baseline cardiopulmonary measurements were similar at rest prior to performance of both CPR methods. During standard and ACD-CPR, respectively, rate-pressure product was 18.2 +/- 3.0 vs. 23.8 +/- 1.7 (x 1000, P CPR compared with standard CPR. Both methods require subanaerobic energy expenditure and can therefore be sustained for a sufficient length of time by most individuals to optimize resuscitation efforts. Due to the slightly higher work requirement, ACD-CPR may be more difficult to perform compared with standard CPR for long periods of time, particularly by individuals unaccustomed to the workload requirement of CPR, in general.

"Booster" training: evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during simulated cardiac arrest.

Science.gov (United States)

Sutton, Robert M; Niles, Dana; Meaney, Peter A; Aplenc, Richard; French, Benjamin; Abella, Benjamin S; Lengetti, Evelyn L; Berg, Robert A; Helfaer, Mark A; Nadkarni, Vinay

2011-05-01

To investigate the effectiveness of brief bedside "booster" cardiopulmonary resuscitation (CPR) training to improve CPR guideline compliance of hospital-based pediatric providers. Prospective, randomized trial. General pediatric wards at Children's Hospital of Philadelphia. Sixty-nine Basic Life Support-certified hospital-based providers. CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated pediatric arrest. After a 60-sec pretraining CPR evaluation, subjects were randomly assigned to one of three instructional/feedback methods to be used during CPR booster training sessions. All sessions (training/CPR manikin practice) were of equal duration (2 mins) and differed only in the method of corrective feedback given to participants during the session. The study arms were as follows: 1) instructor-only training; 2) automated defibrillator feedback only; and 3) instructor training combined with automated feedback. Before instruction, 57% of the care providers performed compressions within guideline rate recommendations (rate >90 min(-1) and 38 mm); and 36% met overall CPR compliance (rate and depth within targets). After instruction, guideline compliance improved (instructor-only training: rate 52% to 87% [p .01], and overall CPR compliance, 43% to 78% [p CPR compliance, 35% to 96% [p training combined with automated feedback: rate 48% to 100% [p CPR compliance, 30% to 100% [p CPR instruction, most certified Pediatric Basic Life Support providers did not perform guideline-compliant CPR. After a brief bedside training, CPR quality improved irrespective of training content (instructor vs. automated feedback). Future studies should investigate bedside training to improve CPR quality during actual pediatric cardiac arrests.

Cardio-pulmonary resuscitation challenges in selected Botswana ...

African Journals Online (AJOL)

The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and ...

Lytr, a phage-derived amidase is most effective in induced lysis of Lactococcus lactis compared with other lactococcal amidases and glucosaminidases

NARCIS (Netherlands)

Steen, Anton; van Schalkwijk, Saskia; Buist, Girbe; Twigt, Marja; Szeliga, Monika; Meijer, Wilco; Kuipers, Oscar P.; Kok, Jan; Hugenholtz, Jeroen

In the genome of Lactococcus lactis IL1403 five genes encoding peptidoglycan hydrolases are present: four glucosaminidases (acmA, acmB, acmC and acmD) and an endopeptidase (yjgB). Genes for six prophage lysins have also been identified. The genes acmB, acmC, acmD, yjgB and the lysin lytR of prophage

The effect of basic life support education on laypersons' willingness in performing bystander hands only cardiopulmonary resuscitation.

Science.gov (United States)

Cho, Gyu Chong; Sohn, You Dong; Kang, Ku Hyun; Lee, Won Woong; Lim, Kyung Soo; Kim, Won; Oh, Bum Jin; Choi, Dai Hai; Yeom, Seok Ran; Lim, Hoon

2010-06-01

Recently, hands only CPR (cardiopulmonary resuscitation) has been proposed as an alternative to standard CPR for bystanders. The present study was performed to identify the effect of basic life support (BLS) training on laypersons' willingness in performing standard CPR and hands only CPR. The participants for this study were non-medical personnel who applied for BLS training program that took place in 7 university hospitals in and around Korea for 6 months. Before and after BLS training, all the participants were given questionnaires for bystander CPR, and 890 respondents were included in the final analyses. Self-assessed confidence score for bystander CPR, using a visual analogue scale from 0 to 100, increased from 51.5+/-30.0 before BLS training to 87.0+/-13.7 after the training with statistical significance (p 0.001). Before the training, 19% of respondents reported willingness to perform standard CPR on a stranger, and 30.1% to perform hands only CPR. After the training, this increased to 56.7% of respondents reporting willingness to perform standard CPR, and 71.9%, hands only CPR, on strangers. Before and after BLS training, the odds ratio of willingness to perform hands only CPR versus standard CPR were 1.8 (95% CI 1.5-2.3) and 2.0 (95% CI 1.7-2.6) for a stranger, respectively. Most of the respondents, who reported they would decline to perform standard CPR, stated that fear of liability and fear of disease transmission were deciding factors after the BLS training. The BLS training increases laypersons' confidence and willingness to perform bystander CPR on a stranger. However, laypersons are more willing to perform hands only CPR rather than to perform standard CPR on a stranger regardless of the BLS training. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Cardiopulmonary Resuscitation Training Disparities in the United States.

Science.gov (United States)

Blewer, Audrey L; Ibrahim, Said A; Leary, Marion; Dutwin, David; McNally, Bryan; Anderson, Monique L; Morrison, Laurie J; Aufderheide, Tom P; Daya, Mohamud; Idris, Ahamed H; Callaway, Clifton W; Kudenchuk, Peter J; Vilke, Gary M; Abella, Benjamin S

2017-05-17

Bystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual-level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training. We administered a cross-sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97-0.99; P trained: OR, 0.99; 95% CI, 0.98-0.99; P =0.04). Furthermore, there was a greater then 4-fold difference in odds of being currently CPR trained from the 30-39 to 70-79 year old age groups (95% CI, 0.10-0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income ( P training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

“Booster” training: Evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during simulated cardiac arrest

Science.gov (United States)

Sutton, Robert M.; Niles, Dana; Meaney, Peter A.; Aplenc, Richard; French, Benjamin; Abella, Benjamin S.; Lengetti, Evelyn L.; Berg, Robert A.; Helfaer, Mark A.; Nadkarni, Vinay

2013-01-01

Objective To investigate the effectiveness of brief bedside “booster” cardiopulmonary resuscitation (CPR) training to improve CPR guideline compliance of hospital-based pediatric providers. Design Prospective, randomized trial. Setting General pediatric wards at Children’s Hospital of Philadelphia. Subjects Sixty-nine Basic Life Support–certified hospital-based providers. Intervention CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated pediatric arrest. After a 60-sec pretraining CPR evaluation, subjects were randomly assigned to one of three instructional/feedback methods to be used during CPR booster training sessions. All sessions (training/CPR manikin practice) were of equal duration (2 mins) and differed only in the method of corrective feedback given to participants during the session. The study arms were as follows: 1) instructor-only training; 2) automated defibrillator feedback only; and 3) instructor training combined with automated feedback. Measurements and Main Results Before instruction, 57% of the care providers performed compressions within guideline rate recommendations (rate >90 min−1 and 38 mm); and 36% met overall CPR compliance (rate and depth within targets). After instruction, guideline compliance improved (instructor-only training: rate 52% to 87% [p .01], and overall CPR compliance, 43% to 78% [p CPR compliance, 35% to 96% [p training combined with automated feedback: rate 48% to 100% [p CPR compliance, 30% to 100% [p CPR instruction, most certified Pediatric Basic Life Support providers did not perform guideline-compliant CPR. After a brief bedside training, CPR quality improved irrespective of training content (instructor vs. automated feedback). Future studies should investigate bedside training to improve CPR quality during actual pediatric cardiac arrests. PMID:20625336

Exposure characteristics of positive tone electron beam resist containing p-chloro-α-methylstyrene

Science.gov (United States)

Ochiai, Shunsuke; Takayama, Tomohiro; Kishimura, Yukiko; Asada, Hironori; Sonoda, Manae; Iwakuma, Minako; Hoshino, Ryoichi

2017-07-01

The positive tone resist consisted of methyl-α-chloroacrylate (ACM) and α-methylstyrene (MS) has higher sensitivity and higher dry etching resistance than poly (methylmethacrylate) (PMMA) due to the presence of a chlorine atom and a phenyl group. Copolymers consisted of ACM and p-chloro-α-methylstyrene (PCMS), where the additional chlorine atom is introduced in phenyl group compared with ACM-MS resist are synthesized and their exposure characteristics are investigated. ACM-PCMS resist with the ACM:PCMS composition ratio of 49:51 indicates the high solubility for amyl acetate developer. As the ACM composition ratio increases, the solubility of ACM-PCMS resist is suppressed. In both ACM-PCMS and ACM-MS resists, the sensitivity decreases while the contrast increases with increasing ACM ratio. When the composition ratio of ACM:PCMS is 69:31, 100/100 nm line and space pattern having a good shape is obtained at 120 μC/cm2 which is comparable to the required exposure dose for conventional ACM-MS resist with ACM:MS=50:50. Dry etching resistance of ACM:PCMS resists for Ar gas is also presented.

End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study.

Science.gov (United States)

Setälä, Piritta Anniina; Virkkunen, Ilkka Tapani; Kämäräinen, Antti Jaakko; Huhtala, Heini Sisko Annamari; Virta, Janne Severi; Yli-Hankala, Arvi Mikael; Hoppu, Sanna Elisa

2018-05-16

Active compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO 2 ) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO 2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts. 10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO 2 values were collected continuously with the defibrillator. Differences in ETCO 2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO 2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases. Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO 2 output, the interaction between the method and the patient was significant (P<0.001). ETCO 2 output was higher with manual CPR in 6 of the 10 cases. This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO 2 is used as a quantitative measure of CPR effectiveness. NCT00951704; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service.

Science.gov (United States)

Sharma, Rupali; Jayathissa, Sisira; Weatherall, Mark

2016-01-08

To determine the knowledge in cardiopulmonary resuscitation (CPR) process, preference for CPR, and desire to participate in end-of-life decision making amongst older hospitalised patients. We prospectively interviewed 100 participants above 65 years of age awaiting discharge from acute medical ward and collected demographics, knowledge of CPR and opinion on CPR in various clinical scenarios. Amongst the participants, 58% had good understanding of all components of CPR and 91% overestimated its success. Fifty-eight percent wished to have CPR in current health status, but this declined if they were presented a hypothetical scenario of critical illness (46%), functional impairment (17%), terminal illness (13%) and dementia (13%). Tertiary education, male gender and not living alone were associated with accepting CPR. Ninety-three percent were comfortable discussing CPR and 84% felt comfortable documenting their wishes in the medical notes. Seventy percent wished such discussion to include themselves and their family. Older inpatients have a reasonable understanding of the components of CPR and wish to be involved in CPR decision-making. Clinical scenarios with poor prognosis may lead to patients declining CPR. Discussion and documentation of resuscitation wishes is useful in routine assessment process among elderly hospitalised patients.

Gene cloning and overexpression of two conjugated polyketone reductases, novel aldo-keto reductase family enzymes, of Candida parapsilosis.

Science.gov (United States)

Kataoka, M; Delacruz-Hidalgo, A-R G; Akond, M A; Sakuradani, E; Kita, K; Shimizu, S

2004-04-01

The genes encoding two conjugated polyketone reductases (CPR-C1, CPR-C2) of Candida parapsilosis IFO 0708 were cloned and sequenced. The genes encoded a total of 304 and 307 amino acid residues for CPR-C1 and CPR-C2, respectively. The deduced amino acid sequences of the two enzymes showed high similarity to each other and to several proteins of the aldo-keto reductase (AKR) superfamily. However, several amino acid residues in putative active sites of AKRs were not conserved in CPR-C1 and CPR-C2. The two CPR genes were overexpressed in Escherichia coli. The E. coli transformant bearing the CPR-C2 gene almost stoichiometrically reduced 30 mg ketopantoyl lactone/ml to D-pantoyl lactone.

Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: a cross-sectional survey of Victorians.

Science.gov (United States)

Bray, Janet E; Smith, Karen; Case, Rosalind; Cartledge, Susie; Straney, Lahn; Finn, Judith

2017-04-01

To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Long-term retention of cardiopulmonary resuscitation skills after shortened chest compression-only training and conventional training: a randomized controlled trial.

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Nishiyama, Chika; Iwami, Taku; Kitamura, Tetsuhisa; Ando, Masahiko; Sakamoto, Tetsuya; Marukawa, Seishiro; Kawamura, Takashi

2014-01-01

It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training. Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, rescue breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. UMIN-CTR UMIN000001675. © 2013 by the Society for Academic Emergency Medicine.

40 CFR Appendix A to Subpart M of... - Interpretive Rule Governing Roof Removal Operations

Science.gov (United States)

2010-07-01

...-containing material (ACM) is material containing more than one percent asbestos as determined using the... NESHAP classifies ACM as either “friable” or “nonfriable”. Friable ACM is ACM that, when dry, can be crumbled, pulverized or reduced to powder by hand pressure. Nonfriable ACM is ACM that, when dry, cannot be...

Novel derivatives of aclacinomycin A block cancer cell migration through inhibition of farnesyl transferase.

Science.gov (United States)

Magi, Shigeyuki; Shitara, Tetsuo; Takemoto, Yasushi; Sawada, Masato; Kitagawa, Mitsuhiro; Tashiro, Etsu; Takahashi, Yoshikazu; Imoto, Masaya

2013-03-01

In the course of screening for an inhibitor of farnesyl transferase (FTase), we identified two compounds, N-benzyl-aclacinomycin A (ACM) and N-allyl-ACM, which are new derivatives of ACM. N-benzyl-ACM and N-allyl-ACM inhibited FTase activity with IC50 values of 0.86 and 2.93 μM, respectively. Not only ACM but also C-10 epimers of each ACM derivative failed to inhibit FTase. The inhibition of FTase by N-benzyl-ACM and N-allyl-ACM seems to be specific, because these two compounds did not inhibit geranylgeranyltransferase or geranylgeranyl pyrophosphate (GGPP) synthase up to 100 μM. In cultured A431 cells, N-benzyl-ACM and N-allyl-ACM also blocked both the membrane localization of H-Ras and activation of the H-Ras-dependent PI3K/Akt pathway. In addition, they inhibited epidermal growth factor (EGF)-induced migration of A431 cells. Thus, N-benzyl-ACM and N-allyl-ACM inhibited EGF-induced migration of A431 cells by inhibiting the farnesylation of H-Ras and subsequent H-Ras-dependent activation of the PI3K/Akt pathway.

78 FR 15014 - Change in Bank Control Notices; Acquisitions of Shares of a Bank or Bank Holding Company

Science.gov (United States)

2013-03-08

... Meyer, Jr., individually and as trustee of the: ACM, Jr. 2010 3Y GRAT A, the ACM, Jr. 2010 3Y GRAT B, the ACM, Jr. 2010 3Y GRAT C, the ACM, Jr. 2013 2Y GRAT A, the ACM, Jr. 2013 2Y GRAT B, the ACM, Jr. 2013 2Y GRAT C, the ACM, Jr. 2013 2Y GRAT D, the Katharine Clara Kimmel Non- Exempt Trust C/U Elisabeth...

Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.

