WorldWideScience

Sample records for avoiding cardiopulmonary by-pass

  1. A numerical performance assessment of a commercial cardiopulmonary by-pass blood heat exchanger.

    Science.gov (United States)

    Consolo, Filippo; Fiore, Gianfranco B; Pelosi, Alessandra; Reggiani, Stefano; Redaelli, Alberto

    2015-06-01

    We developed a numerical model, based on multi-physics computational fluid dynamics (CFD) simulations, to assist the design process of a plastic hollow-fiber bundle blood heat exchanger (BHE) integrated within the INSPIRE(TM), a blood oxygenator (OXY) for cardiopulmonary by-pass procedures, recently released by Sorin Group Italia. In a comparative study, we analyzed five different geometrical design solutions of the BHE module. Quantitative geometrical-dependent parameters providing a comprehensive evaluation of both the hemo- and thermo-dynamics performance of the device were extracted to identify the best-performing prototypical solution. A convenient design configuration was identified, characterized by (i) a uniform blood flow pattern within the fiber bundle, preventing blood flow shunting and the onset of stagnation/recirculation areas and/or high velocity pathways, (ii) an enhanced blood heating efficiency, and (iii) a reduced blood pressure drop. The selected design configuration was then prototyped and tested to experimentally characterize the device performance. Experimental results confirmed numerical predictions, proving the effectiveness of CFD modeling as a reliable tool for in silico identification of suitable working conditions of blood handling medical devices. Notably, the numerical approach limited the need for extensive prototyping, thus reducing the corresponding machinery costs and time-to-market. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  2. The Effect of ringer Lactate as the Priming Solution of the Cardiopulmonary by Pass Circuit on Plasma Potassium Levels after Open Heart Surgery in Children

    Directory of Open Access Journals (Sweden)

    Arash Peivandi Yazdi

    2015-11-01

    Full Text Available Background: Conduct of cardiopulmonary bypass (CPB due to the higher volume of priming solution in comparison to the total blood volume in children requires careful consideration. Recently attention has been focused on the potential risk of hyperkalemia in these patients. Given its significant effects on cardiac rhythm, hyperkalemia is considered a medical emergency. In this cross-sectional study we aimed to determine the changes in K+ and other electrolytes following CPB in a pediatric cardiac surgery setting. Method: Sixty children scheduled for pediatric cardiac surgery weighing more than 5 kilograms with Hct level above 30% were enrolled. The prime solution used was Ringer-lactate. Venous blood were collected at defined time points: before, during and after CPB and at discharge. A p-value of less than 0.05 was considered statistically significant. Results: Mean age of the studied patients was 3.69±2.77 years. A rise in potassium levels during surgery was recorded. Also a significant difference in the potassium levels before surgery and at discharge were observed (p=0.007. A significant drop and a subsequent rise in the Hct level was seen overtime whereas a significant decrease in the PH and bicarbonate levels were detected. 31 experienced cardiac arrhythmia after undergoing CPB. Conclusion: A K+-free crystalloid that will offset the K+ load of stored blood is highly anticipated in these patients

  3. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    2009-01-01

    that are evaluated by independent committees that are blinded with respect to the result of the randomisation. End points include mortality, stroke, myocardial infarction, graft patency, quality of life, and cost-effectiveness. The trial is performed in four different Danish, cardiac surgery centres. TRIAL...

  4. Cardiopulmonary resuscitation.

    Science.gov (United States)

    Rieser, T M

    2000-05-01

    Cardiopulmonary resuscitation (CPR) is a technique used in both human and veterinary medicine. Although a number of innovative adaptations to CPR have been researched, the mainstay of CPR remains intubation, adequate ventilation, chest compressions, and basic drug therapy. The purpose of this article is to review the techniques and drugs commonly used in both closed chest and open chest CPR.

  5. Cardiopulmonary interactions

    African Journals Online (AJOL)

    2006-08-28

    Aug 28, 2006 ... Any treatise on cardiopulmonary interactions has at its foundation a thorough understanding of both pulmonary and cardiac physiology. Although recent articles have addressed advances in the field1 or applications to a particular subspecialty,2-5 the reader is advised to have basic physiological articles ...

  6. 34 CFR 300.190 - By-pass-general.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false By-pass-general. 300.190 Section 300.190 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

  7. Cardiopulmonary bypass and hemostasis

    NARCIS (Netherlands)

    Eijsman, Leon

    1992-01-01

    In chapter 1, we recalled that intracardiac defects can only be corrected when cardiopulmonary circulation is maintained by extracorporeal criculation and ventilation. To prevent clot formation in this artificial circuit, the socalled cardiopulmonary bypass (CPB), we completely depend on the

  8. Fabrication of nanofiber non-wovens on the melt blowing die with air by-passes

    OpenAIRE

    Chen Ting; Yang Kang; Wu Li-Li

    2016-01-01

    The air flow field of the melt blowing die with air by-passes is simulated. The results show that fibers fabricated on the die with air by-passes are much finer than those without air by-passes, which indicates an energy-saving approach to fabricating nanofibers on the melt blowing equipment.

  9. Fabrication of nanofiber non-wovens on the melt blowing die with air by-passes

    Directory of Open Access Journals (Sweden)

    Chen Ting

    2016-01-01

    Full Text Available The air flow field of the melt blowing die with air by-passes is simulated. The results show that fibers fabricated on the die with air by-passes are much finer than those without air by-passes, which indicates an energy-saving approach to fabricating nanofibers on the melt blowing equipment.

  10. Statistics of Epidemics in Networks by Passing Messages

    Science.gov (United States)

    Shrestha, Munik Kumar

    Epidemic processes are common out-of-equilibrium phenomena of broad interdisciplinary interest. In this thesis, we show how message-passing approach can be a helpful tool for simulating epidemic models in disordered medium like networks, and in particular for estimating the probability that a given node will become infectious at a particular time. The sort of dynamics we consider are stochastic, where randomness can arise from the stochastic events or from the randomness of network structures. As in belief propagation, variables or messages in message-passing approach are defined on the directed edges of a network. However, unlike belief propagation, where the posterior distributions are updated according to Bayes' rule, in message-passing approach we write differential equations for the messages over time. It takes correlations between neighboring nodes into account while preventing causal signals from backtracking to their immediate source, and thus avoids "echo chamber effects" where a pair of adjacent nodes each amplify the probability that the other is infectious. In our first results, we develop a message-passing approach to threshold models of behavior popular in sociology. These are models, first proposed by Granovetter, where individuals have to hear about a trend or behavior from some number of neighbors before adopting it themselves. In thermodynamic limit of large random networks, we provide an exact analytic scheme while calculating the time dependence of the probabilities and thus learning about the whole dynamics of bootstrap percolation, which is a simple model known in statistical physics for exhibiting discontinuous phase transition. As an application, we apply a similar model to financial networks, studying when bankruptcies spread due to the sudden devaluation of shared assets in overlapping portfolios. We predict that although diversification may be good for individual institutions, it can create dangerous systemic effects, and as a result

  11. 34 CFR 300.191 - Provisions for services under a by-pass.

    Science.gov (United States)

    2010-07-01

    ... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.191... 34 Education 2 2010-07-01 2010-07-01 false Provisions for services under a by-pass. 300.191 Section 300.191 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF...

  12. 34 CFR 300.192 - Notice of intent to implement a by-pass.

    Science.gov (United States)

    2010-07-01

    ... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.192... 34 Education 2 2010-07-01 2010-07-01 false Notice of intent to implement a by-pass. 300.192 Section 300.192 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF...

  13. Economic consequences of extra by-passes in district heating networks. Investment-, running- and maintenance costs

    International Nuclear Information System (INIS)

    Herbert, P.

    1995-02-01

    For various reasons, extra by-passes are installed in district heating networks to ensure a high flow temperature when the water circulation is insufficient. By 'extra by-pass' we here mean a connection between the distribution pipe and the return pipe. This study mainly deals with extra by-passes to prevent freezing. The estimation of the extra by-pass costs is based on the district heating rates. Our assumption is that an extra by-pass can be regarded as a substation in the district heating network, with regard to the demand for the water flow, heat and power. The reason is the difficulty to obtain available facts to estimate the real costs concerning extra by-passes. Therefore, the method can not claim that the information about the costs is exact but gives an indication of the size of them. The valves in an extra by-pass can be set more or less open. We assume that manual valves in extra by-passes are wide open. Thermostatic valves are, however, assumed to be adjusted in order to cause a very small water flow. 2 refs, 16 figs, 9 tabs, 6 appendices

  14. Cardiopulmonary Collapse during Labour

    Directory of Open Access Journals (Sweden)

    Vasilis Sitras

    2010-01-01

    Full Text Available Cardiopulmonary collapse during labour is a catastrophic event caused by various medical, surgical and obstetrical conditions. It is an emergency that threatens the life of the mother and her unborn child. We present a case of a pregnant woman who suffered from preeclampsia and underwent induction of labour. Severe lung edema occurred early in labour that caused cardiopulmonary collapse. Advanced heart-lung resuscitation was established immediately and continued until an emergency cesarean section was performed few minutes later. The outcome was favourable for both mother and child. We further discuss some aspects of the pathophysiology and appropriate treatment of cardiorespiratory arrest during labour, which involves the coordinated action of the obstetric, pediatric and surgical ward personnel.

  15. Cardiopulmonary bypass in pregnancy

    OpenAIRE

    Mukul Chandra Kapoor

    2014-01-01

    Cardiac surgery carried out on cardiopulmonary bypass (CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and f...

  16. By-Pass Diode Temperature Tests of a Solar Array Coupon under Space Thermal Environment Conditions

    Science.gov (United States)

    Wright, Kenneth H.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Wong, Frankie; Wu, Gordon

    2016-01-01

    By-Pass diodes are a key design feature of solar arrays and system design must be robust against local heating, especially with implementation of larger solar cells. By-Pass diode testing was performed to aid thermal model development for use in future array designs that utilize larger cell sizes that result in higher string currents. Testing was performed on a 56-cell Advanced Triple Junction solar array coupon provided by SSL. Test conditions were vacuum with cold array backside using discrete by-pass diode current steps of 0.25 A ranging from 0 A to 2.0 A.

  17. Cardiopulmonary resuscitation: Advances

    Directory of Open Access Journals (Sweden)

    William Andrés Vargas-Garzón

    2011-06-01

    Full Text Available Reanimation’s guidelines dictated by the AHA (American Heart Association are the strategies to follow in the envi­ronment of any situation related to cardiac arrest. They are acquired after the analysis of the evidence available in reani­mation from higher to less quality, with the best neurological results. After years of observation, was achieved to establish that survival behind cardiac arrest is, in general, low (6%, except that any witness starts immediately cardiopulmonary resuscitation (CPR maneuvers; therefore, medical personal must know and practice these maneuvers. With these con­siderations, it’s necessary to emphasize in the theoretical training of CPR of all health professional and laity, which guarantee everybody be prepared to emergency system ac­tivation, brain’s preservation and defibrillate to recuperate heart and life. The actual approach that combines compres­sions and defibrillation to closed chest, rescue ventilation and cardio tonic drugs. The guidelines AHA 2010, focus on increase frequency and quality of CPR. The objective of this article is to recognize various changes in these guidelines in cardiopulmonary reanimation and promote the continued education’s importance in reanimation.

  18. Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass

    International Nuclear Information System (INIS)

    Swan, R.W.

    1974-01-01

    Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass

  19. Cardiopulmonary bypass in pregnancy.

    Science.gov (United States)

    Kapoor, Mukul Chandra

    2014-01-01

    Cardiac surgery carried out on cardiopulmonary bypass (CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  20. Cardiopulmonary bypass in pregnancy

    Directory of Open Access Journals (Sweden)

    Mukul Chandra Kapoor

    2014-01-01

    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  1. Developmental By-Pass Techniques for Teaching the Secondary Learning Disabled Student.

    Science.gov (United States)

    Mosby, Robert J., Ed.

    Described is an interdisciplinary mainstreaming program for individualizing instruction for secondary learning disabled students, utilizing resource facilities in grades 7-9 in eight separate centers throughout Franklin County, Missouri. Aspects of this program--such as the developmental and by-pass strategies of instruction employed to help…

  2. 34 CFR 300.198 - Continuation of a by-pass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Continuation of a by-pass. 300.198 Section 300.198 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF...

  3. ENGINEERING GEOLOGICAL AND GEOTECHNICAL CHARACTERISTICS OF THE PLOČE BY-PASS ROAD

    Directory of Open Access Journals (Sweden)

    Duško Barčot

    2000-12-01

    Full Text Available The Ploče by-pass road will be constructed partly in limestones and partly in clayey-silty-sandy sediments. In order to obtain reliable data for purposes of safe foundation technique for the road and respective structures, field and laboratory investigations were performed. The results are given in this paper. The limestones were classified based on Geological Strength Index (GSI while the properties of clayey-silty-sandy sediments were determined in the laboratory. The obtained results were used as a base for geostatic calculations by a numerical model and for the design of foundations (the paper is published in Croatian.

  4. ENGINEERING GEOLOGICAL AND GEOTECHNICAL CHARACTERISTICS OF THE PLOČE BY-PASS ROAD

    Directory of Open Access Journals (Sweden)

    Duško Barčot

    2000-12-01

    Full Text Available The Ploče by-pass road will be constructed partly in limestones and partly in clayey-silty-sandy sediments. In order to obtain reliable data for purposes of safe foundation technique for the road and respective structures, field and laboratory investigations were performed. The results are given in this paper. The limestnes were classified based on Geological Strength Index (GSI while properties of clayey-silty-sandy sediments were determined in the laboratory. The obtained results were used as a bas for geostatic calculations by a numerical model and for the design of foundations (the paper is published in Croatian.

  5. Cardiopulmonary resuscitation and oxygen therapy.

    Science.gov (United States)

    Marks, S L

    1999-07-01

    Cardiopulmonary resuscitation and oxygen therapy are often necessary procedures done in veterinary practice. There are variations in CPR technique, especially in cardiac life support. Oxygen therapy can be an important adjunctive therapy in emergency and critical care medicine. The techniques used for oxygen administration differ depending on the medical problem and the animal.

  6. Experimental and Numerical Evaluation of the By-Pass Flow in a Catalytic Plate Reactor for Hydrogen Production

    DEFF Research Database (Denmark)

    Sigurdsson, Haftor Örn; Kær, Søren Knudsen

    2011-01-01

    Numerical and experimental study is performed to evaluate the reactant by-pass flow in a catalytic plate reactor with a coated wire mesh catalyst for steam reforming of methane for hydrogen generation. By-pass of unconverted methane is evaluated under different wire mesh catalyst width to reactor...... duct width ratios, the results show that altering this ratio from 0.98 to 0.96 results in an increase in by-pass mass flow of 22%. Effect of catalytic wire mesh flow resistance on by-pass flow has also been investigated and results show increased by-pass flow as catalytic wire mesh flow resistance...... increases. The numerical results are in good agreement with experimental data. The study improves the understanding of the underlying transport phenomena in these reactors and shows that the flow maldistribution in a catalytic plate reactor using a coated wire mesh has to be considered....

  7. The performance study of oxide by-passed(OB) lateral double diffused MOSFET

    Science.gov (United States)

    Tang, Pan-pan

    2016-10-01

    An SOI LDMOS device structure with Oxide By-passed(OB) was investigated and its breakdown mechanism and characteristic of structure was analyzed. Its performance was verified by 3D numerical simulation with SILVACO TCAD software. The simulated results show that the electrical field element of the device is modulated by the concept of similar Superjunction(SJ) structure. Compared with the SJ LDMOS device, OB LDMOS obtains the same breakdown voltage, simultaneously the specific on-resistance of the OB LDMOS reduces from 3.81mΩ·cm2 to 1.96mΩ·cm2, except for achieving comparable performance and overcoming the high aspect ratio of fabrication structure and the difficulty of accurate concentration match of SJ LDMOS.

  8. Containment by-pass and isolation failure detection with the expert system ALIBABA

    International Nuclear Information System (INIS)

    Janot, L.; Martin, F.; Rague, B.

    1995-01-01

    In the event of an accident arising in an EDF (Electricite de France) pressurized water reactor, the IPSN Emergency Technical Centre (CTC) would be entrusted to provide the safety authorities with technical assistance. As pad of this responsibility it would analyse and forecast the barriers status (fuel clad, reactor coolant system, containment building), and the related safety functions (subcriticality, water inventory, primary pressure and temperature control, confinement). Its assignments would also require it to evaluate the kinetics and magnitude of a possible fission products release, in progress or to come, so as to advise necessary counter measures in order to ensure the surrounding population's protection, should the occasion arise. A realistic assessment of the release requires a good knowledge of the containment quality. It is therefore important to detect potential isolation faults (isolation failure or by-pass of the third barrier) as soon as possible. Once these leaks are identified, the plant operator will set required corrective arrangements rapidly. The CTC would follow up his actions closely. If none of them happen to be effective, containment leakage would be taken into account when estimating releases. Work of the emergency team lies indeed in two main points: early localization of isolation failure or containment by-pass; following up of the plant operator actions meant to remedy the problem. In order to meet these two requirements IPSN has developed an expert system named ALIBABA. Part one presents its advantages, whereas part two describes the expert system. Part three deals with the software environment and part four offers an example of the help provided by ALIBABA

  9. New thoughts on cardiopulmonary resuscitation.

    Science.gov (United States)

    Evans, A T

    1999-05-01

    The results of cardiopulmonary resuscitation (CPR) have been distressingly poor when one considers the amount of research in this field since 1960. Accordingly, some improvements to present protocols have been suggested. Some of the suggestions can be applied by practicing veterinarians to increase the success rate for external chest massage. In addition, veterinarians are encouraged to switch to internal cardiac massage early in the resuscitation period.

  10. 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.

  11. Shade avoidance.

    Science.gov (United States)

    Casal, Jorge J

    2012-01-01

    The presence of neighboring vegetation modifies the light environment experienced by plants, generating signals that are perceived by phytochromes and cryptochromes. These signals cause large changes in plant body form and function, including enhanced growth of the hypocotyl and petioles, a more erect position of the leaves and early flowering in Arabidopsis thaliana. Collectively, these so-called shade-avoidance responses tend to reduce the degree of current or future shade by neighbors. Shade light signals increase the abundance of PHYTOCHROME INTERACTING FACTOR 4 (PIF4) and PIF5 proteins, promote the synthesis and redirection of auxin, favor the degradation of DELLA proteins and increase the expression of auxin, gibberellins and brassinosteroid-promoted genes, among other events downstream the photoreceptors. Selectively disrupting these events by genetic or pharmacological approaches affects shade-avoidance responses with an intensity that depends on the developmental context and the environment. Shade-avoidance responses provide a model to investigate the signaling networks used by plants to take advantage of the cues provided by the environment to adjust to the challenges imposed by the environment itself.

  12. Redesign of emergency water supply system by-pass line from Cernavoda NPP Unit 1 and 2 using self regulating valves

    International Nuclear Information System (INIS)

    Tenescu, Mircea; Bigu, Melania; Nita, Iulian Pavel

    2010-01-01

    In this paper one considered improving the EWS (emergency water supply system) by-pass line in order to replace current manual operated valve with an self operated valve. This change is necessary in order to reduce the human error events in operation of the system in case of a DBE (design basis earthquake). The paper describes a theoretical and practical operation of a system using self regulating flow rate valves. Basically, the elimination of a possible human error in operating a system is important for nuclear safety in case of a DBE because it makes it avoidable in normal reactor cooling systems. The paper describes checking of the functioning of this equipment in operating conditions, investigating how it responds to various operating regimes. (authors)

  13. The importance of cardiopulmonary resuscitation quality.

    Science.gov (United States)

    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.

  14. Collision avoidance

    Energy Technology Data Exchange (ETDEWEB)

    Glynn, P.

    2008-04-01

    A suite of new collision avoidance systems (CAS 1,2,3, and 4) for heavy vehicles particularly mine haul trucks, is presented for vehicles whose structure and size necessarily impeded driver visibility. The systems use probe radar systems, continuous wave Doppler radar, ultrasonic Doppler, radio frequency tagging and laser scanning technology. The main goal of the ACARP/CSIRO funded projects is to determine the appropriate use and adaptation of commercially available technologies, and where possible, produce a low cost variant suitable for use in proximity detection on large mining industry haul trucks. CAS variants produced were subjected to a field demonstration and linked to the output from the earlier CAS 1 project. The research concentrated on large mine haul trucks operating in open cut coal mines. While the results are especially applicable to the Queensland and New South Wales coal industries, they are also applicable worldwide. 1 tab.

  15. By-pass flows and temperature distribution in a hot gas duct internally insulated by carbon stone

    International Nuclear Information System (INIS)

    Konuk, A.A.

    1979-01-01

    A mathematical model has been developed to calculate by-pass flows and temperature distribution in a hot gas duct internally insulated by carbon stone rings. The equations of conservation of mass and momentum are solved for a piping system to obtain axial and radial by-pass velocities. The energy equation is solved next by a marching method to obtain the radial temperature distribution along the duct. The results, although qualitative due to simplifications in the model, are useful to study the effects of duct geometry on its performance. (Author) [pt

  16. Degradabilidad proteica y proteína by-pass en rumiantes: importancia práctica

    OpenAIRE

    Carro Travieso, María Dolores

    2016-01-01

    El racionamiento proteico de los rumiantes es complejo debido a las transformaciones que sufren las proteínas de la dieta en el rumen. Como consecuencia de estos procesos, al duodeno llega una mezcla de proteína microbiana, proteína by-pass (proteína del alimento no degradada) y proteína endógena. El conocimiento de la cantidad de aminoácidos digestibles que aportan la proteína microbiana y la proteína by-pass es fundamental para ajustar de forma precisa esta cantidad a las necesidades de los...

  17. 21 CFR 870.4380 - Cardiopulmonary bypass pump speed control.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass pump speed control. 870... Cardiopulmonary bypass pump speed control. (a) Identification. A cardiopulmonary bypass pump speed control is a... control the speed of blood pumps used in cardiopulmonary bypass surgery. (b) Classification. Class II...

  18. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass coronary pressure gauge... Cardiopulmonary bypass coronary pressure gauge. (a) Identification. A cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing...

  19. Measurement of flow by-passing and turbulent mixing in a model of a fast-reactor steam generator

    International Nuclear Information System (INIS)

    Little, A.J.; Fallows, T.; Central Electricity Generating Board, Leatherhead

    1989-01-01

    A description is given of measurements of edge by-pass velocities and turbulent mixing in a model of a fast reactor steam generator. The velocity measurements were carried out using a DANTEC triple-split fibre probe which allowed both the speed and flow angle of a velocity vector to be measured in a plane normal to the axis of the probe. The measurements revealed the presence of reverse flows in the by-pass and adjacent in-bank channels downstream of a grid plate. The magnitude of the by-pass flow was reduced considerably by the insertion of a kicker grid at the mid point between grid plates. Turbulent mixing measurements revealed that circumferential mixing in channels near the by-pass channel was up to 5 times greater than the radial mixing. The level of radial mixing at the edge of the bank was similar to that measured near the centre of the bank. A method of transposing mass diffusion measurements in air to thermal diffusivities of sodium is discussed. (orig.)

  20. Should family members witness cardiopulmonary resuscitation?

    Science.gov (United States)

    Mottillo, Salvatore; Delaney, J Scott

    2014-11-01

    What is the effect of family presence during cardiopulmonary resuscitation on family members and the medical team? Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368:1008-18. The authors sought to determine whether systematically offering relatives the option to be present during cardiopulmonary resuscitation increases the proportion of relatives with posttraumatic stress disorder-related symptoms after 90 days. Secondary outcomes included the presence of anxiety and depression symptoms in relatives, the effect of family presence on medical efforts at resuscitation, the well-being of the medical team, and the occurrence of medicolegal claims.

  1. Cardiopulmonary function and laparoscopic cholecystectomy.

    Science.gov (United States)

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  2. Cardiopulmonary Syndromes (PDQ®)—Patient Version

    Science.gov (United States)

    Expert-reviewed information summary about common conditions that produce chest symptoms. The cardiopulmonary syndromes addressed in this summary are cancer-related dyspnea, malignant pleural effusion, pericardial effusion, and superior vena cava syndrome.

  3. [Plasma ionized magnesium concentration following cardiopulmonary bypass].

    Science.gov (United States)

    Amaya, Fumimasa; Fukui, Michihiko; Tsuruta, Hiroshi; Kooguchi, Kunihiko; Shimosato, Goshun

    2002-06-01

    We performed a retrospective study to analyze plasma ionized magnesium concentration following cardiopulmonary bypass. Severe decrease of ionized magnesium concentration associated with frequent abnormal ECG sign was found in a patient with magnesium-free cardioplegia. Cardioplegia containing 16 mmol.l-1 of magnesium ion maintained ionized magnesium concentration within normal ranges without postoperative magnesium loading. Use of cardioplegia containing magnesium or adequate magnesium supplement is thought to be essential for patients receiving cardiopulmonary bypass.

  4. [Proximal vein by-pass in the treatment of venous stenosis in expanded polytetrafluoroethylene prosthesis for hemodialysis].

    Science.gov (United States)

    Vega Menéndez, D; Polo Melero, J R; Flores, A; Rueda, J A; López Baena, J A; García Pajares, R; González Tabares, E

    2000-02-01

    To show the long-term results of 97 politetraflouroethylene dialysis grafts submitted to a graft by-pass to treat graft-vein stenosis. Venous stenoses were studied and diagnosed by means of fistulography in cases with fistula dysfunction or during surgery for graft thrombectomy. Both early and late complication rates were studied, as well as primary and secondary patency rates. Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropathy: 19.5%. Types of grafts in which stenoses developed: straight forearms 13; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular 4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follow-up time: 21 +/- 5 months. Late complication rate: 0.30 episodes per graft-year of follow-up. Re-stenosis rate: 0.12 graft-year of follow-up. Primary cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four years, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71% at one, two, three and four years, respectively (p < 0.0016). No differences were observed between secondary patency observed after by-pass to treat dysfunction or thrombosis (p = 0.09259). In our experience, by-pass to proximal vein is associated with good results both at short and long term, probably because the intimal hyperplasia area is excluded and because by-pass is performed on an already dilated vein. The procedure can be performed under local anesthesia and in an outpatient basis between dialysis, with little discomfort for the patient.

  5. Current issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Sayre, Michael R; Swor, Robert; Pepe, Paul E; Overton, Jerry

    2003-01-01

    Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome. In current EMS dispatch practice, traditional cardiopulmonary resuscitation (CPR) instructions are given when needed to bystanders who report a possible cardiac arrest. Recent literature has shown that in certain circumstances, CPR instructions involving chest compressions alone may be given more quickly and can yield an equivalent, if not better, chance of survival. Although this practice is controversial, the general consensus is that any CPR is better than none at all. Therefore, telephone CPR protocols that recommend the immediate initiation of chest compressions may be preferred, particularly for callers who have no previous training in CPR.

  6. Family presence during cardiopulmonary resuscitation.

    Science.gov (United States)

    Jabre, Patricia; Belpomme, Vanessa; Azoulay, Elie; Jacob, Line; Bertrand, Lionel; Lapostolle, Frederic; Tazarourte, Karim; Bouilleau, Guillem; Pinaud, Virginie; Broche, Claire; Normand, Domitille; Baubet, Thierry; Ricard-Hibon, Agnes; Istria, Jacques; Beltramini, Alexandra; Alheritiere, Armelle; Assez, Nathalie; Nace, Lionel; Vivien, Benoit; Turi, Laurent; Launay, Stephane; Desmaizieres, Michel; Borron, Stephen W; Vicaut, Eric; Adnet, Frederic

    2013-03-14

    The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial. We enrolled 570 relatives of patients who were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims. In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medicolegal claims. Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).

  7. 21 CFR 870.4250 - Cardiopulmonary bypass temperature controller.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass temperature controller. 870.4250 Section 870.4250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Cardiopulmonary bypass temperature controller. (a) Identification. A cardiopulmonary bypass temperature controller...

  8. 21 CFR 870.4320 - Cardiopulmonary bypass pulsatile flow generator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass pulsatile flow generator... Cardiopulmonary bypass pulsatile flow generator. (a) Identification. A cardiopulmonary bypass pulsatile flow generator is an electrically and pneumatically operated device used to create pulsatile blood flow. The...

  9. Economic consequences of extra by-passes in district heating networks. Investment-, running- and maintenance costs; Rundgaangars ekonomiska betydelse foer fjaerrvaermenaeten. Investerings-, drift- och underhaallskostnader

    Energy Technology Data Exchange (ETDEWEB)

    Herbert, P. [AaF-Energikonsult Stockholm AB, (Sweden)

    1995-02-01

    For various reasons, extra by-passes are installed in district heating networks to ensure a high flow temperature when the water circulation is insufficient. By `extra by-pass` we here mean a connection between the distribution pipe and the return pipe. This study mainly deals with extra by-passes to prevent freezing. The estimation of the extra by-pass costs is based on the district heating rates. Our assumption is that an extra by-pass can be regarded as a substation in the district heating network, with regard to the demand for the water flow, heat and power. The reason is the difficulty to obtain available facts to estimate the real costs concerning extra by-passes. Therefore, the method can not claim that the information about the costs is exact but gives an indication of the size of them. The valves in an extra by-pass can be set more or less open. We assume that manual valves in extra by-passes are wide open. Thermostatic valves are, however, assumed to be adjusted in order to cause a very small water flow. 2 refs, 16 figs, 9 tabs, 6 appendices

  10. Particulate Matter and Cardiopulmonary Health: A Perspective.

    Science.gov (United States)

    Costa, D L

    2000-01-01

    The epidemiological evidence for PM-associated health effects continues to mount. The effects, including morbidity and mortality, are most evident in the elderly and those with preexisting impairments in cardiopulmonary health. Recent preliminary field and controlled clinical studies support these associations by suggesting that PM can alter cardiac risk factors in a manner consistent with a higher risk of second heart attack. Empirical studies in healthy animals have provided evidence that PM and its emission surrogates cause lung injury, and perhaps more importantly, these PM can exaggerate inflammatory, biochemical, hematologic, and physiologic impairments in animal models of cardiopulmonary disease. These findings have brought attention to the often underappreciated, integral structural and physiological interplay of the heart and lungs within the cardiopulmonary system, especially in conventional inhalation toxicology studies. If animal models are to enhance our understanding of PM health effects in humans, it is critical that we expand our knowledge of this interplay in both humans and animal models when the lung is challenged with PM or its copollutants. How PM modulates autonomic and other homeostatic functions of the cardiopulmonary system, particularly in those with preexisting impairments or heart-lung disease, will enhance our understanding of public health risks and the likely multiplicity of factors that determine the responsiveness of any individual.

  11. Anaesthetists' knowledge of cardiopulmonary resuscitation | Ogboli ...

    African Journals Online (AJOL)

    Background: Cardio-Pulmonary Resuscitation (CPR) is an integral part of an anaesthetist's knowledge and practice. In Nigeria, these skills are taught mainly during medical school and postgraduate training. Objectives: The study sought to assess the knowledge of anaesthetists about CPR. Methodology: A structured ...

  12. Physical training improves cardiopulmonary functional capacity and ...

    African Journals Online (AJOL)

    Physical training improves cardiopulmonary functional capacity and increases cytokine IL-10 levels in individuals with Chagas disease. Wania S Lopes, Érika C Ferreira, Suelen S Silva, Fernanda Tomiotto- Pellissier, Ivete C Costa, Wander R Pavanelli, Silvana M Araújo, Mônica L Gomes ...

  13. Knowledge and practice of cardiopulmonary resuscitation among ...

    African Journals Online (AJOL)

    Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors. Methods: Questionnaires were distributed randomly to doctors in a Nigerian University Teaching ...

  14. The Sunflower Cardiopulmonary Research Project of Children.

    Science.gov (United States)

    Greene, Leon

    A three year project designed to determine the value of a health program incorporating a cardiopulmonary fitness program is described. The instructional programs were in heart health, pulmonary health, nutrition, and physical fitness. A noncompetitive exercise and fitness period was employed in addition to the normal physical education time.…

  15. Physiological consequences : Cardiopulmonary, vestibular, and sensory aspects

    NARCIS (Netherlands)

    Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.

    2000-01-01

    Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high

  16. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital

    Science.gov (United States)

    Garg, Rakesh; Ahmed, Syed Moied; Kapoor, Mukul Chandra; Mishra, Bibhuti Bhusan; Rao, SSC Chakra; Kalandoor, M Venkatagiri; Divatia, Jigeeshu Vasishtha; Singh, Baljit

    2017-01-01

    The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS) for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation. PMID:29217852

  17. Basic cardiopulmonary life support (BCLS for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2017-01-01

    Full Text Available The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation.

  18. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  19. A fixed by-pass for the regulation of low temperature space heating systems; Un bipasse fixe pour la regulation des systemes de chauffage a basse temperature

    Energy Technology Data Exchange (ETDEWEB)

    Didier, G.

    2003-06-01

    A fixed by-pass is an important element of the regulation of a water space heating installation. It allows to stabilize the temperature, to reduce the diameter of the regulation valves and to improve their operation. This technical article makes a numerical comparison between different space heating loops involving a three-way mixing valve or a two-way mixing valve with or without a fixed by-pass. (J.S.)

  20. Artificial neural network cardiopulmonary modeling and diagnosis

    Science.gov (United States)

    Kangas, Lars J.; Keller, Paul E.

    1997-01-01

    The present invention is a method of diagnosing a cardiopulmonary condition in an individual by comparing data from a progressive multi-stage test for the individual to a non-linear multi-variate model, preferably a recurrent artificial neural network having sensor fusion. The present invention relies on a cardiovascular model developed from physiological measurements of an individual. Any differences between the modeled parameters and the parameters of an individual at a given time are used for diagnosis.

  1. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  2. Protective effect of dexmedetomidine combined with ulinastatin on cardiopulmonary function injury caused by cardiopulmonary bypass surgery

    Directory of Open Access Journals (Sweden)

    Zhu Zhu

    2016-11-01

    Full Text Available Objective: To analyze the protective effect of dexmedetomidine combined with ulinastatin on cardiopulmonary function impairment caused by cardiopulmonary bypass surgery. Methods: A total of 78 patients who received valve replacement under cardiopulmonary bypass were divided into observation group and control group (n=39 according to random number table. Control group received intraoperative ulinastatin intervention and observation group received intraoperative dexmedetomidine combined with ulinastatin intervention. Differences in the levels of cardiac function indexes, myocardial injury markers, pulmonary function parameters, inflammatory indexes and so on were compared between two groups of patients 24 hours after operation. Results: Cardiac function parameters LSV, RSV and RVEF values of observation group 24 hours after operation were higher than those of control group while PAP value was lower than that of control group; serum myocardial injury markers H-FABP, cTn-T, CKMB, cTnⅠ and NT-proBNP levels were lower than those of control group; lung function parameters Cs and Cd values were higher than those of control group while RI, R5-R20, X5 and Fres values were lower than those of control group; serum pro-inflammatory factors IL-6 and TNF-α levels were lower than those of control group while anti-inflammatory factors sTNF-RI, IL-4 and IL-10 levels were higher than those of control group. Conclusions: Dexmedetomidine combined with ulinastatin can protect the cardiopulmonary function in patients with cardiopulmonary bypass, and help to reduce the occurrence of postoperative cardiopulmonary dysfunction and other severe complications.

  3. Color-avoiding percolation

    Science.gov (United States)

    Krause, Sebastian M.; Danziger, Michael M.; Zlatić, Vinko

    2017-08-01

    Many real world networks have groups of similar nodes which are vulnerable to the same failure or adversary. Nodes can be colored in such a way that colors encode the shared vulnerabilities. Using multiple paths to avoid these vulnerabilities can greatly improve network robustness, if such paths exist. Color-avoiding percolation provides a theoretical framework for analyzing this scenario, focusing on the maximal set of nodes which can be connected via multiple color-avoiding paths. In this paper we extend the basic theory of color-avoiding percolation that was published in S. M. Krause et al. [Phys. Rev. X 6, 041022 (2016)], 10.1103/PhysRevX.6.041022. We explicitly account for the fact that the same particular link can be part of different paths avoiding different colors. This fact was previously accounted for with a heuristic approximation. Here we propose a better method for solving this problem which is substantially more accurate for many avoided colors. Further, we formulate our method with differentiated node functions, either as senders and receivers, or as transmitters. In both functions, nodes can be explicitly trusted or avoided. With only one avoided color we obtain standard percolation. Avoiding additional colors one by one, we can understand the critical behavior of color-avoiding percolation. For unequal color frequencies, we find that the colors with the largest frequencies control the critical threshold and exponent. Colors of small frequencies have only a minor influence on color-avoiding connectivity, thus allowing for approximations.

  4. Ceftriaxone-Associated Biliary and Cardiopulmonary Adverse Events in Neonates: A Systematic Review of the Literature.

    Science.gov (United States)

    Donnelly, Patrick C; Sutich, Rebecca M; Easton, Ryan; Adejumo, Oluwatunmise A; Lee, Todd A; Logan, Latania K

    2017-02-01

    Ceftriaxone is a third-generation cephalosporin with broad-spectrum activity against both Gram-positive and Gram-negative bacteria. Despite its effectiveness, its use for the treatment of infections in neonatal patients has been limited because of concern about its potential toxicity. Our aim was to review the literature for an association between ceftriaxone and cardiopulmonary events, hyperbilirubinemia, and pseudolithiasis among neonates. We searched PubMed and EMBASE and included studies that evaluated ceftriaxone safety in neonates. Study bias was evaluated in the following domains: exposure measurement, outcome measurement, attrition, generalizability, confounding, statistical analysis, and reporting. We included nine studies regarding ceftriaxone side effects, primarily spontaneous reports, published case reports, and small case series. Reports of bilirubin displacement attributed to ceftriaxone included increases in serum bilirubin necessitating antibiotic change in a subset of infants after administration of ceftriaxone. One study described self-resolving biliary sludge after ceftriaxone administration in six of 80 infants. Cardiopulmonary adverse events included a report of eight cardiopulmonary events related to concomitant ceftriaxone-calcium infusion, including seven infant deaths. Additional cardiopulmonary events reported included perinatal asphyxia, pulmonary hypertension, and thrombocytosis. However, the available literature had small sample sizes, poor external validity, and inconsistent outcome ascertainment methods, which made it impossible to estimate the magnitude of risk. Concomitant administration of intravenous ceftriaxone and calcium-containing solutions should be avoided in neonates. However, further controlled studies are needed to assess whether bilirubin displacement associated with the use of ceftriaxone is clinically relevant, particularly in healthy term and near-term neonates with mild hyperbilirubinemia.

  5. Comparison of current practices of cardiopulmonary perfusion technology in Iran with American Society of Extracorporeal Technology's standards.

    Science.gov (United States)

    Faravan, Amir; Mohammadi, Nooredin; Alizadeh Ghavidel, Alireza; Toutounchi, Mohammad Zia; Ghanbari, Ameneh; Mazloomi, Mehran

    2016-01-01

    Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology. In this descriptive study, data was collected from 48 Iranian public hospitals and educational health centers through a researcher-created questionnaire. The data collection questionnaire assessed the standards which are recommended by American Society of Extracorporeal Technology. Findings showed that appropriate measurements were carried out by the perfusion technology staffs to prevent the hemodilution and avoid the blood transfusion and unnecessary blood products, determine the initial dose of heparin based on one of the proposed methods, monitor the anticoagulants based on ACT measurement, and determine the additional doses of heparin during the cardiopulmonary bypass based on ACT or protamine titration. It was done only in 4.2% of hospitals and health centers. Current practices of cardiopulmonary perfusion technology in Iran are inappropriate based on the standards of American Society of Cardiovascular Perfusion. This represents the necessity of authorities' attention to the validation programs and development of the caring standards on one hand and continuous assessment of using these standards on the other hand.

  6. 21 CFR 870.4390 - Cardiopulmonary bypass pump tubing.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass pump tubing. 870.4390... bypass pump tubing. (a) Identification. A cardiopulmonary bypass pump tubing is polymeric tubing which is used in the blood pump head and which is cyclically compressed by the pump to cause the blood to flow...

  7. Normal values for cardiopulmonary exercise testing in children

    NARCIS (Netherlands)

    ten Harkel, A.D.J.; Takken, T.; van Osch-Gevers, M.; Helbing, W.A.

    BACKGROUND: A reference set of data of normal values of newly developed cardiopulmonary parameters of exercise testing in an 8-18-year-old population is lacking. PATIENTS AND METHODS: Cardiopulmonary exercise testing was performed in 175 healthy school children (8-18 years old). Continuous

  8. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood or...

  9. 21 CFR 870.4300 - Cardiopulmonary bypass gas control unit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass gas control unit. 870.4300... bypass gas control unit. (a) Identification. A cardiopulmonary bypass gas control unit is a device used to control and measure the flow of gas into the oxygenator. The device is calibrated for a specific...

  10. Building and Application of Cardiopulmonary Bypass Model in Rats

    Directory of Open Access Journals (Sweden)

    Zhang Kun

    2017-01-01

    Full Text Available To build a cardiopulmonary bypass model in rats, and research the feasibility. Method Cardiopulmonary bypass was built in 10 adult male SD rats of clean grade through intubation in jugular vein, caudal artery, and femoral artery, and bypass was sustained for 60 min at the flow rate of 100ml/(kg•min to monitor heart rate, blood pressure, blood gas, and electrolyte. Result Puncture succeeded in all the 20 rats, and cardiopulmonary bypass was finished under given conditions. Conclusion The model has the following advantages, economical efficiency, simplicity, minimal invasion, cardiopulmonary bypass parameter setting similar to that of clinical trail, high rate of success. Thus, it is reliable for researching pathological and physiological changes after cardiopulmonary bypass and evaluating therapeutic strategy.

  11. Surveillance Avoidance Technique Demonstration.

    Science.gov (United States)

    1983-12-02

    path and, using the evaluation module for feedback , alter the path until acceptable surveil- lance avoidance performance is achieved. The current ISAS...Nmber Diselav Stage Containing - Date: I I Time ( GIlT ): Figure 3-46: Textual Display for GRAPHICAL Module 3-64 Surveillance Avoidance Final Report System

  12. Biological value (in vitro and in sacco of chemically treated feather as rumen by pass protein source

    Directory of Open Access Journals (Sweden)

    W Puastuti

    2004-06-01

    degradation and the amount of fraction degraded during 24 hours in the rumen were affected by the HCl concentration and the durations of hydrolysis (P<0.01 indicating that more feather meal protein was hydrolized by HCl, therefore weakened or cut the chain of amino acid in the feather protein. Treatment with 12% HCl for 4 days hydrolysis of feather meal resulted in CP fraction degradation during 24 hours incubation in the rumen of 53%, indicating that the potency of CP of HBA as rumen by pass protein was 47%.

  13. Ketosis After Cardiopulmonary Bypass in Children Is Associated With an Inadequate Balance Between Oxygen Transport and Consumption.

    Science.gov (United States)

    Klee, Philippe; Arni, Delphine; Saudan, Sonja; Schwitzgebel, Valérie M; Sharma, Ruchika; Karam, Oliver; Rimensberger, Peter C

    2016-09-01

    Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment. Prospective observational study, in which insulin treatment was initiated when postoperative blood glucose levels were more than 12 mmol/L (216 mg/dL). Tertiary PICU. Ninety-six patients 6 months to 16 years old undergoing cardiac surgery with cardiopulmonary bypass. None. Metabolic tests were performed before anesthesia, at the end of cardiopulmonary bypass, at PICU admission, and 4 and 12 hours after PICU admission, as well as 4 hours after initiation of insulin treatment. Ketosis was present in 17.9% patients at the end of cardiopulmonary bypass and in 31.2% at PICU admission. Young age was an independent risk factor for this condition. Ketosis at PICU admission was an independent risk factor for an increased difference between arterial and venous oxygen saturation. Four hours after admission (p = 0.05). Insulin corrected ketosis within 4 hours. In this study, we found a high prevalence of ketosis at PICU admission, especially in young children. This was independently associated with an imbalance between oxygen transport and consumption and was corrected by insulin. These results set the basis for future randomized controlled trials, to test whether this subgroup of patients might benefit from increased glucose intake and insulin during surgery to avoid ketosis, as improving oxygen transport and consumption might improve patient outcome.

  14. A New Cross-By-Pass-Torus Architecture Based on CBP-Mesh and Torus Interconnection for On-Chip Communication.

    Science.gov (United States)

    Gulzari, Usman Ali; Sajid, Muhammad; Anjum, Sheraz; Agha, Shahrukh; Torres, Frank Sill

    2016-01-01

    A Mesh topology is one of the most promising architecture due to its regular and simple structure for on-chip communication. Performance of mesh topology degraded greatly by increasing the network size due to small bisection width and large network diameter. In order to overcome this limitation, many researchers presented modified Mesh design by adding some extra links to improve its performance in terms of network latency and power consumption. The Cross-By-Pass-Mesh was presented by us as an improved version of Mesh topology by intelligent addition of extra links. This paper presents an efficient topology named Cross-By-Pass-Torus for further increase in the performance of the Cross-By-Pass-Mesh topology. The proposed design merges the best features of the Cross-By-Pass-Mesh and Torus, to reduce the network diameter, minimize the average number of hops between nodes, increase the bisection width and to enhance the overall performance of the network. In this paper, the architectural design of the topology is presented and analyzed against similar kind of 2D topologies in terms of average latency, throughput and power consumption. In order to certify the actual behavior of proposed topology, the synthetic traffic trace and five different real embedded application workloads are applied to the proposed as well as other competitor network topologies. The simulation results indicate that Cross-By-Pass-Torus is an efficient candidate among its predecessor's and competitor topologies due to its less average latency and increased throughput at a slight cost in network power and energy for on-chip communication.

  15. A New Cross-By-Pass-Torus Architecture Based on CBP-Mesh and Torus Interconnection for On-Chip Communication.

    Directory of Open Access Journals (Sweden)

    Usman Ali Gulzari

    Full Text Available A Mesh topology is one of the most promising architecture due to its regular and simple structure for on-chip communication. Performance of mesh topology degraded greatly by increasing the network size due to small bisection width and large network diameter. In order to overcome this limitation, many researchers presented modified Mesh design by adding some extra links to improve its performance in terms of network latency and power consumption. The Cross-By-Pass-Mesh was presented by us as an improved version of Mesh topology by intelligent addition of extra links. This paper presents an efficient topology named Cross-By-Pass-Torus for further increase in the performance of the Cross-By-Pass-Mesh topology. The proposed design merges the best features of the Cross-By-Pass-Mesh and Torus, to reduce the network diameter, minimize the average number of hops between nodes, increase the bisection width and to enhance the overall performance of the network. In this paper, the architectural design of the topology is presented and analyzed against similar kind of 2D topologies in terms of average latency, throughput and power consumption. In order to certify the actual behavior of proposed topology, the synthetic traffic trace and five different real embedded application workloads are applied to the proposed as well as other competitor network topologies. The simulation results indicate that Cross-By-Pass-Torus is an efficient candidate among its predecessor's and competitor topologies due to its less average latency and increased throughput at a slight cost in network power and energy for on-chip communication.

  16. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing.

    Science.gov (United States)

    Berg, Robert A; Sutton, Robert M; Holubkov, Richard; Nicholson, Carol E; Dean, J Michael; Harrison, Rick; Heidemann, Sabrina; Meert, Kathleen; Newth, Christopher; Moler, Frank; Pollack, Murray; Dalton, Heidi; Doctor, Allan; Wessel, David; Berger, John; Shanley, Thomas; Carcillo, Joseph; Nadkarni, Vinay M

    2013-10-01

    The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes. Prospective and observational study. Total of 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database. Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute. None. The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87-91% vs 2004-2010: 94-96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004-2010 compared with 2000-2003 (relative risk, 1.08; 95% CI, 1.03-1.13). In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.

  17. Comprehensive cardiopulmonary life support (CCLS for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2017-01-01

    Full Text Available The cardiopulmonary resuscitation (CPR guideline of comprehensive cardiopulmonary life support (CCLS for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care.

  18. Some Medicolegal Aspects of the Russian Cardiopulmonary Resuscitation Protocol

    Directory of Open Access Journals (Sweden)

    V. A. Kuksinsky

    2006-01-01

    Full Text Available The purpose of the study was to analyze the Russian legislation to identify the medicolegal aspects of cardiopulmonary resuscitation, which are most significant for an intensive care anesthesiologist. Statutory acts concerning human health care, including those pertinent to cardiopulmonary resuscitation and those providing for the responsibility of medical workers in some cases were analyzed. A number of discrepancies in various legal acts concerning human death verification and resuscitative measures were identified. The analysis has revealed the aspects of cardiopulmonary resuscitation, which are, from the point of view of legislation, most important for the physician.

  19. Avoidant personality disorder

    Science.gov (United States)

    American Psychiatric Association. Avoidant personality disorder. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 . 5th ed. Arlington, VA: American Psychiatric Publishing. 2013;672-675. Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA, Hopwood ...

  20. Neuromorphic UAS Collision Avoidance

    Data.gov (United States)

    National Aeronautics and Space Administration — Collision avoidance for unmanned aerial systems (UAS) traveling at high relative speeds is a challenging task. It requires both the detection of a possible collision...

  1. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Science.gov (United States)

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali

    2015-04-01

    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  2. Factor V Leiden and Cardiopulmonary Bypass.

    Science.gov (United States)

    Uppal, Victor; Rosin, Mark; Marcoux, Jo-Anne; Olson, Marnie; Bezaire, Jennifer; Dalshaug, Gregory

    2015-12-01

    We present a case of a patient with factor V Leiden with an antithrombin III activity of 67% who received a successful aortic valve replacement supported by cardiopulmonary bypass (CPB). A safe level of anticoagulation was achieved by monitoring activated clotting time (ACT) and heparin concentration ensuring adequate anticoagulation throughout the procedure. Results from ACT, heparin dose response, heparin protamine titration, and thrombelastography are given. Factor V Leiden patients can be safely anti-coagulated using heparin for CPB procedures when monitored with ACT, heparin protamine titration, and thrombelastography. Postoperative chest tube losses were 360 mL, less than half our institutional average. Anticoagulation for the pre-and post-operative phase is also discussed.

  3. Measuring Cardiac Output during Cardiopulmonary Exercise Testing.

    Science.gov (United States)

    Vignati, Carlo; Cattadori, Gaia

    2017-07-01

    Cardiac output is a key parameter in the assessment of cardiac function, and its measurement is fundamental to the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, cardiac output determination during exercise had been only possible through invasive methods, which were not practical in the clinical setting. Because [Formula: see text]o 2 is cardiac output times arteriovenous content difference, evaluation of cardiac output is usually included in its measurement. Because of the difficulty of directly measuring peak exercise cardiac output, indirect surrogate parameters have been proposed, but with only modest clinical usefulness. Direct measurement of cardiac output can now be made by several noninvasive techniques, such as rebreathing inert gases, impedance cardiology, thoracic bioreactance, estimated continuous cardiac output technology, and transthoracic echocardiography coupled to cardiopulmonary exercise testing, which allow more definitive results and better understanding of the underlying physiopathology.

  4. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

    NARCIS (Netherlands)

    Dijkema, Marieke B A; van Strien, Robert T; van der Zee, Saskia C; Mallant, Sanne F; Fischer, Paul; Hoek, Gerard; Brunekreef, Bert; Gehring, Ulrike

    2016-01-01

    BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with

  5. Cardiopulmonary Syndromes (PDQ®)—Health Professional Version

    Science.gov (United States)

    Expert-reviewed information summary about common conditions that produce chest symptoms. The cardiopulmonary syndromes addressed in this summary are cancer-related dyspnea, malignant pleural effusion, pericardial effusion, and superior vena cava syndrome.

  6. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Siminelakis Stavros N

    2010-01-01

    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  7. Reactive Collision Avoidance Algorithm

    Science.gov (United States)

    Scharf, Daniel; Acikmese, Behcet; Ploen, Scott; Hadaegh, Fred

    2010-01-01

    The reactive collision avoidance (RCA) algorithm allows a spacecraft to find a fuel-optimal trajectory for avoiding an arbitrary number of colliding spacecraft in real time while accounting for acceleration limits. In addition to spacecraft, the technology can be used for vehicles that can accelerate in any direction, such as helicopters and submersibles. In contrast to existing, passive algorithms that simultaneously design trajectories for a cluster of vehicles working to achieve a common goal, RCA is implemented onboard spacecraft only when an imminent collision is detected, and then plans a collision avoidance maneuver for only that host vehicle, thus preventing a collision in an off-nominal situation for which passive algorithms cannot. An example scenario for such a situation might be when a spacecraft in the cluster is approaching another one, but enters safe mode and begins to drift. Functionally, the RCA detects colliding spacecraft, plans an evasion trajectory by solving the Evasion Trajectory Problem (ETP), and then recovers after the collision is avoided. A direct optimization approach was used to develop the algorithm so it can run in real time. In this innovation, a parameterized class of avoidance trajectories is specified, and then the optimal trajectory is found by searching over the parameters. The class of trajectories is selected as bang-off-bang as motivated by optimal control theory. That is, an avoiding spacecraft first applies full acceleration in a constant direction, then coasts, and finally applies full acceleration to stop. The parameter optimization problem can be solved offline and stored as a look-up table of values. Using a look-up table allows the algorithm to run in real time. Given a colliding spacecraft, the properties of the collision geometry serve as indices of the look-up table that gives the optimal trajectory. For multiple colliding spacecraft, the set of trajectories that avoid all spacecraft is rapidly searched on

  8. The Level Of Knowlege Guidelines Cardiopulmonary Resuscitation For Nurses

    OpenAIRE

    Lukešová, Ludmila

    2012-01-01

    The goal of this thesis is to determine the level of theoretical knowledge of the procedures of cardiopulmonary resuscitation of selected non-medical staff members in VFN in Prague. The work is subdivided into a theoretical and a practical part. In the first part I comment on the history of cardiopulmonary resuscitation, the basic and widespread vital support to adults and children and the didactics of CPR. In the second- practical part I compare the theoretical knowledge of CPR of selected n...

  9. Cardiopulmonary disease in the geriatric dog and cat

    International Nuclear Information System (INIS)

    Miller, M.S.; Tilley, L.P.; Smith, F.W.K. Jr.

    1989-01-01

    The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs

  10. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine

    OpenAIRE

    Passaroni, Andréia Cristina; Silva, Marcos Augusto de Moraes; Yoshida, Winston Bonetti

    2015-01-01

    AbstractObjective:To provide a brief review of the development of cardiopulmonary bypass.Methods:A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation.Results:The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from vari...

  11. Outcome of cardiopulmonary resuscitation - predictors of survival

    International Nuclear Information System (INIS)

    Ishtiaq, O.; Iqbal, M.; Zubair, M.; Qayyum, R.; Adil, M.

    2008-01-01

    To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95% CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95% CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95% CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95% CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95% CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95% CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95% CI = 0.85-0.96, p-value = 0.001), and total atropine dose given during CPR (odds ratio = 0.68, 95% CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio 8.69, 95% CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95% CI = 0.87-0.98, p-value = 0.01) were associated with survival at

  12. Human pathogen avoidance adaptations

    NARCIS (Netherlands)

    Tybur, J.M.; Lieberman, D.

    2016-01-01

    Over the past few decades, researchers have become increasingly interested in the adaptations guiding the avoidance of disease-causing organisms. Here we discuss the latest developments in this area, including a recently developed information-processing model of the adaptations underlying pathogen

  13. Avoiding the Flu

    Science.gov (United States)

    ... on. Feature: Flu Avoiding the Flu Past Issues / Fall 2009 Table of Contents Children from six months of age and young people up to 24 years of age are particularly at risk this year from the 2009 H1N1 flu. They ...

  14. Evaluation of dose–response relationship between smoking load and cardiopulmonary fitness in adult smokers: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    V.T. Lauria

    2017-03-01

    Full Text Available Objective: To evaluate the dose–response relationship between smoking load and cardiopulmonary fitness, as measured with cardiopulmonary exercise testing (CPET, in adult smokers free of respiratory diseases. Methods: After a complete clinical evaluation and spirometry, 95 adult smokers (35 men and 60 women underwent CPET on a treadmill. Results: The physiological responses during CPET showed lower cardiorespiratory fitness levels, regardless of smoking load, with a peak V′O2 lower than 100% of the expected value and a lower maximum heart rate. We observed a significant moderate negative correlation between smoking load and peak V′O2. The smoking load also presented a significant negative correlation with maximum heart rate(r = −0.36; p < 0.05, lactate threshold(r = −0.45; p < 0.05, and peak ventilation(r = −0.43; p < 0.05. However, a dose–response relationship between smoking load quartiles and cardiopulmonary fitness was not found comparing quartiles of smoking loads after adjustment for age, sex and cardiovascular risk. Conclusion: There appears to be no dose–response relationship between SL and cardiopulmonary fitness in adult smokers with preserved pulmonary function, after adjusting the analysis for age and cardiovascular risk. Our results suggest that smoking cessation might be useful as the primary strategy to prevent cardiopulmonary fitness decline in smokers, regardless of smoking load. Thus, even a very low dose of tobacco use must be avoided in preventive strategies focusing on becoming people more physically active and fit. Keywords: Smoking load, Cardiopulmonary exercise testing, Spirometry, Physical fitness, Tobacco use disorder

  15. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  16. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation

    Directory of Open Access Journals (Sweden)

    Artur Haddad Herdy

    Full Text Available Abstract Cardiopulmonary exercise test (CPET has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2; carbon dioxide production (VCO2; and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test.

  17. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  18. 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.

  19. Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Li, E S; Cheung, P-Y; O'Reilly, M; Aziz, K; Schmölzer, G M

    2015-02-01

    To assess development of fatigue during chest compressions (CCs) in simulated neonatal cardiopulmonary resuscitation (CPR). Prospective randomized manikin crossover study. Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using (i) 3:1 compression:ventilation (C:V) ratio, (ii) continuous CC with asynchronous ventilation (CCaV) at a rate of 90 CC per min and (iii) CCaV at 120 CC per min for a duration of 10 min on a neonatal manikin. Changes in peak pressure (a surrogate of fatigue) and CC rate were continuously recorded and fatigue among groups was compared. Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial. Compared with baseline, a significant decrease in peak pressure was observed after 72, 96 and 156 s in group CCaV-120, CCaV-90 and 3:1 C:V, respectively. CC depth decreased by 50% within the first 3 min during CCaV-120, 30% during CCaV-90 and 20% during 3:1 C:V. Moreover, 3:1 C:V and CCaV were similarly preferred by healthcare professionals. Similarly, 3:1 C:V and CCaV CPR were also fatiguing. We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR.

  20. Obstacles to bystander cardiopulmonary resuscitation in Japan.

    Science.gov (United States)

    Shibata, K; Taniguchi, T; Yoshida, M; Yamamoto, K

    2000-05-01

    bystander cardiopulmonary resuscitation (CPR) is performed infrequently in Japan. We conducted this study to identify Japanese attitudes toward the performance of bystander CPR. participants were asked about their willingness to perform CPR with varying scenarios and CPR techniques (mouth-to-mouth ventilation plus chest compression (MMV plus CC) versus chest compression alone (CC)). a total of 1302/1355 individuals completed the questionnaire, including high school students, teachers, emergency medical technicians, medical nurses, and medical students. About 2% of high school students, 3% of teachers, 26% of emergency medical technicians, 3% of medical nurses and 16% of medical students claimed they would 'definitely' perform MMV plus CC on a stranger. However, 21-72% claimed they would prefer the alternative of performing CC alone. Respondents claimed their unwillingness to perform MMV is not due to the fear of contracting a communicable disease, but the lack of confidence in their ability to perform CPR properly. in all categories of respondents, willingness to perform MMV plus CC for a stranger was disappointingly low. Better training in MMV together with teaching awareness that CC alone can be given should be instituted to maximize the number of potential providers of CPR in the community, even in communities where the incidence of HIV is very low.

  1. Ventilation Strategies during Neonatal Cardiopulmonary Resuscitation

    Science.gov (United States)

    Baik, Nariae; O’Reilly, Megan; Fray, Caroline; van Os, Sylvia; Cheung, Po-Yin; Schmölzer, Georg M.

    2018-01-01

    Approximately, 10–20% of newborns require breathing assistance at birth, which remains the cornerstone of neonatal resuscitation. Fortunately, the need for chest compression (CC) or medications in the delivery room (DR) is rare. About 0.1% of term infants and up to 15% of preterm infants receive these interventions, this will result in approximately one million newborn deaths annually worldwide. In addition, CC or medications (epinephrine) are more frequent in the preterm population (~15%) due to birth asphyxia. A recent study reported that only 6 per 10,000 infants received epinephrine in the DR. Further, the study reported that infants receiving epinephrine during resuscitation had a high incidence of mortality (41%) and short-term neurologic morbidity (57% hypoxic-ischemic encephalopathy and seizures). A recent review of newborns who received prolonged CC and epinephrine but had no signs of life at 10 min following birth noted 83% mortality, with 93% of survivors suffering moderate-to-severe disability. The poor prognosis associated with receiving CC alone or with medications in the DR raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. PMID:29484288

  2. Avoiding Simplicity Is Complex

    Science.gov (United States)

    Allender, Eric

    It is a trivial observation that every decidable set has strings of length n with Kolmogorov complexity logn + O(1) if it has any strings of length n at all. Things become much more interesting when one asks whether a similar property holds when one considers resource-bounded Kolmogorov complexity. This is the question considered here: Can a feasible set A avoid accepting strings of low resource-bounded Kolmogorov complexity, while still accepting some (or many) strings of length n?

  3. Flocking with Obstacle Avoidance

    Science.gov (United States)

    2003-02-15

    combination of these three protocols led to creation of the first animation of flocking in 1987. In [17], the society of boids is viewed as a distributed...clearly a centralized algorithm which is highly undesirable for flocking due to its high communication cost. The second approach is feasible if the net is... Flocking with Obstacle Avoidance ∗ Reza Olfati Saber † e-mail: olfati@cds.caltech.edu February 15, 2003 Technical Report CIT-CDS 03-006 Abstract In

  4. delta-Opioid-induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation.

    Science.gov (United States)

    Fang, Xiangshao; Tang, Wanchun; Sun, Shijie; Weil, Max Harry

    2006-12-01

    Cardiac arrest and cardiopulmonary resuscitation is an event of global myocardial ischemia and reperfusion, which is associated with severe postresuscitation myocardial dysfunction and fatal outcome. Evidence has demonstrated that mammalian hibernation is triggered by cyclic variation of a delta-opiate-like compound in endogenous serum, during which the myocardial metabolism is dramatically reduced and the myocardium tolerates the stress of ischemia and reperfusion without overt ischemic and reperfusion injury. Previous investigations also proved that the delta-opioid agonist elicited the cardioprotection in a model of regional ischemic intact heart or myocyte. Accordingly, we were prompted to search for an alternative intervention of pharmacologically induced myocardial hibernation that would result in rapid reductions of myocardial metabolism and therefore minimize the myocardial ischemic and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. Prospective, controlled laboratory study. University-affiliated research laboratory. In the series of studies performed in the established rat and pig model of cardiac arrest and cardiopulmonary resuscitation, the delta-opioid receptor agonist, pentazocine, was administered during ventricular fibrillation. : The myocardial metabolism reflected by the concentration of lactate, or myocardial tissue PCO2 and PO2, is dramatically reduced during cardiac arrest and cardiopulmonary resuscitation. These are associated with less severe postresuscitation myocardial dysfunction and longer duration of postresuscitation survival. delta-Opioid-induced pharmacologic myocardial hibernation is an option to minimize the myocardial ischemia and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation.

  5. Experimental study of the core grid by-pass orifices inlet pressure drop of the new core of the R A 6 reactor

    International Nuclear Information System (INIS)

    Masson, V. P; Garcia, J. C; Delmastro, D. F

    2006-01-01

    In this work the core grid by-pass orifices inlet pressure drop of the new core of the R A6 reactor are experimentally studied.The experiments are performed using a 1:1 scale mock-up of an external fuel element cell.Different gaps between fuel elements are considered in order to take into account the design allowances. Different flows are considered to take into account the normal operation flow range.Measurement uncertainties are included.The results will be used to calculate the core flow distribution [es

  6. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Aman Jyoti

    2014-01-01

    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  7. Obstructive sleep apnea, inflammation, and cardiopulmonary disease.

    Science.gov (United States)

    Arter, Jim L; Chi, David S; M, Girish; Fitzgerald, S Matthew; Guha, Bhuvana; Krishnaswamy, Guha

    2004-09-01

    Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.

  8. 21 CFR 870.4360 - Nonroller-type cardiopulmonary bypass blood pump.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonroller-type cardiopulmonary bypass blood pump... Nonroller-type cardiopulmonary bypass blood pump. (a) Identification. A nonroller-type cardiopulmonary bypass blood pump is a device that uses a method other than revolving rollers to pump the blood through...

  9. 21 CFR 870.4370 - Roller-type cardiopulmonary bypass blood pump.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Roller-type cardiopulmonary bypass blood pump. 870... Roller-type cardiopulmonary bypass blood pump. (a) Identification. A roller-type cardiopulmonary bypass blood pump is a device that uses a revolving roller mechanism to pump the blood through the...

  10. 21 CFR 870.4260 - Cardiopulmonary bypass arterial line blood filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass arterial line blood filter... Cardiopulmonary bypass arterial line blood filter. (a) Identification. A cardiopulmonary bypass arterial line blood filter is a device used as part of a gas exchange (oxygenator) system to filter nonbiologic...

  11. Cardiopulmonary fitness and muscle strength in patients with osteogenesis imperfecta type I

    NARCIS (Netherlands)

    Takken, Tim; Terlingen, Heike C.; Helders, Paul J. M.; Pruijs, Hans; van der Ent, Cornelis K.; Engelbert, Raoul H. H.

    2004-01-01

    To evaluate cardiopulmonary function, muscle strength, and cardiopulmonary fitness (VO 2 peak) in patients with osteogenesis imperfecta (OI). In 17 patients with OI type I (mean age 13.3 +/- 3.9 years) cardiopulmonary function was assessed at rest using spirometry, plethysmography,

  12. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class II...

  13. Avoidable waste management costs

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP.

  14. Avoidable waste management costs

    International Nuclear Information System (INIS)

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP

  15. Synchronization and Cardio-pulmonary feedback in Sleep Apnea

    Science.gov (United States)

    Xu, Limei; Ivanov, Plamen Ch.; Chen, Zhi; Hu, Kun; Paydarfar, David; Stanley, H. Eugene

    2004-03-01

    Findings indicate a dynamical coupling between respiratory and cardiac function. However, the nature of this nonlinear interaction remains not well understood. We investigate transient patterns in the cardio-pulmonary interaction under healthy conditions by means of cross-correlation and nonlinear synchronization techniques, and we compare how these patterns change under pathologic conditions such as obstructive sleep apnea --- a periodic cessation of breathing during sleep. We find that during apnea episodes the nonlinear features of cardio-pulmonary interaction change intermittently, and can exhibit variations characterized by different time delays in the phase synchronization between breathing and heartbeat dynamics.

  16. Effect of by-pass and effluent recirculation on nitrogen removal in hybrid constructed wetlands for domestic and industrial wastewater treatment.

    Science.gov (United States)

    Torrijos, V; Gonzalo, O G; Trueba-Santiso, A; Ruiz, I; Soto, M

    2016-10-15

    Hybrid constructed wetlands (CWs) including subsurface horizontal flow (HF) and vertical flow (VF) steps look for effective nitrification and denitrification through the combination of anaerobic/anoxic and aerobic conditions. Several CW configurations including several configurations of single pass systems (HF + HF, VF + VF, VF + HF), the Bp(VF + HF) arrangement (with feeding by-pass) and the R(HF + VF) system (with effluent recirculation) were tested treating synthetic domestic wastewater. Two HF/VF area ratios (AR) were tested for the VF + HF and Bp(VF + HF) systems. In addition, a R(VF + VF) system was tested for the treatment of a high strength industrial wastewater. The percentage removal of TSS, COD and BOD5 was usually higher than 95% in all systems. The single pass systems showed TN removal below the threshold of 50% and low removal rates (0.6-1.2 g TN/m(2) d), except the VF + VF system which reached 63% and 3.5 g TN/m(2) d removal but only at high loading rates. Bp(VF + HF) systems required by-pass ratios of 40-50% and increased TN removal rates to approximately 50-60% in a sustainable manner. Removal rates depended on the AR value, increasing from 1.6 (AR 2.0) to 5.2 g TN/m(2) d (AR 0.5), both working with synthetic domestic wastewater. On real domestic wastewater the Bp (VF + HF) (AR 0.5 and 30% by-pass) reached 2.5 g TN/m(2) d removal rate. Effluent recirculation significantly improved the TN removal efficiency and rate. The R(HF + VF) system showed stable TN removals of approximately 80% at loading rates ranging from 2 to 8 g TN/m(2) d. High TN removal rates (up to 73% TN and 8.4 g TN/m(2) d) were also obtained for the R(VF + VF) system treating industrial wastewater. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

    Science.gov (United States)

    Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.

    2016-01-01

    Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514

  18. Predicting the need for blood during cardiopulmonary bypass

    African Journals Online (AJOL)

    Adele

    ness of autologous blood transfusions during open heart surgery. AR Coetzee, JF Coetzee. Department of Anesthesiology and Critical Care, School of Medicine, Faculty of Health Sciences, University of Stellenbosch, South Africa. Abstract. Background: Haematocrit (Hct) values <18%-20% during cardiopulmonary bypass ...

  19. Cardio-pulmonary manifestations of rheumatoid arthritis among ...

    African Journals Online (AJOL)

    Background: Rheumatoid arthritis is a chronic systemic inflammatory disease, characterized by polyarthritis and extraarticular manifestations. The cardiopulmonary manifestations of rheumatoid arthritis were studied retrospectively in a cohort of rheumatoid arthritis patients. Methods: This was a retrospective study of all ...

  20. Retention of knowledge of and skills in cardiopulmonary ...

    African Journals Online (AJOL)

    2009-10-31

    Oct 31, 2009 ... Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however .... score initial. Knowledge score at three months. Skills test initial. Skills test at three months. CPR frequency. No of times manual read. Age and gender. 1. PMO. A + E.

  1. Family presence during cardiopulmonary resuscitation and invasive procedures in children.

    Science.gov (United States)

    Ferreira, Cristiana Araújo G; Balbino, Flávia Simphronio; Balieiro, Maria Magda F G; Mandetta, Myriam Aparecida

    2014-03-01

    To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Most articles were published in the United States (80%), in Medicine and Nursing (46%), and were surveys (72%) with healthcare team members (67%) as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a) to develop a sensitizing program for healthcare team; b) to educate the healthcare team to include the family in these circumstances; c) to develop a written institutional policy; d) to ensure the attendance of family's needs. Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  2. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    Directory of Open Access Journals (Sweden)

    Cristiana Araujo G. Ferreira

    2014-03-01

    Full Text Available Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Data synthesis : Most articles were published in the United States (80%, in Medicine and Nursing (46%, and were surveys (72% with healthcare team members (67% as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a to develop a sensitizing program for healthcare team; b to educate the healthcare team to include the family in these circumstances; c to develop a written institutional policy; d to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  3. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    NARCIS (Netherlands)

    Cherpanath, T. G. V.; Lagrand, W. K.; Schultz, M. J.; Groeneveld, A. B. J.

    2013-01-01

    Cardiopulmonary interactions induced by mechanical ventilation are complex and only partly understood. Applied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes in right

  4. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

    2004-01-01

    The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

  5. Comparison of Cardio-Pulmonary Responses to Forward and ...

    African Journals Online (AJOL)

    ... locomotion elicits a greater metabolic demand and cardiopulmonary response than forward locomotion. In general, these data suggest that while undergoing rehabilitation an injured athlete may continue to exercise using backward walking/running at an intensity sufficient enough to maintain cardiovascular fitness levels.

  6. Cardiopulmonary fitness is related to disease severity in multiple sclerosis

    NARCIS (Netherlands)

    Heine, Martin; Wens, Inez; Langeskov-Christensen, Martin; Verschuren, Olaf; Eijnde, Bert O; Kwakkel, Gert; Dalgas, Ulrik

    2015-01-01

    BACKGROUND: In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. OBJECTIVE: To investigate the association between disease severity and

  7. Swarm Robotics with Circular Formation Motion Including Obstacles Avoidance

    Directory of Open Access Journals (Sweden)

    Nabil M. Hewahi

    2017-07-01

    Full Text Available The robots science has been developed over the past few years, where robots have become used to accomplish difficult, repetitive or accurate tasks, which are very hard for humans to carry out. In this paper, we propose an algorithm to control the motion of a swarm of robots and make them able to avoid obstacles. The proposed solution is based on forming the robots in circular fashion. A group set of robots consists of multiple groups of robots, each group of robots consists of robots forming a circular shape and each group set is a circular form of robots. The proposed algorithm is concerned with first locating the randomly generated robots in groups and secondly with the swarm robot motion and finally with the swarm obstacle avoidance and swarm reorganization after crossing the obstacle. The proposed algorithm has been simulated with five different obstacles with various numbers of randomly generated robots. The results show that the swarm in the circular form can deal with the obstacles very effectively by passing the obstacles smoothly. The proposed algorithm has been compared with flocking algorithm and it is shown that the circular formation algorithm does not need extensive computation after obstacle avoidance whereas the flocking algorithm needs extensive computation. In addition, the circular formation algorithm maintains every robot in its group after avoiding the obstacles whereas with flocking algorithm does not.

  8. The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation.

    Science.gov (United States)

    Abelairas-Gómez, Cristian; Barcala-Furelos, Roberto; Szarpak, Łukasz; García-García, Óscar; Paz-Domínguez, Álvaro; López-García, Sergio; Rodríguez-Núñez, Antonio

    2017-01-01

    Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation. To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2). After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experi-mental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007). A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

  9. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation.

    Science.gov (United States)

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; Araújo, Claudio Gil Soares de; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; Almeida, Antonio Eduardo Monteiro de; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

    2016-11-01

    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o

  10. Improvements in Low-cost Ultrasonic Measurements of Blood Flow in "by-passes" Using Narrow & Broad Band Transit-time Procedures

    Science.gov (United States)

    Ramos, A.; Calas, H.; Diez, L.; Moreno, E.; Prohías, J.; Villar, A.; Carrillo, E.; Jiménez, A.; Pereira, W. C. A.; Von Krüger, M. A.

    The cardio-pathology by ischemia is an important cause of death, but the re-vascularization of coronary arteries (by-pass operation) is an useful solution to reduce associated morbidity improving quality of life in patients. During these surgeries, the flow in coronary vessels must be measured, using non-invasive ultrasonic methods, known as transit time flow measurements (TTFM), which are the most accurate option nowadays. TTFM is a common intra-operative tool, in conjunction with classic Doppler velocimetry, to check the quality of these surgery processes for implanting grafts in parallel with the coronary arteries. This work shows important improvements achieved in flow-metering, obtained in our research laboratories (CSIC, ICIMAF, COPPE) and tested under real surgical conditions in Cardiocentro-HHA, for both narrowband NB and broadband BB regimes, by applying results of a CYTED multinational project (Ultrasonic & computational systems for cardiovascular diagnostics). mathematical models and phantoms were created to evaluate accurately flow measurements, in laboratory conditions, before our new electronic designs and low-cost implementations, improving previous ttfm systems, which include analogic detection, acquisition & post-processing, and a portable PC. Both regimes (NB and BB), with complementary performances for different conditions, were considered. Finally, specific software was developed to offer facilities to surgeons in their interventions.

  11. Effectiveness of vehicle weight enforcement in a developing country using weigh-in-motion sorting system considering vehicle by-pass and enforcement capability

    Directory of Open Access Journals (Sweden)

    Mohamed Rehan Karim

    2014-03-01

    Full Text Available Vehicle overloading has been identified as one of the major contributors to road pavement damage in Malaysia. In this study, the weigh-in-motion (WIM system has been used to function as a vehicle weight sorting tool to complement the exsiting static weigh bridge enforcement station. Data collected from the developed system is used to explore the effectiveness of using WIM system in terms of generating more accurate data for enforcement purposes and at the same time improving safety and reducing the number of vehicle weight violations on the roads. This study specifically focus on the effect of vehicle by-pass and static weigh station enforcement capability on the overall effectiveness of vehicle weight enforcement system in a developing country. Results from this study suggest that the WIM system will significantly enhance the effectiveness and efficiency of the current vehicle weight enforcement, thus generating substantial revenue that would greatly off-set the current road maintenance budget that comes from tax payers money. If there is substantial reduction in overloaded vehicles, the public will still gain through reduction in road maintenance budget, less accident risks involving heavy trucks, and lesser greenhouse gases (GHGs emissions.

  12. Healthcare avoidance: a critical review.

    Science.gov (United States)

    Byrne, Sharon K

    2008-01-01

    The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

  13. Stimulus conflict triggers behavioral avoidance.

    Science.gov (United States)

    Dignath, David; Eder, Andreas B

    2015-12-01

    According to a recent extension of the conflict-monitoring theory, conflict between two competing response tendencies is registered as an aversive event and triggers a motivation to avoid the source of conflict. In the present study, we tested this assumption. Over five experiments, we examined whether conflict is associated with an avoidance motivation and whether stimulus conflict or response conflict triggers an avoidance tendency. Participants first performed a color Stroop task. In a subsequent motivation test, participants responded to Stroop stimuli with approach- and avoidance-related lever movements. These results showed that Stroop-conflict stimuli increased the frequency of avoidance responses in a free-choice motivation test, and also increased the speed of avoidance relative to approach responses in a forced-choice test. High and low proportions of response conflict in the Stroop task had no effect on avoidance in the motivation test. Avoidance of conflict was, however, obtained even with new conflict stimuli that had not been presented before in a Stroop task, and when the Stroop task was replaced with an unrelated filler task. Taken together, these results suggest that stimulus conflict is sufficient to trigger avoidance.

  14. Cardiopulmonary exercise testing in the assessment of exertional dyspnea

    Directory of Open Access Journals (Sweden)

    Debapriya Datta

    2015-01-01

    Full Text Available Dyspnea on exertion is a commonly encountered problem in clinical practice. It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic. Cardiopulmonary exercise testing (CPET measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea. Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized. The objective of this review is to provide a comprehensible overview of the underlying principles of exercise physiology, indications and contraindications of CPET, methodology and interpretative strategies involved and thereby increase the understanding of the insights that can be gained from the use of CPET.

  15. Climate change. A global threat to cardiopulmonary health.

    Science.gov (United States)

    Rice, Mary B; Thurston, George D; Balmes, John R; Pinkerton, Kent E

    2014-03-01

    Recent changes in the global climate system have resulted in excess mortality and morbidity, particularly among susceptible individuals with preexisting cardiopulmonary disease. These weather patterns are projected to continue and intensify as a result of rising CO2 levels, according to the most recent projections by climate scientists. In this Pulmonary Perspective, motivated by the American Thoracic Society Committees on Environmental Health Policy and International Health, we review the global human health consequences of projected changes in climate for which there is a high level of confidence and scientific evidence of health effects, with a focus on cardiopulmonary health. We discuss how many of the climate-related health effects will disproportionally affect people from economically disadvantaged parts of the world, who contribute relatively little to CO2 emissions. Last, we discuss the financial implications of climate change solutions from a public health perspective and argue for a harmonized approach to clean air and climate change policies.

  16. Retrospective investigation of cardiopulmonary resuscitation outcome in 146 exotic animals.

    Science.gov (United States)

    Onuma, Mamoru; Kondo, Hirotaka; Ono, Sadaharu; Murakami, Akiyoshi; Harada, Tomoko; Sano, Tadashi

    2017-09-29

    The outcomes of cardiopulmonary resuscitation (CPR) were retrospectively evaluated in 146 exotic animals including 20 pet birds, 47 rabbits, 34 hamsters, 18 ferrets, 7 turtles and 20 other small mammals in cardiopulmonary arrest (CPA) at presentation or during hospitalization at an animal clinic. The rates of return of spontaneous circulation, survival after CPR and discharge were 9.3, 2.3 and 1.2%, respectively. The mean success rate of CPR in animals included in this study was lower than those previously reported in dogs and cats. This might have been because of the challenges in effective chest compression, airway management and monitoring as well as establishment of intravenous catheterization route in exotic animals.

  17. Does obstructive sleep apnea impair the cardiopulmonary response to exercise?

    Science.gov (United States)

    Rizzi, Camila F; Cintra, Fatima; Mello-Fujita, Luciane; Rios, Lais F; Mendonca, Elisangela T; Feres, Marcia C; Tufik, Sergio; Poyares, Dalva

    2013-04-01

    The aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls. Case-control study. The study was carried out in Sao Paulo Sleep Institute, Sao Paulo, Brazil. INDIVIDUALS WITH SIMILAR AGES WERE ALLOCATED INTO GROUPS: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group. The participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry. The apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO2) and time of SaO2 exercise cardiorespiratory function.

  18. Ocular, bulbar, limb, and cardiopulmonary involvement in oculopharyngeal muscular dystrophy

    DEFF Research Database (Denmark)

    Witting, N; Mensah, A; Køber, L

    2014-01-01

    OBJECTIVES: To assess skeletal muscle weakness and progression as well as the cardiopulmonary involvement in oculopharyngeal muscular dystrophy (OPMD). MATERIALS AND METHODS: Cross-sectional study including symptomatic patients with genetically confirmed OPMD. Patients were assessed by medical...... history, ptosis, ophthalmoplegia, facial and limb strength, and swallowing capability. Cardiopulmonary function was evaluated using forced expiratory capacity in 1 s (FEV1), electrocardiogram (ECG), Holter monitoring, and echocardiography. RESULTS: We included 13 symptomatic patients (six males, mean age...... was identified. CONCLUSIONS: Limiting limb weakness is common in OPMD and can even be the presenting symptom of the disease. In contrast, dysphagia was not the initial symptom in any of our patients, although it was obligatory for diagnosing OPMD before genetic testing became available. Mild respiratory...

  19. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    DEFF Research Database (Denmark)

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E

    1990-01-01

    /kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary...

  20. Transfusion requirements in elective cardiopulmonary bypass surgery patients

    DEFF Research Database (Denmark)

    Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye

    2017-01-01

    Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...

  1. Hantavirus cardiopulmonary syndrome: a report of two cases

    OpenAIRE

    Marcos Lazaro Moreli; Vivaldo Gomes da Costa; Daiane Pereira da Silva Novaes; Enia Cristina Flor; Juliana Freitas Silva; Keila Rejane Guimarães Vilela; Cácia Régia de Paula

    2013-01-01

    Infection with hantavirus, from the family Bunyaviridae, causes hantavirus cardiopulmonary syndrome (HCPS) in the Americas. This highly lethal anthropozoonosis afflicts preferentially individuals in rural areas and is transmitted by aerosol of excreta from infected wild rodents. The aim of this study is to report the almost simultaneous occurrence of two cases of HCPS in the municipality of Jataí, state of Goiás, Brazil.

  2. Hantavirus cardiopulmonary syndrome: a report of two cases

    Directory of Open Access Journals (Sweden)

    Marcos Lazaro Moreli

    2013-10-01

    Full Text Available Infection with hantavirus, from the family Bunyaviridae, causes hantavirus cardiopulmonary syndrome (HCPS in the Americas. This highly lethal anthropozoonosis afflicts preferentially individuals in rural areas and is transmitted by aerosol of excreta from infected wild rodents. The aim of this study is to report the almost simultaneous occurrence of two cases of HCPS in the municipality of Jataí, state of Goiás, Brazil.

  3. Cardiopulmonary stress during exercise training in patients with COPD.

    Science.gov (United States)

    Probst, V S; Troosters, T; Pitta, F; Decramer, M; Gosselink, R

    2006-06-01

    Exercise training is an essential component of pulmonary rehabilitation. However, the cardiopulmonary stress imposed during different modalities of exercise training is not yet known. In the present study, the cardiopulmonary stress of a 12-week exercise training programme in 11 chronic obstructive pulmonary disease (COPD) patients (forced expiratory volume in one second 42+/-12%pred, age 69+/-6 yrs) was measured. Pulmonary gas exchange and cardiac frequency (f(C)) of three training sessions were measured with a portable metabolic system at the beginning, mid-term and end of the programme. Symptoms were assessed with Borg scores. The exercise intensity was compared with the recommendations for exercise training by the American College of Sports Medicine (ACSM). Training effects were significant (maximum change in work: 14+/-11 Watts, 6-min walk test: 44+/-36 m). Whole body exercises (cycling, walking and stair climbing) consistently resulted in higher cardiopulmonary stress (oxygen uptake (V'(O(2))), minute ventilation and f(C)) than arm cranking and resistance training. Dyspnoea was higher during cycling than resistance training. Patients exercised for >70% (>20 min) of the total exercise time at >40% of the V'(O(2)) reserve and f(C) reserve ("moderate" intensity according to the ACSM) throughout the programme. The cardiopulmonary stress resistance training is lower than during whole-body exercise and results in fewer symptoms. In addition, exercise testing based on guidelines using a fixed percentage of baseline peak performance and symptom scores achieves and sustains training intensities recommended according to the American College of Sports Medicine.

  4. Factors predicting outcome of cardiopulmonary resuscitation in a developing country: the Siriraj cardiopulmonary resuscitation registry.