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Swor, Robert; Compton, Scott

2004-01-01

Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged 50 years was 785,040 dollars. Using a strategy of training only those cost of 53,383 dollars per life saved. Using these assumptions, current CPR training strategy is not a cost

Cardiopulmonary resuscitation using the cardio vent device in a resuscitation model.

Science.gov (United States)

Suner, Selim; Jay, Gregory D; Kleinman, Gary J; Woolard, Robert H; Jagminas, Liudvikas; Becker, Bruce M

2002-05-01

To compare the "Bellows on Sternum Resuscitation" (BSR) device that permits simultaneous compression and ventilation by one rescuer with two person cardiopulmonary resuscitation (CPR) with bag-valve-mask (BVM) ventilation in a single blind crossover study performed in the laboratory setting. Tidal volume and compression depth were recorded continuously during 12-min CPR sessions with the BSR device and two person CPR. Six CPR instructors performed a total of 1,894 ventilations and 10,532 compressions in 3 separate 12-min sessions. Mean tidal volume (MTV) and compression rate (CR) with the BSR device differed significantly from CPR with the BVM group (1242 mL vs. 1065 mL, respectively, p = 0.0018 and 63.2 compressions per minute (cpm) vs. 81.3 cpm, respectively, p = 0.0076). Error in compression depth (ECD) rate of 9.78% was observed with the BSR device compared to 8.49% with BMV CPR (p = 0.1815). Error rate was significantly greater during the second half of CPR sessions for both BSR and BVM groups. It is concluded that one-person CPR with the BSR device is equivalent to two-person CPR with BVM in all measured parameters except for CR. Both groups exhibited greater error rate in CPR performance in the latter half of 12-min CPR sessions.

Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey.

Science.gov (United States)

Son, Jeong Woo; Ryoo, Hyun Wook; Moon, Sungbae; Kim, Jong-Yeon; Ahn, Jae Yun; Park, Jeong Bae; Seo, Kang Suk; Kim, Jong Kun; Kim, Yun Jeong

2017-06-01

Bystander cardiopulmonary resuscitation (CPR) is an important factor associated with improved survival rates and neurologic prognoses in cases of out-of-hospital cardiac arrest. We assessed how factors related to CPR education including timing of education, period from the most recent education session, and content, affected CPR willingness. In February 2012, trained interviewers conducted an interview survey of 1,000 Daegu citizens through an organized questionnaire. The subjects were aged ≥19 years and were selected by quota sampling. Their social and demographic characteristics, as well as CPR and factors related to CPR education, were investigated. Chi-square tests and multivariate logistic regression analyses were used to evaluate how education-related factors affected the willingness to perform CPR. Of total 1,000 cases, 48.0% were male. The multivariate analyses revealed several factors significantly associated with CPR willingness: didactic plus practice group (adjusted odds ratio [AOR], 3.38; 95% confidence interval [CI], 2.3 to 5.0), group with more than four CPR education session (AOR, 7.68; 95% CI, 3.21 to 18.35), interval of less than 6 months from the last CPR education (AOR, 4.47; 95% CI 1.29 to 15.52), and education with automated external defibrillator (AOR, 5.98; 95% CI 2.30 to 15.53). The following were associated with increased willingness to perform CPR: practice sessions and automated electrical defibrillator training in public CPR education, more frequent CPR training, and shorter time period from the most recent CPR education sessions.

Improvement in Trainees' Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training: Cross-Sectional Simulation Study.

Science.gov (United States)

Kim, Jong Won; Lee, Jeong Hun; Lee, Kyeong Ryong; Hong, Dae Young; Baek, Kwang Je; Park, Sang O

2016-08-01

This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality. Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups. Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased. Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

No Benefit in Neurologic Outcomes of Survivors of Out-of-Hospital Cardiac Arrest with Mechanical Compression Device.

Science.gov (United States)

Newberry, Ryan; Redman, Ted; Ross, Elliot; Ely, Rachel; Saidler, Clayton; Arana, Allyson; Wampler, David; Miramontes, David

2018-01-01

Out-of-hospital cardiac arrest (OHCA) is a major cause of death and morbidity in the United States. Quality cardiopulmonary resuscitation (CPR) has proven to be a key factor in improving survival. The aim of our study was to investigate the outcomes of OHCA when mechanical CPR (LUCAS 2 Chest Compression System™) was utilized compared to conventional CPR. Although controlled trials have not demonstrated a survival benefit to the routine use of mechanical CPR devices, there continues to be an interest for their use in OHCA. We conducted a retrospective observational study of OHCA comparing the outcomes of mechanical and manual chest compressions in a fire department based EMS system serving a population of 1.4 million residents. Mechanical CPR devices were geographically distributed on 11 of 33 paramedic ambulances. Data were collected over a 36-month period and outcomes were dichotomized based on utilization of mechanical CPR. The primary outcome measure was survival to hospital discharge with a cerebral performance category (CPC) score of 1 or 2. This series had 3,469 OHCA reports, of which 2,999 had outcome data and met the inclusion criteria. Of these 2,236 received only manual CPR and 763 utilized a mechanical CPR device during the resuscitation. Return of spontaneous circulation (ROSC) was attained in 44% (334/763) of the mechanical CPR resuscitations and in 46% (1,020/2,236) of the standard manual CPR resuscitations (p = 0.32). Survival to hospital discharge was observed in 7% (52/763) of the mechanical CPR resuscitations and 9% (191/2,236) of the manual CPR group (p = 0.13). Discharge with a CPC score of 1 or 2 was observed in 4% (29/763) of the mechanical CPR resuscitation group and 6% (129/2,236) of the manual CPR group (p = 0.036). In our study, use of the mechanical CPR device was associated with a poor neurologic outcome at hospital discharge. However, this difference was no longer evident after logistic regression adjusting for confounding variables

Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Magura Stephen

2012-11-01

Full Text Available Abstract Background Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills. Methods The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. Results Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two did not have a significant effect

Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

Science.gov (United States)

2012-01-01

Background Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills. Methods The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. Results Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two) did not have a significant effect on any outcomes

MiR-320a as a Potential Novel Circulating Biomarker of Arrhythmogenic CardioMyopathy.

Science.gov (United States)

Sommariva, Elena; D'Alessandra, Yuri; Farina, Floriana Maria; Casella, Michela; Cattaneo, Fabio; Catto, Valentina; Chiesa, Mattia; Stadiotti, Ilaria; Brambilla, Silvia; Dello Russo, Antonio; Carbucicchio, Corrado; Vettor, Giulia; Riggio, Daniela; Sandri, Maria Teresa; Barbuti, Andrea; Vernillo, Gianluca; Muratori, Manuela; Dal Ferro, Matteo; Sinagra, Gianfranco; Moimas, Silvia; Giacca, Mauro; Colombo, Gualtiero Ivanoe; Pompilio, Giulio; Tondo, Claudio

2017-07-06

Diagnosis of Arrhythmogenic CardioMyopathy (ACM) is challenging and often late after disease onset. No circulating biomarkers are available to date. Given their involvement in several cardiovascular diseases, plasma microRNAs warranted investigation as potential non-invasive diagnostic tools in ACM. We sought to identify circulating microRNAs differentially expressed in ACM with respect to Healthy Controls (HC) and Idiopathic Ventricular Tachycardia patients (IVT), often in differential diagnosis. ACM and HC subjects were screened for plasmatic expression of 377 microRNAs and validation was performed in 36 ACM, 53 HC, 21 IVT. Variable importance in data partition was estimated through Random Forest analysis and accuracy by Receiver Operating Curves. Plasmatic miR-320a showed 0.53 ± 0.04 fold expression difference in ACM vs. HC (p ACM (n = 13) and HC (n = 17) with athletic lifestyle, a ACM precipitating factor. Importantly, ACM patients miR-320a showed 0.78 ± 0.05 fold expression change vs. IVT (p = 0.03). When compared to non-invasive ACM diagnostic parameters, miR-320a ranked highly in discriminating ACM vs. IVT and it increased their accuracy. Finally, miR-320a expression did not correlate with ACM severity. Our data suggest that miR-320a may be considered a novel potential biomarker of ACM, specifically useful in ACM vs. IVT differentiation.

Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.

Science.gov (United States)

Volandes, Angelo E; Paasche-Orlow, Michael K; Mitchell, Susan L; El-Jawahri, Areej; Davis, Aretha Delight; Barry, Michael J; Hartshorn, Kevan L; Jackson, Vicki Ann; Gillick, Muriel R; Walker-Corkery, Elizabeth S; Chang, Yuchiao; López, Lenny; Kemeny, Margaret; Bulone, Linda; Mann, Eileen; Misra, Sumi; Peachey, Matt; Abbo, Elmer D; Eichler, April F; Epstein, Andrew S; Noy, Ariela; Levin, Tomer T; Temel, Jennifer S

2013-01-20

Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

A paediatric cardiopulmonary resuscitation training project in Honduras.

Science.gov (United States)

Urbano, Javier; Matamoros, Martha M; López-Herce, Jesús; Carrillo, Angel P; Ordóñez, Flora; Moral, Ramón; Mencía, Santiago

2010-04-01

It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: a randomised simulation study.

Science.gov (United States)

Pavo, Noemi; Goliasch, Georg; Nierscher, Franz Josef; Stumpf, Dominik; Haugk, Moritz; Breckwoldt, Jan; Ruetzler, Kurt; Greif, Robert; Fischer, Henrik

2016-05-13

Resuscitation guidelines encourage the use of cardiopulmonary resuscitation (CPR) feedback devices implying better outcomes after sudden cardiac arrest. Whether effective continuous feedback could also be given verbally by a second rescuer ("human feedback") has not been investigated yet. We, therefore, compared the effect of human feedback to a CPR feedback device. In an open, prospective, randomised, controlled trial, we compared CPR performance of three groups of medical students in a two-rescuer scenario. Group "sCPR" was taught standard BLS without continuous feedback, serving as control. Group "mfCPR" was taught BLS with mechanical audio-visual feedback (HeartStart MRx with Q-CPR-Technology™). Group "hfCPR" was taught standard BLS with human feedback. Afterwards, 326 medical students performed two-rescuer BLS on a manikin for 8 min. CPR quality parameters, such as "effective compression ratio" (ECR: compressions with correct hand position, depth and complete decompression multiplied by flow-time fraction), and other compression, ventilation and time-related parameters were assessed for all groups. ECR was comparable between the hfCPR and the mfCPR group (0.33 vs. 0.35, p = 0.435). The hfCPR group needed less time until starting chest compressions (2 vs. 8 s, p feedback or by using a mechanical audio-visual feedback device was similar. Further studies should investigate whether extended human feedback training could further increase CPR quality at comparable costs for training.

Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

DEFF Research Database (Denmark)

Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

2017-01-01

factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders...... obligation to act. CONCLUSIONS: Several factors other than previous hands-on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out-of-hospital cardiac arrest....

What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools? A qualitative study.

Science.gov (United States)

Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej; Folke, Fredrik; Torp-Pedersen, Christian; Tjørnhøj-Thomsen, Tine

2016-04-25

Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose of the study was to explore barriers to implementation of CPR training in Danish secondary schools. A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across the interviews. 8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals. The study population comprised 25 participants, 9 school leadership members and 16 teachers. School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits. To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise

Joint Labeling Of Multiple Regions of Interest (Rois) By Enhanced Auto Context Models.

Science.gov (United States)

Kim, Minjeong; Wu, Guorong; Guo, Yanrong; Shen, Dinggang

2015-04-01

Accurate segmentation of a set of regions of interest (ROIs) in the brain images is a key step in many neuroscience studies. Due to the complexity of image patterns, many learning-based segmentation methods have been proposed, including auto context model (ACM) that can capture high-level contextual information for guiding segmentation. However, since current ACM can only handle one ROI at a time, neighboring ROIs have to be labeled separately with different ACMs that are trained independently without communicating each other. To address this, we enhance the current single-ROI learning ACM to multi-ROI learning ACM for joint labeling of multiple neighboring ROIs (called e ACM). First, we extend current independently-trained single-ROI ACMs to a set of jointly-trained cross-ROI ACMs, by simultaneous training of ACMs for all spatially-connected ROIs to let them to share their respective intermediate outputs for coordinated labeling of each image point. Then, the context features in each ACM can capture the cross-ROI dependence information from the outputs of other ACMs that are designed for neighboring ROIs. Second, we upgrade the output labeling map of each ACM with the multi-scale representation, thus both local and global context information can be effectively used to increase the robustness in characterizing geometric relationship among neighboring ROIs. Third, we integrate ACM into a multi-atlases segmentation paradigm, for encompassing high variations among subjects. Experiments on LONI LPBA40 dataset show much better performance by our e ACM, compared to the conventional ACM.

Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations

Directory of Open Access Journals (Sweden)

Vidhu Bhatnagar

2018-01-01

Full Text Available Background: The cardiopulmonary resuscitation (CPR in prone position has been dealt with in 2010 American Heart Association (AHA guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. Aims: This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. Methods: We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. Results: No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR, CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ. Conclusion: A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses.

Science.gov (United States)

Shah, P S

2009-10-01

Studies of the outcomes of preterm infants after the receipt of extensive cardiopulmonary resuscitation (CPR) at birth or in the neonatal intensive care units (NICUs) have yielded varied results. A systematic review of the outcomes of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants who received extensive resuscitation at birth or in the NICU was carried out. MEDLINE, EMBASE, CINAHL databases were searched for studies of extensive CPR in the delivery room (DR-CPR) and in NICU (NICU-CPR) that have reported neonatal or long-term outcomes. A total of 20 eligible studies were identified (11 of DR-CPR, 7 of NICU-CPR and 2 had combined data). DR-CPR was associated with an increased risk of mortality (odds ratio (OR) 2.83, 95% confidence interval (CI) 1.92, 4.16) and severe neurological injury (OR 2.27, 95% CI 1.40, 3.67) compared with infants who did not receive extensive CPR. NICU-CPR was associated with an increased risk of mortality (OR 55, 95% CI 15, 195) compared with infants who did not receive CPR; however, confidence limits were wide. The long-term outcome of survivors was reported in a limited number of studies. Extensive CPR at birth or in the NICU for VLBW or ELBW infants was associated with higher risk of mortality.

Cardiopulmonary resuscitation in hospitalized infants.

Science.gov (United States)

Hornik, Christoph P; Graham, Eric M; Hill, Kevin; Li, Jennifer S; Ofori-Amanfo, George; Clark, Reese H; Smith, P Brian

2016-10-01

Hospitalized infants requiring cardiopulmonary resuscitation (CPR) represent a high-risk group. Recent data on risk factors for mortality following CPR in this population are lacking. We hypothesized that infant demographic characteristics, diagnoses, and levels of cardiopulmonary support at the time of CPR requirement would be associated with survival to hospital discharge following CPR. Retrospective cohort study. All infants receiving CPR on day of life 2 to 120 admitted to 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We collected data on demographics, interventions, center volume, and death prior to NICU discharge. We evaluated predictors of death after CPR using multivariable logistic regression with generalized estimating equations to account for clustering of the data by center. Our cohort consisted of 2231 infants receiving CPR. Of these, 1127 (51%) survived to hospital discharge. Lower gestational age, postnatal age, 5-min APGAR, congenital anomaly, and markers of severity of illness were associated with higher mortality. Mortality after CPR did not change significantly over time (Cochran-Armitage test for trend p=0.35). Mortality following CPR in infants is high, particularly for less mature, younger infants with congenital anomalies and those requiring cardiopulmonary support prior to CPR. Continued focus on at risk infants may identify targets for CPR prevention and improve outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Knowledge and psychomotor skills of nursing students in North Cyprus in the area of cardiopulmonary resuscitation.