    Science.gov (United States)

    Krittayaphong, Rungroj; Saengsung, Panisara; Chawaruechai, Tanawin; Yindeengam, Ahthit; Udompunturak, Suthipol

    2009-05-01

    Outcomes of cardiac arrest and cardiopulmonary resuscitation (CPR) are not usually evaluated or monitored extensively in developing countries. To determine the outcome of CPR and the factors predicting its outcome. Siriraj Hospital is a 2,400-bed, 17-building, university hospital. Data were analyzed from the Siriraj CPR registry which was modified from the Utstein template. Data entry consisted of demographic data, reason for cardiac arrest, rhythm causing cardiac arrest, type of ward, type of department, status of patients before the event as well as sequence of action including the use of medications and outcome of CPR. The primary outcomes were rated to return of spontaneous circulation (ROSC) and survival to discharge. Univariate and multivariable logistic regression analysis were performed. Approximately 95,000 patients were admitted to the hospital each year. There were a total of 2,747 CPR reports during the time frame from January 2003 to December 2006. Of these 57.9% were males. The average age was 53.3 +/- 25.2 years. Most cardiac arrests occurred in the medicine, surgery and pediatric wards. Basic life support (BLS) was started within 1 minute in 83.1% and advanced life support (ALS) was started within 4 minutes in 78.6%. Of 516 (18.8%) patients were terminal cases. Outcomes of CPR were as follows: 49.8% had ROSC, 21% survived at 24 hours, and 7.4% survived to discharge. From a logistic regression analysis, predicting factors for both ROSC and survival to discharge included non-terminal cases, witnessed arrest, non-cardiac, non-sepsis causes, and arrest during daytime. The rate of ROSC and survival to discharge from the Siriraj CPR registry were 49.8% and 7.4% respectively. Several factors can be used to predict the immediate outcome of CPR. The present analysis should help monitor the quality of CPR and post-resuscitation care and aid in the strategic planning to improve CPR outcomes.

  5. [Family presence during cardiopulmonary resuscitation and other invasive procedures].

    Science.gov (United States)

    Prati, Gabriele; Monti, Massimo

    2010-01-01

    Family presence during patient cardiopulmonary resuscitation and other invasive procedures has been discussed and debated since the early 1990s. Although family presence was nor a well-practiced phenomenon, nor generally accepted, since the early to mid 1990s many American professional organizations have endorsed the idea of family presence. The aim of this study is to identify the policies, preferences, and practices of critical care and emergency personnel for having patients' families present during medical procedures and cardiopulmonary resuscitation. A total of 378 nurses and medical workers filled out a 10-item survey. Among the respondents, nurses tended to disagree more with family presence in comparison to physician. Critical care unit personnel tended to disagree more with family presence in comparison to emergency department personnel and especially pre-hospital care personnel. While 83% of participants disagree with family presence during cardiopulmonary resuscitation, 67% of participant endorse the view that family presence may foster collaboration between family members and staff members. Overall, 92% of participants worked on units without written policies allowing family presence. Training programs aimed at disseminating knowledge about the relational aspects of health care and the development of written policies or guidelines for family presence during medical procedures are recommended.

  6. Sedative and cardiopulmonary effects of buprenorphine and xylazine in horses.

    Science.gov (United States)

    Cruz, Fernando S F; Carregaro, Adriano B; Machado, Melissa; Antonow, Rômulo R

    2011-01-01

    This study investigated the sedative, cardiopulmonary, and gastrointestinal effects produced by buprenorphine and xylazine given in combination to horses. Six healthy adult horses underwent 4 randomized treatments, with an interval of 1 wk between treatments. A control group was given a saline solution intravenously (IV) and the experimental groups received buprenorphine [10 μg/kg bodyweight (BW)] in combination with 1 of 3 different doses of xylazine: 0.25 mg/kg BW (BX25), 0.50 mg/kg BW (BX50), or 0.75 mg/kg BW (BX75), all of them by IV. Cardiopulmonary parameters were evaluated for 120 min after the drugs were administered and intestinal motility was observed for 12 h after treatment. Sedation was found to be dose-dependent in all groups receiving buprenorphine and xylazine and it was observed that the heart rate decreased in the first 5 min and increased at the end of the sedation period. Arterial blood gas tension analyses showed minimal alterations during the experiment. Gastrointestinal hypomotility was observed for up to 8 h. The combination of buprenorphine and 0.50 mg/kg BW of xylazine (BX50) provided a 30-minute period of sedation without intense ataxia and maintained cardiopulmonary parameters within acceptable limits for the species.

  7. Risk factors of severe hand, foot and mouth disease complicated with cardiopulmonary collapse.

    Science.gov (United States)

    Song, Chunlan; Yibing, Cheng; Guo, Yanjun; Jin, Zhipeng; Cui, Yajie; Gu, Xue

    2015-07-01

    The aim of this study was to investigate the risk factors for severe hand, foot and mouth disease (HFMD) complicated with cardiopulmonary collapse in children. In total, 176 children aged 6-45 months with severe HFMD from March 2013 to May 2014 were enrolled in the study and divided into two groups, one with cardiopulmonary collapse and the other without. Univariate analysis and multiple logistic regression analysis were used to analyze the risk factors for severe HFMD complicated with cardiopulmonary collapse. The univariate analysis showed that there was no significant correlation between age, body temperature, consciousness disorders, blood glucose level and severe HFMD complicated with cardiopulmonary collapse. The multiple logistic regression analysis demonstrated that vomiting, circulatory disturbance, enterovirus 71 infection, dysfunction of respiratory rhythm and high level of brain natriuretic peptide were five independent risk factors for severe HFMD complicated with cardiopulmonary collapse. Children with HFMD and the above five risk factors may be at risk for cardiopulmonary collapse and poor prognosis.

  8. Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

    Science.gov (United States)

    Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

    2017-10-01

    To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

  9. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Kawahito, Shinji; Higuchi, Seiichi; Mita, Naoji; Kitagawa, Tetsuya; Kitahata, Hiroshi

    2013-12-01

    We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.

  10. Conflict Avoidance and University Management.

    Science.gov (United States)

    Tagliacozzo, Daisy M.

    The conditions that intensify conflict avoidance by the central administration in making strategic decisions, and the consequences of such avoidance for the management of college affairs, are discussed. The implication of an emerging decision-making style for adapting the organization to changing environments is also considered. Some of the…

  11. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

    Directory of Open Access Journals (Sweden)

    Bartholomay Eduardo

    2003-01-01

    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  12. Surgical Treatment of Renal Cell Carcinoma with Inferior Vena Cava Thrombus: Using Liver Mobilization Technique to Avoid Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Tawatchai Taweemonkongsap

    2008-04-01

    CONCLUSION: These results support the aggressive surgical removal of RCC with IVC thrombus as the initial treatment. Most of the thrombi can be approached and safely controlled by a transabdominal approach without any form of bypass. Tumour thrombus removal provides a high survival chance and offers improvement in quality of life.

  13. Traveler's Health: Avoid Bug Bites

    Science.gov (United States)

    ... fabric. Avoid Bugs Where You Are Staying Choose hotel rooms or other accommodations that are air conditioned ... to Us Policies FOIA Accessibility Privacy No FEAR Act Inspector General USA.gov Contact CDC Centers for ...

  14. Avoided intersections of nodal lines

    International Nuclear Information System (INIS)

    Monastra, Alejandro G; Smilansky, Uzy; Gnutzmann, Sven

    2003-01-01

    We consider real eigenfunctions of the Schroedinger operator in 2D. The nodal lines of separable systems form a regular grid, and the number of nodal crossings equals the number of nodal domains. In contrast, for wavefunctions of non-integrable systems nodal intersections are rare, and for random waves, the expected number of intersections in any finite area vanishes. However, nodal lines display characteristic avoided crossings which we study in this work. We define a measure for the avoidance range and compute its distribution for the random wave ensemble. We show that the avoidance range distribution of wavefunctions of chaotic systems follows the expected random wave distributions, whereas for wavefunctions of classically integrable but quantum non-separable systems, the distribution is quite different. Thus, the study of the avoidance distribution provides more support to the conjecture that nodal structures of chaotic systems are reproduced by the predictions of the random wave ensemble

  15. Predator avoidance in extremophile fish

    OpenAIRE

    Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin

    2013-01-01

    Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions...

  16. Predator avoidance in extremophile fish.

    Science.gov (United States)

    Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin

    2013-02-06

    Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii) females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre) and the adjacent sulfidic surface creek (El Azufre), we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve) and wild-caught (i.e., predator-experienced) individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1) that predator avoidance is still functional in extremophile Poecilia spp. and (2) that predator recognition and avoidance reactions have a strong genetic basis.

  17. Predator Avoidance in Extremophile Fish

    Directory of Open Access Journals (Sweden)

    Martin Plath

    2013-02-01

    Full Text Available Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre and the adjacent sulfidic surface creek (El Azufre, we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve and wild-caught (i.e., predator-experienced individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1 that predator avoidance is still functional in extremophile Poecilia spp. and (2 that predator recognition and avoidance reactions have a strong genetic basis.

  18. Impaired cardiopulmonary exercise capacity in patients with hyperthyroidism.

    Science.gov (United States)

    Kahaly, G; Hellermann, J; Mohr-Kahaly, S; Treese, N

    1996-01-01

    Hyperthyroidism (H) has been implicated as a primary cause of decreased exercise tolerance. To our knowledge, analysis of respiratory gas exchange, an efficient noninvasive method in evaluating cardiopulmonary capacity, has not been performed in patients with H. Using cardiopulmonary exercise testing, 12 consecutive women with Graves' H were examined and controlled in euthyroidism (E). Eighteen women with E, in whom cardiac catheterization had ruled out heart disease, served as control subjects (C). The ventilatory anaerobic threshold was determined by means of the V-slope method. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol of 20 W/min. Echocardiography at rest was performed in all patients. In patients with H, heart rate at rest was higher than in patients with E (p lower increase between rest and anaerobic threshold compared with E patients (p = 0.007) and C (p = 0.009). Work rate was reduced (H, 50% vs E, 70%; p = 0.038). In H patients, the anaerobic threshold occurred at 59.6% of maximal oxygen uptake and 72% in E patients, respectively (p = 0.024). In H patients, the linear regression of the heart rate to oxygen uptake ratio showed a reduced slope in comparison with E patients (p = 0.001) and C (p = 0.004). In patients with H, a reduced tidal volume (p = 0.021) and an increased respiratory rate (p = 0.003) in comparison to patients with E were demonstrated. Echocardiographically, H patients had an increased ejection fraction (p = 0.008) and a higher cardiac index (p = 0.008) in comparison with E patients. Analysis of respiratory gas exchange showed marked alterations of cardiopulmonary exercise capacity in H patients, which are reversible in E patients. The impaired chronotropic response during exercise might be the primary limiting factor of reduced work capacity in patients with H.

  19. Sedative and cardiopulmonary effects of buprenorphine and xylazine in horses

    OpenAIRE

    Cruz, Fernando S.F.; Carregaro, Adriano B.; Machado, Melissa; Antonow, Rômulo R.

    2011-01-01

    This study investigated the sedative, cardiopulmonary, and gastrointestinal effects produced by buprenorphine and xylazine given in combination to horses. Six healthy adult horses underwent 4 randomized treatments, with an interval of 1 wk between treatments. A control group was given a saline solution intravenously (IV) and the experimental groups received buprenorphine [10 μg/kg bodyweight (BW)] in combination with 1 of 3 different doses of xylazine: 0.25 mg/kg BW (BX25), 0.50 mg/kg BW (BX5...

  20. Delayed stenosis of the small intestine after cardiopulmonary arrest.

    Science.gov (United States)

    Adachi, Seiji; Okuno, Mitsuru; Horibe, Yohei; Ono, Tomohiko; Goto, Naoe; Nakamura, Noriaki; Iwama, Midori; Yamauchi, Osamu; Saito, Koshiro

    2014-12-01

    A man in his 70s experienced cardiopulmonary arrest (CPA) due to acute myocardial infarction. He was resuscitated and treated with a multimodal approach, and he fortunately survived CPA without neurological damage. However, abdominal pain and vomiting occurred 45 days after the CPA. Small intestinal endoscopy showed pinhole-like stenosis of the ileum. Although balloon dilation was performed through the scope, his symptoms did not improve. Partial small bowel resection was eventually performed 139 days after the CPA. Pathological findings revealed ischemic changes in the mucosa at two spots. We speculate that an ischemic event occurred in the small bowel during CPA.

  1. Cardiopulmonary Exercise Testing in Patients with Idiopathic Scoliosis.

    Science.gov (United States)

    Shen, Jianxiong; Lin, Youxi; Luo, Jinmei; Xiao, Yi

    2016-10-05

    Scoliosis causes impairment of the respiratory and cardiovascular systems. Traditional pulmonary function tests only examine patients under static conditions. The aim of our study was to investigate the correlation between radiographic parameters and dynamic cardiopulmonary capacity in patients with idiopathic scoliosis. Forty patients with idiopathic scoliosis were included in this prospective study from January 2014 to February 2016. The patients underwent full radiographic assessment of deformity, pulmonary function testing, and cardiopulmonary bicycle ergometer testing. The impact of the severity of thoracic curvature and kyphosis on pulmonary function and physical capacity was investigated. Thirty-three female patients with a mean age of 15.5 years (range, 11 to 35 years) and coronal thoracic curvature of 49.4° (range, 24° to 76°) and 7 male subjects with a mean age of 15.9 years (range, 13 to 18 years) and coronal thoracic curvature of 47.1°(range, 22° to 80°) were included. No correlation was found between coronal thoracic curvature and pulmonary function test results in the female patients. Female patients with a thoracic curve of ≥60° had lower blood oxygen saturation at maximal exercise in the cardiopulmonary exercise test (p = 0.032). Female patients with a thoracic curve of ≥50° had a higher respiratory rate (p = 0.041) and ventilation volume per minute (p = 0.046) and lower breathing reserve at maximal exercise (p = 0.038). Thoracic kyphosis in female patients was positively correlated with pulmonary function, as shown by the forced expiratory volume in 1 second (r = 0.456, p = 0.01), forced vital capacity (r = 0.366, p = 0.043), vital capacity (r = 0.525, p = 0.006), and total lung capacity (r = 0.388, p = 0.031), as well as with tidal volume (r = 0.401, p = 0.025) in cardiopulmonary exercise testing. Female patients who engaged in regular exercise had better peak oxygen intake normalized by body weight (p rate (p = 0.020), and heart rate

  2. Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages.

    Science.gov (United States)

    Carvalho Filho, Elio Barreto de; Marson, Fernando Augusto de Lima; Costa, Loredana Nilkenes Gomes da; Antunes, Nilson

    2014-01-01

    Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

  3. 21 CFR 870.4270 - Cardiopulmonary bypass cardiotomy suction line blood filter.

    Science.gov (United States)

    2010-04-01

    ... blood filter. 870.4270 Section 870.4270 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 870.4270 Cardiopulmonary bypass cardiotomy suction line blood filter. (a) Identification. A cardiopulmonary bypass cardiotomy suction line blood filter is a device used as part of a gas exchange (oxygenator...

  4. Drotrecogin alpha (activated) in two patients with the hantavirus cardiopulmonary syndrome

    OpenAIRE

    McDermid, Robert C; Gibney, RT Noel; Brisebois, Ronald J; Skjodt, Neil M

    2006-01-01

    Hantavirus cardiopulmonary syndrome (HCPS) is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure. To date, treatment remains supportive and includes mechanical ventilation, vasopressors and extracorporeal membrane oxygenation, with mortality approaching 50%. Two HCPS survivors initially given drotrecogin alpha (activated) (DAA) for presumed bacterial septic shock are described. Vasoactive ...

  5. Emergency department repair of blunt right atrial rupture utilizing cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Samuel P. Carmichael

    2017-12-01

    Full Text Available Blunt cardiac injury (BCI with free wall rupture carries a high risk of pre-hospital death. Cardiopulmonary bypass (CPB has been utilized as a bridge to repair of cardiac lesions in select patients. We present an interesting case of emergency department repair of right atrial rupture with cardiopulmonary bypass.

  6. 21 CFR 870.4290 - Cardiopulmonary bypass adaptor, stopcock, manifold, or fitting.

    Science.gov (United States)

    2010-04-01

    ..., or fitting. 870.4290 Section 870.4290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 870.4290 Cardiopulmonary bypass adaptor, stopcock, manifold, or fitting. (a) Identification. A cardiopulmonary bypass adaptor, stopcock, manifold, or fitting is a device used in cardiovascular diagnostic...

  7. Public knowledge and attitudes towards cardiopulmonary resuscitation in Hong Kong: telephone survey.

    Science.gov (United States)

    Chair, S Y; Hung, Maria S Y; Lui, Joseph C Z; Lee, Diana T F; Shiu, Irene Y C; Choi, K C

    2014-04-01

    To investigate the public's knowledge and attitudes about cardiopulmonary resuscitation in Hong Kong. Cross-sectional telephone survey. Hong Kong. Hong Kong residents aged 15 to 64 years. The knowledge and attitudes towards cardiopulmonary resuscitation. Among the 1013 respondents, only 214 (21%) reported that they had received cardiopulmonary resuscitation training. The majority (72%) of these trained respondents had had their latest training more than 2 years earlier. The main reasons for not being involved in cardiopulmonary resuscitation training included lack of time or interest, and "not necessary". People with full-time jobs and higher levels of education were more likely to have such training. Respondents stating they had received cardiopulmonary resuscitation training were more willing to try it if needed at home (odds ratio=3.3; 95% confidence interval, 2.4-4.6; Pcase of emergencies. Overall cardiopulmonary resuscitation knowledge of the respondents was low (median=1, out of 8). Among all the respondents, only four of them (0.4%) answered all the questions correctly. Knowledge of cardiopulmonary resuscitation was still poor among the public in Hong Kong and the percentage of population trained to perform it was also relatively low. Efforts are needed to promote educational activities and explore other approaches to skill reinforcement and refreshment. Besides, we suggest enacting laws to protect bystanders who offer cardiopulmonary resuscitation, and incorporation of relevant training course into secondary school and college curricula.

  8. Cardiopulmonary Exercise Testing in Children and Adolescents With Dystrophinopathies : A Pilot Study

    NARCIS (Netherlands)

    Bartels, Bart; Takken, Tim; Blank, A. Christian; van Moorsel, Huib; van der Pol, W. Ludo; de Groot, Janke F.

    2015-01-01

    Purpose: To determine exercise response during cardiopulmonary exercise testing in children and adolescents with dystrophinopathies. Methods: Exercise response on the cardiopulmonary exercise test (CPET) was compared with a standard care test protocol. Results: Nine boys (aged 10.8 +/- 4.7 years)

  9. Approach/avoidance in dreams.

    Science.gov (United States)

    Malcolm-Smith, Susan; Koopowitz, Sheri; Pantelis, Eleni; Solms, Mark

    2012-03-01

    The influential threat simulation theory (TST) asserts that dreaming yields adaptive advantage by providing a virtual environment in which threat-avoidance may be safely rehearsed. We have previously found the incidence of biologically threatening dreams to be around 20%, with successful threat avoidance occurring in approximately one-fifth of such dreams. TST asserts that threat avoidance is over-represented relative to other possible dream contents. To begin assessing this issue, we contrasted the incidence of 'avoidance' dreams with that of their opposite: 'approach' dreams. Because TST states that the threat-avoidance function is only fully activated in ecologically valid (biologically threatening) contexts, we also performed this contrast for populations living in both high- and low-threat environments. We find that 'approach' dreams are significantly more prevalent across both contexts. We suggest these results are more consistent with the view that dreaming is generated by reward-seeking systems than by fear-conditioning systems, although reward-seeking is clearly not the only factor determining the content of dreams. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

    International Nuclear Information System (INIS)

    Schellhammer, F.

    2003-01-01

    Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 ± 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations

  11. Ozone Exposure, Cardiopulmonary Health, and Obesity: A Substantive Review.

    Science.gov (United States)

    Koman, Patricia D; Mancuso, Peter

    2017-07-17

    From 1999-2014, obesity prevalence increased among adults and youth. Obese individuals may be uniquely susceptible to the proinflammatory effects of ozone because obese humans and animals have been shown to experience a greater decline in lung function than normal-weight subjects. Obesity is independently associated with limitations in lung mechanics with increased ozone dose. However, few epidemiologic studies have examined the interaction between excess weight and ozone exposure among adults. Using PubMed keyword searches and reference lists, we reviewed epidemiologic evidence to identify potential response-modifying factors and determine if obese or overweight adults are at increased risk of ozone-related health effects. We initially identified 170 studies, of which seven studies met the criteria of examining the interaction of excess weight and ozone exposure on cardiopulmonary outcomes in adults, including four short-term ozone exposure studies in controlled laboratory settings and three community epidemiologic studies. In the studies identified, obesity was associated with decreased lung function and increased inflammatory mediators. Results were inconclusive about the effect modification when data were stratified by sex. Obese and overweight populations should be considered as candidate at-risk groups for epidemiologic studies of cardiopulmonary health related to air pollution exposures. Air pollution is a modifiable risk factor that may decrease lung function among obese individuals with implications for environmental and occupational health policy.

  12. Cardiopulmonary Circuit Models for Predicting Injury to the Heart

    Science.gov (United States)

    Ward, Richard; Wing, Sarah; Bassingthwaighte, James; Neal, Maxwell

    2004-11-01

    Circuit models have been used extensively in physiology to describe cardiopulmonary function. Such models are being used in the DARPA Virtual Soldier (VS) Project* to predict the response to injury or physiological stress. The most complex model consists of systemic circulation, pulmonary circulation, and a four-chamber heart sub-model. This model also includes baroreceptor feedback, airway mechanics, gas exchange, and pleural pressure influence on the circulation. As part of the VS Project, Oak Ridge National Laboratory has been evaluating various cardiopulmonary circuit models for predicting the effects of injury to the heart. We describe, from a physicist's perspective, the concept of building circuit models, discuss both unstressed and stressed models, and show how the stressed models are used to predict effects of specific wounds. *This work was supported by a grant from the DARPA, executed by the U.S. Army Medical Research and Materiel Command/TATRC Cooperative Agreement, Contract # W81XWH-04-2-0012. The submitted manuscript has been authored by the U.S. Department of Energy, Office of Science of the Oak Ridge National Laboratory, managed for the U.S. DOE by UT-Battelle, LLC, under contract No. DE-AC05-00OR22725. Accordingly, the U.S. Government retains a non-exclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purpose.

  13. Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

    Energy Technology Data Exchange (ETDEWEB)

    Schellhammer, F. [St. Katharinen Hospital, Frechen (Germany). Dept. of Radiology

    2003-03-01

    Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 {+-} 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations.

  14. [Need of cardiopulmonary resuscitation training in the sport of soccer].

    Science.gov (United States)

    Guerra-Martín, María Dolores; Martínez-Montilla, José Manuel; Amador-Marín, Bárbara

    2016-01-01

    In Spain there are around 25,000 cardiac arrests, many of them in the presence of non-medical personnel. In less than 25% of the cardio-respiratory arrests witnessed, witnesses began cardiopulmonary resuscitation. Soccer is a contact sport with multiple physical characteristics and requirements which pushes your body to the limit, thus leading to a higher chance of developing multiple lesions, including cardio-respiratory arrest. Therefore, our goal was to know the actual situation on training in basic life support in soccer. A literature review was performed on different databases both national (IME, CUIDEN, ENCUENTR@, ENFERMERÍA AL DÍA, ISOC) and international (PUBMED, SCOPUS, CINAHL), with different MESH descriptors related to the topic. A total of 395 references were identified. 17 studies were selected; 8 of them had like main theme cardiopulmonary resuscitation and the remaining 9 spoke on the use of semi-automatic defibrillators. There is a lack of research on this topic in soccer. This strikes our attention because in this area there could be situations requiring immediate rescue action. Therefore, we emphasize the importance of early cardio-respiratory resuscitation because training in basic life support and semi-automatic defibrillators in soccer are fundamental. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  15. Gravity and the Evolution of Cardiopulmonary Morphology in Snakes

    Science.gov (United States)

    Lillywhite, Harvey B.; Albert, James S.; Sheehy, Coleman M.; Seymour, Roger S.

    2011-01-01

    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse – significantly longer heart–head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart–to–head distance and length of vascular lung are co–adaptive cardiopulmonary features of snakes. PMID:22079804

  16. Patterns of technology use in patients attending a cardiopulmonary outpatient clinic: a self-report survey.

    Science.gov (United States)

    Disler, Rebecca T; Inglis, Sally C; Newton, Phillip J; Currow, David C; Macdonald, Peter S; Glanville, Allan R; Donesky, DorAnne; Carrieri-Kohlman, Virginia; Davidson, Patricia M

    2015-03-06

    Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery. The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center. A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic. A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9%), mobile telephone (115/117, 98.3%), and Internet (104/121, 86.0%) use. Emailing (101/121, 83.4%), researching and reading news articles (93/121, 76.9%), social media (71/121, 58.7%), and day-to-day activities (65/121, 53.7%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3%), convenient and easily accessible help and information (12/111, 16.9%), and access to peer support and sharing (9/111, 12.7%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15). Chronic disease burden and long-term self-management tasks provide a

  17. Avoidance: grammatical or semantic causes?

    NARCIS (Netherlands)

    Hulstijn, J.H.; Marchena, E.

    1989-01-01

    This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is

  18. How to avoid sedation complications

    African Journals Online (AJOL)

    To ensure patient safety, it is crucial that the airway is safeguarded. The single most important responsibility is to protect it. An unobstructed airway, with intact protective reflexes and respiratory drive, is essential to avoid complications. In some procedures, e.g. dental, the airway may need to be shared with the surgeon.

  19. Avoiding plagiarism in academic writing.

    Science.gov (United States)

    Anderson, Irene

    Plagiarism means taking the work of another and presenting it as one's own, resulting in potential upset for the original author and disrepute for the professions involved. This article aims to explore the issue of plagiarism and some mechanisms for detection and avoidance.

  20. Avoiding unfavourable outcomes in liposuction

    Directory of Open Access Journals (Sweden)

    Atul Khanna

    2013-01-01

    Full Text Available The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960′s when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL and to highlight the salient points in the literature and in the senior author′s experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.

  1. [Successful management after cardiopulmonary bypass without administration of protamine in a patient with severe food allergy--beneficial result with the use of heparin-coated bypass circuit].

    Science.gov (United States)

    Sawai, Toshiyuki; Uchida, Osamu; Inamori, Shuji; Kuro, Masakazu

    2003-03-01

    We experienced the anesthetic management for cardiac surgery without the administration of protamine in a patient with severe food allergy. The patient, a 15-year-old boy, who had been avoiding many kinds of food including fish due to severe food allergy, received a correction of ventricular septal defect under cardiopulmonary bypass (CPB). To detect intraoperative drugs, including protamine, which might induce allergic reaction, we performed intradermal tests and prick tests. We used heparin-coated bypass circuit to minimize the amount of heparin necessary for anticoagulation during CPB. After CPB, hemostasis was achieved without the administration of protamine, and the patient received neither transfusion nor blood product throughout the perioperative period. Avoidance of protamine is advisable if the patient is allergic to food especially fish. The use of heparin-coated bypass circuit should be considered to establish hemostasis without protamine after CPB and to reduce blood products.

  2. Human avoidance and approach learning: evidence for overlapping neural systems and experiential avoidance modulation of avoidance neurocircuitry.

    Science.gov (United States)

    Schlund, Michael W; Magee, Sandy; Hudgins, Caleb D

    2011-12-01

    Adaptive functioning is thought to reflect a balance between approach and avoidance neural systems with imbalances often producing pathological forms of avoidance. Yet little evidence is available in healthy adults demonstrating a balance between approach and avoidance neural systems and modulation in avoidance neurocircuitry by vulnerability factors for avoidance. Consequently, we used functional magnetic resonance imaging (fMRI) to compare changes in brain activation associated with human avoidance and approach learning and modulation of avoidance neurocircuitry by experiential avoidance. fMRI tracked trial-by-trial increases in activation while adults learned through trial and error an avoidance response that prevented money loss and an approach response that produced money gain. Avoidance and approach cues elicited similar experience-dependent increases in activation in a fronto-limbic-striatal network. Positive and negative reinforcing outcomes (i.e., money gain and avoidance of loss) also elicited similar increases in activation in frontal and striatal regions. Finally, increased experiential avoidance and self-punishment coping was associated with decreased activation in medial/superior frontal regions, anterior cingulate, amygdala and hippocampus. These findings suggest avoidance and approach learning recruit a similar fronto-limbic-striatal network in healthy adults. Increased experiential avoidance also appears to be associated with reduced frontal and limbic reactivity in avoidance, establishing an important link between maladaptive avoidance coping and altered responses in avoidance neurocircuitry. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

    Science.gov (United States)

    de Carvalho Filho, Élio Barreto; Marson, Fernando Augusto de Lima; da Costa, Loredana Nilkenes Gomes; Antunes, Nilson

    2014-01-01

    Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas. PMID:25140478

  4. Quantification of cardiopulmonary blood volume turnover using dynamic PET

    DEFF Research Database (Denmark)

    Harms, Hans; Tolbod, Lars Poulsen; Kero, Tanja

    index, the central circulatory turnover (CCT) which represents the fractional exchange of blood per stroke within the cardiopulmonary blood pool and can be measured from any dynamic PET scan. Methods: Data from 111 clinical patients were analysed retrospectively. Patients underwent a 6-min 15O......Background: Dynamic 15O-water PET is used to quantify myocardial blood flow. For clinical use however, additional information regarding left ventricular performance is often required but is not obtained from standard tracer kinetic modelling. The aim of this study was to explore the use of a novel......-water scan during rest and adenosine-induced stress. Patients were categorized into 4 groups based on stress myocardial blood flow (MBF, in mL/g/min): all segments >2.3 (group 1, n=53), one vessel

  5. Cardiopulmonary auscultation: duo for strings--Opus 99.

    Science.gov (United States)

    Woywodt, A; Höfer, M; Pilz, B; Schneider, W; Dietz, R; Luft, F C

    1999-11-08

    In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.

  6. [Basic cardiopulmonary resuscitation courses for parents of newborns and infants].

    Science.gov (United States)

    Enríquez, Diego; Castro, Adriana; Rabasa, Cecilia; Capelli, Carola; Cores Ponte, Florencia; Gutiérrez, Susana; Mariani, Gonzalo; Pacchioni, Sergio; Pardo, Amorina; Pérez, Gastón; Sorgetti, Mariana; Szyld, Edgardo

    2014-04-01

    Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients' home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients' parents as well as designing and spreading learning material.

  7. The key changes in pediatric and neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Sung, Dyi-Shiang; Hsieh, Kai-Sheng

    2007-01-01

    The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) were changed in 2005. There were some key changes in the recommendations for pediatric basic and advanced life support, and neonatal resuscitation. The key changes included: emphasis on effective compressions (push hard, push fast, allow full chest recoil and minimize interruptions in compressions), a single compression-ventilation ratio (30:2) CPR for all groups of ages (except neonate), confirmation of effective ventilations, medication given and defibrillator charged without interruption of CPR, not recommended to routine tracheal suction the vigorous meconium-stained baby in newborn resuscitation, etc. We illustrate the major key changes and hope everyone is well trained to perform high quality CPR.

  8. Pre-hospital extra-corporeal cardiopulmonary resuscitation.

    Science.gov (United States)

    Singer, Ben; Reynolds, Joshua C; Lockey, David J; O'Brien, Ben

    2018-03-27

    Survival from out-of-hospital cardiac arrest (OHCA) has remained low despite advances in resuscitation science. Hospital-based extra-corporeal cardiopulmonary resuscitation (ECPR) is a novel use of an established technology that provides greater blood flow and oxygen delivery during cardiac arrest than closed chest compressions. Hospital-based ECPR is currently offered to selected OHCA patients in specialized centres. The interval between collapse and restoration of circulation is inversely associated with good clinical outcomes after ECPR. Pre-hospital delivery of ECPR concurrent with conventional resuscitation is one approach to shortening this interval and improving outcomes after OHCA. This article examines the background and rationale for pre-hospital ECPR; summarises the findings of a literature search for published evidence; and considers candidate selection, logistics, and complications for this complex intervention.

  9. Central diabetes insipidus following cardiopulmonary arrest in a dog.

    Science.gov (United States)

    Bellis, Tara; Daly, Meredith; Davidson, Benjamin

    2015-01-01

    To describe a clinical case of transient central diabetes insipidus (CDI) occurring post cardiopulmonary arrest (CPA) in a dog. An 8-week-old dog presented for intensive care after successful resuscitation following CPA. The patient exhibited neurologic deficits at initial presentation and over the following days developed marked polyuria, isosthenuria, and low urine osmolality. Treatment with synthetic vasopressin resulted in a reduction in urine output, increase in urine specific gravity (>50%), and increase in urine osmolality, suggesting a diagnosis of partial CDI. Clinical signs resolved over the following weeks and treatment was discontinued. CPA has been described as a cause of ischemic injury to the pituitary gland resulting in CDI in people. To the authors' knowledge, this is the first report of a dog developing transient partial CDI following CPA and successful resuscitation. © Veterinary Emergency and Critical Care Society 2015.

  10. [Cardiopulmonary interactions in the course of mechanical ventilation].

    Science.gov (United States)

    Lamia, B; Molano, L-C; Muir, J-F; Cuvelier, A

    2016-12-01

    The haemodynamic consequences of ventilation are multiple and complex and may affect all the determinants of cardiac performance such as heart rate, preload, contractility and afterload. These consequences affect both right and left ventricle and are also related to the biventricular interdependence. Ventilation modifies the lung volume and also the intrathoracic pressure. Variations in lung volume have consequences on the pulmonary vascular resistance, hypoxic pulmonary vasoconstriction and ventricular interdependence. Variations in intrathoracic pressure have a major impact and affect systemic venous return, right ventricular preload, left ventricular preload, right ventricular afterload, left ventricular afterload and myocardial contracility. The haemodynamic consequences of positive pressure ventilation depend on the underlying chronic cardiopulmonary pathologies leading to the acute respiratory failure that was the indication for ventilation. In this review, we will focus on severe COPD exacerbation, acute left heart failure and weaning from ventilation. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  11. Blood Pressure Response during Cardiopulmonary Exercise Testing in Heart Failure.

    Science.gov (United States)

    Il'Giovine, Zachary J; Solomon, Nicole; DeVore, Adam D; Wojdyla, Daniel; Patel, Chetan B; Rogers, Joseph G

    2018-02-21

    The prognostic value of peak VO2 and VE/VCO2 slope measured during cardiopulmonary exercise (CPX) testing has been well established in patients with advanced heart failure, but blood pressure response to exercise is less well characterized. We retrospectively studied 151 outpatients who underwent CPX testing as part of an advanced heart failure (HF) evaluation. The outcome of interest was failure of medical management, defined by death, cardiac transplantation, or left ventricular assist device placement. Patients were stratified into tertiles by change in systolic blood pressure (SBP) ( 20 mmHg were associated with an increased hazard (HR 1.046, 95% CI 1.018, 1.075). In conclusion, changes in SBP during CPX testing provide additional prognostic information above standard clinical variables. The peculiar increase in risk noted in those with a rise in SBP > 20 mmHg is less clear and needs to be investigated further.

  12. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B

    2008-01-01

    individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines......BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during...... for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify...

  13. Cardiopulmonary exercise testing after laryngectomy: A connection conundrum

    Directory of Open Access Journals (Sweden)

    Shana Overstreet

    2015-01-01

    Full Text Available A patient presents with a new bronchogenic carcinoma 5 years after laryngectomy for recurrent laryngeal tumor and 13 years after chemoradiation for concurrent lung cancer with synchronous base-of-tongue tumor. Due to his complex history and perceived limited respiratory reserve, he was felt high risk for the completion pneumonectomy needed for resection of this new tumor. The attending surgeon requested a full cardiopulmonary exercise test for risk assessment prior to surgery. We found that there was no commercially available connector that would allow our CPET equipment to reliably collect respiratory gases from a patient with tracheostomy stoma or tube. We report here a simple coupling devised “in house” that allowed for the performance of an interpretable test leading to a significant change in medical care.

  14. [Emphysematous Pyelonephritis with Cardio-Pulmonary Arrest : A Case Report].

    Science.gov (United States)

    Yamamichi, Gaku; Tsutahara, Koichi; Kuribayashi, Sohei; Kawamura, Masataka; Nakano, Kosuke; Kishimoto, Nozomu; Tanigawa, Go; Matsushima, Asako; Fujimi, Satoshi; Takao, Tetsuya; Yamaguchi, Seiji

    2016-08-01

    A 40-year-old woman withuntreated type II diabetes mellitus was discovered withcardiopulmonary arrest in her room. On admission, she had ventricular fibrillation. After cardiopulmonary resuscitation, her own pulse restarted. The plasma glucose was 722 mg/dl and venous PH was 6.704. Abdominal computed tomography revealed gas within the parenchyma of the left kidney. We diagnosed her with emphysematous pyelonephritis and conducted emergency nephrectomy. Urinary and blood cultures were positive for Escherichia coli. Antibiotic therapy was initiated with doripenem and she was restrictively treated with intravenous insulin to control her plasma glucose. On the 8th day of hospital stay, she underwent resection of the small intestine because of necrosis. After multidisciplinary therapy, she was discharged with complete resolution of the infection.

  15. Certified Basic Life Support Instructors Assess Cardiopulmonary Resuscitation Skills Poorly

    DEFF Research Database (Denmark)

    Hansen, Camilla; Rasmussen, Stinne E; Kristensen, Mette Amalie

    2016-01-01

    quality poorly. Currently no studies have evaluated CPR assessment among certified BLS instructors. The aim of this study was to investigate certified BLS instructors’ assessment of chest compressions and rescue breathing.Methods: Data were collected at BLS courses for medical students at Aarhus...... University, Denmark. In pairs, BLS instructors, certified by the European Resuscitation Council, evaluated each learner in an end-of-course cardiac arrest test. Instructors’ assessments were compared with CPR quality data collected from the resuscitation manikin. Correct chest compressions were defined as ≥2......Introduction: High-quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest. During basic life support (BLS) training, instructors assess CPR skills to enhance learning outcome. Emergency department staff and senior residents have been shown to assess chest compression...

  16. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs

    Directory of Open Access Journals (Sweden)

    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.

  17. Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel.

    Science.gov (United States)

    Monsuez, Jean-Jacques; Charniot, Jean-Christophe; Veilhan, Luc Antoine; Mougué, Ferdinand; Bellin, Marie-France; Boissonnas, Alain

    2007-05-01

    Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries. A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment. Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

  18. Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?

    Science.gov (United States)

    Rössler, B; Ziegler, M; Hüpfl, M; Fleischhackl, R; Krychtiuk, K A; Schebesta, K

    2013-07-01

    Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, pflowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Coronary blood flow during cardiopulmonary resuscitation in swine

    International Nuclear Information System (INIS)

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

    1984-01-01

    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic [EMF] and radiomicrosphere [RMS]) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal

  20. Avoidant personality disorder: current insights

    Directory of Open Access Journals (Sweden)

    Lampe L

    2018-03-01

    Full Text Available Lisa Lampe,1 Gin S Malhi2 1Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia; 2Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Abstract: Avoidant personality disorder (AVPD is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD, schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the “severity continuum hypothesis”, in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment. Keywords: avoidant personality disorder, social anxiety disorder, social cognition, psychotherapy, attachment

  1. Behavioral variability as avoidance behavior.

    Science.gov (United States)

    Fonseca Júnior, Amilcar Rodrigues; Leite Hunziker, Maria Helena

    2017-11-01

    This study aimed to investigate whether variable patterns of responses can be acquired and maintained by negative reinforcement under an avoidance contingency. Six male Wistar rats were exposed to sessions in which behavioral variability was reinforced according to a Lag contingency: Sequences of three responses on two levers had to differ from one, two or three previous sequences for shocks to be avoided (Lag 1, Lag 2 and Lag 3, respectively). Performance under the Lag conditions was compared with performance on a Yoke condition in which the animals received the same reinforcement frequency and distribution as in the Lag condition but behavioral variability was not required. The results showed that most of the subjects varied their sequences under the Lag contingencies, avoiding shocks with relatively high probability (≥ 0.7). Under the Yoke procedure, responding continued to occur with high probability, but the behavioral variability decreased. These results suggest that behavioral variability can be negatively reinforced. © 2017 Society for the Experimental Analysis of Behavior.

  2. Avoiding congestion in recommender systems

    Science.gov (United States)

    Ren, Xiaolong; Lü, Linyuan; Liu, Runran; Zhang, Jianlin

    2014-06-01

    Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user-object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods.

  3. Avoiding congestion in recommender systems

    International Nuclear Information System (INIS)

    Ren, Xiaolong; Lü, Linyuan; Liu, Runran; Zhang, Jianlin

    2014-01-01

    Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user–object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods. (paper)

  4. Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

    Science.gov (United States)

    Fong, Y T; Anantharaman, V; Lim, S H; Leong, K F; Pokkan, G

    2001-05-01

    Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

  5. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  6. Wireless System for Continuous Cardiopulmonary Monitoring in a Space Environment, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...

  7. Wireless System for Continuous Cardiopulmonary Monitoring in a Space Environment, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...

  8. Detection of Cardiopulmonary Activity and Related Abnormal Events Using Microsoft Kinect Sensor

    Directory of Open Access Journals (Sweden)

    Ali Al-Naji

    2018-03-01

    Full Text Available Monitoring of cardiopulmonary activity is a challenge when attempted under adverse conditions, including different sleeping postures, environmental settings, and an unclear region of interest (ROI. This study proposes an efficient remote imaging system based on a Microsoft Kinect v2 sensor for the observation of cardiopulmonary-signal-and-detection-related abnormal cardiopulmonary events (e.g., tachycardia, bradycardia, tachypnea, bradypnea, and central apnoea in many possible sleeping postures within varying environmental settings including in total darkness and whether the subject is covered by a blanket or not. The proposed system extracts the signal from the abdominal-thoracic region where cardiopulmonary activity is most pronounced, using a real-time image sequence captured by Kinect v2 sensor. The proposed system shows promising results in any sleep posture, regardless of illumination conditions and unclear ROI even in the presence of a blanket, whilst being reliable, safe, and cost-effective.

  9. Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response

    NARCIS (Netherlands)

    van den Goor, J.; Nieuwland, R.; van den Brink, A.; van Oeveren, W.; Rutten, 27818; Tijssen, J.; Eijsman, L.; Rutten, P

    2004-01-01

    Objective: In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated-

  10. Preliminary Development and Validation of a Paediatric Cardiopulmonary Physiotherapy Discharge Tool

    OpenAIRE

    Ellerton, Cindy; Davis, Aileen; Brooks, Dina

    2011-01-01

    Purpose: The purpose of this study was to develop a paediatric cardiopulmonary physiotherapy (CPT) discharge tool. We report on the initial stages of its development and the tool's sensibility (face/content validity, feasibility, and ease of usage).

  11. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  12. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    NARCIS (Netherlands)

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W

    2002-01-01

    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

  13. Prediction of survival to discharge following cardiopulmonary resuscitation using classification and regression trees.