Science.gov (United States)

Dal, Umran; Sarpkaya, Dilek

2013-07-01

Objective : The aim of the study was to determine the cardiopulmonary resuscitation (CPR) knowledge and skill levels of nursing students in North Cyprus. Methods : The study design was quasi-experimental and longitudinal. A questionnaire was applied to the students before the CPR lecture. Then the students were informed about adult CPR by the researchers and all of the students practiced CPR on a Resusci-Anne manikin. One and six months after this training the same questionnaire and skills checklist of CPR were applied. Results : Eighty three third year students of nursing participated in the study. While the average CPR knowledge score of these students was 9.3 ± 2.9 out of 23 before the lecture, this average increased to 17.0 ± 1.8 one month after the CPR lecture and decreased by two points back to 14.9 ± 3.8 after six months. Skill score of the students one month after the CPR skills training was 18.4 out of 21, and that this average decreased to 13.8 after six months (p<0.05). Nursing students tend to forget theoretical and applied CPR training after couple of months. Hence there is a need for continuous CPR training and education and repeating the skills at regular intervals even after they have graduated to ensure sustainability in the CPR skills.

Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Gyllenborg, Tore; Granfeldt, Asger; Lippert, Freddy

2017-01-01

BACKGROUND: Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM: To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OH...

Effect of spray on performance of the hydrogen mitigation system during LB-LOCA for CPR1000 NPP

International Nuclear Information System (INIS)

Huang, X.G.; Yang, Y.H.; Cheng, X.; Al-Hawshabi, N.H.A.; Casey, S.P.

2011-01-01

Highlights: → This paper presents the spray effect on HMS during LB-LOCA by using GASFLOW. → The positive and negative effects of spray are summarized. → And the combination of DIS and PAR system is suggested as reasonable countermeasures. → This research is an important work aimed at the study of spray and hydrogen mitigation. → The contents of this paper should become a required part of the safety analysis of Chinese NPPs. - Abstract: During the course of the hypothetical large break loss-of-coolant accident (LB-LOCA) in a nuclear power plant (NPP), hydrogen is generated by a reaction between steam and the fuel-cladding inside the reactor pressure vessel (RPV). It is then ejected from the break into the containment along with a large amount of steam. Management of hydrogen safety and prevention of over-pressurization could be implemented through a hydrogen mitigation system (HMS) and spray system in CPR1000 NPP. The computational fluid dynamics (CFD) code GASFLOW is utilized in this study to analyze the spray effect on the performance of HMS during LB-LOCA. Results show that as a kind of HMS, deliberate igniter system (DIS) could initiate hydrogen combustion immediately after the flammability limit of the gas mixture has been reached. However, it will increase the temperature and pressure drastically. Operating the DIS under spray condition could result in hydrogen combustion being suppressed by suspended droplets inside the containment. Furthermore, the droplets could also mitigate local the temperature rise. Operation of a PAR system, another kind of HMS, consumes hydrogen steadily with a lower recombination rate which is not affected noticeably by the spray system. Numerical results indicate that the dual concept, namely the integrated application of DIS and PAR systems, is a constructive improvement for hydrogen safety under spray condition during LB-LOCA.

Strategy analysis of cardiopulmonary resuscitation training in the community

OpenAIRE

Wang, Jin; Ma, Li; Lu, Yuan-Qiang

2015-01-01

Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest. This appreciation produced immense efforts by professional organizations to train laypeople for CPR skills. However, the rate of CPR training is low and varies widely across communities. Several strategies are used in order to improve the rate of CPR training and are performed in some advanced countries. The Chinese CPR training in communities could gain enlightenment from them.

Cardiopulmonary resuscitation during spaceflight: examining the role of timing devices.

Science.gov (United States)

Hurst, Victor W; Whittam, Sarah W; Austin, Paul N; Branson, Richard D; Beck, George

2011-08-01

The majority of International Space Station (ISS) astronauts represent nonmedical professions. In order to serve as Crew Medical Officers (CMO), future crewmembers receive 40-70 h of medical training within 18 mo before missions, including cardiopulmonary resuscitation (CPR) per the Guidelines of the American Heart Association. CPR compliance with the Guidelines is known to vary even among trained clinicians, let alone minimally trained caregivers (e.g., bystanders, nonphysician astronauts). The purpose of this study was to evaluate the effect of timing devices, including audible metronomic tones, on CPR performed by nonmedical personnel, specifically 40 astronaut analogues trained in a fashion and within a timeframe similar to an ISS astronaut. Twenty bystander pairs performed two-person CPR for 4 min on a simulated cardiac arrest patient using three interventions: 1) CPR with no timing devices; 2) CPR with metronomic tones for chest compressions; and 3) CPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Each CPR performance was evaluated for compliance with the (then current) 2000 AHA Guidelines. Numbers of breaths and compressions significantly deviated from target values in the first two interventions (38 and 42 breaths vs. target of 32 breaths; 282 and 318 compressions vs. target of 240 compressions); the use of timing devices for both components of CPR resulted in significant improvement (32 breaths and 231 compressions). CPR timing devices that coordinate both breaths and compressions improve compliance of astronaut analogue rescuers with CPR guidelines, and may improve overall CPR performance and outcome.

Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

Directory of Open Access Journals (Sweden)

Nesreen Yaghmour

2015-03-01

Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

Design of the Circulation Improving Resuscitation Care (CIRC) Trial: a new state of the art design for out-of-hospital cardiac arrest research

NARCIS (Netherlands)

Lerner, E.B.; Persse, D.; Souders, C.M.; Sterz, F.; Malzer, R.; Lozano, M., Jr.; Westfall, M.; Brouwer, M.A.; Grunsven, P.M. van; Whitehead, A.; Olsen, J.A.; Herken, U.R.; Wik, L.

2011-01-01

PURPOSE: Mechanical chest compression devices, such as the AutoPulse((R)), have been developed to overcome problems associated with manual CPR (M-CPR). Animal and human studies have shown that AutoPulse CPR improves hemodynamic parameters over M-CPR. However, human studies conducted in the

Cardiopulmonary Resuscitation Training in Schools: A Comparison of Trainee Satisfaction among Different Age Groups.

Science.gov (United States)

Hori, Shingo; Suzuki, Masaru; Yamazaki, Motoyasu; Aikawa, Naoki; Yamazaki, Hajime

2016-09-25

Cardiopulmonary resuscitation (CPR) has recently been added to the school curriculum worldwide and is currently taught to students between the ages of 10 and 16 years. The effect of the age of trainees on their satisfaction with CPR training has yet been elucidated. The aim of this study was to compare the satisfaction of trainees of different ages who participated in CPR training in schools in Japan. In total, 392 primary school students (10-11 years old), 1798 junior high school students (12-13 years old), and 4162 high schools students (15-16 years old) underwent the same 3-h course of CPR training, according to the guidelines of 2000 for Emergency Cardiovascular Care and CPR. The course was evaluated by a questionnaire completed by the participants. Primary school students responded most positively to all questions, including those reflecting enjoyment and the confidence of participants to apply CPR (Jonckheere-Terpstra test: P CPR training was strongly related to their age. Primary school students enjoyed CPR training more and were more confident in their ability to perform CPR than junior high and high school students were. Therefore, children aged 10-11 years may be the most appropriate candidates for the introduction of CPR training in schools.

Blood Pressure Directed Booster Trainings Improve Intensive Care Unit Provider Retention of Excellent Cardiopulmonary Resuscitation Skills.

Science.gov (United States)

Wolfe, Heather; Maltese, Matthew R; Niles, Dana E; Fischman, Elizabeth; Legkobitova, Veronika; Leffelman, Jessica; Berg, Robert A; Nadkarni, Vinay M; Sutton, Robert M

2015-11-01

Brief, intermittent cardiopulmonary resuscitation (CPR) training sessions, "Booster Trainings," improve CPR skill acquisition and short-term retention. The objective of this study was to incorporate arterial blood pressure (ABP) tracings into Booster Trainings to improve CPR skill retention. We hypothesized that ABP-directed CPR "Booster Trainings" would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining. A CPR manikin creating a realistic relationship between chest compression depth and ABP was used for training/testing. Thirty-six ICU providers were randomized to brief, bedside ABP-directed CPR manikin skill retrainings: (1) Booster Plus (ABP visible during training and testing) versus (2) Booster Alone (ABP visible only during training, not testing) versus (3) control (testing, no intervention). Subjects completed skill tests pretraining (baseline), immediately after training (acquisition), and then retention was assessed at 12 hours, 3 and 6 months. The primary outcome was retention of excellent CPR skills at 3 months. Excellent CPR was defined as systolic blood pressure of 100 mm Hg or higher and compression rate 100 to 120 per minute. Overall, 14 of 24 (58%) participants acquired excellent CPR skills after their initial training (Booster Plus 75% vs 50% Booster Alone, P = 0.21). Adjusted for age, ABP-trained providers were 5.2× more likely to perform excellent CPR after the initial training (95% confidence interval [95% CI], 1.3-21.2; P = 0.02), and to retain these skills at 12 hours (adjusted odds ratio, 4.4; 95% CI, 1.3-14.9; P = 0.018) and 3 months (adjusted odds ratio, 4.1; 95% CI, 1.2-13.9; P = 0.023) when compared to baseline performance. The ABP-directed CPR booster trainings improved ICU provider 3-month retention of excellent CPR skills without the need for interval retraining.

Cardiopulmonary resuscitation training in Washington state public high schools.

Science.gov (United States)

Reder, Sheri; Quan, Linda

2003-03-01

To determine the best approaches for increasing cardiopulmonary resuscitation (CPR) training opportunities for public high school students, we conducted a statewide survey of all 310 public high schools in Washington State. The findings describe CPR student training currently provided by high schools, barriers to providing, and strategies to increase CPR training of high school students. The response rate was 89% (276 schools) from a combination of mail and telephone surveys; 35% (n=97) reported that they did not provide any CPR student training. Of the 132 schools that provided CPR student training, 23% trained less than 10% of their students, and 39% trained more than 90% of their students. The majority of public high schools, 70%, did not have any teacher trained to teach CPR or had only one teacher with such training. Yet 80% of schools felt that CPR training is best provided in school settings. Schools perceived the greatest benefit of CPR training as providing students with the skill to save a life (43%). The most frequently identified barriers were logistical: limited time to teach the curriculum (24%), lack of funds (16%), and instructor scheduling difficulties (17%). Less than 5% of respondents voiced any opposition to CPR training, and that opposition was for logistical reasons. To increase CPR training, the single best strategies suggested were: increase funding, provide time in the curriculum, have more certified instructors, and make CPR student training a requirement.

Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest.

Science.gov (United States)

Plaisance, P; Lurie, K G; Payen, D

2000-03-07

Blood pressure is severely reduced in patients in cardiac arrest receiving standard cardiopulmonary resuscitation (CPR). Although active compression-decompression (ACD) CPR improves acute hemodynamic parameters, arterial pressures remain suboptimal with this technique. We performed ACD CPR in patients with a new inspiratory threshold valve (ITV) to determine whether lowering intrathoracic pressures during the "relaxation" phase of ACD CPR would enhance venous blood return and overall CPR efficiency. This prospective, randomized, blinded trial was performed in prehospital mobile intensive care units in Paris, France. Patients in nontraumatic cardiac arrest received ACD CPR plus the ITV or ACD CPR alone for 30 minutes during advanced cardiac life support. End tidal CO(2) (ETCO(2)), diastolic blood pressure (DAP) and coronary perfusion pressure, and time to return of spontaneous circulation (ROSC) were measured. Groups were similar with respect to age, gender, and initial rhythm. Mean maximal ETCO(2), coronary perfusion pressure, and DAP values, respectively (in mm Hg), were 13.1+/-0.9, 25.0+/-1.4, and 36.5+/-1.5 with ACD CPR alone versus 19.1+/-1.0, 43.3+/-1.6, and 56.4+/-1.7 with ACD plus valve (PCPR alone after 26.5+/-0.7 minutes versus 4 of 11 patients with ACD CPR plus ITV after 19.8+/-2.8 minutes (PCPR increases the efficiency of CPR, leading to diastolic arterial pressures of >50 mm Hg. The long-term benefits of this new CPR technology are under investigation.

Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet.

Science.gov (United States)

Liu, Kirsten Y; Haukoos, Jason S; Sasson, Comilla

2014-01-01

Bystander cardiopulmonary resuscitation (CPR) is a vital link in the chain of survival for out-of-hospital cardiac arrest (OHCA); however, there are racial/ethnic disparities in the provision of bystander CPR. Approximately 32% of Hispanics perform CPR when confronted with cardiac arrest, whereas approximately 41% of non-Hispanics perform CPR. Public education, via the Internet, may be critical in improving the performance of bystander CPR among Hispanics. The objective of this study was to evaluate the availability and quality of CPR-related literature for primary Spanish-speaking individuals on the Internet. Two search engines (Google and Yahoo!) and a video-site (YouTube) were searched using the following terms: "resucitacion cardiopulmonar" and "reanimacion cardiopulmonar." Inclusion criteria were: education of CPR technique. Exclusion criteria were: instruction on pediatric CPR technique, failure to provide any instruction on CPR technique, or duplicated website. Data elements were collected on the content and quality of the websites and videos, such as assessing scene safety, verifying responsiveness, activating EMS, properly positioning hands on chest, performing accurate rate and depth of compressions. Of the 515 websites or videos screened, 116 met criteria for inclusion. The majority of websites (86%; 95% Confidence Interval [CI] 79-92%) educated viewers on traditional bystander CPR (primarily, 30:2 CPR), while only 14% (95% CI 9-21%) taught hands-only CPR. Of websites that used video (N=62), 84% were conducted in Spanish and 16% in English. The quality of CPR education was generally poor (median score of 3/6, IQR of 3.0). Only half of websites properly educated on how to check responsiveness, activate EMS and position hands on chest. Eighty-eight percent of websites failed to educate viewers on assessing scene safety. The majority of websites had improper or no education on both rate and depth of compressions (59% and 63%, respectively). Only 16% of

Sodium nitroprusside enhanced cardiopulmonary resuscitation improves short term survival in a porcine model of ischemic refractory ventricular fibrillation.

Science.gov (United States)

Yannopoulos, Demetris; Bartos, Jason A; George, Stephen A; Sideris, George; Voicu, Sebastian; Oestreich, Brett; Matsuura, Timothy; Shekar, Kadambari; Rees, Jennifer; Aufderheide, Tom P

2017-01-01

Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms. SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model. Sixteen anesthetized pigs had the ostial left anterior descending artery occluded leading to ischemic VF arrest. VF was untreated for 5min. Basic life support was performed for 10min. At minute 10 (EMS arrival), animals received either SNPeCPR (n=8) or standard ACLS (n=8). Defibrillation (200J) occurred every 3min. CPR continued for a total of 45min, then the balloon was deflated simulating revascularization. CPR continued until return of spontaneous circulation (ROSC) or a total of 60min, if unsuccessful. SNPeCPR animals received 2mg of SNP at minute 10 followed by 1mg every 5min until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5min until ROSC. Primary endpoints were ROSC and 4-h survival. All SNPeCPR animals (8/8) achieved sustained ROSC versus 2/8 standard ACLS animals within one hour of resuscitation (p=0.04). The 4-h survival was significantly improved with SNPeCPR compared to standard ACLS, 7/8 versus 1/8 respectively, p=0.0019. SNPeCPR significantly improved ROSC and 4-h survival compared with standard ACLS CPR in a porcine model of prolonged ischemic, refractory VF cardiac arrest. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Assessment of long-term impact of formal certified cardiopulmonary resuscitation training program among nurses.