    Science.gov (United States)

    Ebell, Mark H; Afonso, Anna M; Geocadin, Romergryko G

    2013-12-01

    To predict the likelihood that an inpatient who experiences cardiopulmonary arrest and undergoes cardiopulmonary resuscitation survives to discharge with good neurologic function or with mild deficits (Cerebral Performance Category score = 1). Classification and Regression Trees were used to develop branching algorithms that optimize the ability of a series of tests to correctly classify patients into two or more groups. Data from 2007 to 2008 (n = 38,092) were used to develop candidate Classification and Regression Trees models to predict the outcome of inpatient cardiopulmonary resuscitation episodes and data from 2009 (n = 14,435) to evaluate the accuracy of the models and judge the degree of over fitting. Both supervised and unsupervised approaches to model development were used. 366 hospitals participating in the Get With the Guidelines-Resuscitation registry. Adult inpatients experiencing an index episode of cardiopulmonary arrest and undergoing cardiopulmonary resuscitation in the hospital. The five candidate models had between 8 and 21 nodes and an area under the receiver operating characteristic curve from 0.718 to 0.766 in the derivation group and from 0.683 to 0.746 in the validation group. One of the supervised models had 14 nodes and classified 27.9% of patients as very unlikely to survive neurologically intact or with mild deficits (Tree models that predict survival to discharge with good neurologic function or with mild deficits following in-hospital cardiopulmonary arrest. Models like this can assist physicians and patients who are considering do-not-resuscitate orders.

  14. Relationship between Short Term Memory and Cardiopulmonary Fitness of Administrative Officers at Universitas Padjadjaran

    Directory of Open Access Journals (Sweden)

    Iswaran Ampalakan

    2016-03-01

    Full Text Available Background: The work of administrative officers depends a lot on their capability in memorizing. Increased fitness is strongly associated with a better memory. This study was conducted to determine the relationship between cardiopulmonary fitness and short term memory. Methods: This analytical cross sectional study was carried out from August to September 2014. Subjects from administrative offices within Universitas Padjadjaran were chosen by simple random sampling. 101 individuals were selected, comprising of 68 males and 33 females. Data were obtained through Digit Span Test for short term memory and the cardiopulmonary fitness was measured using Harvard Step Test. The VO2 Max obtained was correlated with the Digit Span Test score. Results: The mean for cardiopulmonary fitness of males was found to be 36.1, with standard deviation 8.63, whereas mean cardiopulmonary fitness for females was found to be 32.94, with standard deviation 7.5. For correlation analysis, the result of Spearman’s rank analysis from the study showed that the p-value is 0.00. Comparing to the significance level α=5%, the p value is worth less, thus the null hypothesis, Ho is rejected. Therefore, it could be concluded that there was a relationship between cardiopulmonary fitness and short term memory of male and female administrative officers at Universitas Padjadjaran. Conclusions: There is a relationship between cardiopulmonary fitness and short term memory of male and female administrative officers at Universitas Padjadjaran.

  15. Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest.

    Science.gov (United States)

    Hunt, Elizabeth A; Heine, Margaret; Shilkofski, Nicole S; Bradshaw, Jamie Haggerty; Nelson-McMillan, Kristen; Duval-Arnould, Jordan; Elfenbein, Ron

    2015-03-01

    To assess whether access to a voice activated decision support system (VADSS) containing video clips demonstrating resuscitation manoeuvres was associated with increased compliance with American Heart Association Basic Life Support (AHA BLS) guidelines. This was a prospective, randomised controlled trial. Subjects with no recent clinical experience were randomised to the VADSS or control group and participated in a 5-min simulated out-of-hospital cardiopulmonary arrest with another 'bystander'. Data on performance for predefined outcome measures based on the AHA BLS guidelines were abstracted from videos and the simulator log. 31 subjects were enrolled (VADSS 16 vs control 15), with no significant differences in baseline characteristics. Study subjects in the VADSS were more likely to direct the bystander to: (1) perform compressions to ventilations at the correct ratio of 30:2 (VADSS 15/16 (94%) vs control 4/15 (27%), p=compressor versus ventilator roles after 2 min (VADSS 12/16 (75%) vs control 2/15 (13%), p=0.001). The VADSS group took longer to initiate chest compressions than the control group: VADSS 159.5 (±53) s versus control 78.2 (±20) s, pcontrol 75.4 (±8.0), p=0.35. The use of an audio and video assisted decision support system during a simulated out-of-hospital cardiopulmonary arrest prompted lay rescuers to follow cardiopulmonary resuscitation (CPR) guidelines but was also associated with an unacceptable delay to starting chest compressions. Future studies should explore: (1) if video is synergistic to audio prompts, (2) how mobile technologies may be leveraged to spread CPR decision support and (3) usability testing to avoid unintended consequences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Brane singularities and their avoidance

    International Nuclear Information System (INIS)

    Antoniadis, Ignatios; Cotsakis, Spiros; Klaoudatou, Ifigeneia

    2010-01-01

    The singularity structure and the corresponding asymptotic behavior of a 3-brane coupled to a scalar field or to a perfect fluid in a five-dimensional bulk is analyzed in full generality using the method of asymptotic splittings. In the case of the scalar field, it is shown that the collapse singularity at a finite distance from the brane can be avoided only at the expense of making the brane world-volume positively or negatively curved. In the case where the bulk field content is parametrized by an analog of perfect fluid with an arbitrary equation of state P = γρ between the 'pressure' P and the 'density' ρ, our results depend crucially on the constant fluid parameter γ. (i) For γ > -1/2, the flat brane solution suffers from a collapse singularity at a finite distance that disappears in the curved case. (ii) For γ < -1, the singularity cannot be avoided and it becomes of the big rip type for a flat brane. (iii) For -1 < γ ≤ -1/2, the surprising result is found that while the curved brane solution is singular, the flat brane is not, opening the possibility for a revival of the self-tuning proposal.

  17. When not to avoid inbreeding.

    Science.gov (United States)

    Kokko, Hanna; Ots, Indrek

    2006-03-01

    Avoidance of incestuous matings is widely reported across many animal taxa, and the adaptive value of such behavior is explained through inbreeding depression. However, an old and somewhat neglected theoretical result predicts that inbred matings offer another, positive effect on the inclusive fitness of parents: an individual who mates with a relative will help that relative to spread genes identical by descent. This benefit can be substantial, if the additional mating achieved by the relative does not harm his mating success otherwise, and in the context of selfing in plants the phenomenon is well known. Here, we develop a model that derives expected values of inbreeding tolerance, that is, the magnitude of inbreeding depression that is required to make individuals avoid inbreeding, for different animal life histories and parental investment patterns. We also distinguish between simultaneous and sequential mate choice, and show that inbreeding tolerance should often be remarkably high in the latter scenario in particular, although egalitarian parental care will lead to lower tolerance. There is a mismatch between theory and data: the almost complete lack of cases where individuals prefer to mate incestuously is at odds with a large overlap between the predicted range of inbreeding tolerance and estimates of inbreeding depression found in nature. We discuss four different solutions to this enigma, and suggest that inbreeding tolerance, where it is found, should not always be attributed to a simple constraint that has prevented finding any other mate.

  18. Avoidant personality disorder: current insights.

    Science.gov (United States)

    Lampe, Lisa; Malhi, Gin S

    2018-01-01

    Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.

  19. Blue light regulated shade avoidance.

    Science.gov (United States)

    Keuskamp, Diederik H; Keller, Mercedes M; Ballaré, Carlos L; Pierik, Ronald

    2012-04-01

    Most plants grow in dense vegetation with the risk of being out-competed by neighboring plants. These neighbors can be detected not only through the depletion in light quantity that they cause, but also through the change in light quality, which plants perceive using specific photoreceptors. Both the reduction of the red:far-red ratio and the depletion of blue light are signals that induce a set of phenotypic traits, such as shoot elongation and leaf hyponasty, which increase the likelihood of light capture in dense plant stands. This set of phenotypic responses are part of the so called shade avoidance syndrome (SAS). This addendum discusses recent findings on the regulation of the SAS of Arabidopsis thaliana upon blue light depletion. Keller et al. and Keuskamp et al. show that the low blue light attenuation induced shade avoidance response of seedling and rosette-stage A. thaliana plants differ in their hormonal regulation. These studies also show there is a regulatory overlap with the R:FR-regulated SAS.

  20. Avoidant personality disorder: current insights

    Science.gov (United States)

    Lampe, Lisa; Malhi, Gin S

    2018-01-01

    Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the “severity continuum hypothesis”, in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment. PMID:29563846

  1. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass

    International Nuclear Information System (INIS)

    Croughwell, N.; Lyth, M.; Quill, T.J.; Newman, M.; Greeley, W.J.; Smith, L.R.; Reves, J.G.

    1990-01-01

    We tested the hypothesis that insulin-dependent diabetic patients with coronary artery bypass graft surgery experience altered coupling of cerebral blood flow and oxygen consumption. In a study of 23 patients (11 diabetics and 12 age-matched controls), cerebral blood flow was measured using 133Xe clearance during nonpulsatile, alpha-stat blood gas managed cardiopulmonary bypass at the conditions of hypothermia and normothermia. In diabetic patients, the cerebral blood flow at 26.6 +/- 2.42 degrees C was 25.3 +/- 14.34 ml/100 g/min and at 36.9 +/- 0.58 degrees C it was 27.3 +/- 7.40 ml/100 g/min (p = NS). The control patients increased cerebral blood flow from 20.7 +/- 6.78 ml/100 g/min at 28.4 +/- 2.81 degrees C to 37.6 +/- 8.81 ml/100 g/min at 36.5 +/- 0.45 degrees C (p less than or equal to 0.005). The oxygen consumption was calculated from jugular bulb effluent and increased from hypothermic values of 0.52 +/- 0.20 ml/100 g/min in diabetics to 1.26 +/- 0.28 ml/100 g/min (p = 0.001) at normothermia and rose from 0.60 +/- 0.27 to 1.49 +/- 0.35 ml/100 g/min (p = 0.0005) in the controls. Thus, despite temperature-mediated changes in oxygen consumption, diabetic patients did not increase cerebral blood flow as metabolism increased. Arteriovenous oxygen saturation gradients and oxygen extraction across the brain were calculated from arterial and jugular bulb blood samples. The increase in arteriovenous oxygen difference between temperature conditions in diabetic patients and controls was significantly different (p = 0.01). These data reveal that diabetic patients lose cerebral autoregulation during cardiopulmonary bypass and compensate for an imbalance in adequate oxygen delivery by increasing oxygen extraction

  2. Hormonal Regulation in Shade Avoidance

    Directory of Open Access Journals (Sweden)

    Chuanwei Yang

    2017-09-01

    Full Text Available At high vegetation density, shade-intolerant plants sense a reduction in the red (660 nm to far-red (730 nm light ratio (R/FR in addition to a general reduction in light intensity. These light signals trigger a spectrum of morphological changes manifested by growth of stem-like tissue (hypocotyl, petiole, etc. instead of harvestable organs (leaves, fruits, seeds, etc.—namely, shade avoidance syndrome (SAS. Common phenotypical changes related to SAS are changes in leaf hyponasty, an increase in hypocotyl and internode elongation and extended petioles. Prolonged shade exposure leads to early flowering, less branching, increased susceptibility to insect herbivory, and decreased seed yield. Thus, shade avoidance significantly impacts on agronomic traits. Many genetic and molecular studies have revealed that phytochromes, cryptochromes and UVR8 (UV-B photoreceptor protein monitor the changes in light intensity under shade and regulate the stability or activity of phytochrome-interacting factors (PIFs. PIF-governed modulation of the expression of auxin biosynthesis, transporter and signaling genes is the major driver for shade-induced hypocotyl elongation. Besides auxin, gibberellins, brassinosteroids, and ethylene are also required for shade-induced hypocotyl or petiole elongation growth. In leaves, accumulated auxin stimulates cytokinin oxidase expression to break down cytokinins and inhibit leaf growth. In the young buds, shade light promotes the accumulation of abscisic acid to repress branching. Shade light also represses jasmonate- and salicylic acid-induced defense responses to balance resource allocation between growth and defense. Here we will summarize recent findings relating to such hormonal regulation in SAS in Arabidopsis thaliana, Brassica rapa, and certain crops.

  3. Validation of a cardiopulmonary exercise test score in heart failure.

    Science.gov (United States)

    Myers, Jonathan; Oliveira, Ricardo; Dewey, Frederick; Arena, Ross; Guazzi, Marco; Chase, Paul; Bensimhon, Daniel; Peberdy, Mary Ann; Ashley, Euan; West, Erin; Cahalin, Lawrence P; Forman, Daniel E

    2013-03-01

    Cardiopulmonary exercise test (CPX) responses are strong predictors of outcomes in patients with heart failure. We recently developed a CPX score that integrated the additive prognostic information from CPX. The purpose of this study was to validate the score in a larger, independent sample of patients. A total of 2625 patients with heart failure underwent CPX and were followed for cardiovascular (CV) mortality and major CV events (death, transplantation, left ventricular assist device implantation). Net reclassification improvement (NRI) for the score and each of its components were determined at 3 years. The VE/VCO2 slope was the strongest predictor of risk and was attributed a relative weight of 7, with weighted scores for abnormal heart rate recovery, oxygen uptake efficiency slope, end-tidal CO2 pressure, and peak VO2 having scores of 5, 3, 3, and 2, respectively. A summed score of >15 was associated with an annual mortality rate of 12.2% and a relative risk >9 for total events, whereas a score of NRI compared with peak VO2 (category-free NRI, 0.61-0.77), and the score provided significant NRI above clinical risk factors for both CV events and mortality (NRI, 0.63 and 0.65 for CPX score compared with clinical variables alone). These results validate the application of a simple, integrated multivariable score based on readily available CPX responses.

  4. Postoperative hemodynamics after cardiopulmonary bypass in survived newborn piglets.

    Science.gov (United States)

    Tirilomis, Theodor; Nolte, Lars; Liakopoulos, Oliver J; Ballat, Carola; Steinke, Katja; Bensch, Marc; Schoendube, Friedrich A

    2009-01-01

    Cardiac function and hemodynamics are frequently decreased during the first hours after heart surgery, resulting in inotropic support for treatment and prevention of further hemodynamic deterioration. The aim of this study was analysis of hemodynamics of neonatal piglets who survived early postoperative course after cardiopulmonary bypass (CPB) and cardioplegic arrest without the use of inotropic drugs. Newborn piglets (younger than 7 days) were placed on mild hypothermic CPB (32 degrees C) for 180 minutes, including 90 minutes of cardioplegic arrest. Hemodynamics were examined after termination of CPB and none of the animals received any inotropic support. After 6 hours, survived animals were euthanized (CPB group, n=4). For control, neonatal piglets were examined for the same time interval after surgery without CPB (control group, n=3). Systolic left-ventricular pressure increased after CPB, mean arterial blood pressure and amplitude of left ventricular wall thickness decreased. Compared with control group, systolic left-ventricular pressure in CPB group was higher (p<0.05). Present data demonstrated hemodynamic depression after cardiac procedures in survived neonatal animals. Although the effects may not be solely attributed to CPB and myocardial ischemia effects may be potentiate by CPB.

  5. 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.

  6. Experimental design for study of cardiopulmonary resuscitation in dogs.

    Science.gov (United States)

    Barsan, W G; Levy, R C

    1981-03-01

    Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. Cardiac output, arterial blood pressure, and electrocardiogram were recorded for three different methods. The methods studied were closed chest compression, closed chest compression with an automatic gas-powered chest compressor, and open chest manual cardiac massage. Cardiac output for both types of external chest compression were less than 17% of control in all cases. With open chest cardiac massage, systemic arterial blood pressures were in the 50 mm Hg to 100 mm Hg range and cardiac output of up to 70% of control was achieved. Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.

  7. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  8. 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.

  9. Brain computed tomographic findings in post-cardiopulmonary resuscitation patients

    International Nuclear Information System (INIS)

    Ishida, Tsuguharu; Yoshinaga, Kazumasa; Horibe, Takashi; Kokubu, Kiyokazu; Kokura, Yoshihiro; Matsui, Konosuke; Inamoto, Kazuo.

    1986-01-01

    We retrospectively assessed the brain computed tomographic (CT) findings in 22 post-cardiopulmonary resuscitation (CPR) patients excluding neonatal cases. On the basis of the CT findings, the patients were divided into two groups. Eight patients (36.4 %) had bilateral abnormal lowdensity areas in the basal ganglia (Group I). The remaining 14 patients (63.6 %) had no abnormalities in that area (Group II). In Group I, the incidence of primary cardiac arrest and duration of advanced life support (ALS) was significantly different (p < 0.05) from Group II. Sex, age, duration of basic life support (BLS), time elapsed from initiation of BLS to initial CT and from initiation of ALS to initial CT was not significantly different between the two groups. Outcome was very poor in both groups and no significant difference was noted between them. We conclude that primary cardiac arrest and long duration of ALS were predictors of abnormal bilateral low-density areas in the basal ganglia in post-CPR patients. However, their appearance was not related to outcome. (author)

  10. Family presence during cardiopulmonary resuscitation: who should decide?

    Science.gov (United States)

    Lederman, Zohar; Garasic, Mirko; Piperberg, Michelle

    2014-05-01

    Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient's best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient's point of view. Since the patient requires CPR, he is invariably unconscious and therefore incompetent. We discuss the Autonomy Principle and the Three-Tiered process for surrogate decision making, as well as the Beneficence Principle and show that these are limited in providing us with an adequate tool for decision making in this particular case. Rather, we rely on a novel principle (or, rather, a novel specification of an existing principle) and a novel integrated model for surrogate decision making. We show that this model is more satisfactory in taking the patient's true wishes under consideration and encourages a joint decision making process by all parties involved.

  11. Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review.

    Science.gov (United States)

    Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Bernard, Stephen; Mitra, Biswadev

    2015-01-01

    Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon are not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options. The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from their commencement to the 8th July 2014. We also searched Google (scholar) for grey literature. We combined MeSH terms and text words for consciousness and CPR, and included studies of all types. The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three of these patients were sedated. Four patients arrested in the out-of-hospital setting and six arrested in hospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints. CPR-induced consciousness was infrequently reported in the medical literature, and varied in management. Given the increasing use of mechanical CPR, guidelines to identify and manage consciousness during CPR are required. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. DOES MEAN PERFUSION PRESSURE DURING CARDIOPULMONARY BYPASS AFFECT RENAL FUNCTION?

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-10-01

    Full Text Available BACKGROUND: After cardiac surgery acute kidney injury (AKI is a common and serious condition carrying significant costs and is independently associated with increased morbidity and mortality. During cardiopulmonary bypass (CPB surgery, modifiable factors may contri bute to post - operative AKI. Their prevention might be a potential target for nephroprotection and any other morbidity after cardiac surgery. METHODS AND MATERIAL : The objective of the present study was to identify and determine whether intraoperative hypot ension or any other cofactor are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End - stage renal disease. On basis of this patients were divided into two groups according to rise in serum creatinine >0.3 mg/dl till 72 hrs postoperatively. Group B patients have developed AKI (n=34 and the remaining patients were in Group A. RESULT : In our study we have found that mean arterial pressure during CPB were less in group B patients compare to group A patients which was statistically significant (p<0.001. And in this group ICU stay and mortality rate were also high compare to group A pati ent who had not developed AKI. CONCLUSION: Lower MAP during CPB is associated with development of postoperative renal derangement, leads to increase ICU stay and mortality. Larger studies are required to further support the evidence

  13. Cardiopulmonary physiology: why the heart and lungs are inextricably linked.

    Science.gov (United States)

    Verhoeff, Kevin; Mitchell, Jamie R

    2017-09-01

    Because the heart and lungs are confined within the thoracic cavity, understanding their interactions is integral for studying each system. Such interactions include changes in external constraint to the heart, blood volume redistribution (venous return), direct ventricular interaction (DVI), and left ventricular (LV) afterload. During mechanical ventilation, these interactions can be amplified and result in reduced cardiac output. For example, increased intrathoracic pressure associated with mechanical ventilation can increase external constraint and limit ventricular diastolic filling and, therefore, output. Similarly, high intrathoracic pressures can alter blood volume distribution and limit diastolic filling of both ventricles while concomitantly increasing pulmonary vascular resistance, leading to increased DVI, which may further limit LV filling. While LV afterload is generally considered to decrease with increased intrathoracic pressure, the question arises if the reduced LV afterload is primarily a consequence of a reduced LV preload. A thorough understanding of the interaction between the heart and lungs can be complicated but is essential for clinicians and health science students alike. In this teaching review, we have attempted to highlight the present understanding of certain salient aspects of cardiopulmonary physiology and pathophysiology, as well as provide a resource for multidisciplined health science educators and students. Copyright © 2017 the American Physiological Society.

  14. Family presence during cardiopulmonary resuscitation: cardiac health care professionals' perspectives.

    Science.gov (United States)

    Kosowan, Sarah; Jensen, Louise

    2011-01-01

    Family presence (FP) during cardiopulmonary resuscitation (CPR) is becoming an increasing practice. Within current literature, the attitudes and beliefs towards FP of cardiac health care professionals in Canada are limited. The purpose of this project was to examine the perceptions of cardiac health care professionals (n=368) concerning FP during CPR. A survey was conducted to explore the attitudes and beliefs of cardiac health care professionals towards family presence during CPR within five Edmonton and surrounding area hospitals. The response rate was 46%, with the greatest response from nurses and physicians. Of the respondents, 44.3% believed that family should have the option to be present, and 40.9% believed that family should be allowed at the bedside during CPR. Less than half of the respondents had experience with FP during CPR. The barriers identified towards FP were lack of support for families, the experience would be too traumatic for families, families would not understand the procedures, fear of families physically interfering with procedures, FP would increase stress levels among staff, and tradition and politics excludes FP. Despite less than half the respondents supporting FP the majority endorsed development of policy and procedures to overcome barriers to FP during CPR.

  15. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  16. 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.

  17. The effects of mobile applications in cardiopulmonary assessment education.

    Science.gov (United States)

    Yoo, In-Young; Lee, Young-Mi

    2015-02-01

    Mobile applications can be used as effective simulations for nursing education. However, little is known regarding the effects of mobile application-mediated training on nursing. The aim of this study was to determine the effectiveness of mobile applications by comparing the effectiveness of a high-fidelity human patient simulator to that of a mobile application on student learning. Following lectures on the lungs and the heart, twenty-two students were separated into two groups to perform a simulation exercise. Then, the students' education effects were evaluated based on their knowledge of lung and heart assessments, their clinical assessment skill, and satisfaction with their education. After four weeks, the mobile application group maintained their knowledge, whereas the high-fidelity human patient simulator group exhibited significantly decreased knowledge of the lung assessment. Knowledge of the heart assessment was significantly increased in both groups. There was no significant difference in clinical assessment skill or educational satisfaction between the groups. We found that mobile applications provide educational tools similarly effective to a high-fidelity human patient simulator to maintain memory and to teach cardiopulmonary assessment skills. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Efficacy of cardiopulmonary resuscitation performed in a dental chair.

    Science.gov (United States)

    Lepere, A J; Finn, J; Jacobs, I

    2003-12-01

    Within the dental setting, historically there has been some concern as to whether cardiopulmonary resuscitation (CPR) can be performed effectively in the dental chair. This study tested the hypothesis that there is no difference in the efficacy of CPR performed in the dental chair or on the floor. Four cycles of two-person CPR were performed by three health professionals on a manikin positioned alternately on the floor and in a dental chair. Ventilation was performed using a Laerdal pocket mask, without oxygen supplementation. Compression and ventilation performance was recorded using a computerized manikin skill meter. Each of the participants was able to achieve a mean cardiac compression depth of between 41 and 50cm, irrespective of the CPR surface. The only statistically significant difference found in expired air resuscitation (EAR) and external cardiac compression performance was that 37 per cent of ventilations performed on the floor were deemed to be too shallow, compared to only 15 per cent in the dental chair (p=0.001). It is possible for those trained in basic life support to perform CPR effectively in the dental chair. Each of the participants agreed that CPR, in particular EAR, was easier to perform when the manikin was in the dental chair compared with the floor. Dentists are encourage to regularly update their CPR knowledge and skills, including the practice of CPR in the dental chair.

  19. A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.

    Science.gov (United States)

    Garibaldi, Brian Thomas; Niessen, Timothy; Gelber, Allan Charles; Clark, Bennett; Lee, Yizhen; Madrazo, Jose Alejandro; Manesh, Reza Sedighi; Apfel, Ariella; Lau, Brandyn D; Liu, Gigi; Canzoniero, Jenna VanLiere; Sperati, C John; Yeh, Hsin-Chieh; Brotman, Daniel J; Traill, Thomas A; Cayea, Danelle; Durso, Samuel C; Stewart, Rosalyn W; Corretti, Mary C; Kasper, Edward K; Desai, Sanjay V

    2017-10-06

    Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

  20. Experiential avoidance in body dysmorphic disorder.

    Science.gov (United States)

    Wilson, Anne C; Wilhelm, Sabine; Hartmann, Andrea S

    2014-09-01

    Experiential avoidance (i.e., the attempt to avoid certain internal experiences including bodily sensations, thoughts, emotions, memories, and urges) has been studied in various psychological disorders. However, research examining experiential avoidance in individuals with body dysmorphic disorder (BDD) is limited and inconsistent. The present study compared experiential avoidance in individuals with primary BDD (n=23) to healthy controls (n=22). Standardized measures were used to assess baseline clinical characteristics as well as experiential avoidance. Compared to healthy controls, individuals with BDD presented with significantly greater experiential avoidance (pdepressive symptoms (p<.01) and avoidant coping strategies (p<.01). Clinician sensitivity to experiential avoidance may serve to improve the course of treatment for BDD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. School Avoidance: Tips for Concerned Parents

    Science.gov (United States)

    ... Email Print Share School Avoidance: Tips for Concerned Parents Page Content ​School avoidance – sometimes called school refusal ... school bully) Actual physical harm Tips for Concerned Parents: As a first step, the management of school ...

  2. Conflict Avoidance in a University Context

    Science.gov (United States)

    Barsky, Allan E.; Wood, Lorinda

    2005-01-01

    This ethnographic study explores patterns of conflict avoidance among university students, professors, administrators and staff. Analysis of their narratives of conflict avoidance suggests that avoidance can be beneficial in some circumstances, depending upon personality issues, cost?benefit analysis, power imbalance, type of work, length of…

  3. 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 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.

  4. Population avoidance in aimpoint selection

    International Nuclear Information System (INIS)

    Andre, C.G.

    1978-01-01

    In most past studies of the effectiveness of tactical nuclear weapons vs the amount of collateral damage produced (civilian casualties), civilians have been congregated into idealized shaped towns and cities, and criteria for city avoidance were usually formulated in terms relating to a town's population. This treatment was sufficient in those studies where weapon yields were so large that great numbers of civilians were almost always placed at risk. As further studies developed, demonstrating that real progress could be made in reducing the numbers of civilians potentially placed at risk in tactical nuclear warfare situations, the inadequacies of the present treatment became obvious. The need existed for a more detailed description of the distribution of civilians. The method described determines the number of civilians at risk for a weapon under consideration being detonated at a given point and displays a symbol relating to the numbers at risk on a map or a transparency that overlays a 1:50,000 map of the region. Thus, a weapons planner making the selection of aimpoints for inflicting the necessary military damage required has the means to reduce potential civilian casualties by properly choosing the weapon and aimpoints

  5. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

    Science.gov (United States)

    Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

    2015-03-01

    To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision

  6. Cardiovascular Surgery with Cardiopulmonary Bypass in Patients with Preoperative Non-dialysis Dependent Renal Insufficiency.

    Science.gov (United States)

    Bahar, Temur; Kaplan, Mehmet; Muruvvet, Yilmaz; Nehir, Selcuk Ummuhan; Tolga, Can; Adlan, Olsun; Hakkı, Aydogan

    2015-04-28

    Preoperative renal insufficiency is a predictor of acute renal injury in patients undergoing cardiovascular surgery with cardiopulmonary bypass. From January 2010 to September 2012, 121 patients undergoing coronary bypass, valve replacement, or both were included in our retrospective study, using cardiopulmonary bypass. We compared the changes in renal function and clinical outcomes of 66 patients with a baseline serum creatinine level more than 1.5 mg/dL with 55 patients with normal serum creatinine levels. We analyzed the impact of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency. In the group of patients with preoperative renal injury, the need for dialysis was greater, time of mechanical ventilation longer, and daily diuresis lesser compared with the group of patients with normal serum creatinine levels. Other clinical outcomes such as postoperative hemodynamic problems and organ dysfunction were similar. Prolonged time of cardiopulmonary bypass and cross-clamp affected postoperative renal injury. The study also showed intraoperative dopamine infusion at renal dose and ultrafiltration are not effective with protecting renal tubular function. Serum creatinine levels and glomerular filtration rate (GFR) were found to be useful parameters for renal injury. These results demonstrate the safety and trustworthiness of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency.

  7. Tracking particles by passing messages between images

    Energy Technology Data Exchange (ETDEWEB)

    Chertkov, Michael [Los Alamos National Laboratory; Kroc, Lukas [Los Alamos National Laboratory; Zdeborova, Lenka [Los Alamos National Laboratory; Krakala, Florent [ESPCI; Vergassola, M [CNRS

    2009-01-01

    Methods to extract information from the tracking of mobile objects/particles have broad interest in biological and physical sciences. Techniques based on the simple criterion of proximity in time-consecutive snapshots are useful to identify the trajectories of the particles. However, they become problematic as the motility and/or the density of the particles increases because of the uncertainties on the trajectories that particles have followed during the acquisition time of the images. Here, we report efficient methods for learning parameters of the dynamics of the particles from their positions in time-consecutive images. Our algorithm belongs to the class of message-passing algorithms, also known in computer science, information theory and statistical physics under the name of Belief Propagation (BP). The algorithm is distributed, thus allowing parallel implementation suitable for computations on multiple machines without significant inter-machine overhead. We test our method on the model example of particle tracking in turbulent flows, which is particularly challenging due to the strong transport that those flows produce. Our numerical experiments show that the BP algorithm compares in quality with exact Markov Chain Monte-Carlo algorithms, yet BP is far superior in speed. We also suggest and analyze a random-distance model that provides theoretical justification for BP accuracy. Methods developed here systematically formulate the problem of particle tracking and provide fast and reliable tools for its extensive range of applications.

  8. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  9. Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

    Science.gov (United States)

    Cobo-Vázquez, Carlos; De Blas, Gemma; García-Canas, Pablo; Del Carmen Gasco-García, María

    2018-01-01

    Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

  10. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study.

    Science.gov (United States)

    Zimmerman, Elise; Cohen, Naiomi; Maniaci, Vincenzo; Pena, Barbara; Lozano, Juan Manuel; Linares, Marc

    2015-11-01

    Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin. A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break. A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%). The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines. Copyright © 2015 by the American Academy of Pediatrics.

  11. Outcome after cardiopulmonary resuscitation in patients with congenital heart disease.

    Science.gov (United States)

    Van Puyvelde, Tim; Ameloot, Koen; Roggen, Mieke; Troost, Els; Gewillig, Marc; Budts, Werner; Van De Bruaene, Alexander

    2017-03-01

    Outcome after cardiopulmonary resuscitation (CPR) in patients with underlying congenital heart disease is uncertain. This study aimed at evaluating outcome after CPR in patients with underlying congenital heart disease, factors related to worse outcome after CPR and whether survivors of sudden cardiac death (SCD) have a worse outcome when compared to an age, gender and disease-matched control population. Between 1984 and 2015, all patients with congenital heart disease who received in or out-of-hospital CPR were identified from the database of congenital heart disease from the University Hospitals Leuven. Postoperative and neonatal (CPR was excluded. For each survivor of SCD, two control patients matched for gender, age and underlying heart defect were included in the study. Thirty-eight patients (66% men; median age 25 years (interquartile range 9-40); 68% out-of-hospital) were identified, of which 27 (66%) survived the event. The main cause of SCD was ventricular tachycardia or fibrillation ( n=21). Heart defect complexity (odds ratio (OR) 5.1; 95% confidence interval (CI) 1.2-21.9; P=0.027), pulmonary hypertension (OR 13.8; 95% CI 2.1-89.5; P=0.006) and time to return of spontaneous circulation (OR 1.1; 95% CI 1.0-1.1; P=0.046) were related to worse outcome. Survivors of SCD had a worse prognosis when compared to an age, gender and disease-matched control group (5-year survival 76% vs. 98%; P=0.002). The complexity of underlying heart defect, pulmonary hypertension and time to return of spontaneous circulation are related to worse outcome in the case of CPR. Survivors of SCD have a worse outcome when compared to matched controls, indicating the need for adequate implantable cardioverter defibrillator indication assessment and for stringent follow-up of patients with worsening haemodynamics.

  12. 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.

  13. Extended effects of air pollution on cardiopulmonary mortality in Vienna

    Science.gov (United States)

    Neuberger, Manfred; Rabczenko, Daniel; Moshammer, Hanns

    BackgroundCurrent standards for fine particulates and nitrogen dioxide are under revision. Patients with cardiovascular disease have been identified as the largest group which need to be protected from effects of urban air pollution. MethodsWe sought to estimate associations between indicators of urban air pollution and daily mortality using time series of daily TSP, PM 10, PM 2.5, NO 2, SO 2, O 3 and nontrauma deaths in Vienna (Austria) 2000-2004. We used polynomial distributed lag analysis adjusted for seasonality, daily temperature, relative humidity, atmospheric pressure and incidence of influenza as registered by sentinels. ResultsAll three particulate measures and NO 2 were associated with mortality from all causes and from ischemic heart disease and COPD at all ages and in the elderly. The magnitude of the effect was largest for PM 2.5 and NO 2. Best predictor of mortality increase lagged 0-7 days was PM 2.5 (for ischemic heart disease and COPD) and NO 2 (for other heart disease and all causes). Total mortality increase, lagged 0-14 days, per 10 μg m -3 was 2.6% for PM 2.5 and 2.9% for NO 2, mainly due to cardiopulmonary and cerebrovascular causes. ConclusionAcute and subacute lethal effects of urban air pollution are predicted by PM 2.5 and NO 2 increase even at relatively low levels of these pollutants. This is consistent with results on hospital admissions and the lack of a threshold. While harvesting (reduction of mortality after short increase due to premature deaths of most sensitive persons) seems to be of minor importance, deaths accumulate during 14 days after an increase of air pollutants. The limit values for PM 2.5 and NO 2 proposed for 2010 in the European Union are unable to prevent serious health effects.

  14. Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization. Case report.

    Science.gov (United States)

    Nascimento, Maurício Serrano; Bernardes, Cassiano Franco; de Medeiros, Roberta Louro

    2002-04-01

    Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg kg(-1)). Anesthesia was induced with fentanyl (16 microg kg(-1)), etomidate (0.3 mg kg(-1)) and pancuronium (0.1 mg kg(-1)), and was maintained with O2, isoflurane (0.5 - 1 MAC) and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol L(-1); BE: 0 mmol L(-1); SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol L(-1); BE: -3 mmol L(-1); SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. Bypass circuit mechanical problems may occur in the intraoperative period, and demand prompt repairs. Technological advances in anesthesia equipment, monitoring and safety standards will lessen the possibility of cases such as this to be repeated, but will never replace anesthesiologists surveillance.

  15. Delivery of cardiopulmonary resuscitation in the microgravity environment

    Science.gov (United States)

    Barratt, M. R.; Billica, R. D.

    1992-01-01

    The microgravity environment presents several challenges for delivering effective cardiopulmonary resuscitation (CPR). Chest compressions must be driven by muscular force rather than by the weight of the rescuer's upper torso. Airway stabilization is influenced by the neutral body posture. Rescuers will consist of crew members of varying sizes and degrees of physical deconditioning from space flight. Several methods of CPR designed to accommodate these factors were tested in the one G environment, in parabolic flight, and on a recent shuttle flight. Methods: Utilizing study participants of varying sizes, different techniques of CPR delivery were evaluated using a recording CPR manikin to assess adequacy of compressive force and frequency. Under conditions of parabolic flight, methods tested included conventional positioning of rescuer and victim, free floating 'Heimlich type' compressions, straddling the patient with active and passive restraints, and utilizing a mechanical cardiac compression assist device (CCAD). Multiple restrain systems and ventilation methods were also assessed. Results: Delivery of effective CPR was possible in all configurations tested. Reliance on muscular force alone was quickly fatiguing to the rescuer. Effectiveness of CPR was dependent on technique, adequate restraint of the rescuer and patient, and rescuer size and preference. Free floating CPR was adequate but rapidly fatiguing. The CCAD was able to provide adequate compressive force but positioning was problematic. Conclusions: Delivery of effective CPR in microgravity will be dependent on adequate resuer and patient restraint, technique, and rescuer size and preference. Free floating CPR may be employed as a stop gap method until patient restraint is available. Development of an adequate CCAD would be desirable to compensate for the effects of deconditioning.

  16. Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan.

    Science.gov (United States)

    Taniguchi, Takumi; Omi, Wataru; Inaba, Hideo

    2007-10-01

    Early initiation of bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. The importance of bystander CPR is attracting more interest, and there has been an increase in attendance at CPR training courses in Japan. However, there have been few reports regarding Japanese attitudes toward the performance of bystander CPR. The present study was performed to identify current Japanese attitudes toward bystander CPR compared to our previous study performed in 1998. Between February and March 2006, participants were asked about their willingness to perform CPR in five varying scenarios, i.e., performing CPR on a stranger, a trauma patient, a child, an elderly person, and a relative, and CPR techniques consisting of chest compression plus mouth-to-mouth ventilation (CC plus MMV) versus chest compression only (CC only). A total of 4223 individuals (male 50%) completed the questionnaire, including high school students, teachers, emergency medical technicians (EMTs), medical nurses, and medical students. About 70% of the subjects had experienced CPR training more than once. Only 10-30% of high school students, teachers, and health care providers reported willingness to perform CC plus MMV, especially on a stranger or trauma victim. In contrast, 70-100% of these subjects reported willingness to perform CC only, which was the same as in our previous study. The reasons for the unwillingness among laypeople to perform CC plus MMV were inadequate knowledge and/or doubt regarding whether they could perform the techniques effectively, while health care providers reported a fear contracting of a disease. Most laypeople and health care providers are unlikely to perform CC plus MMV, especially on a stranger or trauma victim, but are more likely to perform CC only, as also found in our previous study in 1998. These findings suggest that MMV training should be de-emphasised and the awareness of CC alone should be emphasised because

  17. The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation.

    Science.gov (United States)

    Weng, Yi-Ming; Wu, Shih-Hao; Li, Wen-Cheng; Kuo, Chan-Wei; Chen, Shou-Yen; Chen, Jih-Chang

    2013-03-01

    This study was performed to determine the effects of sodium bicarbonate injection during prolonged cardiopulmonary resuscitation (for >15 minutes). The retrospective cohort study consisted of adult patients who presented to the emergency department (ED) with the diagnosis of cardiac arrest in 2009. Data were retrieved from the institutional database. A total of 92 patients were enrolled in the study. Patients were divided into 2 groups based on whether they were treated (group1, n = 30) or not treated (group 2, n = 62) with sodium bicarbonate. There were no significant differences in demographic characteristics between groups. The median time interval between the administration of CPR and sodium bicarbonate injection was 36.0 minutes (IQR: 30.5-41.8 minutes). The median amount of bicarbonate injection was 100.2 mEq (IQR: 66.8-104.4). Patients who received a sodium bicarbonate injection during prolonged CPR had a higher percentage of return of spontaneous circulation, but not statistical significant (ROSC, 40.0% vs. 32.3%; P = .465). Sustained ROSC was achieved by 2 (6.7%) patients in the sodium bicarbonate treatment group, with no survival to discharge. No significant differences in vital signs after ROSC were detected between the 2 groups (heart rate, P = .124; systolic blood pressure, P = .094). Sodium bicarbonate injection during prolonged CPR was not associated with ROSC after adjust for variables by regression analysis (Table 3; P = .615; odds ratio, 1.270; 95% confidence interval: 0.501-3.219) The administration of sodium bicarbonate during prolonged CPR did not significantly improve the rate of ROSC in out-of-hospital cardiac arrest. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Obesity Does Not Affect Propofol Pharmacokinetics During Hypothermic Cardiopulmonary Bypass.

    Science.gov (United States)

    El-Baraky, Iman A; Abbassi, Maggie M; Marei, Tarek A; Sabry, Nirmeen A

    2016-08-01

    Because of the lack of data regarding the impact of obesity on propofol pharmacokinetics in patients undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), the authors sought to explore propofol pharmacokinetics and develop a predictive pharmacokinetic model that characterizes and predicts propofol pharmacokinetics in this population. A prospective, observational study. A teaching hospital. The study comprised 17 obese and 17 control (nonobese) patients undergoing hypothermic CPB. None. Patients mainly underwent valve surgery. On initiation of hypothermic CPB (28°C-32°C), patients received a propofol (1%) bolus (1 mg/kg) immediately followed by a 2 mg/kg/h infusion. Blood samples were withdrawn at the following times: before dosing; 1, 3, 5, and 7 minutes after the propofol bolus dose; every 20 minutes during infusion; just before discontinuation of the infusion; and at 1, 3, 5, 7, 10, 20, 30, and 60 minutes after discontinuation of the infusion. The plasma propofol concentration was determined using high-performance liquid chromatography, and then data were imported into Monolix (Lixoft, Antony, France) for population pharmacokinetic modeling and pharmacokinetic parameters estimation. A 2-compartment pharmacokinetic model with age as a covariate on the peripheral volume of distribution (V2) best described the pooled data. The pooled data was internally evaluated successfully to describe and predict propofol pharmacokinetics in the addressed population. Propofol clearance, intercompartmental clearance, and central volume of distribution were 805 mL/min, 1140 mL/min and 18.8 L, respectively. V2 was calculated as 9.86×exp.(1.88×[age/40]) L. Propofol pharmacokinetic parameters were similar in obese and nonobese patients undergoing hypothermic CPB. Age was the major determinant of propofol V2 in the obese population. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Cardiopulmonary Responses to Supine Cycling during Short-Arm Centrifugation

    Science.gov (United States)

    Vener, J. M.; Simonson, S. R.; Stocks, J.; Evettes, S.; Bailey, K.; Biagini, H.; Jackson, C. G. R.; Greenleaf, J. E.; Dalton, Bonnie P. (Technical Monitor)

    2001-01-01

    The purpose of this study was to investigate cardiopulmonary responses to supine cycling with concomitant +G(sub z) acceleration using the NASA/Ames Human Powered Short-Arm Centrifuge (HPC). Subjects were eight consenting males (32+/-5 yrs, 178+/-5 cm, 86.1+/- 6.2 kg). All subjects completed two maximal exercise tests on the HPC (with and without acceleration) within a three-day period. A two tailed t-test with statistical significance set at p less than or equal to 0.05 was used to compare treatments. Peak acceleration was 3.4+/-0.1 G(sub z), (head to foot acceleration). Peak oxygen uptake (VO2(sub peak) was not different between treatment groups (3.1+/-0.1 Lmin(exp -1) vs. 3.2+/-0.1 Lmin(exp -1) for stationary and acceleration trials, respectively). Peak HR and pulmonary minute ventilation (V(sub E(sub BTPS))) were significantly elevated (p less than or equal to 0.05) for the acceleration trial (182+/-3 BPM (Beats per Minute); 132.0+/-9.0 Lmin(exp -1)) when compared to the stationary trial (175+/-3 BPM; 115.5+/-8.5 Lmin(exp -1)). Ventilatory threshold expressed as a percent of VO2(sub peak) was not different for acceleration and stationary trials (72+/-2% vs. 68+/-2% respectively). Results suggest that 3.4 G(sub z) acceleration does not alter VO2(sub peak) response to supine cycling. However, peak HR and V(sub E(sub BTPS)) response may be increased while ventilatory threshold response expressed as a function of percent VO2(sub peak) is relatively unaffected. Thus, traditional exercise prescription based on VO2 response would be appropriate for this mode of exercise. Prescriptions based on HR response may require modification.