Science.gov (United States)

Saramma, P P; Raj, L Suja; Dash, P K; Sarma, P S

2016-04-01

Cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines are periodically renewed and published by the American Heart Association. Formal training programs are conducted based on these guidelines. Despite widespread training CPR is often poorly performed. Hospital educators spend a significant amount of time and money in training health professionals and maintaining basic life support (BLS) and advanced cardiac life support (ACLS) skills among them. However, very little data are available in the literature highlighting the long-term impact of these training. To evaluate the impact of formal certified CPR training program on the knowledge and skill of CPR among nurses, to identify self-reported outcomes of attempted CPR and training needs of nurses. Tertiary care hospital, Prospective, repeated-measures design. A series of certified BLS and ACLS training programs were conducted during 2010 and 2011. Written and practical performance tests were done. Final testing was undertaken 3-4 years after training. The sample included all available, willing CPR certified nurses and experience matched CPR noncertified nurses. SPSS for Windows version 21.0. The majority of the 206 nurses (93 CPR certified and 113 noncertified) were females. There was a statistically significant increase in mean knowledge level and overall performance before and after the formal certified CPR training program (P = 0.000). However, the mean knowledge scores were equivalent among the CPR certified and noncertified nurses, although the certified nurses scored a higher mean score (P = 0.140). Formal certified CPR training program increases CPR knowledge and skill. However, significant long-term effects could not be found. There is a need for regular and periodic recertification.

Characterisation of [11C]PR04.MZ in Papio anubis baboon: A selective high-affinity radioligand for quantitative imaging of the dopamine transporter

Energy Technology Data Exchange (ETDEWEB)

Riss P. J.; Fowler J.; Riss, P.J.; Hooker, J.M.; Shea, C.; Xu, Y.; Carter, P.; Warner, D.; Ferrari V.; Kim, S.W.; Aigbirhio, F.I.; Fowler, J.S.; Roesch, F.

2011-10-25

N-(4-fluorobut-2-yn-1-yl)-2{beta}-carbomethoxy-3{beta}-(4{prime}-tolyl)nortropane (PR04.MZ, 1) is a PET radioligand for the non-invasive exploration of the function of the cerebral dopamine transporter (DAT). A reliable automated process for routine production of the carbon-11 labelled analogue [{sup 11}C]PR04.MZ ([{sup 11}C]-1) has been developed using GMP compliant equipment. An adult female Papioanubis baboon was studied using a test-retest protocol with [{sup 11}C]-1 in order to assess test-retest reliability, metabolism and CNS distribution profile of the tracer in non-human primates. Blood sampling was performed throughout the studies for determination of the free fraction in plasma (fP), plasma input functions and metabolic degradation of the radiotracer [{sup 11}C]-1. Time-activity curves were derived for the putamen, the caudate nucleus, the ventral striatum, the midbrain and the cerebellum. Distribution volumes (VT) and non-displaceable binding potentials (BPND) for various brain regions and the blood were obtained from kinetic modelling. [{sup 11}C]-1 shows promising results as aselective marker of the presynaptic dopamine transporter. With the reliable visualisation of the extra-striatal dopaminergic neurons and no indication on labelled metabolites, the tracer provides excellent potential for translation into man.

Cardiopulmonary resuscitation: what cost to cheat death?

Science.gov (United States)

Lee, K H; Angus, D C; Abramson, N S

1996-12-01

To review the various outcomes from cardiopulmonary resuscitation (CPR), the factors that influence these outcomes, the costs associated with CPR, and the application of cost-analyses to CPR. Data used to prepare this article were drawn from published articles and work in progress. Articles were selected for their relevance to the subjects of CPR and cost-analysis by MEDLINE keyword search. The authors extracted all applicable data from the English literature. Cost-analysis studies of CPR programs are limited by the high variation in resources consumed and attribution of cost to these resources. Furthermore, cost projections have not been adjusted to reflect patient-dependent variation in outcome. Variation in the patient's underlying condition, presenting cardiac rhythm, time to provision of definitive CPR, and effective perfusion all influence final outcome and, consequently, influence the cost-effectiveness of CPR programs. Based on cost data from previous studies, preliminary estimates of the cost-effectiveness of CPR programs for all 6-month survivors of a large international multicenter collaborative trial are $406,605.00 per life saved (range $344,314.00 to $966,759.00), and $225,892.00 per quality-adjusted-life-year (range $191,286.00 to $537,088.00). Reported outcome from CPR has varied from reasonable rates of good recovery, including return to full employment to 100% mortality. Appropriate CPR is encouraged, but continued widespread application appears extremely expensive.

The effectiveness of ultrabrief and brief educational videos for training lay responders in hands-only cardiopulmonary resuscitation: implications for the future of citizen cardiopulmonary resuscitation training.

Science.gov (United States)

Bobrow, Bentley J; Vadeboncoeur, Tyler F; Spaite, Daniel W; Potts, Jerald; Denninghoff, Kurt; Chikani, Vatsal; Brazil, Paula R; Ramsey, Bob; Abella, Benjamin S

2011-03-01

Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals. This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P38 mm) than the control group (PCPR videos are more likely to attempt CPR and show superior CPR skills than untrained laypersons. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01191736.

Retention of Cardiopulmonary Resuscitation Skills in Nigerian Secondary School Students

Science.gov (United States)

Onyeaso, Adedamola Olutoyin

2016-01-01

Background/Objective: For effective bystander cardiopulmonary resuscitation (CPR), retention of CPR skills after the training is central. The objective of this study was to find out how much of the CPR skills a group of Nigerian secondary school students would retain six weeks after their first exposure to the conventional CPR training. Materials…

A Novel Use of a Metronome in Dispatcher-assisted Cardiopulmonary Resuscitation.

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Ateyyah, Khalid A; Cady, Charles E; Poltrock, James T; Pirrallo, Ronald G

2015-01-01

Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.

Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit.

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Foglia, Elizabeth E; Langeveld, Robert; Heimall, Lauren; Deveney, Alyson; Ades, Anne; Jensen, Erik A; Nadkarni, Vinay M

2017-01-01

The contemporary characteristics and outcomes of cardiopulmonary resuscitation (CPR) in the neonatal intensive care unit (NICU) are poorly described. The objectives of this study were to determine the incidence, interventions, and outcomes of CPR in a quaternary referral NICU. Retrospective observational study of infants who received chest compressions for resuscitation in the Children's Hospital of Philadelphia NICU between April 1, 2011 and June 30, 2015. Patient, event, and survival characteristics were abstracted from the medical record and the hospital-wide resuscitation database. The primary outcome was survival to hospital discharge. Univariable and multivariable analyses were performed to identify patient and event factors associated with survival to discharge. There were 1.2 CPR events per 1000 patient days. CPR was performed in 113 of 5046 (2.2%) infants admitted to the NICU during the study period. The median duration of chest compressions was 2min (interquartile range 1, 6min). Adrenaline was administered in 34 (30%) CPR events. Of 113 infants with at least one CPR event, 69 (61%) survived to hospital discharge. Factors independently associated with decreased survival to hospital discharge were inotrope treatment prior to CPR (adjusted Odds Ratio [aOR] 0.14, 95% Confidence Interval [CI] 0.04, 0.54), and adrenaline administration during CPR (aOR 0.14, 95% CI 0.04, 0.50). Although it was not uncommon, the incidence of CPR was low (CPR and adrenaline administration during CPR were less likely to survive to hospital discharge. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Earthcare Cloud Profiling Radar, its PFM development status (Conference Presentation)

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Nakatsuka, Hirotaka; Tomita, Eichi; Aida, Yoshihisa; Seki, Yoshihiro; Okada, Kazuyuki; Maruyama, Kenta; Ishii, Yasuyuki; Tomiyama, Nobuhiro; Ohno, Yuichi; Horie, Hiroaki; Sato, Kenji

2016-10-01

The Earth Clouds, Aerosols and Radiation Explorer (EarthCARE) mission is joint mission between Europe and Japan for the launch year of 2018. Mission objective is to improve scientific understanding of cloud-aerosol-radiation interactions that is one of the biggest uncertain factors for numerical climate and weather predictions. The EarthCARE spacecraft equips four instruments such as an ultra violet lidar (ATLID), a cloud profiling radar (CPR), a broadband radiometer (BBR), and a multi-spectral imager (MSI) and perform complete synergy observation to observe aerosols, clouds and their interactions simultaneously from the orbit. Japan Aerospace Exploration Agency (JAXA) is responsible for development of the CPR in this EarthCARE mission and the CPR will be the first space-borne W-band Doppler radar. The CPR is defined with minimum radar sensitivity of -35dBz (6dB better than current space-borne cloud radar, i.e. CloudSat, NASA), radiometric accuracy of 2.7 dB, and Doppler velocity measurement accuracy of less than 1.3 m/s. These specifications require highly accurate pointing technique in orbit and high power source with large antenna dish. JAXA and National Institute of Information and Communications Technology (NICT) have been jointly developed this CPR to meet these strict requirements so far and then achieved the development such as new CFRP flex-core structure, long life extended interaction klystron, low loss quasi optical feed technique, and so on. Through these development successes, CPR development phase has been progressed to critical design phase. In addition, new ground calibration technique is also being progressed for launch of EarthCARE/CPR. The unique feature of EarthCARE CPR is vertical Doppler velocity measurement capability. Vertical Doppler velocity measurement is very attractive function from the science point of view, because vertical motions of cloud particles are related with cloud microphysics and dynamics. However, from engineering point of

Knowledge and willingness to teach cardiopulmonary resuscitation: a survey amongst 4273 teachers.

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Mpotos, Nicolas; Vekeman, Eva; Monsieurs, Koenraad; Derese, Anselm; Valcke, Martin

2013-04-01

Schoolteachers are expected to play a role in teaching cardiopulmonary resuscitation (CPR) to schoolchildren, but little is known about their attitudes, actual knowledge and willingness to do so. We conducted a survey about CPR knowledge, preparedness to perform and teach CPR as well as attitude towards an alternative self-learning strategy amongst Flemish teachers. A questionnaire was developed consisting of four distinct parts: (1) Demographics; (2) CPR knowledge and skills level; (3) Attitude towards training and (4) Resuscitation experience. Content experts screened the questionnaire in view of content validity. One hundred and seventy-one students in Educational Sciences were each asked to interview 25 different teachers. A total of 4273 teachers participated in the study (primary school n=856; secondary school n=2562; higher education n=855). Of all respondents, 59% (2539/4273) had received previous CPR training with the highest proportion observed in primary schoolteachers (69%) and in the age group 21-30 years (68%). Mandatory CPR training at school was supported by 41% (1751/4273) of the teachers and only 36% was aware that CPR is now formally included in the secondary education curriculum. Sixty-one percent (2621/4273) did not feel capable and was not willing to teach CPR, mainly because of a perceived lack of knowledge in 50% (2151/2621). In addition 69% (2927/4273) felt incompetent to perform correct CPR and 73% (3137/4273) wished more training. Feeling incompetent and not willing to teach was related to the absence of previous training. Primary schoolteachers and the age group 21-30 years were most willing to teach CPR. Although many teachers mentioned previous CPR training, only a minority of mostly young and primary schoolteachers felt competent in CPR and was willing to teach it to their students. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

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Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Høyland, Sindre; Braut, Geir Sverre; Søreide, Eldar

2017-02-01

Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

The importance of cardiopulmonary resuscitation quality.

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Abella, Benjamin S

2013-06-01

Cardiopulmonary resuscitation (CPR) is a fundamental component of initial care for the victim of cardiac arrest. In the past few years, increasing quantitative evidence has demonstrated that survival from cardiac arrest is dependent on the quality of delivered CPR. This review will focus on this body of evidence and on a range of practical approaches to improving CPR performance. A number of strategies to improve CPR quality have been evaluated recently, during both prehospital and in-hospital cardiac arrest care. These strategies have included the use of real-time CPR sensing and feedback, the employment of physiologic monitoring such as end-tidal CO(2) measurement and the use of metronome prompting. The use of mechanical CPR devices to avoid the challenges of manual CPR performance has also represented a topic of great current interest. Additional approaches have focused on both prearrest training (e.g. high-fidelity simulation education and CPR refreshers) and postarrest training (e.g. debriefing). A number of strategies have been evaluated to improve CPR performance. While many questions remain surrounding the relative value of each approach, it is likely that combinations of these methods may be useful in a variety of care settings to improve care for cardiac arrest victims.

Cardiopulmonary resuscitation; use, training and self-confidence in skills. A self-report study among hospital personnel

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Hopstock Laila A

2008-12-01

Full Text Available Abstract Background Immediate start of basic cardiopulmonary resuscitation (CPR and early defibrillation have been highlighted as crucial for survival from cardiac arrest, but despite new knowledge, new technology and massive personnel training the survival rates from in-hospital cardiac arrest are still low. National guidelines recommend regular intervals of CPR training to make all hospital personnel able to perform basic CPR till advanced care is available. This study investigates CPR training, resuscitation experience and self-confidence in skills among hospital personnel outside critical care areas. Methods A cross-sectional study was performed at three Norwegian hospitals. Data on CPR training and CPR use were collected by self-reports from 361 hospital personnel. Results A total of 89% reported training in CPR, but only 11% had updated their skills in accordance with the time interval recommended by national guidelines. Real resuscitation experience was reported by one third of the respondents. Both training intervals and use of skills in resuscitation situations differed among the professions. Self-reported confidence decreased only after more than two years since last CPR training. Conclusion There is a gap between recommendations and reality in CPR training among hospital personnel working outside critical care areas.

Analisis Pengaruh Pelatihan Resusitasi Jantung Paru RJP Dewasa terhadap Retensi Pengetahuan dan Ketrampilan RJP pada Mahasiswa Keperawatan di Yogyakarta

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Linda Widyarani

2017-11-01

Full Text Available ABSTRACT Cardiac arrest is a major public health problem affecting thousands of individuals each year in both out-of-hospital and in-hospital setting. High quality of cardiopulmonary resuscitation (CPR provide return of spontaneous after cardiac arrest, but majority of nursing students feel unconfident to practice CPR. The aim of the study was to assess the effect of CPR training program on knowledge and practices of nursing students in Yogyakarta. The study design was quasi-experimental and one group pretest – posttest design. A questionnaire was applied to the students before CPR training, then the student were informed about adult CPR by the researchers and all of the students practice CPR on a Resusci-Anne manikin. One months after this training the same questionnaire and skills checklist of CPR were apllied. Sixty five students of nursing participated in this study. This study show CPR training significantly positive impact cognitive and skills performance in nursing students. While the average CPR knowledge score of these students was 44,43%, before CPR training, this average increased to 89,64% after CPR training and decreased to 77,54% after one month CPR training. Skill score of the students one month after the CPR skill training was 70,61%. Nursing students tend to forget theoretical and applied CPR training after one month. Hence there is a need for continuous CPR training and education and repeating the skills at regular intervals ever after they have graduated to ensure sustainability in the CPR skills.Keywords : cardiopulmonary resuscitation, bystander CPR, training ABSTRAKHenti jantung merupakan penyebab kematian utama pada kasus kegawatdaruratan kardiovaskuler, baik pada setting prehospital (OHCA maupun intrahospital. RJP yang berkualitas dapat mengoptimalkan return of spontaneous circulation pada OHCA, tetapi banyak mahasiswa keperawatan tidak percaya diri dalam melakukan prosedur ini sehingga mereka membutuhkan pelatihan RJP

A comparison between over-the-head and lateral cardiopulmonary resuscitation with a single rescuer by bag-valve mask

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Ebrahim Nasiri

2014-01-01

Full Text Available Context: mask fixation in the lateral position is difficult during CPR. Aim: the aim of this study is to compare the lateral CPR for the use of bag-valve mask by single paramedic rescuer as well as over-the-head CPR on the chest compression and ventilation on the manikin. Settings and Design: Mazandaran University of Medical Sciences. The design of this study was a randomized cross-over trial. Methods: participants learned a standardized theoretical introduction CPR according to the 2010 guidelines. The total number of chest compressions per two minutes was measured. Total number of correct and wrong ventilation per two minutes was evaluated. Statistical Analysis: we used Wilcoxon signed-rank test to analyze the non-normally distributed data in dependence groups A. P-value of more than 0.05 was considered to show statistical significance. Results: there were 100 participants (45 women and 55 men who participated in the study from September to March, 2011. The compression and ventilation rate in lateral CPR was lower than OTH CPR. Around 51% of participants had correct chest compression rate more than 90 beats per minute in lateral CPR and 65% of them had equal or more than ten correct ventilations per minute. Conclusions: in conclusion, this study confirmed that in a simulated CPR model over-the-head position CPR led to a better BLS than the lateral position CPR by a single paramedic student with a BVM device. We also concluded that by this new BVM fixation method on the face of the patients in the lateral position CPR can be a good alternative over-the-head mask fixation by a single trained rescuer.

Influence of miscibility phenomenon on crystalline polymorph transition in poly(vinylidene fluoride)/acrylic rubber/clay nanocomposite hybrid.

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Abolhasani, Mohammad Mahdi; Naebe, Minoo; Jalali-Arani, Azam; Guo, Qipeng

2014-01-01

In this paper, intercalation of nanoclay in the miscible polymer blend of poly(vinylidene fluoride) (PVDF) and acrylic rubber(ACM) was studied. X-ray diffraction was used to investigate the formation of nanoscale polymer blend/clay hybrid. Infrared spectroscopy and X-ray analysis revealed the coexistence of β and γ crystalline forms in PVDF/Clay nanocomposite while α crystalline form was found to be dominant in PVDF/ACM/Clay miscible hybrids. Flory-Huggins interaction parameter (B) was used to further explain the miscibility phenomenon observed. The B parameter was determined by combining the melting point depression and the binary interaction model. The estimated B values for the ternary PVDF/ACM/Clay and PVDF/ACM pairs were all negative, showing both proper intercalation of the polymer melt into the nanoclay galleries and the good miscibility of PVDF and ACM blend. The B value for the PVDF/ACM blend was almost the same as that measured for the PVDF/ACM/Clay hybrid, suggesting that PVDF chains in nanocomposite hybrids interact with ACM chains and that nanoclay in hybrid systems is wrapped by ACM molecules.

Ketonization of Proline Residues in the Peptide Chains of Actinomycins by a 4-Oxoproline Synthase.

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Semsary, Siamak; Crnovčić, Ivana; Driller, Ronja; Vater, Joachim; Loll, Bernhard; Keller, Ullrich

2018-04-04

X-type actinomycins (Acms) contain 4-hydroxyproline (Acm X 0 ) or 4-oxoproline (Acm X 2 ) in their β-pentapeptide lactone rings, whereas their α ring contains proline. We demonstrate that these Acms are formed through asymmetric condensation of Acm half molecules (Acm halves) containing proline with 4-hydroxyproline- or 4-oxoproline-containing Acm halves. In turn, we show-using an artificial Acm half analogue (PPL 1) with proline in its peptide chain-their conversion into the 4-hydroxyproline- and 4-oxoproline-containing Acm halves, PPL 0 and PPL 2, in mycelial suspensions of Streptomyces antibioticus. Two responsible genes of the Acm X biosynthetic gene cluster of S. antibioticus, saacmM and saacmN, encoding a cytochrome P450 monooxygenase (Cyp) and a ferredoxin were identified. After coexpression in Escherichia coli, their gene products converted PPL 1 into PPL 0 and PPL 2 in vivo as well as in situ in permeabilized cell of the transformed E. coli strain in conjunction with the host-encoded ferredoxin reductase in a NADH (NADPH)-dependent manner. saAcmM has high sequence similarity to the Cyp107Z (Ema) family of Cyps, which can convert avermectin B1 into its keto derivative, 4''-oxoavermectin B1. Determination of the structure of saAcmM reveals high similarity to the Ema structure but with significant differences in residues decorating their active sites, which defines saAcmM and its orthologues as a distinct new family of peptidylprolineketonizing Cyp. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Basic life support and cardiopulmonary resuscitation training for pharmacy students and the community by a pharmacy student committee.

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Goddard, Kara B; Eppert, Heather D; Underwood, Elizabeth L; McLean, Katie Maxwell; Finks, Shannon W; Rogers, Kelly C

2010-08-10

To create a self-sufficient, innovative method for providing cardiopulmonary resuscitation (CPR) education within a college of pharmacy using a student-driven committee, and disseminating CPR education into the community through a service learning experience. A CPR committee comprised of doctor of pharmacy (PharmD) students at the University of Tennessee College of Pharmacy provided CPR certification to all pharmacy students. The committee developed a service learning project by providing CPR training courses in the community. Participants in the course were required to complete an evaluation form at the conclusion of each training course. The CPR committee successfully certified more than 1,950 PharmD students and 240 community members from 1996 to 2009. Evaluations completed by participants were favorable, with 99% of all respondents (n = 351) rating the training course as either "excellent" or "good" in each of the categories evaluated. A PharmD student-directed committee successfully provided CPR training to other students and community members as a service learning experience.

Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs

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Wohlfart Björn

2010-10-01

Full Text Available Abstract Background Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005 for cardiopulmonary resuscitation (CPR. The aim of the present study was to compare manual CPR with LUCAS-CPR. Methods 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8 or LUCAS-CPR (n = 8 was started and run for 20 minutes. Professional paramedics gave manual chest compression's alternating in 2-minute periods. Ventilation, one breath for each 10 compressions, was given to all animals. Defibrillation and, if needed, adrenaline were given to obtain a return of spontaneous circulation (ROSC. Results The mean coronary perfusion pressure was significantly (p Conclusions LUCAS-CPR gave significantly higher coronary perfusion pressure and significantly fewer rib fractures than manual CPR in this porcine model.

High dose naloxone does not improve cerebral or myocardial blood flow during cardiopulmonary resuscitation in pigs.

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Gervais, H W; Eberle, B; Hennes, H J; Grimm, W; Kilian, A; Konietzke, D; Massing, C; Dick, W

1997-06-01

In a prospective, randomized, placebo-controlled, double-blind trial we tested the hypothesis that naloxone given during cardiopulmonary resuscitation (CPR) enhances cerebral and myocardial blood flow. Twenty-one anesthetized, normoventilated pigs were instrumented for measurements of right atrial and aortic pressures, and regional organ blood flow (radiolabeled microspheres). After 5 min of untreated fibrillatory arrest, CPR was commenced using a pneumatic chest compressor/ventilator. With onset of CPR, an i.v. bolus of 40 micrograms/kg b.w. of epinephrine was given, followed by an infusion of 0.4 micrograms/kg per min. After 5 min of CPR, either naloxone, 10 mg/kg b.w. (group N, n = 11) or normal saline (group S, n = 10) was given i.v. Prior to, and after 1, 15, and 30 min of CPR, hemodynamic and blood flow measurements were obtained. After 30 min of CPR, mean arterial pressure was significantly higher in group N (26 +/- 5 vs. 13 +/- 3 mmHg, P CPR.

C-Peptide Level in Fasting Plasma and Pooled Urine Predicts HbA1c after Hospitalization in Patients with Type 2 Diabetes Mellitus.

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Remi Sonoda

Full Text Available In this study, we investigate how measures of insulin secretion and other clinical information affect long-term glycemic control in patients with type 2 diabetes mellitus. Between October 2012 and June 2014, we monitored 202 diabetes patients who were admitted to the hospital of Asahi Life Foundation for glycemic control, as well as for training and education in diabetes management. We measured glycated hemoglobin (HbA1c six months after discharge to assess disease management. In univariate analysis, fasting plasma C-peptide immunoreactivity (F-CPR and pooled urine CPR (U-CPR were significantly associated with HbA1c, in contrast to ΔCPR and C-peptide index (CPI. This association was strongly independent of most other patient variables. In exploratory factor analysis, five underlying factors, namely insulin resistance, aging, sex differences, insulin secretion, and glycemic control, represented patient characteristics. In particular, insulin secretion and resistance strongly influenced F-CPR, while insulin secretion affected U-CPR. In conclusion, the data indicate that among patients with type 2 diabetes mellitus, F-CPR and U-CPR may predict improved glycemic control six months after hospitalization.

Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.

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Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W

2015-08-01

To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Success Rate of Pediatric In-Hospital Cardiopulmonary Resuscitation in Ahvaz Training Hospitals

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Shideh Assar

2016-01-01

Full Text Available Research Objective. This study determined the outcome of cardiopulmonary resuscitation (CPR after in-hospital cardiac arrest and factors influencing it in two training hospitals in Ahvaz. Method. Patients hospitalized in the pediatric wards and exposed to CPR during hospital stay were included in the study (September 2013 to May 2014. The primary outcome of CPR was assumed to be the return of spontaneous circulation (ROSC and the secondary outcome was assumed to be survival to discharge. The neurological outcome of survivors was assessed using the Pediatric Cerebral Performance Category (PCPC method. Results. Of the 279 study participants, 138 patients (49.4% showed ROSC, 81 patients (29% survived for 24 hours after the CPR, and 33 patients (11.8% survived to discharge. Of the surviving patients, 16 (48.5% had favorable neurological outcome. The resuscitation during holidays resulted in fewer ROSC. Multivariate analysis showed that longer CPR duration, CPR by junior residents, growth deficiency, and prearrest vasoactive drug infusion were associated with decreased survival to discharge (p<0.05. Infants and patients with respiratory disease had higher survival rates. Conclusion. The rate of successful CPR in our study was lower than rates reported by developed countries. However, factors influencing the outcome of CPR were similar. These results reflect the necessity of paying more attention to pediatric CPR training, postresuscitation conditions, and expansion of intensive care facilities.

"Stayin' alive": a novel mental metronome to maintain compression rates in simulated cardiac arrests.

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Hafner, John W; Sturgell, Jeremy L; Matlock, David L; Bockewitz, Elizabeth G; Barker, Lisa T

2012-11-01

A novel and yet untested memory aid has anecdotally been proposed for aiding practitioners in complying with American Heart Association (AHA) cardiopulmonary resuscitation (CPR) compression rate guidelines (at least 100 compressions per minute). This study investigates how subjects using this memory aid adhered to current CPR guidelines in the short and long term. A prospective observational study was conducted with medical providers certified in 2005 AHA guideline CPR. Subjects were randomly paired and alternated administering CPR compressions on a mannequin during a standardized cardiac arrest scenario. While performing compressions, subjects listened to a digital recording of the Bee Gees song "Stayin' Alive," and were asked to time compressions to the musical beat. After at least 5 weeks, the participants were retested without directly listening to the recorded music. Attitudinal views were gathered using a post-session questionnaire. Fifteen subjects (mean age 29.3 years, 66.7% resident physicians and 80% male) were enrolled. The mean compression rate during the primary assessment (with music) was 109.1, and during the secondary assessment (without music) the rate was 113.2. Mean CPR compression rates did not vary by training level, CPR experience, or time to secondary assessment. Subjects felt that utilizing the music improved their ability to provide CPR and they felt more confident in performing CPR. Medical providers trained to use a novel musical memory aid effectively maintained AHA guideline CPR compression rates initially and in long-term follow-up. Subjects felt that the aid improved their technical abilities and confidence in providing CPR. Copyright © 2012. Published by Elsevier Inc.

Coupled motions direct electrons along human microsomal P450 Chains.

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Christopher R Pudney

2011-12-01

Full Text Available Protein domain motion is often implicated in biological electron transfer, but the general significance of motion is not clear. Motion has been implicated in the transfer of electrons from human cytochrome P450 reductase (CPR to all microsomal cytochrome P450s (CYPs. Our hypothesis is that tight coupling of motion with enzyme chemistry can signal "ready and waiting" states for electron transfer from CPR to downstream CYPs and support vectorial electron transfer across complex redox chains. We developed a novel approach to study the time-dependence of dynamical change during catalysis that reports on the changing conformational states of CPR. FRET was linked to stopped-flow studies of electron transfer in CPR that contains donor-acceptor fluorophores on the enzyme surface. Open and closed states of CPR were correlated with key steps in the catalytic cycle which demonstrated how redox chemistry and NADPH binding drive successive opening and closing of the enzyme. Specifically, we provide evidence that reduction of the flavin moieties in CPR induces CPR opening, whereas ligand binding induces CPR closing. A dynamic reaction cycle was created in which CPR optimizes internal electron transfer between flavin cofactors by adopting closed states and signals "ready and waiting" conformations to partner CYP enzymes by adopting more open states. This complex, temporal control of enzyme motion is used to catalyze directional electron transfer from NADPH→FAD→FMN→heme, thereby facilitating all microsomal P450-catalysed reactions. Motions critical to the broader biological functions of CPR are tightly coupled to enzyme chemistry in the human NADPH-CPR-CYP redox chain. That redox chemistry alone is sufficient to drive functionally necessary, large-scale conformational change is remarkable. Rather than relying on stochastic conformational sampling, our study highlights a need for tight coupling of motion to enzyme chemistry to give vectorial electron

RNA interference of NADPH-cytochrome P450 reductase results in reduced insecticide resistance in the bed bug, Cimex lectularius.