  20. The Effects of Cigarette Smoking on Cardiopulmonary Function and Exercise Tolerance in Teenagers

    Directory of Open Access Journals (Sweden)

    Dianna Louie

    2001-01-01

    Full Text Available Teenagers who smoke are frequently warned that cigarette smoking will have detrimental effects on the function of their cardiopulmonary system and on their ability to perform exercise. However, there is little published evidence to support this statement. Therefore, in the present study, peak expiratory flow was measured as an indicator of lung function, expired carbon monoxide level was measured as an indicator of current smoking and the associated reduction in the oxygen carrying capacity of the blood, and blood pressure and heart rate were measured as indicators of cardiovascular hemodynamics before and after a one-mile run in 27 teenagers. The results show that, even at a young age, cigarette smoking is associated with significant detrimental effects on cardiopulmonary function and exercise tolerance. Objective evidence of an effect of smoking on cardiopulmonary function and exercise tolerance in this age group may assist educators and health care professionals in convincing teenagers to quit smoking.

  1. THE BASIC LAWS AND FEATURES OF CYTOKINE DYNAMICS IN PROCESS AND EARLY TERMS AFTER CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    S. I. Suskov

    2011-01-01

    Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications. 

  2. Updates in the American Heart Association guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients.

    Science.gov (United States)

    Maton, Barbara L; Smarick, Sean D

    2012-04-01

    To review the updates in the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and identify potential applications to veterinary patients. Cardiopulmonary arrest is common in veterinary emergency and critical care, and consensus guidelines are lacking. Human resuscitation guidelines are continually evolving as new clinical and experimental studies support updated recommendations. Synthesis of human, experimental animal model, and veterinary literature support the potential for updates and advancement in veterinary CPR practices. This review serves to highlight updates in the AHA guidelines for CPR and evaluate their application to small animal veterinary patients. Interventions identified will be evaluated for trans-species potential, raise questions regarding best resuscitation recommendations, and offer opportunities for further research to continue to advance veterinary CPR. The prognosis for any patient undergoing cardiopulmonary arrest remains guarded. © Veterinary Emergency and Critical Care Society 2012.

  3. The effects of obesity on the cardiopulmonary system: implications for critical care nursing.

    Science.gov (United States)

    Garrett, Kim; Lauer, Kathy; Christopher, Beth-Anne

    2004-01-01

    Obesity has risen at epidemic rates over the last 20 years. This increase crosses all ages, genders, racial/ethnic groups, and income and educational levels. A variety of genetic, environmental, physiological, psychological, and sociocultural factors influence the development of obesity. Increased morbidity and mortality are associated with obesity. Most health-related problems and the increased risk of death in obesity are due to cardiopulmonary compromise. This paper addresses the physiologic effects of obesity on the cardiopulmonary system and the impact obesity has on the critically ill patient. Suggestions for alterations in cardiovascular and pulmonary assessment techniques are discussed. Nursing practice interventions are presented for maximizing cardiopulmonary function and preventing complications. The advocacy role of the nurse is addressed as a critical component in working to develop a culture of understanding and acceptance for the obese patient.

  4. Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moreira Daniel Martins

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

  5. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management During Cardiopulmonary Bypass.

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A; Likosky, Donald S; Grigore, Alina; Dickinson, Timothy A; Shore-Lesserson, Linda; Hammon, John W

    2015-08-01

    In order to improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendations: CLASS I RECOMMENDATIONS: a)The oxygenator arterial outlet blood temperature is recommended to be utilized as a surrogate for cerebral temperature measurement during CPB. (Class I, Level C) b)To monitor cerebral perfusate temperature during warming, it should be assumed that the oxygenator arterial outlet blood temperature under-estimates cerebral perfusate temperature. (Class I, Level C) c)Surgical teams should limit arterial outlet blood temperature to<37°C to avoid cerebral hyperthermia. (Class 1, Level C) d)Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB cooling should not exceed 10°C to avoid generation of gaseous emboli. (Class 1, Level C) e)Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB rewarming should not exceed 10°C to avoid out-gassing when blood is returned to the patient. (Class 1, Level C) CLASS IIa a)Pulmonary artery or nasopharyngeal temperature recording is reasonable for weaning and immediate post-bypass temperature measurement. (Class IIa, Level C)b)Rewarming when arterial blood outlet temperature ≥30° C: i.To achieve the desired temperature for separation from bypass, it is reasonable to maintain a temperature gradient between

  6. Generalization of socially transmitted and instructed avoidance

    Directory of Open Access Journals (Sweden)

    Gemma eCameron

    2015-06-01

    Full Text Available Excessive avoidance behavior, in which an instrumental action prevents an upcoming aversive event, is a defining feature of anxiety disorders. Left unchecked, both fear and avoidance of potentially threatening stimuli may generalize to perceptually related stimuli and situations. The behavioral consequences of generalization mean that aversive learning experiences with specific threats may lead people to infer that classes of related stimuli are threatening, potentially dangerous, and need to be avoided, despite differences in physical form. Little is known about avoidance generalization in humans and the learning pathways by which it may be transmitted. In the present study, we compared two pathways to avoidance, instructions and social observation, on subsequent generalization of avoidance behavior, fear expectancy and physiological arousal. Participants first learned that one cue was a danger cue (conditioned stimulus, CS+ and another was a safety cue (CS-. Groups then were either instructed that a simple avoidance response in the presence of the CS+ cancelled upcoming shock presentations (instructed-learning group or observed a short movie showing a demonstrator performing the avoidance response to prevent shock (observational-learning group. During generalization testing, danger and safety cues were presented along with generalization stimuli that parametrically varied in perceptual similarity to the CS+. Reinstatement of fear and avoidance was also tested. Findings demonstrate, for the first time, generalization of socially transmitted and instructed avoidance: both groups showed comparable generalization gradients in fear expectancy, avoidance behavior and arousal. Return of fear was evident, suggesting that generalized avoidance remains persistent following extinction testing. The utility of the present paradigm for research on avoidance generalization is discussed.

  7. Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Bradley, Carolyn; Keithline, Michelle; Petrocelli, Meghan; Scanlon, Mary; Parkosewich, Janet

    2017-03-01

    Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those ≥ 66 years old ( P = .01) and nonwhite participants were 2.7 times more likely than white participants ( P = .049) to want family presence. Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present. ©2017 American Association of Critical-Care Nurses.

  8. Serum big endothelin-1 as a clinical marker for cardiopulmonary and neoplastic diseases in dogs.

    Science.gov (United States)

    Fukumoto, Shinya; Hanazono, Kiwamu; Miyasho, Taku; Endo, Yoshifumi; Kadosawa, Tsuyoshi; Iwano, Hidetomo; Uchide, Tsuyoshi

    2014-11-24

    Many studies of human subjects have demonstrated the utility of assessing serum levels of endothelin-1 (ET-1) and big ET-1 as clinical biomarkers in cardiopulmonary and neoplastic diseases. In this study we explored the feasibility of using serum big ET-1 as a reliable veterinary marker in dogs with various cardiopulmonary and neoplastic diseases. Serum big ET-1 levels were measured by ELISA in dogs with cardiopulmonary (n=21) and neoplastic diseases (n=57). Dogs exhibiting cardiopulmonary disease were divided into two groups based on the velocity of tricuspid valve regurgitation (3.0>m/s) measured by ultrasound: without and with pulmonary hypertension. Big ET-1 levels for the dogs with the diseases were compared with levels in normal healthy dogs (n=17). Dogs with cardiopulmonary disease (4.6±4.6 pmol/l) showed a significantly (Pdogs (1.1±0.53 pmol/l). Serum levels in the dogs with pulmonary hypertension (6.2±5.3 pmol/l) were significantly (Ppulmonary hypertension (2.0±0.6 pmol/l). Dogs with hemangiosarcoma (5.6±2.2 pmol/l), adenocarcinoma (2.0±1.8 pmol/l), histiocytic sarcoma (3.3±1.9 pmol/l), chondrosarcoma or osteosarcoma (3.0±1.6 pmol/l) and hepatocellular carcinoma (2.7±1.8 pmol/l) showed significantly (Pdogs. These findings point to the potential of serum big ET-1 as a clinical marker for cardiopulmonary and neoplastic diseases in dogs. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Basic life support knowledge of secondary school students in cardiopulmonary resuscitation training using a song.

    Science.gov (United States)

    Fonseca Del Pozo, Francisco Javier; Valle Alonso, Joaquin; Canales Velis, Nancy Beatriz; Andrade Barahona, Mario Miguel; Siggers, Aidan; Lopera, Elisa

    2016-07-20

    To examine the effectiveness of a "cardiopulmonary resuscitation song" in improving the basic life support skills of secondary school students. This pre-test/post-test control design study enrolled secondary school students from two middle schools randomly chosen in Córdoba, Andalucia, Spain. The study included 608 teenagers. A random sample of 87 students in the intervention group and 35 in the control group, aged 12-14 years were selected. The intervention included a cardiopulmonary resuscitation song and video. A questionnaire was conducted at three-time points: pre-intervention, one month and eight months post-intervention. On global knowledge of cardiopulmonary resuscitation, there were no significant differences between the intervention group and the control group in the trial pre-intervention and at the month post-intervention. However, at 8 months there were significant differences with a p-value = 0.000 (intervention group, 95% CI: 6.39 to 7.13 vs. control group, 95% CI: 4.75 to 5.92), F(1,120)=16.644, p=0.000). In addition, significant differences about students' basic life support knowledge about chest compressions at eight months post-intervention (F(1,120)=15.561, p=0.000) were found. Our study showed that incorporating the song component in the cardiopulmonary resuscitation teaching increased its effectiveness and the ability to remember the cardiopulmonary resuscitation algorithm. Our study highlights the need for different methods in the cardiopulmonary resuscitation teaching to facilitate knowledge retention and increase the number of positive outcomes after sudden cardiac arrest.

  10. Pressure and time dependence of the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Otto M.E.B.

    2004-01-01

    Full Text Available The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negative pressure (LBNP in patients with hypertensive cardiomyopathy have not been investigated in detail. We studied 15 hypertensive patients with left ventricular dysfunction (LVD and 15 matched normal controls to observe the time course response of the forearm vascular resistance (FVR during 3 min of LBNP at -10, -15, and -40 mmHg in unloading the cardiopulmonary receptors. Analysis of the average of 3-min intervals of FVR showed a blunted response of the LVD patients at -10 mmHg (P = 0.03, but a similar response in both groups at -15 and -40 mmHg. However, using a minute-to-minute analysis of the FVR at -15 and -40 mmHg, we observed a similar response in both groups at the 1st min, but a marked decrease of FVR in the LVD group at the 3rd min of LBNP at -15 mmHg (P = 0.017, and -40 mmHg (P = 0.004. Plasma norepinephrine levels were analyzed as another neurohumoral measurement of cardiopulmonary receptor response to LBNP, and showed a blunted response in the LVD group at -10 (P = 0.013, -15 (P = 0.032 and -40 mmHg (P = 0.004. We concluded that the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy is blunted at lower levels of LBNP. However, at higher levels, the cardiopulmonary reflex has a normal initial response that decreases progressively with time. As a consequence of the time-dependent response, the cardiopulmonary reflex response should be measured over small intervals of time in clinical studies.

  11. Arterial pressure during cardiopulmonary bypass is not associated with acute kidney injury

    DEFF Research Database (Denmark)

    Kandler, K; Jensen, M E; Nilsson, J C

    2015-01-01

    underwent coronary artery bypass grafting with or without concomitant procedures was conducted. AKI was defined using the RIFLE criteria. Data on arterial pressure and use of norepinephrine during cardiopulmonary bypass were entered in a binary logistic regression model to control for possible perioperative...... and in higher amounts, during cardiopulmonary bypass, in patients who developed AKI. These differences in arterial pressures and use of norepinephrine between the groups were not found to be significant when entered in the binary logistic regression model. CONCLUSION: No independent relationship between...

  12. A simple technique can reduce cardiopulmonary bypass use during lung transplantation

    Directory of Open Access Journals (Sweden)

    Marcos N. Samano

    2016-04-01

    Full Text Available Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.

  13. Successfully repaired traumatic tracheal disruption and cardiac rupture with cardiopulmonary support.

    Science.gov (United States)

    Daitoku, Kazuyuki; Sakai, Takehiro; Yamada, Yoshitsugu; Tsushima, Takao; Koyama, Masayuki; Takaya, Shunichi

    2002-02-01

    A 19-year-old man suffering from dyspnea associated with tracheal and cardiac rupture from a traffic accident was found by bronchoscopy to have a 7.5 cm longitudinal tear in the membranous portion of the trachea. Right posterolateral thoracotomy was conducted and open ventilation through the left main bronchus initiated with standby cardiopulmonary bypass cannulation of the right femoral artery and vein. When oxygenation was poor, extracorporeal circulation was initiated through the cannulated artery and vein. Under the cardiopulmonary bypass, we safely repaired the tracheal laceration and cardiac rupture.

  14. The impact assessment of weight loss on an aggressive behavior and satisfaction with the connubial or cohabitation relationship in patients after Roux-en-Y gastric-by-pass surgery performed laparoscopically.

    Science.gov (United States)

    Bielecka, Ilona; Osemek, Paweł; Paśnik, Krzysztof

    2012-09-01

    was an assesment the impact of weight loss in patients undergoing gastric by-pass surgery on an aggressive behavior affecting the satisfaction with the connubial or cohabitation relationship The study included a total number of 100 people (50 people with morbid obesity underwent gastric-bypass surgery and their male or female partners). The study was conducted by using two questionnaires: the Psychological Inventory of Aggression Syndrome-1 authorship by Z.B. Gaś as well as Extinguishes and the Chosen Marriage Questionnaire-2 developed by M. Plop and J. Rostowski The analysis of the results showed the influence of the weight loss on the aggressive behaviour at the examined group. Important differences were shown in the first phase of the examination among the examined group and the control group on scales: emotional self-aggression, the hostility towards surroundings and directed outside aggression. Regression analysis showed a statistical relationship between outward aggression and disappointment, 0.346 pcohabitation relationship.

  15. Bidirectional Glenn on cardiopulmonary bypass: A comparison of three techniques.

    Science.gov (United States)

    Talwar, Sachin; Kumar, Manikala Vinod; Nehra, Ashima; Malhotra Kapoor, Poonam; Makhija, Neeti; Sreenivas, Vishnubhatla; Choudhary, Shiv Kumar; Airan, Balram

    2017-05-01

    To analyze the intraoperative and early results of the bidirectional Glenn (BDG) procedure performed on cardiopulmonary bypass (CPB) using three different techniques. Between September 2013 and June 2015, 75 consecutive patients (mean age 42 ± 34.4 months) undergoing BDG were randomly assigned to either technique I: open anastomosis or technique II: superior vena cava (SVC) cannulation or technique III: intermittent SVC clamping. We monitored the cerebral near infrared spectrophotometry (NIRS), SVC pressure, CPB time, intensive care unit (ICU) stay, and neurocognitive function. Patients in technique III had abnormal lower NIRS values during the procedure (57 ± 7.4) compared to techniques I and II (64 ± 7.5 and 61 ± 8.0, P = 0.01). Postoperative SVC pressure in technique III was higher than other two groups (17.6 ± 3.7 mmHg vs. 14.2 ± 3.5 mmHg and 15.3 ± 2.0 mmHg in techniques I and II, respectively = 0.0008). CPB time was highest in technique II (44 ± 18 min) compared to techniques I and III (29 ± 14 min and 38 ± 16 min, P = 0.006), respectively. ICU stay was longer in technique III (30 ± 15 h) compared to the other two techniques (22 ± 8.5 h and 27 ± 8.3 h in techniques I and II, respectively = 0.04). No patient experienced significant neurocognitive dysfunction. All techniques of BDG provided acceptable results. The open technique was faster and its use in smaller children merits consideration. The technique of intermittent clamping should be used as a last resort. © 2017 Wiley Periodicals, Inc.

  16. Change in tidal volume during cardiopulmonary resuscitation in newborn piglets.

    Science.gov (United States)

    Li, Elliott S; Cheung, Po-Yin; O'Reilly, Megan; Schmölzer, Georg M

    2015-11-01

    The purpose of inflations during cardiopulmonary resuscitation (CPR) is to deliver an adequate tidal volume (VT) to facilitate gas exchange. However, no study has examined VT delivery during chest compression (CC) in detail to understand the effect of CC on lung aeration. The aim of the study was to examine VT changes during CC and their effect on lung aeration. Piglets were anaesthetised, instrumented and intubated with zero leak. They were then randomly assigned to CPR using either 3:1 compression:ventilation ratio (C:V) (n=6), continuous CC with asynchronous ventilations (CCaV) (90 CC/min with 30/min asynchronous ventilations) (n=6) or continuous CC superimposed with 30 s sustained inflations (CC+SI) with a CC rate of 120/min (n=5). A respiratory function monitor (NM3, Respironics, Philips, Andover, Massachusetts, USA) was used to continuously measure inspiration tidal volume (VTi) and expirational tidal volume (VTe). ANOVA with Bonferroni post-test were used to compare variables of all three groups. During the inflation in the 3:1 C:V group, the mean (SD) VTi and VTe was 23.5 (5.3) mL/kg and 19.4 (2.7) mL/kg (p=0.16), respectively. During the CC, we observed a significant VT loss in the 3:1 group with VTi and VTe being 4.1 (1.2) mL/kg and 11.1 (3.3) mL/kg (p=0.007), respectively. In the CCaV group, VTe was higher compared with VTi, but this was not significant. In the CC+SI group, a VT gain during each CC with VTi and VTe of 16.3 (3.2) mL/kg and 14 (3) mL/kg (p=0.21), respectively, was observed. VT delivery is improved using CC+SI compared with 3:1 C:V. This improvement in VT delivery may lead to better alveolar oxygen delivery and lung aeration. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Assessing the depth of isoflurane anaesthesia during cardiopulmonary bypass.

    Science.gov (United States)

    Ng, Ka Ting; Alston, R Peter; Just, George; McKenzie, Chris

    2018-03-01

    Bispectral index (BIS) and monitoring of end-tidal concentration may be associated with a reduction in the incidence of awareness during volatile-based general anaesthesia. An analogue of end-tidal concentration during cardiopulmonary bypass (CPB) is measuring exhausted isoflurane concentration from the oxygenator as an estimate to blood and, so, brain concentration. The aim of this study was to determine the relationships between oxygenator exhaust and blood concentrations of isoflurane and the BIS score during CPB when administering isoflurane into the sweep gas supply to the oxygenator. Seventeen patients undergoing elective cardiac surgery using CPB and isoflurane with BIS monitoring were recruited in a single-centre university hospital. Isoflurane gas was delivered via a calibrated vaporiser at the beginning of anaesthetic induction. Radial arterial blood samples were collected after the initiation of CPB and before aortic cross-clamping, which were analysed for isoflurane by gas chromatography and mass spectrometry. The BIS score and the concentration of exhausted isoflurane from the oxygenator membrane, as measured by an anaesthetic gas analyser, were recorded at the time of blood sampling. The mean duration of anaesthetic induction to arterial blood sampling was 90 min (95%CI: 80,100). On CPB, the median BIS was 39 (range, 7-43) and the mean oxygenator exhaust isoflurane concentration was 1.24 ± 0.21%. No significant correlation was demonstrated between BIS with arterial isoflurane concentration (r=-0.19, p=0.47) or oxygenator exhaust isoflurane concentration (r=0.07, p=0.80). Mixed-venous blood temperature was moderately correlated to BIS (r=0.50, p=0.04). Oxygenator exhaust isoflurane concentration was moderately, positively correlated with its arterial concentration (r=0.64, p<0.01). In conclusion, in patients undergoing heart surgery with CPB, the findings of this study indicate that, whilst oxygenator exhaust concentrations were significantly

  18. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation.

    Science.gov (United States)

    Mitchell, Michael J; Stubbs, Benjamin A; Eisenberg, Mickey S

    2009-01-01

    Although socioeconomic status (SES) has been linked to multiple health outcomes, there have been few studies of the effect of SES on the provision of bystander cardiopulmonary resuscitation (CPR) during cardiac arrest events and no studies that we know of on the effect of SES on the provision of dispatcher-assisted bystander CPR. This study sought to define the relationship between SES and the provision of bystander CPR in an emergency medical system that includes dispatcher-provided CPR instructions. This study was a retrospective, cohort analysis of cardiac arrests due to cardiac causes occurring in private residences in King County, Washington, from January 1, 1999, to December 31, 2005. We used the tax-assessed value of the location of the cardiac arrest as an estimate of the SES of potential bystanders as well as multiple measures from 2000 Census data (education, employment, median household income, and race/ethnicity). We also examined the effect of patient and system characteristics that may affect the provision of bystander CPR. Logistic regression models were used to analyze the association of these factors with two outcomes: the provision of bystander CPR with and without dispatcher assistance. Forty-four percent (1,151/2,618) of cardiac arrest victims received bystander CPR. Four hundred fifty-seven people (17.5% of the entire study population, 39.7% of those who received any bystander CPR) received CPR without telephone instructions. A total of 694 people received dispatcher-assisted bystander CPR (25.6% of the entire population, 60.4% of those receiving any bystander CPR). After adjusting for demographic and care factors, we found a strong association between the tax-assessed value of the cardiac arrest location and increased odds of the provision of bystander CPR without dispatcher instructions and bystander CPR with dispatcher assistance compared with no bystander CPR. This study suggests that higher bystander SES is associated with increased rates

  19. Integration of Weather Avoidance and Traffic Separation

    Science.gov (United States)

    Consiglio, Maria C.; Chamberlain, James P.; Wilson, Sara R.

    2011-01-01

    This paper describes a dynamic convective weather avoidance concept that compensates for weather motion uncertainties; the integration of this weather avoidance concept into a prototype 4-D trajectory-based Airborne Separation Assurance System (ASAS) application; and test results from a batch (non-piloted) simulation of the integrated application with high traffic densities and a dynamic convective weather model. The weather model can simulate a number of pseudo-random hazardous weather patterns, such as slow- or fast-moving cells and opening or closing weather gaps, and also allows for modeling of onboard weather radar limitations in range and azimuth. The weather avoidance concept employs nested "core" and "avoid" polygons around convective weather cells, and the simulations assess the effectiveness of various avoid polygon sizes in the presence of different weather patterns, using traffic scenarios representing approximately two times the current traffic density in en-route airspace. Results from the simulation experiment show that the weather avoidance concept is effective over a wide range of weather patterns and cell speeds. Avoid polygons that are only 2-3 miles larger than their core polygons are sufficient to account for weather uncertainties in almost all cases, and traffic separation performance does not appear to degrade with the addition of weather polygon avoidance. Additional "lessons learned" from the batch simulation study are discussed in the paper, along with insights for improving the weather avoidance concept. Introduction

  20. Effects of IFRS adoption on tax avoidance

    Directory of Open Access Journals (Sweden)

    Renata Nogueira Braga

    Full Text Available ABSTRACT This study investigates the association between mandatory International Financial Reporting Standards (IFRS adoption and corporate tax avoidance. In this study, tax avoidance is defined as a reduction in the effective corporate income tax rate through tax planning activities, whether these are legal, questionable, or even illegal. Three measures of tax avoidance are used and factors at the country and firm level (that have already been associated with tax avoidance in prior research are controlled. Using samples that range from 9,389 to 15,423 publicly-traded companies from 35 countries, covering 1999 to 2014, it is found that IFRS adoption is associated with higher levels of corporate tax avoidance, even when the level of book-tax conformity required in the countries and the volume of accruals are controlled, both of which are considered potential determinants of this relationship. Furthermore, the results suggest that after IFRS adoption, firms in higher book-tax conformity environments engage more in tax avoidance than firms in lower book-tax conformity environments. It is also identified that engagement in tax avoidance after IFRS adoption derives not only from accruals management, but also from practices that do not involve accruals. The main conclusion is that companies engage more in tax avoidance after mandatory IFRS adoption.

  1. Strategic Family Therapy of Avoidant Behavior.

    Science.gov (United States)

    Burgess, Thomas A.; Hinkle, J. Scott

    1993-01-01

    Notes that Millon's biopsychosocial model asserts that socioenvironmental factors of parental or peer rejection may shape development of avoidant behavior but does not elaborate on how family system may perpetuate its existence once disorder has evolved. Presents brief overview of avoidant behavior and strategic family therapy case study.…

  2. Detection of a spontaneous pulse in photoplethysmograms during automated cardiopulmonary resuscitation in a porcine model

    NARCIS (Netherlands)

    Wijshoff, R.W.; Sar, T. van der; Peeters, W.H.; Bezemer, R.; Aelen, P.; Paulussen, I.W.; Ordelman, S.C.; Venema, A.; Berkom, P.F. van; Aarts, R.M.; Woerlee, P.H.; Scheffer, G.J.; Noordergraaf, G.J.

    2013-01-01

    INTRODUCTION: Reliable, non-invasive detection of return of spontaneous circulation (ROSC) with minimal interruptions to chest compressions would be valuable for high-quality cardiopulmonary resuscitation (CPR). We investigated the potential of photoplethysmography (PPG) to detect the presence of a

  3. Feasibility and Safety of Cardiopulmonary Exercise Testing in Multiple Sclerosis: A Systematic Review

    NARCIS (Netherlands)

    van den Akker, L.E.; Heine, M.; van der Veldt, N.; Dekker, J.; de Groot, V.; Beckerman, H.

    2015-01-01

    Objective To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS). Data Sources PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014.

  4. Feasibility and Safety of Cardiopulmonary Exercise Testing in Multiple Sclerosis: A Systematic Review

    NARCIS (Netherlands)

    Van Den Akker, Lizanne Eva; Heine, M; van der Veldt, Nikki; Dekker, Joost; de Groot, Vincent; Beckerman, Heleen

    2015-01-01

    OBJECTIVE: To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS). DATA SOURCES: PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014.

  5. Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia.

    NARCIS (Netherlands)

    Bergman, R.; Tjan, D.H.; Adriaanse, M.W.; Vugt, R. van; Zanten, A.R. van

    2008-01-01

    A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of

  6. Pulsatile cardiopulmonary bypass and renal function in elderly patients undergoing aortic valve surgery

    NARCIS (Netherlands)

    Milano, Aldo Domenico; Dodonov, Mikhail; Van Oeveren, Willem; Onorati, Francesco; Gu, Y. John; Tessari, Maddalena; Menon, Tiziano; Gottin, Leonardo; Faggian, Giuseppe

    OBJECTIVES: To evaluate if pulsatile cardiopulmonary bypass (CPB) has any protective influence on renal function in elderly patients undergoing aortic valve replacement (AVR). METHODS: Forty-six patients (>= 75 years old) with aortic valve stenosis underwent AVR with either pulsatile perfusion (PP)

  7. Effects of Age, Gender, School Class on Cardiopulmonary Resuscitation Skills of Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin; Onyeaso, Chukwudi Ochi

    2016-01-01

    Background: The need for training of schoolchildren on cardiopulmonary resuscitation (CPR) as potential bystander CPR providers is growing globally but Nigeria is still behind and lacks basic necessary data. Purpose: The purpose of this study was to investigate the effects of age, gender and school class on CPR skills of Nigerian secondary school…

  8. Workshop: Preventing Air Pollution-related Cardiopulmonary Illnesses: Innovative, Cross-disciplinary Solutions

    Science.gov (United States)

    On Sept. 28-29, 2016 in Washington, DC, EPA’s held its first workshop to share multi-stakeholder perspectives on how to improve cardiopulmonary health outcomes through the integration of environmental health, public health, health care services, data.

  9. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte

  10. Influence of norepinephrine and phenylephrine on frontal lobe oxygenation during cardiopulmonary bypass in patients with diabetes.

    Science.gov (United States)

    Brassard, Patrice; Pelletier, Claudine; Martin, Mickaël; Gagné, Nathalie; Poirier, Paul; Ainslie, Philip N; Caouette, Manon; Bussières, Jean S

    2014-06-01

    Although utilization of vasopressors recently has been associated with reduced cerebral oxygenation, the influence of vasopressors on cerebral oxygenation during cardiopulmonary bypass in patients with diabetes is unknown. The aim of this study was to document the impact of norepinephrine and phenylephrine utilization on cerebral oxygenation in patients with and without diabetes during cardiopulmonary bypass. Prospective, clinical study. Academic medical center. Fourteen patients with diabetes and 17 patients without diabetes undergoing cardiac surgery. During cardiopulmonary bypass, norepinephrine (diabetics n = 6; non-diabetics n = 8) or phenylephrine (diabetics n = 8; non-diabetics n = 9) was administered intravenously to maintain mean arterial pressure above 60 mmHg. Mean arterial pressure, venous temperature, arterial oxygenation, and frontal lobe oxygenation (monitored by near-infrared spectroscopy) were recorded before anesthesia induction (baseline) and continuously during cardiopulmonary bypass. Frontal lobe oxygenation was lowered to a greater extent in diabetics versus non-diabetics with administration of norepinephrine (-14±13 v 3±12%; pfrontal lobe oxygenation in diabetics but not in patients without diabetes. Administration of phenylephrine also were associated with a trend towards a greater reduction in frontal lobe oxygenation in diabetics. The clinical implications of these findings deserve future consideration. © 2013 Elsevier Inc. All rights reserved.

  11. Usefulness of the cardiopulmonary exercise testing in the asses of unexplained dyspnoea

    International Nuclear Information System (INIS)

    Benavides L, Herney

    2009-01-01

    Dyspnoea is a frequent presenting complaint. The assess of this symptom is problematic when its cause is unknown once the initial diagnosis tests are done. Cardiopulmonary exercise testing is an important clinical tool to evaluate dyspnoea as it provides an approach to the integrative exercise responses involving all the organ systems. This would not be possible to reflect by means of individual studies.

  12. Physiological basis of cardiopulmonary rehabilitation in patients with lung or heart disease

    Directory of Open Access Journals (Sweden)

    Zafeiris Louvaris

    2015-06-01

    Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD and those with congestive heart failure (CHF. Both of these symptoms negatively impact on patients’ daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels.

  13. Measurement and analysis of cardiopulmonary vascular in Lanzhou healthy adults with multislice spiral CT

    International Nuclear Information System (INIS)

    Shi Xiaonan; Guo Shunlin

    2013-01-01

    Objective: To constitute a normal standard of cardiopulmonary vascular diameter and size of normal adult in Lanzhou, and to compared with the other's data reported in the previous bibliography by measuring diameter and area of cardiopulmonary artery lumen of the healthy adults in Lanzhou with multislice spiral CT (MSCT). Methods: Three hundred Lanzhou adults with no cardiopulmonary disease were equally assigned to 3 groups according to their age (A group: 18-39 years, B group: 40-60 years, C group: 61-80 years; 50 females and 50 males in each group). CT data were acquired at the end of deep inspiration phase and measurements were done on 3D reconstruction image with precise landmarks. All the results were statistically analyzed. Results: The diameters and areas of the main pulmonary artery left pulmonary artery right pulmonary artery ascending aorta and descending aorta differed significantly among the 3 groups (P<0.05). In groups B and C, there were significant differences in diameters and areas of pulmonary artery left pulmonary artery and right pulmonary between different genders (P<0.05). Conclusion: Imaging standard is provided for Lanzhou adult in early diagnosis of cardiopulmonary disease. The diameters and areas of main pulmonary artery left pulmonary artery and right pulmonary artery of Lanzhou healthy adults are different from that of other regions. It may be related to the geographical environment and the state of air pollution in Lanzhou. (authors)

  14. Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

    DEFF Research Database (Denmark)

    Thomassen, Sisse Anette; Larsson, A; Andreasen, Jan Jesper

    Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior...... not improve cerebral and systemic oxygenation compared to a blood flow based on BSA....

  15. extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest

    DEFF Research Database (Denmark)

    Obling, Laust; Wiberg, Sebastian; Møller, Jacob Eifer

    2017-01-01

    Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of e...

  16. Median sternotomy for double lung transplantation with cardiopulmonary bypass in seven consecutive patients

    DEFF Research Database (Denmark)

    Kohno, Mitsutomo; Steinbrüchel, Daniel A

    2012-01-01

    We describe our technique of using median sternotomy to perform double lung transplantations with cardiopulmonary bypass. By sparing the respiratory muscles, median sternotomy is probably less invasive and preserves lung function. Furthermore, it causes less long-term discomfort than intercostal...

  17. 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.

  18. Survival benefit of cardiopulmonary bypass support in bilateral lung transplantation for emphysema patients

    NARCIS (Netherlands)

    Hepkema, BG; Loef, BG; van der Bij, W; Verschuuren, EAM; Lems, SPM; Ebels, T

    2002-01-01

    Background. This study is designed to examine a possible association of cardiopulmonary bypass (CPB) support and outcome of lung transplantation in a well-balanced group of emphysema patients. Methods. We performed a retrospective analysis of 62 consecutive primary bilateral lung transplantations

  19. A Comparative Analysis of Student Learning with a Collaborative Computer Simulation of the Cardiopulmonary System

    Science.gov (United States)

    Keyser, Diane

    2010-01-01

    To design a series of assessments that could be used to compare the learning gains of high school students studying the cardiopulmonary system using traditional methods to those who used a collaborative computer simulation, called "Mr. Vetro". Five teachers and 264 HS biology students participated in the study. The students were in…

  20. BIOCOMPATIBILITY OF LEUKOCYTE REMOVAL FILTERS DURING LEUKOCYTE FILTRATION OF CARDIOPULMONARY BYPASS PERFUSATE

    NARCIS (Netherlands)

    GU, YJ; OBSTER, R; HAAN, J; HUET, RCGG; EIJGELAAR, A; VANOEVEREN, W

    To evaluate the biocompatibility and the efficacy of leukocyte removal filters, we performed a prospective study by using the cardiopulmonary bypass perfusate taken from the heart-lung machine for 20 patients who underwent cardiac surgery and were randomly divided into four groups according to the

  1. Differential Regulation of PAI-1 in Hantavirus Cardiopulmonary Syndrome and Hemorrhagic Fever With Renal Syndrome

    OpenAIRE

    Bellomo, Carla; Korva, Miša; Papa, Anna; Mäkelä, Satu; Mustonen, Jukka; Avšič-Županc, Tatjana; Vaheri, Antti; Martinez, Valeria P; Strandin, Tomas

    2018-01-01

    Abstract We analyzed the levels of circulating tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI)–1 in acute hantavirus cardiopulmonary syndrome (HCPS) and hemorrhagic fever with renal syndrome (HFRS). The levels of tPA commonly increased in both diseases, whereas PAI-1 correlated with disease severity in HCPS but not in HFRS.

  2. Cardiopulmonary determinants of functional capacity in patients with chronic heart failure compared with normals.

    Science.gov (United States)

    Meyer, K; Westbrook, S; Schwaibold, M; Hajric, R; Lehmann, M; Roskamm, H

    1996-12-01

    Patients with chronic heart failure (CHF) are characterized by abnormal gas exchange and ventilatory responses to exercise. This study compares variables obtained from cardiopulmonary exercise testing in 35 patients with CHF with 35 age- and weight-matched healthy subjects. A second goal was to obtain cardiopulmonary variables measured at ventilatory threshold to distinguish patient changes from those of healthy subjects. Exercise testing was carried out using bicycle ergometry with ramplike protocol (work rate increments 12.5 W/min). Gas exchange and ventilation were measured breath by breath. Compared with healthy subjects, the VO2 in patients was lower at identical work rates (p rate, the variables for VO2, VCO2, ventilation, O2 pulse, ventilatory equivalents for O2 and CO2, and VD/VT (physiologic deadspace to tidal volume ratio), as well as lactate differed significantly at identical work rates. With the exception of VD/VT, all cardiopulmonary variables showed significant differences in their slopes during exercise. By means of a discriminant analysis, VCO2 and ventilation proved to be the most distinguishing variables at ventilatory threshold between patients with CHF and healthy subjects. These results indicate the clinical usefulness of cardiopulmonary exercise testing when assessing functional impairment due to CHF. For treatment evaluation, not only VO2 but also VCO2 and ventilation responses to exercise should be considered.

  3. MEMBRANE-OXYGENATOR PREVENTS LUNG REPERFUSION INJURY IN CANINE CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    GU, YJ; WANG, YS; CHIANG, BY; GAO, XD; YE, CX; WILDEVUUR, CRH

    The effect of blood activation on lung reperfusion injury during cardiopulmonary bypass was investigated in 20 dogs with the use of a bubble oxygenator (n = 10) or a membrane oxygenator (n = 10). In the bubble oxygenator group, significant leukocyte and platelet right to left atrium gradients were

  4. Adding lactate to the prime solution during hypothermic cardiopulmonary bypass: a quantitative acid-base analysis

    NARCIS (Netherlands)

    Himpe, D.; Neels, H.; de Hert, S.; van Cauwelaert, P.

    2003-01-01

    BACKGROUND: The effect of adding lactate to the cardiopulmonary bypass (CPB) prime was investigated using Stewart's quantitative acid-base approach. According to this quantitative model, serum pH and bicarbonate are determined by three independent factors: the partial pressure of carbon dioxide

  5. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery

    NARCIS (Netherlands)

    Kist-van Holthe tot Echten, J. E.; Goedvolk, C. A.; Doornaar, M. B.; van der Vorst, M. M.; Bosman-Vermeeren, J. M.; Brand, R.; van der Heijden, A. J.; Schoof, P. H.; Hazekamp, M. G.

    2001-01-01

    The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before,

  6. Cardio-pulmonary involvement in systemic sclerosis: A study at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Geetakiran Arakkal

    2017-01-01

    Conclusions: In our patients, pulmonary involvement was more common than cardiac involvement. Interstitial lung disease and cardiac involvement were more commonly seen in diffuse systemic sclerosis whereas pulmonary hypertension was more frequent in limited systemic sclerosis. Hence, it is important to screen the patients for cardiopulmonary involvement for early diagnosis and treatment and a better prognostic outcome.

  7. Imaging the human microcirculation during cardiopulmonary resuscitation in a hypothermic victim of submersion trauma

    NARCIS (Netherlands)

    Elbers, Paul W. G.; Craenen, Antonius J.; Driessen, Antoine; Stehouwer, Marco C.; Munsterman, Luuk; Prins, Miranda; van Iterson, Mat; Bruins, Peter; Ince, Can

    2010-01-01

    The microcirculation is essential for delivery of oxygen and nutrients to tissue. However, the human microvascular response to cardiopulmonary resuscitation (CPR) is unknown. We report on the first use of sidestream dark field imaging to assess the human microcirculation during CPR with a mechanical

  8. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Whitlock, Richard P; Devereaux, P J; Teoh, Kevin H; Lamy, Andre; Vincent, Jessica; Pogue, Janice; Paparella, Domenico; Sessler, Daniel I; Karthikeyan, Ganesan; Villar, Juan Carlos; Zuo, Yunxia; Avezum, Álvaro; Quantz, Mackenzie; Tagarakis, Georgios I; Shah, Pallav J; Abbasi, Seyed Hesameddin; Zheng, Hong; Pettit, Shirley; Chrolavicius, Susan; Yusuf, Salim

    2015-09-26

    Cardiopulmonary bypass initiates a systemic inflammatory response syndrome that is associated with postoperative morbidity and mortality. Steroids suppress inflammatory responses and might improve outcomes in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass. We aimed to assess the effects of steroids in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass. The Steroids In caRdiac Surgery (SIRS) study is a double-blind, randomised, controlled trial. We used a central computerised phone or interactive web system to randomly assign (1:1) patients at high risk of morbidity and mortality from 80 hospital or cardiac surgery centres in 18 countries undergoing cardiac surgery with the use of cardiopulmonary bypass to receive either methylprednisolone (250 mg at anaesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients were assigned with block randomisation with random block sizes of 2, 4, or 6 and stratified by centre. Patients aged 18 years or older were eligible if they had a European System for Cardiac Operative Risk Evaluation of at least 6. Patients were excluded if they were taking or expected to receive systemic steroids in the immediate postoperative period or had a history of bacterial or fungal infection in the preceding 30 days. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcomes were 30-day mortality and a composite of death and major morbidity (ie, myocardial injury, stroke, renal failure, or respiratory failure) within 30 days, both analysed by intention to treat. Safety outcomes were also analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00427388. Patients were recruited between June 21, 2007, and Dec 19, 2013. Complete 30-day data was available for all 7507 patients randomly assigned to methylprednisolone (n=3755) and to placebo (n=3752). Methylprednisolone, compared

  9. Sodium/hydrogen-exchanger inhibition during cardioplegic arrest and cardiopulmonary bypass: an experimental study.

    Science.gov (United States)

    Cox, Charles S; Sauer, Henning; Allen, Steven J; Buja, L Maximilian; Laine, Glen A

    2002-05-01

    We sought to determine whether pretreatment with a sodium/hydrogen-exchange inhibitor (EMD 96 785) improves myocardial performance and reduces myocardial edema after cardioplegic arrest and cardiopulmonary bypass. Anesthetized dogs (n = 13) were instrumented with vascular catheters, myocardial ultrasonic crystals, and left ventricular micromanometers to measure preload recruitable stroke work, maximum rate of pressure rise (positive and negative), and left ventricular end-diastolic volume and pressure. Cardiac output was measured by means of thermodilution. Myocardial tissue water content was determined from sequential biopsy. After baseline measurements, hypothermic (28 degrees C) cardiopulmonary bypass was initiated. Cardioplegic arrest (4 degrees C Bretschneider crystalloid cardioplegic solution) was maintained for 2 hours, followed by reperfusion-rewarming and separation from cardiopulmonary bypass. Preload recruitable stroke work and myocardial tissue water content were measured at 30, 60, and 120 minutes after bypass. EMD 96 785 (3 mg/kg) was given 15 minutes before bypass, and 2 micromol was given in the cardioplegic solution. Control animals received the same volume of saline vehicle. Arterial-coronary sinus lactate difference was similar in both animals receiving EMD 96 785 and control animals, suggesting equivalent myocardial ischemia in each group. Myocardial tissue water content increased from baseline in both animals receiving EMD 96 785 and control animals with cardiopulmonary bypass and cardioplegic arrest but was statistically lower in animals receiving EMD 96 785 compared with control animals (range, 1.0%-1.5% lower in animals receiving EMD 96 785). Preload recruitable stroke work decreased from baseline (97 +/- 2 mm Hg) at 30 (59 +/- 6 mm Hg) and 60 (72 +/- 9 mm Hg) minutes after cardiopulmonary bypass and cardioplegic arrest in control animals; preload recruitable stroke work did not decrease from baseline (98 +/- 2 mm Hg) in animals receiving

  10. Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey

    Directory of Open Access Journals (Sweden)

    Yeonhee Park

    2017-08-01

    Full Text Available Background Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs and the current level of cardiopulmonary arrest rate in tertiary hospitals. Methods This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. Results Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009. Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854. National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001. High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001 and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001. Conclusions RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.