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Zhu, Fang; Sams, Sarah; Moural, Tim; Haynes, Kenneth F; Potter, Michael F; Palli, Subba R

2012-01-01

NADPH-cytochrome P450 reductase (CPR) plays a central role in cytochrome P450 action. The genes coding for P450s are not yet fully identified in the bed bug, Cimex lectularius. Hence, we decided to clone cDNA and knockdown the expression of the gene coding for CPR which is suggested to be required for the function of all P450s to determine whether or not P450s are involved in resistance of bed bugs to insecticides. The full length Cimex lectularius CPR (ClCPR) cDNA was isolated from a deltamethrin resistant bed bug population (CIN-1) using a combined PCR strategy. Bioinformatics and in silico modeling were employed to identify three conserved binding domains (FMN, FAD, NADP), a FAD binding motif, and the catalytic residues. The critical amino acids involved in FMN, FAD, NADP binding and their putative functions were also analyzed. No signal peptide but a membrane anchor domain with 21 amino acids which facilitates the localization of ClCPR on the endoplasmic reticulum was identified in ClCPR protein. Phylogenetic analysis showed that ClCPR is closer to the CPR from the body louse, Pediculus humanus corporis than to the CPRs from the other insect species studied. The ClCPR gene was ubiquitously expressed in all tissues tested but showed an increase in expression as immature stages develop into adults. We exploited the traumatic insemination mechanism of bed bugs to inject dsRNA and successfully knockdown the expression of the gene coding for ClCPR. Suppression of the ClCPR expression increased susceptibility to deltamethrin in resistant populations but not in the susceptible population of bed bugs. These data suggest that P450-mediated metabolic detoxification may serve as one of the resistance mechanisms in bed bugs.

Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs.

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Pytte, Morten; Kramer-Johansen, Jo; Eilevstjønn, Joar; Eriksen, Morten; Strømme, Taevje A; Godang, Kristin; Wik, Lars; Steen, Petter Andreas; Sunde, Kjetil

2006-12-01

Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis. After 4 min of cardiac arrest, followed by 4 min of basic life support, 14 pigs were randomised to ClinicalCPR (intermittent manual chest compressions, compression-to-ventilation ratio 15:2, compression depth 30-38 mm) or LabCPR (continuous mechanical chest compressions, 12 ventilations/min, compression depth 45 mm). Adrenaline 0.02 mg/kg was administered 30 s thereafter. Plasma adrenaline concentration peaked earlier with LabCPR than with ClinicalCPR, median (range), 90 (30, 150) versus 150 (90, 270) s (p = 0.007), respectively. Coronary perfusion pressure (CPP) and cortical cerebral blood flow (CCBF) increased and femoral blood flow (FBF) decreased after adrenaline during LabCPR (mean differences (95% CI) CPP 17 (6, 29) mmHg (p = 0.01), FBF -5.0 (-8.8, -1.2) ml min(-1) (p = 0.02) and median difference CCBF 12% of baseline (p = 0.04)). There were no significant effects during ClinicalCPR (mean differences (95% CI) CPP 4.7 (-3.2, 13) mmHg (p = 0.2), FBF -0.2 (-4.6, 4.2) ml min(-1)(p = 0.9) and CCBF 3.6 (-1.8, 9.0)% of baseline (p = 0.15)). Slope VF waveform analysis reflected changes in CPP. Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.

Bystander Cardiopulmonary Resuscitation Is Clustered and Associated With Neighborhood Socioeconomic Characteristics: A Geospatial Analysis of Kent County, Michigan.

Science.gov (United States)

Uber, Amy; Sadler, Richard C; Chassee, Todd; Reynolds, Joshua C

2017-08-01

Geographic clustering of bystander cardiopulmonary resuscitation (CPR) is associated with demographic and socioeconomic features of the community where out-of-hospital cardiac arrest (OHCA) occurred, although this association remains largely untested in rural areas. With a significant rural component and relative racial homogeneity, Kent County, Michigan, provides a unique setting to externally validate or identify new community features associated with bystander CPR. Using a large, countywide data set, we tested for geographic clustering of bystander CPR and its associations with community socioeconomic features. Secondary analysis of adult OHCA subjects (2010-2015) in the Cardiac Arrest Registry to Enhance Survival (CARES) data set for Kent County, Michigan. After linking geocoded OHCA cases to U.S. census data, we used Moran's I-test to assess for spatial autocorrelation of population-weighted cardiac arrest rate by census block group. Getis-Ord Gi statistic assessed for spatial clustering of bystander CPR and mixed-effects hierarchical logistic regression estimated adjusted associations between community features and bystander CPR. Of 1,592 subjects, 1,465 met inclusion criteria. Geospatial analysis revealed significant clustering of OHCA in more populated/urban areas. Conversely, bystander CPR was less likely in these areas (99% confidence) and more likely in suburban and rural areas (99% confidence). Adjusting for clinical, demographic, and socioeconomic covariates, bystander CPR was associated with public location (odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.03-1.39), initially shockable rhythms (OR = 1.48; 95% CI = 1.12-1.96), and those in urban neighborhoods (OR = 0.54; 95% CI = 0.38-0.77). Out-of-hospital cardiac arrest and bystander CPR are geographically clustered in Kent County, Michigan, but bystander CPR is inversely associated with urban designation. These results offer new insight into bystander CPR patterns in mixed urban and rural

Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark: A Nationwide Survey.

Science.gov (United States)

Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær; Tjørnhøj-Thomsen, Tine; Wissenberg, Mads; Lippert, Freddy Knudsen; Weeke, Peter; Gislason, Gunnar Hilmar; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

2017-03-14

School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9.68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1.57-2.76]). Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. © 2017 The Authors. Published on behalf of the

A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

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Eikeland Husebø Sissel I

2012-04-01

Full Text Available Abstract Background Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14 performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14 performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team

Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

DEFF Research Database (Denmark)

Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

2017-01-01

is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands-on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral......BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what......, until data saturation. We used cross-sectional indexing (using software), and inductive in-depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands-on CPR training, the following were described as facilitators: prior knowledge that intervention...

INDIKASI DAN KETERAMPILAN RESUSITASI JANTUNG PARU (RJP

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Kaliammah Ganthikumar

2016-05-01

Full Text Available Cardiopulmonary resuscitation (CPR is a livesaving technique which is very useful in many emergencies, such as heart attack or near drowning, in which someone’s breathing or heartbeat has stopped.The American Heart Association recommends that everyone - doesn’t have experience or medical personnel can start CPR with chest compression. Chest compression can help to save someone’s life eventhough you doesn’t have knowledge. Its better then doing nothing. CPR can delivery enough oxygen to brain and vital organ till definitive medication is given to restore normal heart rthym. The supply of oxygen to brain is distupted for eight to te minutes can cause death.CPR for a cardiac arrest I starting from circulation then breathing then airway( C-B-A Keyword:Technique CPR, CPR for cardiac arrest

CPR - infant

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... as 4 to 6 minutes later. Machines called automated external defibrillators (AEDs) can be found in many ... side down. Follow the guidelines for using infant car seats. Teach your baby the meaning of "don' ...

CPR: Infant

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Full Text Available ... LIFEGUARDING Refresher Putting It All Together: CPR—Infant (1:52) Refresher videos only utilize this player QUICK LINKS Home RedCross.org Purchase Course Materials Shop Our Store Contact Us Privacy Policy Terms and Conditions All rights reserved. 2011 American National Red Cross.

Report on the "Secure Vehicular Communications: Results and Challenges Ahead" Workshop

OpenAIRE

Papadimitratos, Panos; Hubaux, Jean-Pierre

2008-01-01

© ACM, (2008). This is the author’s version of the work. It is posted here by permission of ACM for your personaluse. Not for redistribution. The definitive version was published in ACM SIGMOBILE Mobile Computing and Communications Review . http://doi.acm.org/10.114510/1394555.1394567 .QC 20110712

Influence of Miscibility Phenomenon on Crystalline Polymorph Transition in Poly(Vinylidene Fluoride)/Acrylic Rubber/Clay Nanocomposite Hybrid

Science.gov (United States)

Abolhasani, Mohammad Mahdi; Naebe, Minoo; Jalali-Arani, Azam; Guo, Qipeng

2014-01-01

In this paper, intercalation of nanoclay in the miscible polymer blend of poly(vinylidene fluoride) (PVDF) and acrylic rubber(ACM) was studied. X-ray diffraction was used to investigate the formation of nanoscale polymer blend/clay hybrid. Infrared spectroscopy and X-ray analysis revealed the coexistence of β and γ crystalline forms in PVDF/Clay nanocomposite while α crystalline form was found to be dominant in PVDF/ACM/Clay miscible hybrids. Flory-Huggins interaction parameter (B) was used to further explain the miscibility phenomenon observed. The B parameter was determined by combining the melting point depression and the binary interaction model. The estimated B values for the ternary PVDF/ACM/Clay and PVDF/ACM pairs were all negative, showing both proper intercalation of the polymer melt into the nanoclay galleries and the good miscibility of PVDF and ACM blend. The B value for the PVDF/ACM blend was almost the same as that measured for the PVDF/ACM/Clay hybrid, suggesting that PVDF chains in nanocomposite hybrids interact with ACM chains and that nanoclay in hybrid systems is wrapped by ACM molecules. PMID:24551141

Influence of miscibility phenomenon on crystalline polymorph transition in poly(vinylidene fluoride/acrylic rubber/clay nanocomposite hybrid.

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Mohammad Mahdi Abolhasani

Full Text Available In this paper, intercalation of nanoclay in the miscible polymer blend of poly(vinylidene fluoride (PVDF and acrylic rubber(ACM was studied. X-ray diffraction was used to investigate the formation of nanoscale polymer blend/clay hybrid. Infrared spectroscopy and X-ray analysis revealed the coexistence of β and γ crystalline forms in PVDF/Clay nanocomposite while α crystalline form was found to be dominant in PVDF/ACM/Clay miscible hybrids. Flory-Huggins interaction parameter (B was used to further explain the miscibility phenomenon observed. The B parameter was determined by combining the melting point depression and the binary interaction model. The estimated B values for the ternary PVDF/ACM/Clay and PVDF/ACM pairs were all negative, showing both proper intercalation of the polymer melt into the nanoclay galleries and the good miscibility of PVDF and ACM blend. The B value for the PVDF/ACM blend was almost the same as that measured for the PVDF/ACM/Clay hybrid, suggesting that PVDF chains in nanocomposite hybrids interact with ACM chains and that nanoclay in hybrid systems is wrapped by ACM molecules.

Genetic basis of arrhythmogenic cardiomyopathy.

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Karmouch, Jennifer; Protonotarios, Alexandros; Syrris, Petros

2018-05-01

To date 16 genes have been associated with arrhythmogenic cardiomyopathy (ACM). Mutations in these genes can lead to a broad spectrum of phenotypic expression ranging from disease affecting predominantly the right or left ventricle, to biventricular subtypes. Understanding the genetic causes of ACM is important in diagnosis and management of the disorder. This review summarizes recent advances in molecular genetics and discusses the application of next-generation sequencing technology in genetic testing in ACM. Use of next-generation sequencing methods has resulted in the identification of novel causative variants and genes for ACM. The involvement of filamin C in ACM demonstrates the genetic overlap between ACM and other types of cardiomyopathy. Putative pathogenic variants have been detected in cadherin 2 gene, a protein involved in cell adhesion. Large genomic rearrangements in desmosome genes have been systematically investigated in a cohort of ACM patients. Recent studies have identified novel causes of ACM providing new insights into the genetic spectrum of the disease and highlighting an overlapping phenotype between ACM and dilated cardiomyopathy. Next-generation sequencing is a useful tool for research and genetic diagnostic screening but interpretation of identified sequence variants requires caution and should be performed in specialized centres.

77 FR 30005 - Office of the Assistant Secretary for Health, Statement of Organization, Functions, and...

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2012-05-21

.... Specifically, it realigns these functions in the Office of the Surgeon General (ACM) and abolishes the Office... Section AC.20, Functions, delete Paragraph ``I. Office of Surgeon General (ACM),'' in its entirety and replace with the following: I. Office of the Surgeon General (ACM) Section ACM.00 Mission: The Office of...

Grade of a doctor does not influence acquisition of knowledge and skill during CPR training in a developing country

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Olufemi B Bankole

2014-01-01

Full Text Available Background: Our teaching hospitals have different grades of doctors with varied exposure to cardiac arrest settings and their resuscitation skills are often inadequate. Objectives: We investigated whether the grade of a doctor influenced acquisition of knowledge and skill during cardiopulmonary resuscitation (CPR training in Nigeria. Materials and Methods: Doctors who attended a two-day resuscitation training program between December 2007 and April 2009 were scored on their knowledge of Basic Life Support, Advanced Life Support, and performance at five skill stations. A pass mark was awarded for a post-test score ≥ 75% and a pass in all skill stations. Results: A total of 130 doctors were studied with a mean of 10.99 ± 6.51 years since medical qualification (range, 2-28 years. The mean pre-test score was 54.43 ± 16.10% (range 30.5-91.8% while the mean post-test score was 88.48 ± 6.8% (range, 54.6-94%, (P < 0.001. Mean post-test scores were not significantly different between grades. Mean scores for questions on Basic Life Support, defibrillator use, and drug therapy and in performance at skill stations were not significantly different between grades. A significant difference however existed in questions on cardiac arrest rhythms (P = 0.031. Sixty-five participants (50% passed the post-test at first attempt. Consultants, senior registrars, and registrars had pass rates of 59.2%, 53.6%, and 43.5% respectively (P = 0.336. After re-training at performance stations, 124 doctors (95.4% passed the test with no significant difference in overall pass in the various grades (P = 0.605. Conclusion : Grade of doctor did not affect the acquisition of knowledge and skill during resuscitation training.

Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled prospective study in secondary schools in Germany.

Science.gov (United States)

Wingen, Sabine; Schroeder, Daniel C; Ecker, Hannes; Steinhauser, Susanne; Altin, Sibel; Stock, Stephanie; Lechleuthner, Alex; Hohn, Andreas; Böttiger, Bernd W

2018-01-02

Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. Prospective, randomised-interventional controlled study. Four secondary schools in Germany. Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P CPR training improves the level of knowledge and self-confidence in 14 to 18-year-old schoolchildren. Older schoolchildren are more likely to have increased self-confidence with respect to initiating CPR. Schoolchildren with an immigrant background showed a significantly lower increase in their level of knowledge and self-confidence compared with native children. Adaptation and simplification of teaching materials and further research on educational methods for CPR are urgently needed to enable a sustainable approach to teaching CPR, which also produces a long-lasting effect in the entire population.

Liabilities of the competent person for radiation protection

International Nuclear Information System (INIS)

Bizet, A.

2008-01-01

The article R. 4456-1 of the Labour code requires employer to appoint a competent person for radiation protection (C.P.R.). Although the prerogatives of the CPR are exercised under the responsibility of the employer, the traditional rules of questioning the liability apply to the employer as well as to the C.P.R.. For the civil liability, the object of which is to guarantee the compensation of damage by its author, but also for the criminal liability, which aims at punishing an illegal behaviour, the C.P.R. does not escape these traditional rules which, however, apply in a particular way considering the daily missions of the C.P.R.. If the responsibility of the employer is more questioned, notably because of the authority he/she exercises on his/her employee, the C.P.R. must not be considered as irresponsible regarding civil and penal requirements; the C.P.R. may indeed be questioned by an employee victim of damage. The activity of the C.P.R. (and thus the cases allowing the questioning of its liability) rests widely on the means which it has and the context in which it discharges its missions. Moreover the judge does take into account the resources which an agent has to judge his responsibility. Thus, the relations of the C.P.R. with other actors of the radiation protection, internal or external in the establishment, are determining. (author)

Do Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training in Australia and New Zealand?