  11. Workplace Health Promotion: Assessing the Cardiopulmonary Risks of the Construction Workforce in Hong Kong.

    Science.gov (United States)

    Tin, Sze Pui Pamela; Lam, Wendy W T; Yoon, Sungwon; Zhang, Na; Xia, Nan; Zhang, Weiwei; Ma, Ke; Fielding, Richard

    2016-01-01

    Health needs of different employee subgroups within an industry can differ. We report the results of a workplace cardiopulmonary risk assessment targeting workers and support staff in the construction industry. A free worksite-based cardiopulmonary risk assessment for 1,903 workers on infrastructural contracts across Hong Kong was initiated in May 2014. Cardiopulmonary risk screening was performed in 60-minute blocks for approximately 30 workers/block with individualized feedback and lifestyle counseling. Risk profiles stratified by occupational roles are differentiated using the χ2-test for categorical and Student's t-test for continuous variables. Most construction workers and clerks/professionals were male (83.2% and 71.2%, respectively) and Chinese (78.7% and 90.9%, respectively). Construction workers were older (mean: 44.9 years, SD 11.5) and less well-educated (6.1% received tertiary education) than clerks/professionals (35.0 years, 10.7; 72.6% received tertiary education), but more likely to be hypertensive (22.6% vs. 15.4%, pconstruction workers and 9.7% of office clerks/professions had three or more metabolic syndrome risk factors. While construction workers were more likely than clerks/professionals to be daily smokers, they reported better work-related physical activity and diet. Simple worksite health risk screening can identify potentially high-cardiopulmonary-risk construction industry employee subgroups for onward confirmatory referral. Separate cardiopulmonary health promotion strategies that account for the varying lifestyle profiles of the two employee subgroups in the industry appear justified.

  12. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  13. 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

  14. Banda gástrica com desvio jejunoileal: nova opção técnica em cirurgia bariátrica Gastric band with jejunoileal by-pass: new option in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2010-06-01

    Full Text Available RACIONAL: Os procedimentos cirúrgicos para tratamento da obesidade morbida têm sido eficientes na resolução desta afecção a curto e longo prazo. Com exceção da banda gástrica ajustável todos estes procedimentos de alguma forma são capazes de induzir a liberação de hormônios intestinais em função do desvio intestinal e desta forma exercerem um efeito metabólico. OBJETIVO: Com a intenção de obter efeitos semelhantes às operações que promovem um desvio intestinal, com as vantagens de baixa morbidade e mortalidade da BGA, foi proposto novo procedimento técnico associando à banda gástrica ajustável a um desvio jejunoileal. MÉTODO: O procedimento cirúrgico totalmente conduzido por videolaparoscopia, consiste na aplicação inicial da banda gástrica e a seguir a realização de anastomose látero-lateral a 80 cm do ângulo duodenojejunal e 120 cm da válvula ileocecal. RESULTADOS: Foram operados 10 pacientes com esta técnica, seis mulheres e quatro homens com IMC médio de 40 kg/m². A perda média de excesso de peso nos seis primeiros meses foi de 51,56%. Em quatro pacientes diabéticos houve normalização dos níveis glicêmicos e suspensão do uso da medicação antidiabética. CONCLUSÃO: Adição de desvio jejunoileal látero-lateral à banda gástrica pode melhorar a perda de peso em pacientes portadores de obesidade mórbida e contribuir para o controle da diabete tipo II.BACKGROUND: Current procedures for surgical treatment of morbid obesity have proved to be efficient in controlling the process in the short and long follow-up. The bariatric surgical procedures, with the exception of the adjustable gastric banding are capable, in one way or another, of inducing hormonal release due to the intestinal by-pass that they may promote and therefore offering a metabolic effect. AIM: With the intention to maintain the same results promoted by gastrojejunal diversion, while maintaining the lower mortality rates of the

  15. Moving Obstacle Avoidance for Unmanned Aerial Vehicles

    Science.gov (United States)

    Lin, Yucong

    There has been a vast increase in applications of Unmanned Aerial Vehicles (UAVs) in civilian domains. To operate in the civilian airspace, a UAV must be able to sense and avoid both static and moving obstacles for flight safety. While indoor and low-altitude environments are mainly occupied by static obstacles, risks in space of higher altitude primarily come from moving obstacles such as other aircraft or flying vehicles in the airspace. Therefore, the ability to avoid moving obstacles becomes a necessity for Unmanned Aerial Vehicles. Towards enabling a UAV to autonomously sense and avoid moving obstacles, this thesis makes the following contributions. Initially, an image-based reactive motion planner is developed for a quadrotor to avoid a fast approaching obstacle. Furthermore, A Dubin's curve based geometry method is developed as a global path planner for a fixed-wing UAV to avoid collisions with aircraft. The image-based method is unable to produce an optimal path and the geometry method uses a simplified UAV model. To compensate these two disadvantages, a series of algorithms built upon the Closed-Loop Rapid Exploratory Random Tree are developed as global path planners to generate collision avoidance paths in real time. The algorithms are validated in Software-In-the-Loop (SITL) and Hardware-In-the-Loop (HIL) simulations using a fixed-wing UAV model and in real flight experiments using quadrotors. It is observed that the algorithm enables a UAV to avoid moving obstacles approaching to it with different directions and speeds.

  16. Individual differences in women's rape avoidance behaviors.

    Science.gov (United States)

    McKibbin, William F; Shackelford, Todd K; Miner, Emily J; Bates, Vincent M; Liddle, James R

    2011-04-01

    Rape can exact severe psychological, physical, and reproductive costs on women, and likely was a recurrent adaptive problem over human evolutionary history. Therefore, women may have evolved psychological mechanisms that motivate rape avoidance behaviors. Guided heuristically by an evolutionary perspective, we tested the hypothesis that women's rape avoidance behaviors would vary with several individual difference variables. Specifically, we predicted that rape avoidance behaviors would covary positively with (1) women's attractiveness, (2) women's involvement in a committed romantic relationship, and (3) the number of family members living nearby. We also predicted that women's rape avoidance behaviors would covary negatively with age. We administered the Rape Avoidance Inventory (McKibbin et al., Pers Indiv Differ 39:336-340, 2009) and a demographic survey to a sample of women (n = 144). The results of correlational and regression analyses were consistent with the predictions, with the exception that women's rape avoidance behaviors did not covary with women's age. Discussion highlighted limitations of the current research and directions for future research on women's rape avoidance psychology and behaviors.

  17. How to avoid overheating during exercise

    Science.gov (United States)

    ... patientinstructions/000865.htm How to avoid overheating during exercise To use the sharing features on this page, ... condition can get heat illness. Stay Cool During Exercise Try these tips to help prevent heat-related ...

  18. Dual Eligibles and Potentially Avoidable Hospitalizations

    Data.gov (United States)

    U.S. Department of Health & Human Services — About 25 percent of the hospitalizations for dual eligible beneficiaries in 2005 were potentially avoidable. Medicare and Medicaid spending for those potentially...

  19. USAID IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    US Agency for International Development — The Office of the Chief Information Officer in the Management Bureau of USAID launched initiatives designed for IT cost savings and avoidance. This dataset includes...

  20. GSA IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    General Services Administration — GSA IT provides data related to Agency IT initiatives that save or avoid expenditures. This data is provided as a requirement of OMB's Integrated Data Collection...

  1. Food Waste Avoidance Actions in Food Retailing

    DEFF Research Database (Denmark)

    Kulikovskaja, Viktorija; Aschemann-Witzel, Jessica

    2017-01-01

    Food waste occurs throughout the entire food supply chain, from production to consumption of food in households. Retailers are in a unique position to contribute to food waste avoidance, not only by minimizing the amount of waste in their distribution channels but also by influencing consumer...... attitudes and behaviors. This explorative study aims to identify which food waste avoidance actions are conducted by retailers in Denmark, to which extent, and how they vary across food categories and supermarket chain. Based on an analysis of secondary and empirical data collected via observations...... at retail stores, the authors identify 22 food waste avoidance actions in Danish retail. The results provide new insights into food waste avoidance in retail. Based on the findings, suggestions for further research directions are developed that should serve to identify the most efficient customer targeted...

  2. Directional Collision Avoidance in Ad Hoc Networks

    National Research Council Canada - National Science Library

    Wang, Yu; Garcia-Luna-Aceves, J. J

    2004-01-01

    This paper analyzes the performance of directional collision avoidance schemes, in which antenna systems are used to direct the transmission and reception of control and data packets in channel access...

  3. The challenges for scientists in avoiding plagiarism.

    Science.gov (United States)

    Fisher, E R; Partin, K M

    2014-01-01

    Although it might seem to be a simple task for scientists to avoid plagiarism and thereby an allegation of research misconduct, assessment of trainees in the Responsible Conduct of Research and recent findings from the National Science Foundation Office of Inspector General regarding plagiarism suggests otherwise. Our experiences at a land-grant academic institution in assisting researchers in avoiding plagiarism are described. We provide evidence from a university-wide multi-disciplinary course that understanding how to avoid plagiarism in scientific writing is more difficult than it might appear, and that a failure to learn the rules of appropriate citation may cause dire consequences. We suggest that new strategies to provide training in avoiding plagiarism are required.

  4. Toddlers at the Table: Avoiding Power Struggles

    Science.gov (United States)

    ... try a new food being offered. Avoid the Junk Food Trap Toddlers need to eat healthy to get ... need. Candy, potato chips, and other low-nutrient "junk foods" shouldn't be part of their diet because ...

  5. When Should a Mother Avoid Breastfeeding?

    Science.gov (United States)

    ... submit" name="commit" type="submit" value="Submit" /> Breastfeeding Information for Families Breastfeeding Hotline The HHS Office ... Tweet Share Compartir When should a mother avoid breastfeeding? Health professionals agree that human milk provides the ...

  6. Avoiding Anemia: Boost Your Red Blood Cells

    Science.gov (United States)

    ... Issues Subscribe January 2014 Print this issue Avoiding Anemia Boost Your Red Blood Cells En español Send ... Disease When Blood Cells Bend Wise Choices Preventing Anemia To prevent or treat iron-deficiency anemia: Eat ...

  7. Postoperative pulmonary hypertensive crisis caused by inverted left atrial appendage after cardiopulmonary bypass surgery for congenital heart disease in a neonate.

    Science.gov (United States)

    Zhao, Qifeng; Hu, Xingti

    2013-09-01

    Postoperative pulmonary hypertensive crisis (PHC) caused by an inverted left atrial appendage (ILAA) is a rare complication following cardiac surgery. We present a case of 23 day-old male infant who developed postoperative PHC attacks after undergoing cardiopulmonary bypass (CPB) surgery for repair of the coactation of aorta. A hyperechogenic left atrial mass was detected via bedside transthoracic echocardiography (TTE), which was identified as an ILAA and corrected following repeat surgery. In this case, both the negative pressure in vent catheter and the long left atrial appendage (LAA) with a narrow base led to an irreversible ILAA. As in this neonate, ILAA had significant influence on the left atrial volume and caused PHC since the ILAA was located on the mitral valve orifice and interfered with the blood flow through the valve. Therefore, we recommend that the vent catheter should be turned off before removing to avoid this potential complication. Additionally, LAA should be carefully inspected after CPB surgery, and intra-operative and post-operative transoesophageal echocardiography (TEE) should be performed to detect ILAA intraoperatively so as to avoid the reoperation. When an ILAA is diagnosed postoperatively, whether conservative treatment or surgery will depend on the balance of benefit and risk for a particular patient. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  8. Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity.

    Science.gov (United States)

    Thompson, Brian L; Waltz, Jennifer

    2010-05-01

    Mindfulness reflects an awareness of present moment experiences through an attitude of acceptance and openness (Bishop et al., 2004; Cardaciotto, Herbert, Forman, Moitra, & Farrow, 2008). Experiential avoidance, by contrast, refers to attempts to change, alter, or avoid private experiences (e.g., thoughts, feelings, sensations), and it is believed to underlie a number of psychopathologies, including PTSD (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). We were interested in the ability of mindfulness to predict the variance of PTSD avoidance symptom severity above and beyond experiential avoidance. 378 introductory psychology students were administered self-report measures of PTSD, mindfulness, experiential avoidance, thought suppression, alexithymia, and avoidant coping. Mindfulness, specifically nonjudgment of experiences, accounted for a unique portion of the variance in PTSD avoidance symptoms. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. Banking deregulation and corporate tax avoidance

    Directory of Open Access Journals (Sweden)

    Bill B. Francis

    2017-06-01

    Full Text Available We investigate whether tax avoidance substitutes for external financing. We exploit interstate banking deregulation as a quasi-external shock to examine whether firms engage in less tax avoidance after banking deregulation, because of cheaper and easier access to credit from banks. We find no empirical evidence to support this substitutive relation, even for firms with higher financial constraints or firms with higher external financing dependence.

  10. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Kleinman, Monica E; Goldberger, Zachary D; Rea, Thomas; Swor, Robert A; Bobrow, Bentley J; Brennan, Erin E; Terry, Mark; Hemphill, Robin; Gazmuri, Raúl J; Hazinski, Mary Fran; Travers, Andrew H

    2018-01-02

    Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation. © 2017 American Heart Association, Inc.

  11. Mobile Robot Collision Avoidance in Human Environments

    Directory of Open Access Journals (Sweden)

    Lingqi Zeng

    2013-01-01

    Full Text Available Collision avoidance is a fundamental requirement for mobile robots. Avoiding moving obstacles (also termed dynamic obstacles with unpredictable direction changes, such as humans, is more challenging than avoiding moving obstacles whose motion can be predicted. Precise information on the future moving directions of humans is unobtainable for use in navigation algorithms. Furthermore, humans should be able to pursue their activities unhindered and without worrying about the robots around them. In this paper, both active and critical regions are used to deal with the uncertainty of human motion. A procedure is introduced to calculate the region sizes based on worst-case avoidance conditions. Next, a novel virtual force field-based mobile robot navigation algorithm (termed QVFF is presented. This algorithm may be used with both holonomic and nonholonomic robots. It incorporates improved virtual force functions for avoiding moving obstacles and its stability is proven using a piecewise continuous Lyapunov function. Simulation and experimental results are provided for a human walking towards the robot and blocking the path to a goal location. Next, the proposed algorithm is compared with five state-of-the-art navigation algorithms for an environment with one human walking with an unpredictable change in direction. Finally, avoidance results are presented for an environment containing three walking humans. The QVFF algorithm consistently generated collision-free paths to the goal.

  12. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  13. Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement

    NARCIS (Netherlands)

    Boller, Manuel; Fletcher, Dan J; Brainard, Benjamin M; Haskins, Steve; Hopper, Kate; Nadkarni, Vinay M; Morley, Peter T; McMichael, Maureen; Nishimura, Ryohei; Robben, Joris H; Rozanski, Elizabeth; Rudloff, Elke; Rush, John; Shih, Andre; Smarick, Sean; Tello, Luis H

    2016-01-01

    OBJECTIVE: To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology. DESIGN: Consensus guidelines. SETTING: International, academia, referral

  14. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time

    NARCIS (Netherlands)

    Helvoort, H.A.C. van; Boer, R.C. de; Broek, L. van den; Dekhuijzen, R.; Heijdra, Y.F.

    2011-01-01

    OBJECTIVES: To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary

  15. Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

    NARCIS (Netherlands)

    Krage, R.; Zwaan, L.; Tjon Soei Len, L.; Kolenbrander, M.; Groeningen, D. van; Loer, S.A.; Wagner, C.; Schober, P.

    2017-01-01

    Background: Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary

  16. A non-fatal case of hantavirus cardiopulmonary syndrome imported into the UK (ex Panama), July 2014

    OpenAIRE

    Atkinson, Barry; Jameson, Lisa J.; Bovill, Bego?a A.; Aarons, Emma J.; Clewlow, Jodie; Lumley, Sarah; Latham, Jennie; Jenkins, Megan H.; MacGowan, Alasdair P.; Simpson, Andrew J.; Ahmed, Javeed; Brooks, Timothy J.; Hewson, Roger

    2015-01-01

    Highlights ? Detection of hantavirus cardiopulmonary syndrome imported into Europe. ? Additional evidence that Choclo hantavirus is currently circulating and causing human disease in Panama. ? Novel diagnostic and sequencing assays for identifying cases of Choclo hantavirus infection.

  17. 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

    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...

  18. CARDIOPULMONARY GENE EXPRESSION PROFILES IN NORMO- AND SPONTANEOUSLY HYPERSENSITIVE (SH) RATS: IMPACT OF PARTICULATE MATTER (PM) EXPOSURE

    Science.gov (United States)

    CARDIOPULMONARY GENE EXPRESSION PROFILES IN NORMO- AND SPONTANEOUSLY HYPERTENSIVE (SH) RATS: IMPACT OF PARTICULATE MATTER (PM) EXPOSURE. SS Nadadur UP Kodavanti, Pulmonary Toxicology Branch, ETD, ORD, NHEERL, US Environmental Protection Agency, Research Triangle Park, NC 27711.

  19. Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning.

    Science.gov (United States)

    Cason, Carolyn L; Kardong-Edgren, Suzan; Cazzell, Mary; Behan, Deborah; Mancini, Mary Elizabeth

    2009-01-01

    Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

  20. Effect of thyroid hormone on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass

    OpenAIRE

    Qing-Bin Wei; Fei Xie; Shi-Li Wang; Gang Li

    2017-01-01

    Objective: To study the effect of thyroid hormone (euthyrox) on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass. Methods: A total of 76 patients who received valve replacement under cardiopulmonary bypass in our hospital between January 2013 and December 2016 were collected and divided into control group (n=38) and observation group (n=38) according to random number table. Observation group took euthyrox orally 1 week before...

  1. Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure.

    Science.gov (United States)

    Dharmarajan, Kumar; Strait, Kelly M; Tinetti, Mary E; Lagu, Tara; Lindenauer, Peter K; Lynn, Joanne; Krukas, Michelle R; Ernst, Frank R; Li, Shu-Xia; Krumholz, Harlan M

    2016-08-01

    To determine how often hospitalized older adults principally diagnosed with pneumonia, chronic obstructive pulmonary disease (COPD), or heart failure (HF) are concurrently treated for two or more of these acute cardiopulmonary conditions. Retrospective cohort study. 368 U.S. hospitals in the Premier research database. Individuals aged 65 and older principally hospitalized with pneumonia, COPD, or HF in 2009 or 2010. Proportion of diagnosed episodes of pneumonia, COPD, or HF concurrently treated for two or more of these acute cardiopulmonary conditions during the first 2 hospital days. Of 91,709 diagnosed pneumonia hospitalizations, 32% received treatment for two or more acute cardiopulmonary conditions (18% for HF, 18% for COPD, 4% for both). Of 41,052 diagnosed COPD hospitalizations, 19% received treatment for two or more acute cardiopulmonary conditions (all of which involved additional HF treatment). Of 118,061 diagnosed HF hospitalizations, 38% received treatment for two or more acute cardiopulmonary conditions (34% for pneumonia, 9% for COPD, 5% for both). Hospitalized older adults diagnosed with pneumonia, COPD, or HF are frequently treated for two or more acute cardiopulmonary conditions, suggesting that clinical syndromes often fall between traditional diagnostic categories. Research is needed to evaluate the risks and benefits of real-world treatment for the many older adults whose presentations elicit diagnostic uncertainty or concern about coexisting acute conditions. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  2. Increased post-operative cardiopulmonary fitness in gastric bypass patients is explained by weight loss

    DEFF Research Database (Denmark)

    Lund, M. T.; Hansen, M.; Wimmelmann, C. L.

    2016-01-01

    -perceived physical fitness increased after RYGB. Self-reported low- and high-intensity physical activity did not change. With weight loss, self-rated fitness level increased and the limitations to perform exercise decreased in RYGB patients. Nevertheless, as shown by the lower absolute VO2max, RYGB patients do......Roux-en-Y gastric bypass (RYGB) leads to a major weight loss in obese patients. However, given that most patients remain obese after the weight loss, regular exercise should be part of a healthier lifestyle. The primary aim of this study was to investigate the cardiopulmonary fitness in obese...... patients before and after RYGB. Thirty-four patients had body composition and cardiopulmonary fitness (VO2max) assessed and completed questionnaires regarding physical activity and function twice before RYGB (time points A and B) and 4 and 18 months after surgery (time points C and D). Weight loss was 37...

  3. The use of mice and rats as animal models for cardiopulmonary resuscitation research.

    Science.gov (United States)

    Papadimitriou, D; Xanthos, T; Dontas, I; Lelovas, P; Perrea, D

    2008-07-01

    Cardiopulmonary resuscitation (CPR) after the induction of cardiac arrest (CA) has been studied in mice and rats. The anatomical and physiological parameters of the cardiopulmonary system of these two species have been defined during experimental studies and are comparable with those of humans. Moreover, these animal models are more ethical to establish and are easier to manipulate, when compared with larger experimental animals. Accordingly, the effects of successful CPR on the function of vital organs, such as the brain, have been investigated because damage to these vital organs is of concern in CA survivors. Furthermore, the efficacy of several drugs, such as adrenaline (epinephrine), vasopressin and nitroglycerin, has been evaluated for use in CA in these small animal models. The purpose of these studies is not only to increase the rate of survival of CA victims, but also to improve their quality of life by reducing damage to their vital organs after CA and during CPR.

  4. Drotrecogin Alpha (Activated in Two Patients with the Hantavirus Cardiopulmonary Syndrome

    Directory of Open Access Journals (Sweden)

    Robert C McDermid

    2006-01-01

    Full Text Available Hantavirus cardiopulmonary syndrome (HCPS is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure. To date, treatment remains supportive and includes mechanical ventilation, vasopressors and extracorporeal membrane oxygenation, with mortality approaching 50%. Two HCPS survivors initially given drotrecogin alpha (activated (DAA for presumed bacterial septic shock are described. Vasoactive medications were required for a maximum of 52 h, whereas creatinine levels and platelet counts normalized within seven to nine days. Given the similar presentations of HCPS and bacterial septic shock, empirical DAA therapy will likely be initiated before a definitive diagnosis of HCPS is made. Further observations of DAA in HCPS seem warranted.

  5. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Sant, Jetske Van't; Versteeg, Henneke

    2016-01-01

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT......-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic...... response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only...

  6. Rape avoidance behavior among Slovak women.

    Science.gov (United States)

    Prokop, Pavol

    2013-05-28

    Rape has been a recurrent adaptive problem for many species, including humans. Rape is costly to women in terms of disease transmission, partner abandonment, and unwanted pregnancy (among other costs). Therefore, behavioral strategies which allow women to avoid coercive men may have been favored by selection. In line with this evolutionary reasoning, the current research documented that physically stronger women and those in a committed romantic relationship reported more rape avoidance behavior. In addition, virgin women tended to perform more rape avoidance behavior compared with their non-virgin counterparts. Women with high conception risk perceived themselves as physically stronger, which may protect them against a potential rapist. Fear of unwanted pregnancy from rape decreased as age increased, reflecting higher fertility among younger participants. However, older women reported more rape avoidance behavior, which contradicts evolutionary predictions. The results provide some support for evolutionary hypotheses of rape avoidance behavior which suggest that woman's perception of rape is influenced by parental investment and perceived physical condition.

  7. DNA elasticity: topology of self-avoidance

    International Nuclear Information System (INIS)

    Samuel, Joseph; Sinha, Supurna; Ghosh, Abhijit

    2006-01-01

    We present a theoretical treatment of DNA stretching and twisting experiments, in which we discuss global topological subtleties of self-avoiding ribbons and provide an underlying justification for the worm-like rod chain (WLRC) model proposed by Bouchiat and Mezard. Some theoretical points regarding the WLRC model are clarified: the 'local writhe formula' and the use of an adjustable cut-off parameter to 'regularize' the model. Our treatment brings out the precise relation between the worm-like chain (WLC), the paraxial worm-like chain (PWLC) and the WLRC models. We describe the phenomenon of 'topological untwisting' and the resulting collapse of link sectors in the WLC model and note that this leads to a free energy profile periodic in the applied link. This periodicity disappears when one takes into account the topology of self-avoidance or at large stretch forces (paraxial limit). We note that the difficult non-local notion of self-avoidance can be replaced (in an approximation) by the simpler local notion of 'south avoidance'. This gives an explanation for the efficacy of the approach of Bouchiat and Mezard in explaining the 'hat curves' using the WLRC model, which is a south avoiding model. We propose a new class of experiments to probe the continuous transition between the periodic and aperiodic behaviour of the free energy

  8. Peer conflict avoidance: associations with loneliness, social anxiety, and social avoidance.

    Science.gov (United States)

    Johnson, H D; LaVoie, J C; Spenceri, M C; Mahoney-Wernli, M A

    2001-02-01

    Failure to resolve peer conflict is associated with children's reports of loneliness, social anxiety, and social avoidance. Although these relationships are well established, researchers have not examined the association between the avoidance of peer conflict and various adjustment characteristics. The current study examined the association between avoidance of conflict and measures of loneliness, social anxiety, and social avoidance for 59 pupils in Grade 4 (31 boys and 28 girls) and 47 in Grade 8 (22 boys and 25 girls). Volunteers indicated that conflict avoidance based on autonomy, e.g., independence issues, and interpersonal issues, e.g., closeness and cohesion, was associated with scores on loneliness for boys and girls, respectively. Conflict avoidance for emotional and physical well-being and fear of punishment was associated with increased reports of loneliness and social anxiety for children in Grade 4.

  9. Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study.

    Science.gov (United States)

    Amacher, Simon Adrian; Schumacher, Cleo; Legeret, Corinne; Tschan, Franziska; Semmer, Norbert Karl; Marsch, Stephan; Hunziker, Sabina

    2017-07-01

    Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance. Prospective, randomized simulator study. High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland). Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three. None. We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition. We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.

  10. Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

    Science.gov (United States)

    Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

    2012-09-01

    This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p Leadership skills were not significantly associated with more simple technical skills such as chest-compression rate, depth, and ventilation rate. Prior training in team leader skills was independently associated with better leadership behavior. There is an association between team leadership skills and cardiac arrest simulation test score, preshock pause, and hands off ratio. Developing leadership

  11. CARDIOPULMONARY AND BLOOD GAS PARAMETERS IN SHEEP UNDER INHALATIONAL ANESTHESIA DURING DECUBITUS ALTERNATIONS

    OpenAIRE

    Liana Villela Gouvea; João Gabriel César Palermo; José Renato Junqueira Borges; Ricardo Miyasaka Almeida; Fábio Henrique Bezerra Ximenes; Roberta Ferro de Godoy

    2016-01-01

    Sheep herds, especially Santa Ines breed, have grown in the Brazilian Midwest in recent years. Therefore, clinical cases have also grown, and along came the need of conducting major surgeries without pain associated with the use of inhalational anesthesia. This study evaluated the cardiopulmonary and blood gas parameters in sheep under inhalational anesthesia with controlled ventilation, and assessed the effect of decubitus alternations on the parameters. The animals were anesthetized with ac...

  12. Cardiopulmonary exercise testing prior to myeloablative allo-SCT: a feasibility study.

    Science.gov (United States)

    Kelsey, C R; Scott, J M; Lane, A; Schwitzer, E; West, M J; Thomas, S; Herndon, J E; Michalski, M G; Horwitz, M E; Hennig, T; Jones, L W

    2014-10-01

    The feasibility of symptom-limited cardiopulmonary exercise testing (CPET) prior to allo-SCT was assessed in addition to the prognostic value of CPET-derived measures. CPET was performed prospectively on 21 patients with hematologic malignancies, with assessments of peak (for example, peak oxygen consumption, VO2peak) and submaximal (for example, ventilatory threshold (VT)) measures of cardiopulmonary function. No serious adverse events were observed during CPET procedures, with 95% of patients achieving criteria for a peak test. Mean VO2peak was 24.7±6.4 mL kg(-1 )min(-1) (range: 10.9-35.5), equivalent to 29%±17% below that of age-matched healthy controls. All patients proceeded with the conditioning regimen followed by allo-SCT. Median follow-up was 25 months. During this period, 11 (52.4%) patients died (n=6, relapsed disease; n=5, non-relapse mortality (NRM)); 9 patients (43%) developed pulmonary toxicity. In univariate analyses, both peak and submaximal markers of cardiopulmonary function were predictors of OS, pulmonary toxicity and NRM. For OS, the HR for VO2peak and VT were 0.89 (95% CI, 0.8-0.99, P=0.04) and 0.84 (95% CI, 0.71-0.98, P=0.03), respectively. In conclusion, CPET is safe and feasible prior to allo-SCT. Patients have marked impairments in cardiopulmonary function prior to allo-SCT. CPET-derived metrics may complement conventional measures to improve risk stratification.

  13. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    OpenAIRE

    Botelho,Renata Maria de Oliveira; Campanharo,Cássia Regina Vancini; Lopes,Maria Carolina Barbosa Teixeira; Okuno,Meiry Fernanda Pinto; Góis,Aécio Flávio Teixeira de; Batista,Ruth Ester Assayag

    2016-01-01

    ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condit...

  14. Effects of flashlight guidance on chest compression performance in cardiopulmonary resuscitation in a noisy environment

    OpenAIRE

    You, Je Sung; Chung, Sung Phil; Chang, Chul Ho; Park, Incheol; Lee, Hye Sun; Kim, SeungHo; Lee, Hahn Shick

    2012-01-01

    Background In real cardiopulmonary resuscitation (CPR), noise can arise from instructional voices and environmental sounds in places such as a battlefield and industrial and high-traffic areas. A feedback device using a flashing light was designed to overcome noise-induced stimulus saturation during CPR. This study was conducted to determine whether ?flashlight? guidance influences CPR performance in a simulated noisy setting. Materials and methods We recruited 30 senior medical students with...

  15. Hemodynamic–directed cardiopulmonary resuscitation during in–hospital cardiac arrest*

    OpenAIRE

    Sutton, Robert M.; Friess, Stuart H.; Maltese, Matthew R.; Naim, Maryam Y.; Bratinov, George; Weiland, Theodore R.; Garuccio, Mia; Bhalala, Utpal; Nadkarni, Vinay M.; Becker, Lance B.; Berg, Robert A.

    2014-01-01

    Cardiopulmonary resuscitation (CPR) guidelines assume that cardiac arrest victims can be treated with a uniform chest compression (CC) depth and a standardized interval administration of vasopressor drugs. This non-personalized approach does not incorporate a patient’s individualized response into ongoing resuscitative efforts. In previously reported porcine models of hypoxic and normoxic ventricular fibrillation (VF), a hemodynamic-directed resuscitation improved short-term survival compared...

  16. ASSESSMENT OF KNOWLEDGE & ATTITUDE OF THE PEDIATRIC RESIDENT ABOUT NEONATAL & PEDIATRIC CARDIOPULMONARY RESUSCITATION

    Directory of Open Access Journals (Sweden)

    M KADIAVAR

    2003-09-01

    Full Text Available Introduction: A high leve of skill & knowledge is required in circumstances of cardiopulmonary resucitation which represents the most urgent clinical situations. The difficulties for pediatric residents who are fronted with the most cases of pediatric & neonatal resucitation are due to different causes of cardiorespiratory arrest in camparison to adults. This study aimed to assess the knowledge & their personal attitude toward the neonatal & pediatric cardiopulmonary resuscitatin. Methods: By cross - sectional multicenter study between the pediatric residents who were studied in the teaching hospitals in Tehran (1378-90. Data were gathered among 140 residents by self-completed questionnaires which were included three parts as. demographic information assessment of their attitude by summation of score via ranking list questions and total score from assessment to their knowledge by different scenarios which were formatted in the multiple choice questions. Results: 35.7% of the residents studied in the first year of residency 35.0% in the second year and the remainder (29/3% in the third year More than 90% of them considered their knowledge about neonatal and pediatric cardiopulmonary resuscitation low & less than average. Net only 80% of the residents self - assessed their actual ability about this issue low but also declaired the insufficient education during the medical training. The total score of knowledge assessment was 14.7 + 1_0.54 from 30 without any significant relations among the residents in different hospitals or various levels of pediatric residency. (P value= 0.1 , 0.7 There was not significant correlation between the total score from their attitude & their knowledge. Conclusion: Pediatric residents as the key personnel in the management of cardiopulmonary resuscitation of the neonates and children should have enough knowledge and skills about this topic. This survey demonstrates a low level of the pediatric & neonatal

  17. [Characteristics and evolution of cardiopulmonary arrest in children in Spain: comparison between autonomous communities].

    Science.gov (United States)

    López-Herce Cid, J; García Sanz, C; Domínguez Sampedro, P; Carrillo Alvarez, A; Rodríguez Núñez, A; Calvo Macías, C

    2006-01-01

    In Spain there are many differences between autonomous regions in terms of geography, population distribution and health care organisation. We do not know if these differences could have influenced the characteristics and evolution of cardiopulmonary arrest in children. A secondary analysis of data from a prospective, multicenter and previously published study, analysing cardiorespiratory arrest in children was made to compare the characteristics and evolution of cardiopulmonary arrest in children depending on the region where the arrest occurred. We studied 283 children aged between 7 days and 17 years who suffered respiratory or cardiopulmonary arrest. Data were recorded according to the international Utstein style recommendations. Patients were classified according to the autonomous region where the cardiac arrest occurred: Catalonia (94 cases), Andalusia (64 cases), Madrid (61 cases) and the rest of the regions (64 patients). A statistical analysis was performed to compare the characteristics of cardiac arrest, resuscitation, evolution and survival between the four groups. Sixty percent of patients initially survived the cardiac arrest episode and 33% (94 patients) were still alive one year later. No significant differences in the characteristics of arrest, resuscitation and evolution were found when the autonomous regions were compared. Even though the differences were not statistically significant, there was a tendency to less than expected survival in Andalusia and higher than expected survival in Catalonia. There are no important differences in the characteristics of pediatric cardiopulmonary arrest, resuscitation, evolution and survival between the autonomous regions in Spain. Additional studies are needed to analyze the hypothetical influence of health care organization and life support training on survival.

  18. Cardiopulmonary Bypass and Blood Transfusion (Indications and Problems in Tranfusion of Blood Components as of 1986)

    OpenAIRE

    金沢, 宏; 大関, 一; 矢沢, 正知; 江口, 昭治; Kanazawa, Hiroshi; Oozeki, Hajime; Yazawa, Masatomo; Eguchi, Shoji

    1987-01-01

    Cardiopulmonary bypass (CPB), functioning as the pumping system and the gas exchange functions, is one of the important instruments in cardiovascular operations. But it has many unfavourable problems such as massive blood transfusion, hemodilution, abnormality of coagulation, etc. In fact, 5 or 6 units of blood are necessary to prime CPB in infant, child, and adult. After CPB, massive blood transfusion is necessary to keep good circulation, and to recover from hemodilution and abnormal coagul...

  19. 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...

  20. Families? Stressors and Needs at Time of Cardio-Pulmonary Resuscitation: A Jordanian Perspective

    OpenAIRE

    Masa?Deh, Rami; Saifan, Ahmad; Timmons, Stephen; Nairn, Stuart

    2013-01-01

    Background: During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hos...

  1. 30: 2: A Game Designed to Promote the Cardiopulmonary Resuscitation Protocol

    OpenAIRE

    Boada, Imma; Rodriguez-Benitez, Antonio; Garcia-Gonzalez, Juan Manuel; Thió i Fernández de Henestrosa, Santiago; Sbert, Mateu

    2016-01-01

    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 survival chances of cardiac arrest victims. We propose 30 : 2, a videogame designed to introduce the main steps of the CPR protocol. It is not intended for certification and training purpose. Driven by the 2010 European Resuscitation Council guidelines we have designed a game composed of eight min...

  2. Acute Mallory–Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    OpenAIRE

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong

    2015-01-01

    A report of a 62-year-old female patient with severe Mallory–Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient's total blood loss was estimated to be approximately 3000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory–Weiss syndrome after CPR may occur and should be considered as a potentially serious complication aft...

  3. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    OpenAIRE

    Morais, Daniela Aparecida; Carvalho, Daclé Vilma; Correa, Allana dos Reis

    2014-01-01

    OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESUL...

  4. T Cells and Pathogenesis of Hantavirus Cardiopulmonary Syndrome and Hemorrhagic Fever with Renal Syndrome

    OpenAIRE

    Francis A. Ennis; Masanori Terajima

    2011-01-01

    We previously hypothesized that increased capillary permeability observed in both hantavirus cardiopulmonary syndrome (HCPS) and hemorrhagic fever with renal syndrome (HFRS) may be caused by hantavirus-specific cytotoxic T cells attacking endothelial cells presenting viral antigens on their surface based on clinical observations and in vitro experiments. In HCPS, hantavirus-specific T cell responses positively correlated with disease severity. In HFRS, in one report, contrary to HCPS, T cell ...

  5. The Effects of Cigarette Smoking on Cardiopulmonary Function and Exercise Tolerance in Teenagers

    OpenAIRE

    Louie, Dianna

    2001-01-01

    Teenagers who smoke are frequently warned that cigarette smoking will have detrimental effects on the function of their cardiopulmonary system and on their ability to perform exercise. However, there is little published evidence to support this statement. Therefore, in the present study, peak expiratory flow was measured as an indicator of lung function, expired carbon monoxide level was measured as an indicator of current smoking and the associated reduction in the oxygen carrying capacity o...

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

    OpenAIRE

    Lakshmi Rajeswaran; Valerie J. Ehlers

    2013-01-01

    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...

  7. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century

    OpenAIRE

    Ekmektzoglou, Konstantinos A.; Johnson, Elizabeth O.; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation...

  8. Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories

    Directory of Open Access Journals (Sweden)

    Laurel S. Morris

    2017-01-01

    Conclusions: FND patients had impaired instrumental avoidance learning, findings that parallel previous observations of impaired action-outcome binding. FND patients further show enhanced behavioural and neural sensitivity to negative information. However, this did not translate to improved avoidance learning. Put together, our findings do not support the theory of harm avoidance in FND. We highlight a potential mechanism by which negative contexts interfere with adaptive behaviours in this under-explored disorder.

  9. Assessment of therapeutic options for mild obstructive sleep apnea using cardiopulmonary coupling measures.

    Science.gov (United States)

    Schramm, Preetam J; Thomas, Robert J

    2012-06-15

    To examine the efficacy of various therapeutic modalities for mild obstructive sleep apnea using cardiopulmonary coupling variables of sleep quality. A 67-year-old Caucasian subject's sleep was recorded at home for 10 nights using a type 3 sleep recording device that measured ECG and body position, followed by generation of the cardiopulmonary sleep spectrogram. Three baseline nights, one night with a sleep jacket containing 3 tennis balls to restrict sleep in the supine position, 2 nights with oxygen only delivered via a nasal cannula at a flow rate of 2 L/minute, 2 nights with a mandible advancing appliance (MAA) only, and 2 nights using oxygen at 2 L/minute with the MAA were compared. Baseline sleep quality estimated using the ratio of high-frequency and low-frequency coupling (1.03) was below the expected normal adult values ranging from 1.67-4.0. The sleep quality ratio was significantly higher (2.08) using the MAA alone compared to baseline, sleep position restriction (1.61), oxygen therapy (0.81), and the combination of MAA with oxygen (1.66). Sleep quality measured objectively using cardiopulmonary coupling variables differentiated the efficacy of therapeutic options for mild obstructive sleep apnea. Such an approach may have practical utility.

  10. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

    Science.gov (United States)

    Fallat, Mary E

    2014-04-01

    This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.

  11. Predictors of public support for family presence during cardiopulmonary resuscitation: A population based study.

    Science.gov (United States)

    Dwyer, Trudy A

    2015-06-01

    The debate on whether individuals want their family to be present during cardiopulmonary resuscitation continues to be a contentious issue, but there is little analysis of the predictors of the general public's opinion. The aim of this population based study was to identify factors that predict public support for having family present during cardiopulmonary resuscitation. Data for this cross-sectional population based study were collected via computer-assisted-telephone-interviews of people (n=1208) residing in Central Queensland, Australia. Participants supported family members being present should their child (75%), an adult relative (52%) or they themselves (51%) require cardiopulmonary resuscitation. Reasons cited for not wanting to be present were; distraction for the medical team (30.4%), too distressing (30%) or not known/not considered the option (19%). Sex and prior exposure to being present during the resuscitation of adults and children were both predictors of support (presuscitation varies according to; sex, prior exposure and if the family member who is being resuscitated is a family member, their child or the person themselves. A considerable proportion of the public have not considered nor planned for the option of being present during a cardiac arrest of an adult relative. Clinicians may find it useful to explain the experiences of other people who have been present when supporting families to make informed decisions about their involvement in emergency interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Science.gov (United States)

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  13. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  14. Value of wedge resection for lung cancer in poor cardiopulmonary status patients.

    Science.gov (United States)

    Mahesh, Balakrishnan; Forrester-Wood, Christopher; Amer, Khalid; Ascione, Raimondo

    2006-04-01

    The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.96 years) with baseline poor cardiopulmonary status underwent wide-margin wedge resection of preoperatively diagnosed primary lung cancer. All patients suffered from chronic obstructive pulmonary disease and 9 (37.5%) also had symptomatic ischemic heart disease. Eight patients were in New York Heart Association class III and 12 were in class IV. There were no post-operative deaths. Complications included chest infection in 3, surgical emphysema with prolonged air leak in 1, and atrial fibrillation in 6. Overall 7-year survival was 23.3%. Three patients with ischemic heart disease suffered late non-cancer-related death due to myocardial infarction at 48, 60, and 60 months postoperatively. Cancer-free 5-year survival was 54.3%, with 7/24 (29%) late recurrences. Our study suggests that wide-margin wedge resection is a valuable surgical option for primary lung cancer in patients with poor cardiopulmonary status.

  15. Google Glass for Residents Dealing With Pediatric Cardiopulmonary Arrest: A Randomized, Controlled, Simulation-Based Study.

    Science.gov (United States)

    Drummond, David; Arnaud, Cécile; Guedj, Romain; Duguet, Alexandre; de Suremain, Nathalie; Petit, Arnaud

    2017-02-01

    To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. Randomized controlled study. Children's hospital at a tertiary care academic medical center. Forty-two first-year pediatric residents. Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p Google Glass group than in the control group. Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.

  16. Bioavailable transition metals in particulate matter mediate cardiopulmonary injury in healthy and compromised animal models

    Energy Technology Data Exchange (ETDEWEB)

    Costa, D.L.; Dreher, K.L. [US Environmental Protection Agency, Research Triangle Park, NC (United States). National Health and Environmental Effects Research Lab.