Science.gov (United States)

Cartledge, Susie H; Bray, Janet E; Stub, Dion; Krum, Henry; Finn, Judith

2016-06-01

Cardiac rehabilitation may provide an ideal environment to train high-risk cardiac patients and their families in cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. The aims of this study were to: 1) describe the prevalence of CPR training in cardiac rehabilitation programs in Australia and New Zealand (NZ); and 2) examine perceived barriers and attitudes of cardiac rehabilitation coordinators towards providing CPR training. We conducted a cross-sectional online survey of Australian and NZ cardiac rehabilitation coordinators. We received 253 completed surveys (46.7% response rate) (Australia n=208, NZ n=45). Cardiopulmonary resuscitation training was included in 23.9% of Australian programs and 56.6% in NZ. Common barriers to CPR training included lack of resources (49.7%) and a lack of awareness to provide CPR training for this high-risk group (33.7%). The majority of coordinators believed that lay people should be trained in CPR (96.3%) and were comfortable with recommending CPR training to this high-risk group (89.4%). While cardiac rehabilitation coordinators have positive attitudes towards CPR training, it is not currently part of most programs - particularly in Australia. Organisations formulating cardiac rehabilitation recommendations and guidelines should give consideration to include the provision of CPR training. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

The effect of retraining of nurses on cardiopulmonary resuscitationsuccess rate and short-term and long-term survival in patients revived

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Dahi M

2015-02-01

Full Text Available Background and Objective: Cardiopulmonary resuscitation (CPR is performed in order to restore the functioning of two most important body organs the heart and brain. The present study was performed to investigate the effect of retraining of nurses on CPR success rate and short-term and long-term CPR survival. Materials and Method: The study population of the present quasi-experimental study consisted of all nurses of Taleghani Hospital affiliated with Shahid Beheshti University, Tehran, Iran, in 2011. The study subjects (n = 400 were selected using convenience and purposive sampling method. The patient survival rate during the first 24 hours (short-term survival and discharge from the hospital (long-term survival after CPR were reported. Then, the study subjects, in groups of 20, participated in CPR training courses. Short-term (24 hours and long-term (discharge from hospital in good mental status survival subsequent to CPR were reevaluated and compared with pre-training results. Data were analyzed using SPSS software version 20, and t-test and chi-square test. Results: Retraining promoted CPR success rates. This increase in the short-term success rate was not significant, but the increase in long-term success rate was statistically significant (P = 0.007. Conclusion: Periodic retraining of nurses may improve CPR success rate particularly long-term survival or discharge from hospital. Therefore, further studies on long-term success of CPR considering confounding factors are recommended

Assessment of Iranian nurses and emergency medical personnel in terms of cardiopulmonary resuscitation knowledge based on the 2010 guideline

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Reza Pourmirza Kalhori

2017-01-01

Full Text Available Background: The aim of this study was to compare the cardiopulmonary resuscitation (CPR knowledge of hospital nurses and emergency medical personnel in Kermanshah, Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 330 hospital nurses and 159 emergency medical personnel working in educational hospitals and emergency medical centers in Kermanshah. Data were collected using a validated and reliable (r = 0.74 researcher-made questionnaire consisting of a demographic characteristics questionnaire and the 2010 CPR knowledge questionnaire. Results: Based on the most recent CPR guidelines, the knowledge of 19.5%, 78.6%, and 1.9% of the emergency medical staff was excellent, good, and moderate, respectively. None of the participants had poor knowledge. In addition, the knowledge of 20.2%, 65.4%, 14%, and 0.4% of the nurses in this study was excellent, good, moderate, and poor, respectively. There was no significant difference in CPR knowledge between hospital nurses and emergency medical staff. Moreover, no significant association was found between CPR knowledge and gender, age, work experience, field of study, previous occupation, and advanced resuscitation courses. However, CPR knowledge of individuals with training in basic CPR courses was higher than participants without training in these courses (P < 0.05. Conclusions: Based on the findings of this study, CPR knowledge among Iranian nurses and emergency medical personnel was in an acceptable range. Nevertheless, it is strongly recommended that nurses and emergency staff receive training according to the most recent CPR guidelines.

Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: a feasibility trial.

Science.gov (United States)

Blewer, Audrey L; Leary, Marion; Decker, Christopher S; Andersen, James C; Fredericks, Amanda C; Bobrow, Bentley J; Abella, Benjamin S

2011-09-01

Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest (SCA), yet rates of bystander CPR are low. This is especially the case for SCA occurring in the home setting, as family members of at-risk patients are often not CPR trained. To evaluate the feasibility of a novel hospital-based CPR education program targeted to family members of patients at increased risk for SCA. Prospective, multicenter, cohort study. Inpatient wards at 3 hospitals. Family members of inpatients admitted with cardiac-related diagnoses. Family members were offered CPR training via a proctored video-self instruction (VSI) program. After training, CPR skills and participant perspectives regarding their training experience were assessed. Surveys were conducted one month postdischarge to measure the rate of "secondary training" of other individuals by enrolled family members. At the 3 study sites, 756 subjects were offered CPR instruction; 280 agreed to training and 136 underwent instruction using the VSI program. Of these, 78 of 136 (57%) had no previous CPR training. After training, chest compression performance was generally adequate (mean compression rate 90 ± 26/minute, mean depth 37 ± 12 mm). At 1 month, 57 of 122 (47%) of subjects performed secondary training for friends or family members, with a calculated mean of 2.1 persons trained per kit distributed. The hospital setting offers a unique "point of capture" to provide CPR instruction to an important, undertrained population in contact with at-risk individuals. Copyright © 2010 Society of Hospital Medicine.

Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome.

Science.gov (United States)

N Bligh, Larissa; Alsolai, Amal A; Greer, Ristan M; Kumar, Sailesh

2017-06-08

Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to prospectively evaluate the screening performance of the CPR 10 th centile for detection of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) in low-risk women from 36 weeks and to determine the best CPR threshold from three previously described in the literature. In a blinded, prospective, observational, cohort study, 483 women with uncomplicated singleton pregnancies underwent fortnightly CPR measurement from 36 weeks to delivery and intrapartum and neonatal outcomes were recorded. The CPR 10 th centile threshold screening test performance was calculated for emergency Cesarean section for IFC and composite ANO, incorporating acidosis at birth, Apgar Cesarean section for IFC and 17.9% had a composite ANO. Sensitivity and specificity for CPR Cesarean section IFC and composite ANO, respectively. Comparing the three CPR thresholds, CPR Cesarean section for IFC area under the receiver operating characteristic curve = 0.72, composite ANO area under the receiver operating characteristic curve = 0.58), although its predictive utility was only fair for Cesarean section for IFC and poor for composite ANO. The CPR 10 th centile may be useful as a component of a risk assessment tool for Cesarean section for IFC in low risk pregnancies at term. This article is protected by copyright. All rights reserved.

Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia

International Nuclear Information System (INIS)

Al-Turki, Yousef A.; Al-Fraih, Yasser S.; Jalalay, Jalal B.; Al-Maghlouth, Ibrahim A.; Al-Rashoudi, Fahad H.; Al-Otaibi, Azzam F.; Al-Thnayan, Anas A.; Trabzoni, Abdulmohsin I.; Al-Shaykh, Abdulaziz S.

2008-01-01

Objective was to assess the knowledge and attitudes towards cardiopulmonary resuscitation (CPR) among the students of King Saud University. This study was a cross sectional survey among King Saud University students, Riyadh, Kingdom of Saudi Arabia, which took place on December 17-20, 2006. The data was collected from self-administered questionnaires prepared in Arabic. The questionnaires were distributed to all 15 colleges of the university. Out of a study sample of 2250 students, 31% did not have prior CPR information. Of those with previous knowledge, 85% feel that it is inadequate. The most common sources of information were television and movies. The 12.7% of individuals encountered a situation that required the use of CPR. However, 14% of them performed it. This was mostly due to lack of knowledge (42.8%). Eighty-eight percent of students would like to learn how to perform CPR. Out of all King Saud University students, 45% believe that CPR training should be a graduation requirement. It was found that overall attitude towards CPR was positive. However, the knowledge on the topic was insufficient. Thus, more focus should be placed on the improvement of CPR skills. In addition, more studies are needed to assess knowledge and attitudes towards CPR in the community. (author)

Controlled by Love: The Harmful Relational Consequences of Perceived Conditional Positive Regard.

Science.gov (United States)

Kanat-Maymon, Yaniv; Roth, Guy; Assor, Avi; Raizer, Abira

2016-08-01

Research on conditional positive regard (CPR) has shown that this seemingly benign practice has maladaptive correlates when used by parents. However, there is no research on the correlates of this practice in romantic relationships or on the processes mediating its effects. Building on self-determination theory (Deci & Ryan, ), three studies tested the hypothesis that perceived CPR impairs relationship quality, partly because it undermines the fulfillment of the basic psychological needs for autonomy and relatedness. Study 1 (N = 125) examined perceived CPR and relationship quality across four relationship targets: mother, father, romantic partner, and best friend. Study 2, involving romantic partners (N = 142), examined whether needs fulfillment mediated the association between perceived CPR and relationship quality. Study 3, involving romantic dyads (N = 85), also included partner reports on CPR. Across the three studies, CPR was linked with poor relationship quality between relationships, between people, and between dyadic partners. Moreover, results of Study 2 and Study 3 revealed that the inverse association between perceived CPR and relationship quality was mediated by dissatisfaction of autonomy but not relatedness. Despite its seemingly benign nature, CPR is detrimental to relationship quality, partly because it thwarts the basic need for autonomy. © 2015 Wiley Periodicals, Inc.

Coastal Fishermen as Lifesavers While Sailing at High Speed: A Crossover Study

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Ramón Fungueiriño-Suárez

2018-01-01

Full Text Available Purpose. Starting basic cardiopulmonary resuscitation (CPR early improves survival. Fishermen are the first bystanders while at work. Our objective was to test in a simulated scenario the CPR quality performed by fishermen while at port and while navigating at different speeds. Methods. Twenty coastal fishermen were asked to perform 2 minutes of CPR (chest compressions and mouth-to-mouth ventilations on a manikin, in three different scenarios: (A at port on land, (B on the boat floor sailing at 10 knots, and (C sailing at 20 knots. Data was recorded using quality CPR software, adjusted to current CPR international guidelines. Results. The quality of CPR (QCPR was significantly higher at port (43%±10 than sailing at 10 knots (30%±15; p=0.01 or at 20 knots (26%±12; p=0.001. The percentage of ventilation that achieved some lung insufflation was also significantly higher when CPR was done at port (77%±14 than while sailing at 10 knots (59%±18 or 20 knots (57%±21 (p=0.01. Conclusion. In the event of drowning or cardiac arrest on a small boat, fishermen should immediately start basic CPR and navigate at a relatively high speed to the nearest port if the sea conditions are safe.

Use of empirically supported interventions for psychopathology: can the participatory approach move us beyond the research-to-practice gap?

Science.gov (United States)

Becker, Carolyn Black; Stice, Eric; Shaw, Heather; Woda, Susan

2009-04-01

Dissemination, or distribution, of empirically supported interventions (ESIs) for psychopathology remains a significant challenge. This paper reviews the principles of community-partnership research (CPR) and explores why CPR might improve distribution of psychological ESIs. Benefits of CPR include building trust, pooling resources and knowledge, and better serving a community by directly involving its members in the design and implementation of research. In addition, after establishing a community's trust using CPR, researchers are likely to be better positioned to partner with communities in the further distribution of ESIs via community networks. This paper reviews the case of dissonance-based eating disorder prevention interventions to provide an example of how CPR can facilitate the adoption and distribution of an ESI by a community, in this case, sororities. CPR also presents a number of challenges, however, because it is time consuming and does not always align with funding mechanisms and research designs used in randomized controlled trials. Further, CPR does not necessarily solve the challenge of training providers, though it may help with problem solving. Ultimately, we suggest that the benefits of CPR far outweigh the challenges, and hope that more researchers will adopt these practices so that more individuals can benefit from empirically supported psychological interventions.

Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik

2016-01-01

30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% confidence interval [CI]: 12.8-16.4) versus...... 6.3% (95% CI: 5.1-7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) versus 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander...... CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs 1.5% [95% CI: 0.6-2.7]), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish...

Gender aspects in cardiopulmonary resuscitation by schoolchildren: A systematic review.

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Finke, Simon-Richard; Schroeder, Daniel C; Ecker, Hannes; Wingen, Sabine; Hinkelbein, Jochen; Wetsch, Wolfgang A; Köhler, Daniela; Böttiger, Bernd W

2018-04-01

Bystander CPR-rates are embarrassingly low in some European countries. To increase bystander CPR-rates, many different approaches are used; one of them is training of schoolchildren in CPR. Multiple authors investigated practical and theoretical CPR performance and demonstrated gender differences related to schoolchildren CPR. The objective was to elaborate gender aspects in practical and theoretical CPR-performance from the current literature to better address female and male students. A systematic search in PubMed-database with different search terms was performed for controlled and uncontrolled prospective investigations. Altogether, n = 2360 articles were identified and checked for aptitude. From n = 97 appropriated articles, n = 24 met the inclusion criteria and were finally included for full review and incorporated in the manuscript. Female students demonstrated higher motivation to attend CPR-training (p multiplier effect (p multiplier and need to be individually addressed in intensified practical training. Male students achieve a more sufficient chest compression depth and -fraction and could benefit from individual motivation. Copyright © 2018 Elsevier B.V. All rights reserved.

Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience

OpenAIRE

L?pez-Herce, Jes?s; Matamoros, Martha M.; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, ?ngel; del Castillo, Jimena; Menc?a, Santiago; Moral, Ram?n; Ordo?ez, Flora; S?nchez, Carlos; Lagos, Lina; Johnson, Mar?a; Mendoza, Ovidio

2017-01-01

Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised tea...

Growth and acid production of Lactobacillus delbrueckii ssp. bulgaricus ATCC 11842 in the fermentation of algal carcass.

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Li, C; Zhang, G F; Mao, X; Wang, J Y; Duan, C Y; Wang, Z J; Liu, L B

2016-06-01

Algal carcass is a low-value byproduct of algae after its conversion to biodiesel. Dried algal carcass is rich in protein, carbohydrate, and multiple amino acids, and it is typically well suited for growth and acid production of lactic acid bacteria. In this study, Lactobacillus delbrueckii ssp. bulgaricus ATCC 11842 was used to ferment different algal carcass media (ACM), including 2% ACM, 2% ACM with 1.9% glucose (ACM-G), and 2% ACM with 1.9% glucose and 2g/L amino acid mixture (ACM-GA). Concentrations of organic acids (lactic acid and acetic acid), acetyl-CoA, and ATP were analyzed by HPLC, and activities of lactate dehydrogenase (LDH), acetokinase (ACK), pyruvate kinase (PK), and phosphofructokinase (PFK) were determined by using a chemical approach. The growth of L. bulgaricus cells in ACM-GA was close to that in the control medium (de Man, Rogosa, and Sharpe). Lactic acid and acetic acid contents were greatly reduced when L. bulgaricus cells were grown in ACM compared with the control medium. Acetyl-CoA content varied with organic acid content and was increased in cells grown in different ACM compared with the control medium. The ATP content of L. bulgaricus cells in ACM was reduced compared with that of cells grown in the control medium. Activities of PFK and ACK of L. bulgaricus cells grown in ACM were higher and those of PK and LDH were lower compared with the control. Thus, ACM rich in nutrients may serve as an excellent substrate for growth by lactic acid bacteria, and addition of appropriate amounts of glucose and amino acids can improve growth and acid production. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Kunstigt åndedraet udgør fortsat en del af basal genoplivning

DEFF Research Database (Denmark)

Krarup, Niels Henrik; Løfgren, Bo

2009-01-01

Bystander cardiopulmonary resuscitation (CPR) consisting of mouth-to-mouth ventilation and chest compressions improves survival from cardiac arrest. Bystanders perform CPR only in a minority of cardiac arrests. To improve the number of bystanders initiating CPR, the American Heart Association...

Genetic interrelations in the actinomycin biosynthetic gene clusters of Streptomyces antibioticus IMRU 3720 and Streptomyces chrysomallus ATCC11523, producers of actinomycin X and actinomycin C

Science.gov (United States)

Crnovčić, Ivana; Rückert, Christian; Semsary, Siamak; Lang, Manuel; Kalinowski, Jörn; Keller, Ullrich

2017-01-01

Sequencing the actinomycin (acm) biosynthetic gene cluster of Streptomyces antibioticus IMRU 3720, which produces actinomycin X (Acm X), revealed 20 genes organized into a highly similar framework as in the bi-armed acm C biosynthetic gene cluster of Streptomyces chrysomallus but without an attached additional extra arm of orthologues as in the latter. Curiously, the extra arm of the S. chrysomallus gene cluster turned out to perfectly match the single arm of the S. antibioticus gene cluster in the same order of orthologues including the the presence of two pseudogenes, scacmM and scacmN, encoding a cytochrome P450 and its ferredoxin, respectively. Orthologues of the latter genes were both missing in the principal arm of the S. chrysomallus acm C gene cluster. All orthologues of the extra arm showed a G +C-contents different from that of their counterparts in the principal arm. Moreover, the similarities of translation products from the extra arm were all higher to the corresponding translation products of orthologue genes from the S. antibioticus acm X gene cluster than to those encoded by the principal arm of their own gene cluster. This suggests that the duplicated structure of the S. chrysomallus acm C biosynthetic gene cluster evolved from previous fusion between two one-armed acm gene clusters each from a different genetic background. However, while scacmM and scacmN in the extra arm of the S. chrysomallus acm C gene cluster are mutated and therefore are non-functional, their orthologues saacmM and saacmN in the S. antibioticus acm C gene cluster show no defects seemingly encoding active enzymes with functions specific for Acm X biosynthesis. Both acm biosynthetic gene clusters lack a kynurenine-3-monooxygenase gene necessary for biosynthesis of 3-hydroxy-4-methylanthranilic acid, the building block of the Acm chromophore, which suggests participation of a genome-encoded relevant monooxygenase during Acm biosynthesis in both S. chrysomallus and S

Rates of cardiopulmonary resuscitation training in the United States.

Science.gov (United States)

Anderson, Monique L; Cox, Margueritte; Al-Khatib, Sana M; Nichol, Graham; Thomas, Kevin L; Chan, Paul S; Saha-Chaudhuri, Paramita; Fosbol, Emil L; Eigel, Brian; Clendenen, Bill; Peterson, Eric D

2014-02-01

Prompt bystander cardiopulmonary resuscitation (CPR) improves the likelihood of surviving an out-of-hospital cardiac arrest. Large regional variations in survival after an out-of-hospital cardiac arrest have been noted. To determine whether regional variations in county-level rates of CPR training exist across the United States and the factors associated with low rates in US counties. We used a cross-sectional ecologic study design to analyze county-level rates of CPR training in all US counties from July 1, 2010, through June 30, 2011. We used CPR training data from the American Heart Association, the American Red Cross, and the Health & Safety Institute. Using multivariable logistic regression models, we examined the association of annual rates of adult CPR training of citizens by these 3 organizations (categorized as tertiles) with a county's geographic, population, and health care characteristics. Completion of CPR training. Rate of CPR training measured as CPR course completion cards distributed and CPR training products sold by the American Heart Association, persons trained in CPR by the American Red Cross, and product sales data from the Health & Safety Institute. RESULTS During the study period, 13.1 million persons in 3143 US counties received CPR training. Rates of county training ranged from 0.00% to less than 1.29% (median, 0.51%) in the lower tertile, 1.29% to 4.07% (median, 2.39%) in the middle tertile, and greater than 4.07% or greater (median, 6.81%) in the upper tertile. Counties with rates of CPR training in the lower tertile were more likely to have a higher proportion of rural areas (adjusted odds ratio, 1.12 [95% CI, 1.10-1.15] per 5-percentage point [PP] change), higher proportions of black (1.09 [1.06-1.13] per 5-PP change) and Hispanic (1.06 [1.02-1.11] per 5-PP change) residents, a lower median household income (1.18 [1.04-1.34] per $10 000 decrease), and a higher median age (1.28 [1.04-1.58] per 10-year change). Counties in the South

Cancer recurrence and mortality after pediatric heart transplantation for anthracycline cardiomyopathy: A report from the Pediatric Heart Transplant Study (PHTS) group.

Science.gov (United States)

Bock, Matthew J; Pahl, Elfriede; Rusconi, Paolo G; Boyle, Gerard J; Parent, John J; Twist, Clare J; Kirklin, James K; Pruitt, Elizabeth; Bernstein, Daniel

2017-08-01

We aimed to determine whether malignancy after pediatric HTx for ACM affects overall post-HTx survival. Patients ACM in the PHTS database between 1993 and 2014 were compared to those with DCM. A 2:1 matched DCM cohort was also compared. Wait-list and post-HTx survival, along with freedom from common HTx complications, were compared. Eighty subjects were listed due to ACM, whereas 1985 were listed for DCM. Although wait-list survival was higher in the ACM group, post-HTx survival was lower for the ACM cohort. Neither difference persisted in the matched cohort analysis. Primary cause of death in the ACM group was infection, which was higher than the DCM group. Malignancy rates were not different. All ACM malignancies were due to PTLD without primary cancer recurrence or SMN. Long-term graft survival after pediatric HTx for ACM is no different than for matched DCM peers, nor is there an increased risk of any malignancy. However, risk of infection and death from infection after HTx are higher in the ACM group. Further studies are needed to assess the effects of prior chemotherapy on susceptibility to infection in this group. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Dedifferentiation, Proliferation, and Redifferentiation of Adult Mammalian Cardiomyocytes After Ischemic Injury.

Science.gov (United States)

Wang, Wei Eric; Li, Liangpeng; Xia, Xuewei; Fu, Wenbin; Liao, Qiao; Lan, Cong; Yang, Dezhong; Chen, Hongmei; Yue, Rongchuan; Zeng, Cindy; Zhou, Lin; Zhou, Bin; Duan, Dayue Darrel; Chen, Xiongwen; Houser, Steven R; Zeng, Chunyu

2017-08-29

Adult mammalian hearts have a limited ability to generate new cardiomyocytes. Proliferation of existing adult cardiomyocytes (ACMs) is a potential source of new cardiomyocytes. Understanding the fundamental biology of ACM proliferation could be of great clinical significance for treating myocardial infarction (MI). We aim to understand the process and regulation of ACM proliferation and its role in new cardiomyocyte formation of post-MI mouse hearts. β-Actin-green fluorescent protein transgenic mice and fate-mapping Myh6-MerCreMer-tdTomato/lacZ mice were used to trace the fate of ACMs. In a coculture system with neonatal rat ventricular myocytes, ACM proliferation was documented with clear evidence of cytokinesis observed with time-lapse imaging. Cardiomyocyte proliferation in the adult mouse post-MI heart was detected by cell cycle markers and 5-ethynyl-2-deoxyuridine incorporation analysis. Echocardiography was used to measure cardiac function, and histology was performed to determine infarction size. In vitro, mononucleated and bi/multinucleated ACMs were able to proliferate at a similar rate (7.0%) in the coculture. Dedifferentiation proceeded ACM proliferation, which was followed by redifferentiation. Redifferentiation was essential to endow the daughter cells with cardiomyocyte contractile function. Intercellular propagation of Ca 2+ from contracting neonatal rat ventricular myocytes into ACM daughter cells was required to activate the Ca 2+ -dependent calcineurin-nuclear factor of activated T-cell signaling pathway to induce ACM redifferentiation. The properties of neonatal rat ventricular myocyte Ca 2+ transients influenced the rate of ACM redifferentiation. Hypoxia impaired the function of gap junctions by dephosphorylating its component protein connexin 43, the major mediator of intercellular Ca 2+ propagation between cardiomyocytes, thereby impairing ACM redifferentiation. In vivo, ACM proliferation was found primarily in the MI border zone. An ischemia

Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times After Out-of-Hospital Cardiac Arrest.

Science.gov (United States)

Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Steen Møller; Gerds, Thomas A; Kragholm, Kristian; Hansen, Carolina Malta; Karlsson, Lena; Lippert, Freddy K; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

2016-12-20

Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases. We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used to examine the association between time from 911 call to emergency medical service arrival (response time) and survival according to whether bystander CPR was provided (yes or no). Reported are 30-day survival chances with 95% bootstrap confidence intervals. With increasing response times, adjusted 30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% confidence interval [CI]: 12.8-16.4) versus 6.3% (95% CI: 5.1-7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) versus 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs 1.5% [95% CI: 0.6-2.7]), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median

The study of knowledge and attitude of new coming residents in cardiopulmonary resuscitation in Tehran University of Medical Sciences, 1377-78

Directory of Open Access Journals (Sweden)

Haj Zeinali AM

2000-09-01

Full Text Available Cardiopulmonary resuscitation (CPR is one of the most important skills that every body must know it in medical services. In educational hospitals, the (Newly-arrived residents are in first cell for management of victims, specially in emergency rooms and at nights. Their knowledge and ability for successful CPR have a direct relation with prevalence of total mortality and morbidity. This research has assessed the knowledge and attitude of the new residents about CPR, and for answering to this question: "Is the CPR workshops necessary for all of the new residents in the beginning of their courses". All of the 506 new residents were examined simultaneously in 2 separate years with a questionnaire consist of 50 questions about their CPR secence and skills and 8 questions about their attitude in CPR. These informations were analyzed by SPSS and EPI6 softwares. The mean correct answers were 55%±11.8. The best results were about arrythmias (68.6% and airway management (63.6% and the worst were about IV access (43.1% and pediatric CPR (31.5%. These findings were similar in 2 sequential years. Their knowledge had significant relation with sex (P=0.002, their original university (P=0.031, their residency course (P=0.024 and their residency reception scores (P<0.001. Males and knowledge more than females. The max scores were from Kerman (62% and Beheshti universities (60.5% and the min score were from Hamadan (48% and Kashan universities (37%. The orthopedic (62.5% and urologic residents (61.6% had the most knowledge and the gynecology residents (53.8% had the least. The knowledge had no relation with the time of graduation. About their attitude in CPR: Their knowledge was moderate (65.8%, their abilities was moderate (58% and their education about CPR in MD course had been low (51.5%. Their references for education had been individual studies (74.6%, CPR workshop had not been condected in the most universities (92.7%. knowledge about CPR is low (55

CORRELATION OF CEREBROPLACENTAL RATIO WITH PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

Directory of Open Access Journals (Sweden)

Sajala Vimalraj

2016-07-01

Full Text Available BACKGROUND Doppler velocimetry is a non-invasive method of measuring changes in blood flow. (1,2,3 Randomised Control Trials (RCTs have shown that using Doppler indices in the management of Intrauterine Growth Restriction (IUGR cases leads to a significant reduction in perinatal mortality rate. Deterioration of various Doppler indices precedes abnormal Biophysical Profile (BPP by 1-2 weeks. (1,2,3,4 Umbilical artery indices only reflect the placental status. Fetal response to this increasing placental insufficiency can be deduced from studying the Cerebroplacental Ratio {CPR}, which gives us an idea of the fetal response to the placental status and is potentially more advantageous in predicting fetal outcome. OBJECTIVES To compare CPR in predicting fetal outcome with UA and MCA indices. MATERIALS AND METHODS Prospective cohort study of cases of IUGR - January 2013 to December 2013. 180 cases of clinically diagnosed IUGR were selected. Obstetric USG and Doppler was performed. The S/D ratio, RI, PR values were obtained and CPR calculated. All cases were managed as per the protocol then in place using U/A SD ratios for determining the timing & mode of termination RESULTS Of 180 cases of IUGR were selected most women were primigravidae, 20-34 years, and from low socio-economic status. (3 25 women (13.8% had oligohydramnios (AFI <5. Of these women, 24 had an abnormal CPR, 1 normal CPR. 47% with abnormal CPR had caesarean for fetal distress. Birth weight was <1.5 kg in 14.4% of patients all of whom were in the abnormal CPR group. 7.5% had an Apgar <7; all these babies were in the abnormal CPR group. 43.9% of babies from the abnormal CPR group needed resuscitation. 79% of the abnormal CPR group babies needed NICU admission. CONCLUSION Utilization of only UA and MCA indices may cause unnecessary early intervention in some cases. (1,5 CPR can help triage pregnancies in need of termination while prolonging those which are relatively stable so as to gain

Knockdown of NADPH-cytochrome P450 reductase results in reduced resistance to buprofezin in the small brown planthopper, Laodelphax striatellus (fallén).

Science.gov (United States)

Zhang, Yueliang; Wang, Yaming; Wang, Lihua; Yao, Jing; Guo, Huifang; Fang, Jichao

2016-02-01

NADPH-cytochrome P450 reductase (CPR) plays an important role in cytochrome P450 function, and CPR knockdown in several insects leads to increased susceptibility to insecticides. However, a putative CPR gene has not yet been fully characterized in the small brown planthopper Laodelphax striatellus, a notorious agricultural pest in rice that causes serious damage by transmitting rice stripe and rice black-streaked dwarf viruses. The objective of this study was to clone the cDNA and to knock down the expression of the gene that encodes L. striatellus CPR (LsCPR) to further determine whether P450s are involved in the resistance of L. striatellus to buprofezin. First, the full-length cDNA of LsCPR was cloned and found to contain an open reading frame (ORF) encoding a polypeptide of 679 amino acids with a calculated molecular mass and isoelectric point of 76.92kDa and 5.37, respectively. The deduced amino acid sequence shares high identity with the CPRs of other insects (98%, 97%, 75% and 68% for Sogatella furcifera, Nilaparvata lugens, Cimex lectularius and Anopheles gambiae, respectively) and possesses the characteristic features of classical CPRs, such as an N-terminal membrane anchor and conserved domains for flavin mononucleotide (FMN), flavin adenine dinucleotide (FAD) and nicotinamide adenine dinucleotide phosphate (NADPH) binding. Phylogenetic analysis revealed that LsCPR is located in a branch along with the CPRs of other hemipteran insects. LsCPR mRNA was detectable in all examined body parts and developmental stages of L. striatellus, as determined by real-time quantitative PCR (qPCR), and transcripts were most abundant in the adult abdomen and in first-instar nymphs and adults. Ingestion of 200μg/mL of LsCPR double-stranded RNA (dsLsCPR) by the planthopper for 5days significantly reduced the transcription level of LsCPR. Moreover, silencing of LsCPR caused increased susceptibility to buprofezin in a buprofezin-resistant (YN-BPF) strain but not in a