    1997-09-01

    Many epidemiologic reports associate ambient levels of particulate matter (PM) with human mortality and morbidity, particularly in people with preexisting cardiopulmonary disease (e.g., chronic obstructive pulmonary disease, infection, asthma). Because much ambient PM is derived from combustion sources, the hypothesis that the health effects of PM arise from anthropogenic PM that contains bioavailable transition metals was tested. The PM samples studied derived from three emission sources (two oil and one coal fly ash) and four ambient airsheds (St. Louis, MO, USA; Washington, DC (USA); Duesseldorf, Germany; and Ottawa, Canada). PM was administered to rats by intratracheal instillation in equimass or equimetal doses to address directly the influence of PM mass versus metal content on actual lung injury and inflammation. Results indicated that the lung dose of bioavailable transition metal, not instilled PM mass, was the primary determinant of the acute inflammatory response for both the combustion source and ambient PM samples. Residual oil fly ash, a combustion PM rich in bioavailable metal, and evaluated in rat model of cardiopulmonary disease (pulmonary vasculitis/hypertension) to ascertain whether the disease state augmented sensitivity to that PM. It is proposed that soluble metals from PM mediate the array of PM-associated injuries to the cardiopulmonary system of the healthy and at-risk compromised host.

  17. Stimulation of the cardiopulmonary baroreflex enhances ventricular contractility in awake dogs: a mathematical analysis study.

    Science.gov (United States)

    Sala-Mercado, Javier A; Moslehpour, Mohsen; Hammond, Robert L; Ichinose, Masashi; Chen, Xiaoxiao; Evan, Sell; O'Leary, Donal S; Mukkamala, Ramakrishna

    2014-08-15

    The cardiopulmonary baroreflex responds to an increase in central venous pressure (CVP) by decreasing total peripheral resistance and increasing heart rate (HR) in dogs. However, the direction of ventricular contractility change is not well understood. The aim was to elucidate the cardiopulmonary baroreflex control of ventricular contractility during normal physiological conditions via a mathematical analysis. Spontaneous beat-to-beat fluctuations in maximal ventricular elastance (Emax), which is perhaps the best available index of ventricular contractility, CVP, arterial blood pressure (ABP), and HR were measured from awake dogs at rest before and after β-adrenergic receptor blockade. An autoregressive exogenous input model was employed to jointly identify the three causal transfer functions relating beat-to-beat fluctuations in CVP to Emax (CVP → Emax), which characterizes the cardiopulmonary baroreflex control of ventricular contractility, ABP to Emax, which characterizes the arterial baroreflex control of ventricular contractility, and HR to Emax, which characterizes the force-frequency relation. The CVP → Emax transfer function showed a static gain of 0.037 ± 0.010 ml(-1) (different from zero; P baroreflex. Following β-adrenergic receptor blockade, the CVP → Emax transfer function showed a static gain of 0.0007 ± 0.0113 ml(-1) (different from control; P baroreflex increases ventricular contractility through β-adrenergic receptor system mediation. Copyright © 2014 the American Physiological Society.

  18. New apparatus for training the avoidance reaction.

    Science.gov (United States)

    Tikal, K

    1988-01-01

    A new apparatus for active avoidance training in rats consists of a short, wide runway which can be tilted from a horizontal to vertical position. One half of the electrifiable grid floor is covered by a nonconducting sheet. For brightness (black-white) discrimination training a white walled goal box can be inserted into the runway and shifted from left to right during training. Avoidance training of 24 rats (female Wistar SPF) required 14.1 +/- 2.6 (mean +/- SEM) to-criterion trials (9/10) and was completed in less than 4 min. Brightness discrimination training required 21.3 +/- 2.1 to-criterion trials and the time of training did not exceed 12 min. The retention of the acquired responses was very good in both cases. The main advantage of the apparatus is very rapid acquisition of the one-way and discriminated avoidance without the necessity of manual manipulation of the animal.

  19. Do allergic families avoid keeping furry pets?

    Science.gov (United States)

    Bertelsen, R J; Carlsen, K C L; Granum, B; Carlsen, K-H; Håland, G; Devulapalli, C S; Munthe-Kaas, M C; Mowinckel, P; Løvik, M

    2010-06-01

    Studies addressing the relationship between pet keeping and development of asthma and allergies may be influenced by pet avoidance in families with a history of allergic disease. Following a cohort of 1019 children in Oslo till 10 years of age, we studied the association of pet keeping with socio-economic factors and allergic disease in the family. A family history of asthma and rhinoconjunctivitis was not significantly associated with pet ownership at birth or with pet removal by 10 years. Acquiring cats and dogs was less likely if the child had allergic rhinoconjunctivitis, whereas no association was seen with asthma (in any family member). Single parenthood increased the likelihood of acquiring a cat, smoking parents more often had cats or dogs, and having older siblings was associated with keeping dogs and other furry pets. Among 319 families reporting pet avoidance, 70% never had pets, 8% had given up pets, and 22% avoided a particular type of pet only. Twenty-four per cent of the parents failed to retrospectively report pet keeping during the child's first year of life. Overall, allergic rhinitis, but not asthma was associated with actual pet avoidance, whereas the strongest predictors for keeping pets were found to be socio-economic factors. Allergic disease in a child most often does not lead to the removal of the family's furry pet. Pet avoidance is associated with allergic symptoms, but not asthma. Socio-economic factors like parental education, single parenthood and smoking affects the families' decisions on pet keeping, including the type of pets the families will avoid or acquire. The large recall error demonstrated points to the need for prospective data regarding pet keeping.

  20. Reasonable Avoidability, Responsibility and Lifestyle Diseases

    DEFF Research Database (Denmark)

    Andersen, Martin Marchman

    2012-01-01

    In “Health, Luck and Justice” Shlomi Segall argues for a luck egalitarian approach to justice in health care. As the basis for a just distribution he suggests a principle of Reasonable Avoidability, which he takes to imply that we do not have justice-based reasons to treat diseases brought about...... such as smoking and over-eating, nor that responsibility is ultimately irrelevant for the principle of Reasonable Avoidability. Second, I object to an argument of Segall’s, according to which the size of the health-care costs related to smoking and obesity is irrelevant for whether society reasonably can expect...

  1. Further results on self-avoiding walks

    Science.gov (United States)

    Temperley, H. N. V.

    1994-05-01

    A Gaussian model of self-avoiding walks is studied. Not only is any cluster integral exactly evaluable, but whole sub-series can be evaluated exactly in terms of associated Riemann zeta functions. The results are compared with information recently obtained on self-avoiding walks on the plane square and simple cubic lattices and, as expected, are very similar. Use is made of the author's recent result that the reciprocal of the walks generating function is the generating function for irreducible cluster-sums. This is split into sub-series all of which have the same radius of convergence, and the significance of this is discussed.

  2. Collision Avoidance Short Course Part I: Theory

    Science.gov (United States)

    Hejduk, Matthew D.

    2017-01-01

    Satellite conjunction assessment is perhaps the fastest-growing area in space situational awareness and protection, with military, civil, and commercial satellite owner operators embracing more and more sophisticated processes to avoid the avoidable namely collisions between high-value space assets and orbital debris. NASA and CNES have collaborated to offer an introductory short course on all the major aspects of the conjunction assessment problem. This half-day course will cover satellite conjunction dynamics and theory, JSpOC conjunction data products, major risk assessment parameters and plots, conjunction remediation decision support, and present and future challenges. This briefing represents the NASA portion of the course.

  3. Telerobotics with whole-arm collision avoidance

    Science.gov (United States)

    Wilhelmsen, Karl C.; Strenn, Stephen

    1993-12-01

    The complexity of telerobotic operations in a cluttered environment is exacerbated by the need to present collision information to the operator in an understandable fashion. In addition to preventing movements which will cause collisions, a system providing some form of virtual force reflection is desirable. With this goal in mind Lawrence Livermore National Laboratory (LLNL) has installed a kinetically similar master/slave system and developed a whole arm collision avoidance system which interacts directly with the telerobotic controller. LLNL has also provided a structure to allow for automated upgrades of workcell models and provide collision avoidance even in a dynamically changing workcell.

  4. Workplace Health Promotion: Assessing the Cardiopulmonary Risks of the Construction Workforce in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Sze Pui Pamela Tin

    Full Text Available Health needs of different employee subgroups within an industry can differ. We report the results of a workplace cardiopulmonary risk assessment targeting workers and support staff in the construction industry.A free worksite-based cardiopulmonary risk assessment for 1,903 workers on infrastructural contracts across Hong Kong was initiated in May 2014. Cardiopulmonary risk screening was performed in 60-minute blocks for approximately 30 workers/block with individualized feedback and lifestyle counseling. Risk profiles stratified by occupational roles are differentiated using the χ2-test for categorical and Student's t-test for continuous variables.Most construction workers and clerks/professionals were male (83.2% and 71.2%, respectively and Chinese (78.7% and 90.9%, respectively. Construction workers were older (mean: 44.9 years, SD 11.5 and less well-educated (6.1% received tertiary education than clerks/professionals (35.0 years, 10.7; 72.6% received tertiary education, but more likely to be hypertensive (22.6% vs. 15.4%, p<0.001, overweight/obese (71.7% vs. 56.6%, p<0.001, centrally obese (53.1% vs. 35.5%, p<0.001, and have undesirable levels of high-density lipoprotein (41.6% vs. 35.8%, p<0.05 and diabetic levels of non-fasting blood glucose (4.3% vs. 1.6%, p<0.05. Up to 12.6% of construction workers and 9.7% of office clerks/professions had three or more metabolic syndrome risk factors. While construction workers were more likely than clerks/professionals to be daily smokers, they reported better work-related physical activity and diet.Simple worksite health risk screening can identify potentially high-cardiopulmonary-risk construction industry employee subgroups for onward confirmatory referral. Separate cardiopulmonary health promotion strategies that account for the varying lifestyle profiles of the two employee subgroups in the industry appear justified.

  5. Women Coping with a Partner's Sexual Avoidance.

    Science.gov (United States)

    Renshaw, Domeena C.

    2001-01-01

    Discusses the complexities of sexual avoidance, or Hypoactive Sexual Desire (HSD), a previously neglected aspect of a couple's relationship. Suggests that learning from a therapist to accept and enjoy other forms of sexual exchange can open up new horizons of physical and emotional intimacy. (Contains 17 references.) (GCP)

  6. Audit incorporating avoidability and appropriate intervention can ...

    African Journals Online (AJOL)

    Audit incorporating avoidability and appropriate intervention can significantly decrease perinatal mortality. H. R. G. Ward, G. R. Howarth, O. J. N. Jennings,. R. C. Pattinson .... 6 months) and seven interns. The study was .... maternity care notes study: a randomized control trial to assess the effects of giving expectant mothers ...

  7. The Netherlands Bird Avoidance Model, Final Report

    NARCIS (Netherlands)

    Shamoun-Baranes, J.; Bouten, W.; Sierdsema, H.; van Belle, J.; van Gasteren, J.R.; van Loon, E.E.

    2006-01-01

    The NL-BAM was developed as a web-based decision support tool to be used by the bird hazard avoidance experts in the ecology unit of the Royal Netherlands Air Force. The NL-BAM will be used together with the ROBIN 4 radar system to provide BirdTAMS, for real time warnings and flight planning and to

  8. 49 CFR 260.49 - Avoiding defaults.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Avoiding defaults. 260.49 Section 260.49 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Procedures To Be Followed in the Event of Default § 260.49...

  9. Avoidance Motivation and Conservation of Energy

    NARCIS (Netherlands)

    Roskes, Marieke; Elliot, Andrew J.; Nijstad, Bernard A.; De Dreu, Carsten K. W.

    Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive

  10. Reasonable Avoidability, Responsibility and Lifestyle Diseases

    DEFF Research Database (Denmark)

    Andersen, Martin Marchman

    2012-01-01

    by imprudent behavior such as smoking and over-eating. While I seek to investigate how more precisely we are to understand this principle of Reasonable Avoidability, I also object to it. First, I argue that Segall neither succeeds in showing that individuals quite generally are responsible for behaviors...

  11. Avoidance motivation and conservation of energy

    NARCIS (Netherlands)

    Roskes, Marieke; Elliot, Andrew J.; Nijstad, Bernard A.; De Dreu, Carsten K W

    Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive

  12. Rewarding peak avoidance: the Dutch 'Spitsmijden' projects

    NARCIS (Netherlands)

    Knockaert, J.; Bakens, J.; Ettema, D.F.; Verhoef, E.

    2011-01-01

    The Dutch road network is becoming increasingly congested. In late 2006, a group of companies, universities and government institutions established the Spitsmijden project. ‘Spitsmijden’ is the Dutch term for ‘avoiding the peak’. This joint initiative aimed to identify and assess a short-term

  13. Wake Vortex Avoidance System and Method

    Science.gov (United States)

    Shams, Qamar A. (Inventor); Zuckerwar, Allan J. (Inventor); Knight, Howard K. (Inventor)

    2017-01-01

    A wake vortex avoidance system includes a microphone array configured to detect low frequency sounds. A signal processor determines a geometric mean coherence based on the detected low frequency sounds. A display displays wake vortices based on the determined geometric mean coherence.

  14. Audit incorporating avoidability and appropriate intervention can ...

    African Journals Online (AJOL)

    Objective. To evaluate the role of the ICA (Identification, Cause, Avoidable factor) Solution method of perinatal audit in reducing perinatal mortality. Design. Retrospective audit of 1 060 perinatal deaths between 1 January 1991 and 31 December 1992. Setting. Livingstone Hospital Maternity Service. Subjects. One thousand ...

  15. Obstacle detection and avoiding of quadcopter

    Science.gov (United States)

    Wang, Dizhong; Lin, Jiajian

    2017-10-01

    Recent years, the flight control technology over quadcopter has been boosted vigorously and acquired the comprehensive application in a variety of industries. However, it is prominent for there to be problems existed in the stable and secure flight with the development of its autonomous flight. Through comparing with the characteristics of ultrasonic ranging and laser Time-of-Flight(abbreviated to ToF) distance as well as vision measurement and its related sensors, the obstacle detection and identification sensors need to be installed in order to effectively enhance the safety flying for aircraft, which is essential for avoiding the dangers around the surroundings. That the major sensors applied to objects perception at present are distance measuring instruments which based on the principle and application of non-contact detection technology . Prior to acknowledging the general principles of flight and obstacle avoiding, the aerodynamics modeling of the quadcopter and its object detection means has been initially determined on this paper. Based on such premise, this article emphasized on describing and analyzing the research on obstacle avoiding technology and its application status, and making an expectation for the trend of its development after analyzing the primary existing problems concerning its accuracy object avoidance.

  16. Approach and avoidance in fear of spiders

    NARCIS (Netherlands)

    Rinck, M.; Becker, E.S.

    2007-01-01

    We examined attitudes towards spiders by employing an Approach-Avoidance Task, in which participants respond to pictures by pulling a joystick towards themselves or by pushing it away from themselves. For spider fearfuls, this stimulus–response assignment is either compatible (push spiders away) or

  17. Detect and Avoid (DAA) Automation Maneuver Study

    Science.gov (United States)

    2017-02-01

    controlled a UAS through airspace including several proximal aircraft. 15. SUBJECT TERMS Drones ; Detect and Avoid; Remotely Piloted Aircraft...maneuver guidance presentation but the transparency “threshold” needed to result in appropriate automation usage , which is defined as both high rates of

  18. Adjusting the Interview to Avoid Cultural Bias.

    Science.gov (United States)

    Mahoney, Frances Eileen

    1992-01-01

    Considers cultural bias in employment interviews. Compares white American and Navajo interview styles and suggests new approach for recruiters to make interviewing less culturally biased. Recommends that recruiters not ask direct questions about personal achievements, try indirect approach, avoid making judgments on first impressions and…

  19. How to Interpret Uncertainty Avoidance Scores

    DEFF Research Database (Denmark)

    Schramm, Jette

    2000-01-01

    Addresses the cultural dimension of uncertainty avoidance (UA), of US and German staffing decisions – but uses a different viewpoint. Discusses and challenges the hitherto accepted meaning of individual positions of countries UA, using Höfstede’s guide. Adumbrates the concept of UA at the two lev...

  20. [Femicide: a Avoidable Mortality? The "Tivoli" Model].

    Science.gov (United States)

    De Salazar, Vitaliano; Borzi, Claudia; Maggiani, Michela; Amato, Simona

    2017-01-01

    The Instabul Convention is a normative tool for the prevention of women's violence in Europe. Rome 5 Local Healthcare Authority has implemented a synergistic intervention model in joint ventures with all stakeholders and institutions involved: the Tivoli Model. This model provides a synergistic social, health, legal and training approach to prevent violence against women in a logic of preventing an avoidable mortality.

  1. Simple Obstacle Avoidance Algorithm for Rehabilitation Robots

    NARCIS (Netherlands)

    Stuyt, Floran H.A.; Römer, GertWillem R.B.E.; Stuyt, Harry .J.A.

    2007-01-01

    The efficiency of a rehabilitation robot is improved by offering record-and-replay to operate the robot. While automatically moving to a stored target (replay) collisions of the robot with obstacles in its work space must be avoided. A simple, though effective, generic and deterministic algorithm

  2. FORUM Achieving weight loss and avoiding obesity

    African Journals Online (AJOL)

    The efficacy of diets advocating extreme macronutrient manipulation has been reviewed extensively. Studies involving participation for 12 months or longer revealed that diet adherence, length of intervention and level of calorie. ISSUES IN MEDICINE. Achieving weight loss and avoiding obesity. Maria Elizabeth Catsicas.

  3. Pathological Demand Avoidance: Exploring the Behavioural Profile

    Science.gov (United States)

    O'Nions, Elizabeth; Viding, Essi; Greven, Corina U; Ronald, Angelica; Happé, Francesca

    2014-01-01

    "Pathological Demand Avoidance" is a term increasingly used by practitioners in the United Kingdom. It was coined to describe a profile of obsessive resistance to everyday demands and requests, with a tendency to resort to "socially manipulative" behaviour, including outrageous or embarrassing acts. Pathological demand…

  4. Power Factor Controller Avoids False Turnoff

    Science.gov (United States)

    Nola, F. J.

    1983-01-01

    Single-phase power-factor controller includes special inhibiting circuit to avoid false turnoff. If thyristor trigger signal occurs during flow of current from preceding half cycle, inhibiting signal delays application of trigger pulse until beginning of next current half cycle.

  5. Avoidable cancers in the Nordic countries. Occupation

    DEFF Research Database (Denmark)

    Dreyer, L; Andersen, A; Pukkala, E

    1997-01-01

    around the year 2000, with 1,890 among men and fewer than 25 among women. The proportions that could be avoided if industrial carcinogens were eliminated would be 70% of mesotheliomas, 20% of cancers of the nasal cavity and sinuses, 12% of lung cancers, 5% of laryngeal cancers, 2% of urinary bladder...

  6. Measuring Patients’ Attachment Avoidance in Psychotherapy: Development of the Attachment Avoidance in Therapy Scale (AATS

    Directory of Open Access Journals (Sweden)

    András Láng

    2012-11-01

    Full Text Available A new scale measuring patient-therapist attachment avoidance was developed. Attachment Avoidance in Therapy Scale is a new measure based on the Bartholomew model of adult attachment (Bartholomew & Horowitz, 1991 and the Experience in Close Relationships Scale (Brennan, Clark, & Shaver, 1998 to measure patients’ attachment avoidance towards therapists. With 112 patient-therapist dyads participating in the study, validation of a preliminary scale – measuring both attachment anxiety and attachment avoidance in therapy – took place using therapists’ evaluations of patients’ relational behavior and patients’ self-reports about their attitude toward psychotherapy. Analysis of the data revealed six underlying scales. Results showed all six scales to be reliable. Validation of scales measuring attachment anxiety failed. The importance of Attachment Avoidance in Therapy Scale and its subscales is discussed.

  7. Bursting neurons and ultrasound avoidance in crickets

    Directory of Open Access Journals (Sweden)

    Gary eMarsat

    2012-07-01

    Full Text Available Decision making in invertebrates often relies on simple neural circuits composed of only a few identified neurons. The relative simplicity of these circuits makes it possible to identify the key computation and neural properties underlying decisions. In this review, we summarize recent research on the neural basis of ultrasound avoidance in crickets, a response that allows escape from echolocating bats. The key neural property shaping behavioral output is high-frequency bursting of an identified interneuron, AN2, which carries information about ultrasound stimuli from receptor neurons to the brain. AN2's spike train consists of clusters of spikes –bursts– that may be interspersed with isolated, non-burst spikes. AN2 firing is necessary and sufficient to trigger avoidance steering but only high-rate firing, such as occurs in bursts, evokes this response. AN2 bursts are therefore at the core of the computation involved in deciding whether or not to steer away from ultrasound. Bursts in AN2 are triggered by synaptic input from nearly synchronous bursts in ultrasound receptors. Thus the population response at the very first stage of sensory processing –the auditory receptor- already differentiates the features of the stimulus that will trigger a behavioral response from those that will not. Adaptation, both intrinsic to AN2 and within ultrasound receptors, scales the burst-generating features according to the stimulus statistics, thus filtering out background noise and ensuring that bursts occur selectively in response to salient peaks in ultrasound intensity. Furthermore AN2’s sensitivity to ultrasound varies adaptively with predation pressure, through both developmental and evolutionary mechanisms. We discuss how this key relationship between bursting and the triggering of avoidance behavior is also observed in other invertebrate systems such as the avoidance of looming visual stimuli in locusts or heat avoidance in beetles.

  8. Señales neurohormonales tras gastrectomía tubular y by-pass gástrico: implicación en la pérdida de peso y resolución de la diabetes mellitus tipo 2

    OpenAIRE

    Navarro García, María Inmaculada

    2015-01-01

    PALABRAS CLAVE: Cirugía bariatrica.Gastrectomía tubular laparoscópica.Bypass gástrico laparoscópico. Pérdida de exceso de peso.Diabetes Mellitus. Hormonas gastrointestinales.Ghrelina.GLP-1.PYY. SEÑALES NEUROHORMONALES TRAS GASTRECTOMÍA TUBULAR Y BY-PASS GÁSTRICO.IMPLICACIÓN EN LA PÉRDIDA DE PESO Y RESOLUCIÓN DE LA DIABETES MELLITUS TIPO 2. OBJETIVO Nuestro objetivo fue comparar la técnica gastrectomía tubular (GT) con el by-pass gástrico (BP),en cuanto a la pérdida ponde...

  9. Tomographic patient registration and conformal avoidance tomotherapy

    Science.gov (United States)

    Aldridge, Jennifer Stacy

    Development of tomotherapy has led to the emergence of several processes, providing the basis for many unique investigative opportunities. These processes include setup verification, tomographic verification, megavoltage dose reconstruction, and conformal avoidance tomotherapy. Setup verification and conformal avoidance tomotherapy, in particular, are two closely intertwined matters. In order to avoid critical structures located within or adjacent to indistinct tumor regions, accurate patient positioning from fraction to fraction must be ensured. With tomographic patient registration, a higher level of assurance is offered than with traditional positioning methods. Translational and rotational offsets are calculated directly from projection data using cross- correlation or fast Fourier transforms. Experiments assessing the algorithm's ability to calculate individual offsets were conducted using the University of Wisconsin's Tomotherapy Benchtop. These experiments indicate statistical errors within +/-1 mm for offsets up to approximately 20 mm, with maximum offset errors of about +/-2 mm for displacements up to 35 mm. The angular offset component is within +/-2°. To evaluate the registration process as a whole, experimental results from a few multi-parameter examples are also analyzed. With the development of tomographic patient registration in projection space, efforts to promote further sparing of critical structures are justified. Conformal avoidance tomotherapy has as its objective to treat an indistinct tumor region while conformally avoiding any normal critical structures in that region. To demonstrate the advantages of conformal avoidance tomotherapy, conventional and tomotherapy treatments are contrasted for both nasopharyngeal and breast carcinoma cases. For initial research efforts, computed tomography data sets of a human male and female were obtained via the ``Visible Human Project''. Since these data sets are on the order of hundreds of megabytes, both

  10. Effect of thyroid hormone on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Qing-Bin Wei

    2017-07-01

    Full Text Available Objective: To study the effect of thyroid hormone (euthyrox on myocardial and cerebral ischemia reperfusion injury in valve replacement under cardiopulmonary bypass. Methods: A total of 76 patients who received valve replacement under cardiopulmonary bypass in our hospital between January 2013 and December 2016 were collected and divided into control group (n=38 and observation group (n=38 according to random number table. Observation group took euthyrox orally 1 week before surgery, control group took vitamin C tablets orally at the same point in time, and both therapies lasted for 1 week. Before taking medicine and after cardiopulmonary bypass (before end of surgery, serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were compared between the two groups of patients. Results: Before taking medicine, differences in the serum levels of myocardial enzyme spectrum indexes and nerve injury indexes were not statistically significant between the two groups of patients. After cardiopulmonary bypass, serum myocardial enzyme spectrum indexes cTnT, CK-MB, α-HBD and LDH levels in observation group were lower than those in control group; serum nerve injury indexes NSE, S100B and GFAP levels were lower than those in control group while bFGF level was higher than that in control group. Conclusion: Euthyrox intervention in valve replacement under cardiopulmonary bypass can effectively reduce the myocardial and cerebral ischemia reperfusion injury.

  11. Neurological complications and risk factors of cardiopulmonary failure of EV-A71-related hand, foot and mouth disease.

    Science.gov (United States)

    Long, Lili; Xu, Lin; Xiao, Zhenghui; Hu, Shixiong; Luo, Ruping; Wang, Hua; Lu, Xiulan; Xu, Zhiyue; Yao, Xu; Zhou, Luo; Long, Hongyu; Gong, Jiaoe; Song, Yanmin; Zhao, Li; Luo, Kaiwei; Zhang, Mengqi; Feng, Li; Yang, Liming; Sheng, Xiaoqi; Fan, Xuegong; Xiao, Bo

    2016-03-22

    From 2010 to 2012, large outbreaks of EV-A71-related- hand foot and mouth disease (HFMD) occurred annually in China. Some cases had neurological complications and were closely associated with fatal cardiopulmonary collapse, but not all children with central nervous system (CNS) involvement demonstrated a poor prognosis. To identify which patients and which neurological complications are more likely to progress to cardiopulmonary failure, we retrospectively studied 1,125 paediatric inpatients diagnosed with EV-A71-related HFMD in Hunan province, including 1,017 cases with CNS involvement. These patients were divided into cardiopulmonary failure (976 people) group and group without cardiopulmonary failure (149 people). A logistic regression analysis was used to compare the clinical symptoms, laboratory test results, and neurological complications between these two groups. The most significant risk factors included young age, fever duration ≥3 days, coma, limb weakness, drowsiness and ANS involvement. Patients with brainstem encephalitis and more CNS-involved regions were more likely to progress to cardiopulmonary failure. These findings can help front-line clinicians rapidly and accurately determine patient prognosis, thus rationally distributing the limited medical resources and implementing interventions as early as possible.

  12. The Feasibility of Avoiding Future Climate Impacts: Results from the AVOID Programmes

    Science.gov (United States)

    Lowe, J. A.; Warren, R.; Arnell, N.; Buckle, S.

    2014-12-01

    The AVOID programme and its successor, AVOID2, have focused on answering three core questions: how do we characterise potentially dangerous climate change and impacts, which emissions pathways can avoid at least some of these impacts, and how feasible are the future reductions needed to significantly deviate from a business-as-usual future emissions pathway. The first AVOID project succeeded in providing the UK Government with evidence to inform its position on climate change. A key part of the work involved developing a range of global emissions pathways and estimating and understanding the corresponding global impacts. This made use of a combination of complex general circulation models, simple climate models, pattern-scaling and state-of-the art impacts models. The results characterise the range of avoidable impacts across the globe in several key sectors including river and coastal flooding, cooling and heating energy demand, crop productivity and aspects of biodiversity. The avoided impacts between a scenario compatible with a 4ºC global warming and one with a 2ºC global warming were found to be highly sector dependent and avoided fractions typically ranged between 20% and 70%. A further key aspect was characterising the magnitude of the uncertainty involved, which is found to be very large in some impact sectors although the avoided fraction appears a more robust metric. The AVOID2 programme began in 2014 and will provide results in the run up to the Paris CoP in 2015. This includes new post-IPCC 5th assessment evidence to inform the long-term climate goal, a more comprehensive assessment of the uncertainty ranges of feasible emission pathways compatible with the long-term goal and enhanced estimates of global impacts using the latest generation of impact models and scenarios.

  13. Discovering and avoiding self-contradiction:

    DEFF Research Database (Denmark)

    Olivares Bøgeskov, Benjamin Miguel

    This paper presents an innovative method to teach ethics, which has so far been implemented amongst Danish students. The method focuses on developing skills to conduct a methodical, ethical dialogue by teaching students to become aware of self-contradictions and learning to avoid them. This method......, this method focuses not so much on teaching what other people think, but rather starts by finding out what the students think, and to which degree they contradict themselves. In addition the method focuses on how students argue for their positions when entering an ethical dialogue. The method focuses on two...... (learning the skills to conduct an ethical dialogue) builds on the previous ability to identify contradictions. This is done by focusing in 4 basic rules that introduce the basic principles of a dialectical dialogue. These rules allow them to avoid fundamental mistakes which otherwise hinder an ethical...

  14. Avoidant Personality Disorder: a Current Review.

    Science.gov (United States)

    Weinbrecht, Anna; Schulze, Lars; Boettcher, Johanna; Renneberg, Babette

    2016-03-01

    This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.

  15. How to avoid deferred-compensation troubles.

    Science.gov (United States)

    Freeman, Todd I

    2005-06-01

    Executive compensation packages have long included stock options and deferred compensation plans in order to compete for talent. Last year, Congress passed a law in response to the Enron debacle, in which executives were perceived to be protecting their deferred compensation at the expense of employees, creditors, and investors. The new law is designed to protect companies and their shareholders from being raided by the very executives that guided the company to financial ruin. Physicians who are part owners of medical practices need to know about the changes in the law regarding deferred compensation and how to avoid costly tax penalties. This article discusses how the changes affect medical practices as well as steps physician-owned clinics can take to avoid the risk of penalty, such as freezing deferred compensation and creating a new deferred compensation plan.

  16. Discovering and avoiding self-contradiction:

    DEFF Research Database (Denmark)

    Olivares Bøgeskov, Benjamin Miguel

    This paper presents an innovative method to teach ethics, which has so far been implemented amongst Danish students. The method focuses on developing skills to conduct a methodical, ethical dialogue by teaching students to become aware of self-contradictions and learning to avoid them. This method...... was created as a response to a recurring disappointment relating to the common way of teaching ethics in Danish nursing schools, in which students are introduced to ethical theories and asked to use them to reflect on concrete ethical cases. In these courses, quite commonly students were able to understand...... aspects –first developing critical self-refection and secondly developing skills to conduct an ethical dialogue. The first aspect is addressed by finding out what the students think, do they contradict themselves and how to avoid self-contradictions. This is done by using a questionnaire with 13 ethical...

  17. Reducing voluntary, avoidable turnover through selection.

    Science.gov (United States)

    Barrick, Murray R; Zimmerman, Ryan D

    2005-01-01

    The authors investigated the efficacy of several variables used to predict voluntary, organizationally avoidable turnover even before the employee is hired. Analyses conducted on applicant data collected in 2 separate organizations (N = 445) confirmed that biodata, clear-purpose attitudes and intentions, and disguised-purpose dispositional retention scales predicted voluntary, avoidable turnover (rs ranged from -.16 to -.22, R = .37, adjusted R = .33). Results also revealed that biodata scales and disguised-purpose retention scales added incremental validity, whereas clear-purpose retention scales did not explain significant incremental variance in turnover beyond what was explained by biodata and disguised-purpose scales. Furthermore, disparate impact (subgroup differences on race, sex, and age) was consistently small (average d = 0.12 when the majority group scored higher than the minority group).

  18. Construction dispute research conceptualisation, avoidance and resolution

    CERN Document Server

    2014-01-01

    There are three specific purposes of Construction Dispute Research. First, this volume aims to summarise studies on construction dispute. Second, apart from the theoretical constructs, where appropriate empirical tests are also included. This approach serves to go beyond the commonly used anecdotal approach for the subject matters. Third, it is the sincere hope of the authors that this book will help shaping research agenda of construction dispute.  The studies are mostly framed from a management perspective drawing on methods and concepts in contract law, economics, psychology and management science.   The book has twenty chapters that are arranged in four parts covering conceptualisation, avoidance, negotiation and mediation. Part 1 is devoted for dispute conceptualisation. A building is only as strong as its foundation. Thus it is no better start to study construction dispute by conceptualisation. The theme of Part 2 is dispute avoidance. The conventional wisdom of ‘prevention is better than cure’ se...

  19. Research on embedded automobile collision avoidance system

    Directory of Open Access Journals (Sweden)

    TAO Feng

    2016-08-01

    Full Text Available Taking ARM embedded Linux operating system as the development platform,combined with AVR microcontroller,while optimizing the ranging algorithm and using air ultrasonic transducer,the measurement range of which can be up to 50 meter,this paper designs a high-precision,range far,low price,various models suitable automobile collision avoidance warning system.The system adopts Forlinx OK6410 development board for the master.AVR microcontroller is responsible for taking the data of traveling distance between vehicles,and with the ARM development board via RS232 communication transfers vehicle′s distance and speed information to the ARM development boards.The system uses the established collision avoidance model to get alarm information.Experiments show that the system can accurately send out alarm information within a certain range.It is innovative and practical.

  20. Optical Flow based Robot Obstacle Avoidance

    Directory of Open Access Journals (Sweden)

    Kahlouche Souhila

    2008-11-01

    Full Text Available In this paper we try to develop an algorithm for visual obstacle avoidance of autonomous mobile robot. The input of the algorithm is an image sequence grabbed by an embedded camera on the B21r robot in motion. Then, the optical flow information is extracted from the image sequence in order to be used in the navigation algorithm. The optical flow provides very important information about the robot environment, like: the obstacles disposition, the robot heading, the time to collision and the depth. The strategy consists in balancing the amount of left and right side flow to avoid obstacles, this technique allows robot navigation without any collision with obstacles. The robustness of the algorithm will be showed by some examples.

  1. Cod avoidance by area regulations in Kattegat

    DEFF Research Database (Denmark)

    Eliasen, Søren Qvist

    2014-01-01

    presents two initiatives for cod avoidance in Kattegat; a fisher initiative sharing information about cod bycatch which could lead to real time closures in areas with high bycatch of juveniles, for vessels with low cod quota to avoid catch of all cod, and a Danish Swedish Government initiative of permanent...... fair and the goals should be clear, not least when the descriptors of the Marine Strategy Framework Directive, which might be more intangible for the fishers, are part of the goal of the measures. If incentives created by the regulation are stable over at least a few years the fishers and fishers......’ organisations are more capable at being active partners in developing the systems that support the discard ban. An example from the examined initiatives are the outline of a fleet information system, providing the skipper with information about hotspots of unwanted species allowing him to make a better plan...

  2. Flashback Avoidance in Swirling Flow Burners

    Directory of Open Access Journals (Sweden)

    Vigueras-Zúñiga Marco Osvaldo

    2014-10-01

    Full Text Available Lean premixed combustion using swirling flows is widely used in gas turbines and combustion. Although flashback is not generally a problem with natural gas combustion, there are some reports of flashback damage with existing gas turbines, whilst hydrogen enriched fuel blends cause concerns in this area. Thus, this paper describes a practical approach to study and avoid flashback in a pilot scale 100 kW tangential swirl burner. The flashback phenomenon is studied experimentally via the derivation of flashback limits for a variety of different geometrical conditions. A high speed camera is used to visualize the process and distinguish new patterns of avoidance. The use of a central fuel injector is shown to give substantial benefits in terms of flashback resistance. Conclusions are drawn as to mitigation technologies.

  3. Robot maps, robot moves, robot avoids

    OpenAIRE

    Farrugia, Claire

    2014-01-01

    Robotics is a cornerstone for this century’s innovations. From robot nurses to your own personal assistant, most robots need to know: ‘where is it?’ ‘Where should it go?’ And ‘how to get there?’ Without answers to these questions a robot cannot do much. http://www.um.edu.mt/think/robot-maps-robot-moves-robot-avoids/

  4. Tax avoidance: Definition and prevention issues

    Directory of Open Access Journals (Sweden)

    Anđelković Mileva

    2014-01-01

    Full Text Available The problem of resolving issues pertaining to tax avoidance, and particularly its aggressive forms, has been the focal point of discussion among tax scholars which is increasingly gaining attention of politicians alike. As opposed to tax evasion (which is illegal, the phenomenon of tax avoidance calls for careful consideration of state fiscal interests and a highly precise demarcation of the thin line between the acceptable and unacceptable conduct. In many contemporary states, tax avoidance (which implies a formal behaviour of tax payers within the limits of tax legislation but contrary to the tax regulation objectives is declared to be illegitimate. State authorities do not want to tolerate such activity, which results in tax payers' reduction or avoidance of tax liabilities. We should also bear in mind that all tax payers have the tax planning option at their disposal, by means of which they make sure that they do not pay more tax than they are legally obliged to. However, in case they skilfully use the tax regulation flaws and loopholes for the sole purpose of tax evasion, and/or resort to misrepresentation and deceptive constructs, they are considered to be exceeding the limits of acceptable tax behaviour. In comparison to the specific anti-abuse measures which have been built into some national tax legislations, there is a growing number of states that introduce the general anti-abuse legislations, which is based on judicial doctrines or statutory legislation. Yet, there is a notable difference among the envisaged anti-abuse measures depending on whether the national legislation is based on the Anglo-American or European-Continental legal system. The efficiency of applying these general anti-abuse rules in taxation largely rests on their interpretation as well as on their relationship with the principle of legality.

  5. The International Double Taxation – Avoiding Methods

    OpenAIRE

    Nicoleta Barbuta-Misu

    2009-01-01

    The paper presents the main causes that determine double taxation, its forms, i.e. the economicdouble taxation and the international legal double taxation, the need for eliminating the double taxation andavoiding methods. In the presentation of the avoidance methods have been used practical examples forcomparison of the tax advantages for income beneficiary between: the total exemption method andprogressive exemption method, on the one hand, and total crediting method and ordinary crediting m...

  6. Avoiding breakdown in the CGS algorithm

    Science.gov (United States)

    Brezinski, Claude; Sadok, Hassane

    1991-06-01

    The conjugate gradient squared algorithm can suffer of similar breakdowns as Lanczos type methods for the same reason that is the non-existence of some formal orthogonal polynomials. Thus curing such breakdowns is possible by jumping over these non-existing polynomials and using only those of them which exist. The technique used is similar to that employed for avoiding breakdowns in Lanczos type methods. The implementation of these new methods is discussed. Numerical examples are given.

  7. Coda-avoiding : some Evidence from Portuguese

    OpenAIRE

    Veloso, João

    2008-01-01

    Romance languages are known to be more restrictive than Germanic languages as far as segmental coda-filling is concerned. Moreover, it is also known that within the Romance family some languages have more restrictive constraints ruling coda-filling than others. This paper deals with the specific question of segmental coda-filling in Portuguese. Looking at a large array of different historical phenomena, it is claimed that avoiding any segmental material in coda position corresponds to a very ...

  8. Traffic jam driving with NMV avoidance

    OpenAIRE

    Milanés Montero, Vicente; Alonso, Luciano; Villagra Serrano, Jorge; Godoy, Jorge; Pedro Lucio, María Teresa de; Oria, Juan P.

    2012-01-01

    n recent years, the development of advanced driver assistance systems (ADAS) – mainly based on lidar and cameras – has considerably improved the safety of driving in urban environments. These systems provide warning signals for the driver in the case that any unexpected traffic circumstance is detected. The next step is to develop systems capable not only of warning the driver but also of taking over control of the car to avoid a potential collision. In the present communication, a system cap...

  9. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  10. Airborne Collision Detection and Avoidance for Small UAS Sense and Avoid Systems

    Science.gov (United States)

    Sahawneh, Laith Rasmi

    The increasing demand to integrate unmanned aircraft systems (UAS) into the national airspace is motivated by the rapid growth of the UAS industry, especially small UAS weighing less than 55 pounds. Their use however has been limited by the Federal Aviation Administration regulations due to collision risk they pose, safety and regulatory concerns. Therefore, before civil aviation authorities can approve routine UAS flight operations, UAS must be equipped with sense-and-avoid technology comparable to the see-and-avoid requirements for manned aircraft. The sense-and-avoid problem includes several important aspects including regulatory and system-level requirements, design specifications and performance standards, intruder detecting and tracking, collision risk assessment, and finally path planning and collision avoidance. In this dissertation, our primary focus is on developing an collision detection, risk assessment and avoidance framework that is computationally affordable and suitable to run on-board small UAS. To begin with, we address the minimum sensing range for the sense-and-avoid (SAA) system. We present an approximate close form analytical solution to compute the minimum sensing range to safely avoid an imminent collision. The approach is then demonstrated using a radar sensor prototype that achieves the required minimum sensing range. In the area of collision risk assessment and collision prediction, we present two approaches to estimate the collision risk of an encounter scenario. The first is a deterministic approach similar to those been developed for Traffic Alert and Collision Avoidance (TCAS) in manned aviation. We extend the approach to account for uncertainties of state estimates by deriving an analytic expression to propagate the error variance using Taylor series approximation. To address unanticipated intruders maneuvers, we propose an innovative probabilistic approach to quantify likely intruder trajectories and estimate the probability of

  11. Granting silence to avoid wireless collisions

    KAUST Repository

    Choi, Jung Il

    2010-10-01

    We describe grant-to-send, a novel collision avoidance algorithm for wireless mesh networks. Rather than announce packets it intends to send, a node using grant-to-send announces packets it expects to hear others send. We present evidence that inverting collision avoidance in this way greatly improves wireless mesh performance. Evaluating four protocols from 802.11 meshes and 802.15.4 sensor networks, we find that grant-to-send matches or outperforms CSMA and RTS/CTS in all cases. For example, in a 4-hop UDP flow, grantto- send can achieve 96% of the theoretical maximum throughput while maintaining a 99.9% packet delivery ratio. Grant-tosend is also general enough to replace protocol-specific collision avoidance mechanisms common to sensor network protocols. Grant-to-send is simple. For example, incorporating it into 802.11 requires only 11 lines of driver code and no hardware changes. Furthermore, as it reuses existing 802.11 mechanisms, grant-to-send inter-operates with current networks and can be incrementally deployed. © 2010 IEEE.

  12. Knowing and Avoiding Plagiarism During Scientific Writing

    Science.gov (United States)

    Kumar, P Mohan; Priya, N Swapna; Musalaiah, SVVS; Nagasree, M

    2014-01-01

    Plagiarism has become more common in both dental and medical communities. Most of the writers do not know that plagiarism is a serious problem. Plagiarism can range from simple dishonesty (minor copy paste/any discrepancy) to a more serious problem (major discrepancy/duplication of manuscript) when the authors do cut-copy-paste from the original source without giving adequate credit to the main source. When we search databases like PubMed/MedLine there is a lot of information regarding plagiarism. However, it is still a current topic of interest to all the researchers to know how to avoid plagiarism. It's time to every young researcher to know ethical guidelines while writing any scientific publications. By using one's own ideas, we can write the paper completely without looking at the original source. Specific words from the source can be added by using quotations and citing them which can help in not only supporting your work and amplifying ideas but also avoids plagiarism. It is compulsory to all the authors, reviewers and editors of all the scientific journals to know about the plagiarism and how to avoid it by following ethical guidelines and use of plagiarism detection software while scientific writing. PMID:25364588

  13. Urban water restrictions: Attitudes and avoidance

    Science.gov (United States)

    Cooper, Bethany; Burton, Michael; Crase, Lin

    2011-12-01

    In most urban cities across Australia, water restrictions remain the dominant policy mechanism to restrict urban water consumption. The extensive adoption of water restrictions as a means to limit demand, over several years, means that Australian urban water prices have consistently not reflected the opportunity cost of water. Given the generally strong political support for water restrictions and the likelihood that they will persist for some time, there is value in understanding households' attitudes in this context. More specifically, identifying the welfare gains associated with avoiding urban water restrictions entirely would be a nontrivial contribution to our knowledge and offer insights into the benefits of alternative policy responses. This paper describes the results from a contingent valuation study that investigates consumers' willingness to pay to avoid urban water restrictions. Importantly, the research also investigates the influence of cognitive and exogenous dimensions on the utility gain associated with avoiding water restrictions. The results provide insights into the impact of the current policy mechanism on economic welfare.

  14. Pavlovian Control of Escape and Avoidance.

    Science.gov (United States)

    Millner, Alexander J; Gershman, Samuel J; Nock, Matthew K; den Ouden, Hanneke E M

    2017-12-15

    To survive in complex environments, animals need to have mechanisms to select effective actions quickly, with minimal computational costs. As perhaps the computationally most parsimonious of these systems, Pavlovian control accomplishes this by hardwiring specific stereotyped responses to certain classes of stimuli. It is well documented that appetitive cues initiate a Pavlovian bias toward vigorous approach; however, Pavlovian responses to aversive stimuli are less well understood. Gaining a deeper understanding of aversive Pavlovian responses, such as active avoidance, is important given the critical role these behaviors play in several psychiatric conditions. The goal of the current study was to establish a behavioral and computational framework to examine aversive Pavlovian responses (activation vs. inhibition) depending on the proximity of an aversive state (escape vs. avoidance). We introduce a novel task in which participants are exposed to primary aversive (noise) stimuli and characterized behavior using a novel generative computational model. This model combines reinforcement learning and drift-diffusion models so as to capture effects of invigoration/inhibition in both explicit choice behavior as well as changes in RT. Choice and RT results both suggest that escape is associated with a bias for vigorous action, whereas avoidance is associated with behavioral inhibition. These results lay a foundation for future work seeking insights into typical and atypical aversive Pavlovian responses involved in psychiatric disorders, allowing us to quantify both implicit and explicit indices of vigorous choice behavior in the context of aversion.

  15. Traffic jam driving with NMV avoidance

    Science.gov (United States)

    Milanés, Vicente; Alonso, Luciano; Villagrá, Jorge; Godoy, Jorge; de Pedro, Teresa; Oria, Juan P.

    2012-08-01

    In recent years, the development of advanced driver assistance systems (ADAS) - mainly based on lidar and cameras - has considerably improved the safety of driving in urban environments. These systems provide warning signals for the driver in the case that any unexpected traffic circumstance is detected. The next step is to develop systems capable not only of warning the driver but also of taking over control of the car to avoid a potential collision. In the present communication, a system capable of autonomously avoiding collisions in traffic jam situations is presented. First, a perception system was developed for urban situations—in which not only vehicles have to be considered, but also pedestrians and other non-motor-vehicles (NMV). It comprises a differential global positioning system (DGPS) and wireless communication for vehicle detection, and an ultrasound sensor for NMV detection. Then, the vehicle's actuators - brake and throttle pedals - were modified to permit autonomous control. Finally, a fuzzy logic controller was implemented capable of analyzing the information provided by the perception system and of sending control commands to the vehicle's actuators so as to avoid accidents. The feasibility of the integrated system was tested by mounting it in a commercial vehicle, with the results being encouraging.

  16. Pâncreas anular: ressecção pancreática ou derivação duodenal Anular pancreas: pancreatic resection or duodenal by-pass

    Directory of Open Access Journals (Sweden)

    Marcelo Kruel Schmidt

    2004-01-01

    obstructive symptoms were the most common. Abdominal pain was present in adult patients. The diagnostic investigation began with radiological studies such as upper gastrointestinal barium series, upper endoscopy and abdominal computed tomographic scan, although all the diagnoses required surgery for confirmation. The duodenoduodenostomy was the treatment of choice in the pediatric patients, and division of the anulus was carried out in the adults. RESULTS: All patients had symptomatic relief and postoperative recovery. The hospital stay ranged from 9 to 12 days (median 10.5 days. There were no postoperative complications. All patients remain asymptomatic up to now. CONCLUSION: The rare condition of anular pancreas does not allow a more detailed and comparative study. The results of the authors showed that both gastrointestinal by-pass and division of the pancreas are effective and safe treatments.

  17. Rapid Assessment of Avoidable Blindness in India.

    Directory of Open Access Journals (Sweden)

    John Neena

    Full Text Available BACKGROUND: Rapid assessment of avoidable blindness provides valid estimates in a short period of time to assess the magnitude and causes of avoidable blindness. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population. METHODS AND FINDINGS: Sixteen randomly selected districts where blindness surveys were undertaken 7 to 10 years earlier were identified for a follow up survey. Stratified cluster sampling was used and 25 clusters (20 rural and 5 urban were randomly picked in each district.. After a random start, 100 individuals aged 50+ were enumerated and examined sequentially in each cluster. All those with presenting vision = 50 years were enumerated, and 94.7% examined. Based on presenting vision,, 4.4% (95% Confidence Interval[CI]: 4.1,4.8 were severely visually impaired (vision<6/60 to 3/60 in the better eye and 3.6% (95% CI: 3.3,3.9 were blind (vision<3/60 in the better eye. Prevalence of low vision (<6/18 to 6/60 in the better eye was 16.8% (95% CI: 16.0,17.5. Prevalence of blindness and severe visual impairment (<6/60 in the better eye was higher among rural residents (8.2%; 95% CI: 7.9,8.6 compared to urban (7.1%; 95% CI: 5.0, 9.2, among females (9.2%; 95% CI: 8.6,9.8 compared to males (6.5%; 95% CI: 6.0,7.1 and people above 70 years (20.6%; 95% CI: 19.1,22.0 compared to people aged 50-54 years (1.3%; 95% CI: 1.1,1.6. Of all blindness, 88.2% was avoidable. of which 81.9% was due to cataract and 7.1% to uncorrected refractive errors/uncorrected aphakia. CONCLUSIONS: Cataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them. Most blindness and low vision burden is avoidable.

  18. Predictable and avoidable: What’s next?

    Directory of Open Access Journals (Sweden)

    Ivo Pezzuto

    2014-09-01

    Full Text Available The author of this paper (Dr. Ivo Pezzuto has been one of the first authors to write back in 2008 about the alleged "subprime mortgage loans fraud" which has triggered the 2008 financial crisis, in combination with multiple other complex, highly interrelated, and concurrent factors. The author has been also one of the first authors to report in that same working paper of 2008 (available on SSRN and titled "Miraculous Financial Engineering or Toxic Finance? The Genesis of the U.S. Subprime Mortgage Loans Crisis and its Consequences on the Global Financial Markets and Real Economy" the high probability of a Eurozone debt crisis, due to a number of unsolved structural macroeconomic problems, the lack of a single crisis resolution scheme, current account imbalances, and in some countries, housing bubbles/high private debt. In the book published in 2013 and titled "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", Dr. Ivo Pezzuto has exposed the root causes of the financial crisis in order to enables readers to understand that the crisis we have seen was predictable and should have been avoidable, and that a recurrence can be avoided, if lessons are learned and the right action taken. Almost one year after the publication of the book "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", the author has decided to write this working paper to explore what happened in the meantime to the financial markets and to the financial regulation implementation. Most of all, the author with this working paper aims to provide an updated analysis as strategist and scenario analyst on the topics addressed in the book "Predictable and Avoidable" based on a forward-looking perspective and on potential "tail risk" scenarios. The topics reported in this paper relate to financial crises; Government policy; financial regulation; corporate governance; credit risk management

  19. See-and-Avoid Collision Avoidance Using ADS-B Signal and Radar Sensing, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — IAI proposes an innovative collision avoidance radar and communication technology to detect and track both cooperative and non-cooperative targets. The system...

  20. Quantitative blood flow measurements in the small animal cardiopulmonary system using digital subtraction angiography

    International Nuclear Information System (INIS)

    Lin Mingde; Marshall, Craig T.; Qi, Yi; Johnston, Samuel M.; Badea, Cristian T.; Piantadosi, Claude A.; Johnson, G. Allan

    2009-01-01

    Purpose: The use of preclinical rodent models of disease continues to grow because these models help elucidate pathogenic mechanisms and provide robust test beds for drug development. Among the major anatomic and physiologic indicators of disease progression and genetic or drug modification of responses are measurements of blood vessel caliber and flow. Moreover, cardiopulmonary blood flow is a critical indicator of gas exchange. Current methods of measuring cardiopulmonary blood flow suffer from some or all of the following limitations--they produce relative values, are limited to global measurements, do not provide vasculature visualization, are not able to measure acute changes, are invasive, or require euthanasia. Methods: In this study, high-spatial and high-temporal resolution x-ray digital subtraction angiography (DSA) was used to obtain vasculature visualization, quantitative blood flow in absolute metrics (ml/min instead of arbitrary units or velocity), and relative blood volume dynamics from discrete regions of interest on a pixel-by-pixel basis (100x100 μm 2 ). Results: A series of calibrations linked the DSA flow measurements to standard physiological measurement using thermodilution and Fick's method for cardiac output (CO), which in eight anesthetized Fischer-344 rats was found to be 37.0±5.1 ml/min. Phantom experiments were conducted to calibrate the radiographic density to vessel thickness, allowing a link of DSA cardiac output measurements to cardiopulmonary blood flow measurements in discrete regions of interest. The scaling factor linking relative DSA cardiac output measurements to the Fick's absolute measurements was found to be 18.90xCO DSA =CO Fick . Conclusions: This calibrated DSA approach allows repeated simultaneous visualization of vasculature and measurement of blood flow dynamics on a regional level in the living rat.

  1. Quantitative blood flow measurements in the small animal cardiopulmonary system using digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lin Mingde; Marshall, Craig T.; Qi, Yi; Johnston, Samuel M.; Badea, Cristian T.; Piantadosi, Claude A.; Johnson, G. Allan [Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Division of Pulmonary and Critical Care Medicine and Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Box 3823, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Division of Pulmonary and Critical Care Medicine and Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Box 3823, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States)

    2009-11-15

    Purpose: The use of preclinical rodent models of disease continues to grow because these models help elucidate pathogenic mechanisms and provide robust test beds for drug development. Among the major anatomic and physiologic indicators of disease progression and genetic or drug modification of responses are measurements of blood vessel caliber and flow. Moreover, cardiopulmonary blood flow is a critical indicator of gas exchange. Current methods of measuring cardiopulmonary blood flow suffer from some or all of the following limitations--they produce relative values, are limited to global measurements, do not provide vasculature visualization, are not able to measure acute changes, are invasive, or require euthanasia. Methods: In this study, high-spatial and high-temporal resolution x-ray digital subtraction angiography (DSA) was used to obtain vasculature visualization, quantitative blood flow in absolute metrics (ml/min instead of arbitrary units or velocity), and relative blood volume dynamics from discrete regions of interest on a pixel-by-pixel basis (100x100 {mu}m{sup 2}). Results: A series of calibrations linked the DSA flow measurements to standard physiological measurement using thermodilution and Fick's method for cardiac output (CO), which in eight anesthetized Fischer-344 rats was found to be 37.0{+-}5.1 ml/min. Phantom experiments were conducted to calibrate the radiographic density to vessel thickness, allowing a link of DSA cardiac output measurements to cardiopulmonary blood flow measurements in discrete regions of interest. The scaling factor linking relative DSA cardiac output measurements to the Fick's absolute measurements was found to be 18.90xCO{sub DSA}=CO{sub Fick}. Conclusions: This calibrated DSA approach allows repeated simultaneous visualization of vasculature and measurement of blood flow dynamics on a regional level in the living rat.

  2. 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.

  3. Selected cardiopulmonary values and baroreceptor reflex in conscious green iguanas (Iguana iguana).

    Science.gov (United States)

    Hernandez, Sonia M; Schumacher, Juergen; Lewis, Stephen J; Odoi, Agricola; Divers, Stephen J

    2011-11-01

    To determine selected cardiopulmonary values and baroreceptor response in conscious green iguanas (Iguana iguana) and to evaluate the use of blood gas analysis and pulse oximetry in this species. 15 healthy juvenile green iguanas. Baseline cardiopulmonary values were determined in 15 conscious iguanas breathing room air. Effects of 100% O(2) inspiration were also measured (n = 6), and the baroreceptor reflex was characterized by exponential sigmoidal curve fitting analysis. Conscious iguanas had a mean ± SD resting heart rate of 52 ± 8 beats/min, respiratory rate of 28 ± 6 breaths/min, and systolic, mean, and diastolic arterial blood pressures of 69 ± 10 mm Hg, 62 ± 12 mm Hg, and 56 ± 13 mm Hg, respectively. Mean arterial pH at 37°C was 7.29 ± 0.11, PaO(2) was 81 ± 10 mm Hg, and PaCO(2) was 42 ± 9 mm Hg; corrected for a body temperature of 30°C, mean arterial pH at 37°C was 7.382 ±0.12, PaO(2) was 54 ± 15 mm Hg, and PaCO(2) was 32 ± 7 mm Hg. Inspiration of 100% O(2) did not change heart and respiratory rates but increased PaO(2) to 486 ± 105 mm Hg (corrected value, 437 ± 96 mm Hg). A baroreceptor reflex was evident, with mean heart rates ranging from 30 ± 3 beats/min to 63 ± 5 beats/min and mean arterial blood pressures ranging from 42 ± 3 mm Hg to 58 ± 3 mm Hg. This study provided needed information on cardiopulmonary values in healthy green iguanas, the application and limitation of arterial and venous blood gas analysis, and the accuracy of pulse oximetry.

  4. Patient-Reported Dyspnea Correlates Poorly with Aerobic Exercise Capacity Measured During Cardiopulmonary Exercise Testing.

    Science.gov (United States)

    Gaspard, Dany; Kass, Jonathan; Akers, Stephen; Hunter, Krystal; Pratter, Melvin

    2017-10-01

    Patient-reported dyspnea plays a central role in assessing cardiopulmonary disease. There is little evidence, however, that dyspnea correlates with objective exercise capacity measurements. If the correlation is poor, dyspnea as a proxy for objective assessment may be misleading. To compare patient's perception of dyspnea with maximum oxygen uptake (MaxVO2) during cardiopulmonary exercise testing (CPET). Fifty patients undergoing CPET for dyspnea evaluation were studied prospectively. Dyspnea assessment was measured by a metabolic equivalent of task (METs) table, Mahler Dyspnea Index, Borg Index, number of blocks walked, and flights of stairs climbed before stopping due to dyspnea. These descriptors were compared to MaxVO2. MaxVO2 showed low correlation with METs table (r = 0.388, p = 0.005) and no correlation with Mahler Index (r = 0.24, p = 0.093), Borg Index (r = -0.017, p = 0.905), number of blocks walked (r = 0.266, p = 0.077) or flights of stairs climbed (r = 0.188, p = 0.217). When adjusted for weight (maxVO2/kg), there was significant correlation between MaxVO2 and METs table (r = 0.711, p  30 had moderate correlation between MaxVO2 and METs table (r = 0.568, p = 0.002). Patient-reported dyspnea correlates poorly with MaxVO2 and fails to predict exercise capacity. Reliance on reported dyspnea may result in suboptimal categorization of cardiopulmonary disease severity.

  5. Are radiologists able to manage serious anaphylactic reactions and cardiopulmonary arrest?

    Science.gov (United States)

    Tapping, C R; Culverwell, A D

    2009-10-01

    In this study, we aimed to assess the ability and confidence of radiologists in managing adult life support in cardiopulmonary arrest and acute anaphylaxis reactions. We used a questionnaire survey assessing the knowledge of how to manage and the confidence in managing an adult cardiorespiratory arrest scenario. This was sent to 165 radiology consultants and registrars in 6 NHS trusts in Yorkshire: 105 participated. The questionnaire elicited basic demographic details and included eight questions aimed at assessing recent training, knowledge and confidence in the management of adult resuscitation (Resuscitation Council (UK) 2005 guidelines) and acute anaphylaxis. Despite the fact that 90% of participants stated that they would feel confident to initiate life support, the average score from the questions assessing life support procedure was 2.3 out of 5, with only 13% of participants answering all questions correctly. There was no correlation between grade of radiologist and likelihood of a correct answer, nor was there a correlation between feeling confident and knowing the correct life support procedure. Flaws in training were highlighted, with only 61% of radiologists having attended a life support course in the last 4 years. Those who had attended a course more recently were more likely to perform cardiopulmonary resuscitation correctly (p = 0.02). Individuals who were confident in initialising cardiopulmonary resuscitation were more likely to be confident that other members of staff could assist them (p = 0.028). This study emphasises the need for regular life support training and the need to alter the attitude of radiologists, who must consider it their role to initiate effective life support in the radiology environment.

  6. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery.

    Science.gov (United States)

    Erek, Ersin; Aydın, Selim; Suzan, Dilek; Yıldız, Okan; Altın, Fırat; Kırat, Barış; Demir, Ibrahim Halil; Ödemiş, Ender

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is used to provide cardiorespiratory support during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation; ECPR) unresponsive to conventional methods. In this study, the results of ECPR in a cardiac arrest setting after cardiac surgery in children were analyzed. In this retrospective cohort study, between November 2010 and June 2014, 613 congenital heart operations were performed by the same surgical team. Medical records of all the patients who experienced cardiac arrest and ECPR in an early postoperative period (n=25; 4%) were analyzed. Their ages were between 2 days and 4.5 years (median: 3 months). Sixteen patients had palliative procedures. In 88% of the patients, cardiac arrest episodes occurred in the first 24 h after operation. Mechanical support was provided by cardiopulmonary bypass only (n=10) or by ECMO (n=15) during CPR. The CPR duration until commencing mechanical support was 40 min in 12 patients. Eleven patients (44%) were weaned successfully from ECMO and survived more than 7 days. Five of them (20%) could be discharged. The CPR duration before ECMO (p=0.01) and biventricular physiology (p=0.022) was the key factor affecting survival. The follow-up duration was a mean of 15±11.9 months. While four patients were observed to have normal neuromotor development, one patient died of cerebral bleeding 6 months after discharge. Postoperative cardiac arrest usually occurs in the first 24 h after operation. ECPR provides a second chance for survival in children who have had cardiac arrest. Shortening the duration of CPR before ECMO might increase survival rates.

  7. Evolution of patients with heart disease after cardiopulmonary rehabilitation program: case report

    Directory of Open Access Journals (Sweden)

    Saulo Fabrin

    Full Text Available Abstract Introduction: Recovery and maintenance of patients suffering from heart and respiratory diseases using the cardiopulmonary rehabilitation program (CPRP help maintain their functionality and improve the activities of daily living (ADLs carried out according to their functional limitations. Objective: To investigate the efficacy of a CPRP in a patient with cardiopulmonary disease, following a 5-month training program. Methods: A 66-year-old female patient, body weight 78 kg, height 1.55 m, diagnosed with acute myocardial infarction and bronchial asthma underwent a six-minute walk test (6MWT to measure exercise tolerance; the Wells Bench was used to measure the flexibility of the posterior chain and lower limbs (LL, and a hand-held dynamometer (HHD was used to measure upper limb strength (ULS.Vital sign measurements include blood pressure (BP, heart rate (HR, respiratory rate (RR, oxygen saturation (SpO2 as well as dyspnea and LL fatigue (modified Borg scale at rest, during and after 5-month CPRP. Results: An increase of 145 meters during the cardiopulmonary rehabilitation program i.e. 30% of walk distance (WD in the 6MWT (pre = 345, post = 490m. There was an increase of 32% in flexibility (pre = 13, post = 19cm; in right upper limb (pre = 26, post = 60 kgf and left lower limb strength (pre = 28, post = 72kgf, there was an increase of 57% and 61%, respectively. Conclusion: The CPRP proved to be effective in increasing exercise capacity, upper limb strength and flexibility of the posterior chain and lower limbs.

  8. Relationship between cardiopulmonary responses and isokinetic moments: the optimal angular velocity for muscular endurance.

    Science.gov (United States)

    Lee, Chan-Bok; Eun, Denny; Kim, Kang-Ho; Park, Jae-Wan; Jee, Yong-Seok

    2017-04-01

    Most protocols for testing and rehabilitation for recovery and improvement of muscular endurance have been set at 180°/sec, 240°/sec, and 300°/sec. These protocols can cause confusion to clinical providers or other researchers. This study was aimed at investigating the optimal isokinetic angular speed for measuring or developing muscular endurance after assessing the relationship between cardiopulmonary responses and isokinetic moments. This study was conducted with 31 male and female college students. Graded exercise test and body composition were measured as well as the isokinetic moments of the knee muscles at three angular speeds: 180°/sec, 240°/sec, and 300°/sec. The specific isokinetic moments of knee muscles that were measured included: peak torque (PT) and total work (TW) on extensor (e) and flexor (f) of knee joints, which were denoted as ePT180, fPT180, eTW180, fTW180, ePT240, fPT240, eTW240, fTW240, ePT300, fPT300, eTW300, and fTW300 according to the three angular speeds. Spearman correlation test was used to examine the relationship between the sum means of cardiopulmonary responses and the variables of isokinetic moments. This study confirmed that the optimal angular speed for testing or training for muscular endurance was 180°/sec, which showed a stronger relationship between cardiopulmonary responses and isokinetic moments. Therefore, this angular speed is recommended for testing and training for muscular endurance of the knee joints.

  9. A randomised controlled trial of roller versus centrifugal cardiopulmonary bypass pumps in patients undergoing pulmonary endarterectomy.

    Science.gov (United States)

    Mlejnsky, F; Klein, A A; Lindner, J; Maruna, P; Kvasnicka, J; Kvasnicka, T; Zima, T; Pecha, O; Lips, M; Rulisek, J; Porizka, M; Kopecky, P; Kunstyr, J

    2015-10-01

    There is some controversy as to whether there is a benefit from the use of a centrifugal pump compared with a roller pump during cardiopulmonary bypass to facilitate cardiac surgery. We compared the two pumps, with the primary aim of determining any difference in the effects on inflammation after pulmonary endarterectomy surgery which required prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest. Between September 2010 and July 2013, 58 elective patients undergoing pulmonary endarterectomy were included in this prospective, randomised, controlled study; 30 patients were randomly allocated to the control group, which used a roller pump, and 28 patients to the treatment group, which used a centrifugal pump. Interleukin-6, procalcitonin, C-reactive protein, thromboelastographic parameters, P-selectin, international normalised ratio, activated prothrombin time, free haemoglobin, haematocrit, red blood cell count, white blood cell count, platelet count and protein S100β were recorded during and after the procedure. We also recorded the length of intensive care unit stay, blood loss and transfusion, neurological outcomes and respiratory and renal failure. There was a significant difference in the primary outcome measure: Interleukin-6 was significantly higher in the roller pump group (587 ± 38 ng · l(-1) vs. 327 ± 37 ng · l(-1); ppump group 48 hours following surgery (0.79 (0.08-25.25) ng · ml(-1) vs. 0.36 (0.02-5.83) ng · ml(-1); pcentrifugal pump during prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with a reduced inflammatory response compared to the standard roller pump. Larger multi-centre trials in this area of practice are required. © The Author(s) 2014.

  10. Latent myocardial damage after cardiopulmonary resuscitation in a teenager without prior cardiac disease

    Directory of Open Access Journals (Sweden)

    A. S. Sharykin

    2014-01-01

    Full Text Available Cardiopulmonary resuscitation is an integral part of intensive care in children and adolescents with a number of diseases, most commonly with congenital heart disease, critical cardiac arrhythmias, or severe traumas. This procedure can cause a number of complications, most of them are still completely unstudied, and many of them are associated with the underlying disease. We have a unique case report of a 14-year-old boy without any cardiac disease, who underwent extensive resuscitative measures, including closed-chest massage, tracheal intubation with mechanical ventilation, as well as a few electrical defibrillations with transient myocardial injury. 

  11. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.

    Science.gov (United States)

    Niles, Dana E; Duval-Arnould, Jordan; Skellett, Sophie; Knight, Lynda; Su, Felice; Raymond, Tia T; Sweberg, Todd; Sen, Anita I; Atkins, Dianne L; Friess, Stuart H; de Caen, Allan R; Kurosawa, Hiroshi; Sutton, Robert M; Wolfe, Heather; Berg, Robert A; Silver, Annemarie; Hunt, Elizabeth A; Nadkarni, Vinay M

    2018-03-10

    Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. Twelve pediatric hospitals across United States, Canada, and Europe. In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. None. There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and

  12. Nurses' reactions to participation in cardiopulmonary resuscitation on the nursing unit.

    Science.gov (United States)

    Pups, G M; Weyker, J D; Rodgers, B L

    1997-02-01

    A wide range of emotions are associated with cardiopulmonary resuscitation (CPR) attempts. Articles documenting nurses' reactions to CPR situations are scarce in the nursing literature. This study contains nurses' own descriptions of feelings experienced during and after CPR attempts and the nurses' suggestions for what could make the experience easier, what makes it more difficult, and what interventions the nurses use to reconcile their emotions. The participants were 29 registered nurses employed at an urban Midwestern hospital who completed an open-ended questionnaire that elicited descriptions of CPR events. The data were analyzed using a process of thematic analysis.

  13. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement.

    Science.gov (United States)

    Moons, Philip; Norekvål, Tone M

    2008-01-01

    Empirical evidence suggests that family presence during cardiopulmonary resuscitation (CPR) has beneficial effects. Although many American professional organizations have endorsed the idea of family presence, there is less formal support in Europe. In addition, the attitude of nurses from Anglo-Saxon countries, such as United Kingdom and Ireland, is more positive toward family presence than the attitude of nurses of mainland Europe. In order to support existing guidelines and to stimulate health care organizations to develop a formal policy with respect to family witnessed CPR, 3 important European nursing organizations have recently developed a joint position statement.

  14. Acute Mallory–Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Directory of Open Access Journals (Sweden)

    Dae Hee Kim

    2015-10-01

    Full Text Available A report of a 62-year-old female patient with severe Mallory–Weiss syndrome after successful cardiopulmonary resuscitation (CPR by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient's total blood loss was estimated to be approximately 3000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory–Weiss syndrome after CPR may occur and should be considered as a potentially serious complication after CPR.

  15. Report - Cerebral electrical impedance value reflects brain edema caused by cardiopulmonary bypass in infants.

    Science.gov (United States)

    Peng, Mingqing; Guo, Chunbao; Gong, Fang; Li, Min; Li, Yuan; Peng, Qiang; Bo, Lin

    2017-05-01

    The study aimed to investigate if the dynamic changes in cerebral electrical impedance (CEI) values could be used to monitor brain edema during cardiopulmonary bypass (CPB) in infants. Forty infants (mean age: 1.4±0.38y) with acyanotic congenital heart disease who underwent CPB open-heart surgery between September 2009 and March 2010 were prospectively enrolled, and divided into 2 groups based on aortic cross-clamping (ACC) time: CPB-A (ACCbrain edema in infants undergoing CPB, and is an index reflecting brain damage during CPB in infants.

  16. Cardiopulmonary Arrest and Pneumoencephaly Developing after Epidural Oxygen-ozone Mixture Therapy.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan; Altaş, Cafer; Sayhan, Havva

    2018-01-01

    Pain treatment can comprise a combination of pharmacological, interventional, surgical, physical, psycological methods. Interventional procedures, particularly minimally invasive percutaneous therapies, have been widely used in recent years. Corticosteroid, hyperbaric saline or oxygen-ozone therapy is a safe procedure for patients in whom pain cannot be relieved by epidural adhesiolysis or other treatments. Complication related to oxygen-ozone therapy have been reported rarely in lumbar sciatalgia. Herein, we present a patient who developed cardiopulmonary arrest and pneumoencephaly as a rare but life-threatening complication of oxygen-ozone therapy, for epidural lysis, applied to the epidural space due to low back pain.

  17. Emergency management of heat exchanger leak on cardiopulmonary bypass with hypothermia.

    Science.gov (United States)

    Gukop, P; Tiezzi, A; Mattam, K; Sarsam, M

    2015-11-01

    Heat exchanger leak on cardiopulmonary bypass is very rare, but serious. The exact incidence is not known. It is an emergency associated with the potential risk of blood contamination, air embolism and haemolysis, difficulty with re-warming, acidosis, subsequent septic shock, multi-organ failure and death. We present a prompt, highly co-ordinated algorithm for the successful management of this important rare complication. There is need for further research to look for safety devices that detect leaks and techniques to reduce bacterial load. It is essential that teams practice oxygenator change-out routines and have a well-established change-out protocol. © The Author(s) 2015.

  18. A Nonfatal Case of Dobrava Hantavirus Hemorrhagic Fever with Renal Syndrome Combined with Hantavirus Cardiopulmonary Syndrome

    Directory of Open Access Journals (Sweden)

    Shemsedin Dreshaj

    2018-01-01

    Full Text Available Among hantaviruses (HTNV, 22 are known as pathogenic for humans. HTNV can cause two clinical entities: hemorrhagic fever with renal syndrome (HFRS and hantavirus pulmonary syndrome or hantavirus cardiopulmonary syndrome (HCPS. In most countries of Eastern Europe as well as in Kosovo, HTNV infection is presented mainly as HFRS. Here, we report a 20-year-old man with HFRS and HCPS caused by Dobrava hantavirus strain, successfully treated in Intensive Care Unit of Infectious Diseases Clinic, University Clinical Center of Kosovo. In HFRS endemic areas, patients with acute respiratory distress syndrome need to be evaluated for Dobrava hantavirus strain as a possible causative agent.

  19. Modelling ventricular fibrillation coarseness during cardiopulmonary resuscitation by mixed effects stochastic differential equations.

    Science.gov (United States)

    Gundersen, Kenneth; Kvaløy, Jan Terje; Eftestøl, Trygve; Kramer-Johansen, Jo

    2015-10-15

    For patients undergoing cardiopulmonary resuscitation (CPR) and being in a shockable rhythm, the coarseness of the electrocardiogram (ECG) signal is an indicator of the state of the patient. In the current work, we show how mixed effects stochastic differential equations (SDE) models, commonly used in pharmacokinetic and pharmacodynamic modelling, can be used to model the relationship between CPR quality measurements and ECG coarseness. This is a novel application of mixed effects SDE models to a setting quite different from previous applications of such models and where using such models nicely solves many of the challenges involved in analysing the available data. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  1. Physical self-concept and its link to cardiopulmonary exercise tolerance among adolescents with mild congenital heart disease.

    Science.gov (United States)

    Chen, Chi-Wen; Su, Wen-Jen; Wang, Jou-Kou; Yang, Hsiao-Ling; Chiang, Yueh-Tao; Moons, Philip

    2015-06-01

    Due to medical advances, most children with congenital heart disease (CHD) are expected to survive into adulthood. Establishing adequate physical self-concept and cardiopulmonary tolerance during the adolescent period can primarily enhance overall well-being. The purpose of this study was to undertake a gender-specific evaluation of the domain of physical self-concept among adolescents with mild CHD, and to examine the relationships between physical self-concept and cardiopulmonary exercise tolerance among adolescents with mild CHD. Four hundred and thirteen adolescents 12-20 years of age, whose cardiologists had not recommended any limitation of exercise, completed Physical Self-Description Questionnaires and three-minute step tests in two outpatient cardiology departments. The male participants had significantly greater scores in measures of overall physical self-concept, competence in sports, physical appearance, body fat, physical activity, endurance, and strength than did the female participants. More than 80% of the participants had at least an average cardiopulmonary exercise tolerance index. The perception of not being 'too fat' and being more physically active were significant correlates of better cardiopulmonary exercise tolerance for adolescents with mild CHD. The results provided evidence for gender-specific evaluation of domains of physical self-concept among adolescents with mild CHD. The three-minute step test to measure cardiopulmonary exercise tolerance in adolescents with mild CHD may be an appropriate objective measure for use in future research. Continued efforts are needed in early intervention to promote cardiopulmonary exercise tolerance. © The European Society of Cardiology 2014.

  2. Atrial septal defect closure on cardiopulmonary bypass in a sickle cell anemia: Role of hydroxyurea and partial exchange transfusion

    Directory of Open Access Journals (Sweden)

    Gosavi Kundan

    2010-01-01

    Full Text Available Partial exchange transfusion during cardiopulmonary bypass, while conducting cardiac surgery may be a useful technique in patients with high level of sickle hemoglobin. Along with this preoperative use of hydroxyurea and alternative analgesic modalities such as transcutaneous electrical nerve stimulation in postoperative period may be beneficial, in our opinion. A 16-year-old female of Turner′s syndrome having sickle cell anemia scheduled for closure of arterial septal defect on cardiopulmonary bypass was managed with partial exchange transfusion and warm cardioplegia.

  3. The global cost of eliminating avoidable blindness

    Directory of Open Access Journals (Sweden)

    Kirsten L Armstrong

    2012-01-01

    Full Text Available Aims : To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ′backlog′ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods : Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results : The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$. As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world′s inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions : This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.

  4. The global cost of eliminating avoidable blindness

    Science.gov (United States)

    Armstrong, Kirsten L; Jovic, Martin; Vo-Phuoc, Jennifer L; Thorpe, Jeremy G; Doolan, Brian L

    2012-01-01

    Aims: To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ‘backlog’ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods: Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results: The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$). As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world's inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions: This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector. PMID:22944763

  5. Guide to the collision avoidance rules

    CERN Document Server

    Cockcroft, A N

    2004-01-01

    A Guide to the Collision Avoidance Rules is the essential reference to the safe operation of all vessels at sea. Published continuously since 1965, this respected and expert guide is the classic text for all who need to, practically and legally, understand and comply with the Rules. This sixth edition incorporates all of the amendments to the International Regulations for Preventing Collisions at Sea which came into force in November 2003.The books sets out all of the Rules with clear explanation of their meaning, and gives detailed examples of how the rules have been used in practice

  6. Wireless vehicular networks for car collision avoidance

    CERN Document Server

    2013-01-01

    Wireless Vehicular Networks for Car Collision Avoidance focuses on the development of the ITS (Intelligent Transportation Systems) in order to minimize vehicular accidents. The book presents and analyses a range of concrete accident scenarios while examining the causes of vehicular collision and proposing countermeasures based on wireless vehicular networks. The book also describes the vehicular network standards and quality of service mechanisms focusing on improving critical dissemination of safety information. With recommendations on techniques and protocols to consider when improving road safety policies in order to minimize crashes and collision risks.

  7. Avoidable cancers in the Nordic countries. Occupation

    DEFF Research Database (Denmark)

    Dreyer, L; Andersen, A; Pukkala, E

    1997-01-01

    to be identified. The tissues affected are mainly the epithelial lining of the respiratory organs (nasal cavity, paranasal sinuses, larynx and lung), and urinary tract (renal parenchyma, renal pelvis and urinary bladder), the mesothelial linings, the bone marrow and the liver. During the period 1970-84, almost 4...... around the year 2000, with 1,890 among men and fewer than 25 among women. The proportions that could be avoided if industrial carcinogens were eliminated would be 70% of mesotheliomas, 20% of cancers of the nasal cavity and sinuses, 12% of lung cancers, 5% of laryngeal cancers, 2% of urinary bladder...

  8. The International Double Taxation – Avoiding Methods

    Directory of Open Access Journals (Sweden)

    Nicoleta Barbuta-Misu

    2009-06-01

    Full Text Available The paper presents the main causes that determine double taxation, its forms, i.e. the economicdouble taxation and the international legal double taxation, the need for eliminating the double taxation andavoiding methods. In the presentation of the avoidance methods have been used practical examples forcomparison of the tax advantages for income beneficiary between: the total exemption method andprogressive exemption method, on the one hand, and total crediting method and ordinary crediting method,on the other hand, but the comparing of tax reduction between methods of exemption and crediting.

  9. CORPORATE SOCIAL RESPONSIBILITY VERSUS TAX AVOIDANCE PRACTICES

    Directory of Open Access Journals (Sweden)

    Stoian Ciprian-Dumitru

    2012-07-01

    Full Text Available Worldwide crisis has made multinational companies that are engaged in corporate social responsibility actions to manage their businesses through the lens of various tax avoidance practices. The content of this paper is important due to the fact that tries to identify the impact in case of companies active in corporate social responsibility actions versus their tax structures orientation. Corporate social responsibility literature did not paid enough attention on the impact of the tax avoidance practices of companies. Tax, as a concept, brings in itself an important corporate financial impact with subsequent effects for the life of multiple citizens in countries where private entities are operating. Even though companies are usually expressing their ethical and responsible conduct in respect of the social environment, there are many cases when the business practices were not aligned with the declared corporate behavior. This paper seeks firstly to examine whether companies engaged in tax avoidance practices (ex. offshore tax havens consider that continue to act socially responsible. Secondly, the paper examines the influence on attending the stakeholders’ goals for those companies practicing tax avoidance and its implications on corporate social responsibility actions. Moreover, the paper focuses also on the aspects described before from the perspective of the corporate entities operating in Romania. This paper’s intention is to use and to develop the results of previous research carried out by Lutz Preus (University of London and, subsequently, by Senators Levin, Coleman and Obama in their “Stop Tax Haven Abuse Bill”. The implications and the objectives of this material are to highlight, to identify and to spot clearly the relations and the influences of the tax haven practices of corporations versus their undertaken social responsibility actions. Moreover, this paper brings a fresh perspective of this topic from the

  10. Avoiding plagiarism: guidance for nursing students.

    Science.gov (United States)

    Price, Bob

    The pressures of study, diversity of source materials, past assumptions relating to good writing practice, ambiguous writing guidance on best practice and students' insecurity about their reasoning ability, can lead to plagiarism. With the use of source checking software, there is an increased chance that plagiarised work will be identified and investigated, and penalties given. In extreme cases, plagiarised work may be reported to the Nursing and Midwifery Council and professional as well as academic penalties may apply. This article provides information on how students can avoid plagiarism when preparing their coursework for submission.

  11. Avoidance learning: a review of theoretical models and recent developments

    Science.gov (United States)

    Krypotos, Angelos-Miltiadis; Effting, Marieke; Kindt, Merel; Beckers, Tom

    2015-01-01

    Avoidance is a key characteristic of adaptive and maladaptive fear. Here, we review past and contemporary theories of avoidance learning. Based on the theories, experimental findings and clinical observations reviewed, we distill key principles of how adaptive and maladaptive avoidance behavior is acquired and maintained. We highlight clinical implications of avoidance learning theories and describe intervention strategies that could reduce maladaptive avoidance and prevent its return. We end with a brief overview of recent developments and avenues for further research. PMID:26257618

  12. Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories.

    Science.gov (United States)

    Morris, Laurel S; To, Benjaman; Baek, Kwangyeol; Chang-Webb, Yee-Chien; Mitchell, Simon; Strelchuk, Daniela; Mikheenko, Yevheniia; Phillips, Wendy; Zandi, Michael; Jenaway, Allison; Walsh, Cathy; Voon, Valerie

    2017-01-01

    Functional neurological disorder (FND) is an elusive disorder characterized by unexplained neurological symptoms alongside aberrant cognitive processing and negative affect, often associated with amygdala reactivity. We examined the effect of negative conditioning on cognitive function and amygdala reactivity in 25 FND patients and 20 healthy volunteers (HV). Participants were first conditioned to stimuli paired with negative affective or neutral (CS +/CS -) information. During functional MRI, subjects then performed an instrumental associative learning task to avoid monetary losses in the context of the previously conditioned stimuli. We expected that FND patients would be better at learning to avoid losses when faced with negatively conditioned stimuli (increased harm avoidance). Multi-echo resting state fMRI was also collected from the same subjects and a robust denoising method was employed, important for removing motion and physiological artifacts. FND subjects were more sensitive to the negative CS + compared to HV, demonstrated by a reinforcement learning model. Contrary to expectation, FND patients were generally more impaired at learning to avoid losses under both contexts (CS +/CS -), persisting to choose the option that resulted in a negative outcome demonstrated by both behavioural and computational analyses. FND patients showed enhanced amygdala but reduced dorsolateral prefrontal cortex responses when they received negative feedback. Patients also had increased resting state functional connectivity between these two regions. FND patients had impaired instrumental avoidance learning, findings that parallel previous observations of impaired action-outcome binding. FND patients further show enhanced behavioural and neural sensitivity to negative information. However, this did not translate to improved avoidance learning. Put together, our findings do not support the theory of harm avoidance in FND. We highlight a potential mechanism by which

  13. Vigilance-avoidance and disengagement are differentially associated with fear and avoidant behaviors in social anxiety.

    Science.gov (United States)

    Evans, Travis C; Walukevich, Katherine A; Britton, Jennifer C

    2016-07-15

    Individuals with Social Anxiety Disorder (SAD) often exhibit preferential attention for social threat, demonstrating abnormal orientation to threat (i.e., vigilance-avoidance) and/or difficulty disengaging from threat. However, no research has compared the relationship between attention indices (i.e., vigilance-avoidance, difficulty disengaging from threat) and characteristic features of the disorder such as fear during social situations (social fear) and avoidant behaviors (social avoidance). To address this issue, seventy adults (19.29±1.47 years, 33 females) were separated into low (n=37) or high (n=33) socially anxious groups using clinical cutoff scores on the Social Interaction Anxiety Scale (SIAS). Participants in both groups completed a dot-probe task with congruent, incongruent, and neutral trials to obtain measures of vigilance-avoidance and difficulty disengaging. Using linear regression, we examined the associations each attention index shared with self-reported social fear and social avoidance. Exclusively in the high anxious group, greater vigilance towards threat was associated with higher self-reported social fear, but not with social avoidance. However, difficulty disengaging was not associated with either social measure. In the low anxiety group, no relationships between attention indices and either social measure emerged. Future research with clinical samples is necessary to replicate and extend these findings. The small sample size studied may have limited our ability to detect other smaller effects. Indices of attention bias may contribute differently to the etiology and maintenance of SAD, which offers important implications for novel treatments that target attention. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. 113Insup(m) radiocardiographic measurements of cardiopulmonary parameters in healthy subjects and in cardiac patients

    International Nuclear Information System (INIS)

    Kuikka, Jyrki.

    1976-05-01

    Single detector arrangements are used to measure heart radioactivity curves in healthy subjects and in patients with various heart failures. A method is developed from a modified gamma function to determine the cardiopulmonary parameters from the radiocardiograms: systemic flow, pulmonary flow, right to left shunting flow, left to right shunting flow, regurgitant fractions, stroke volume, atrial blood volumes, ventricular end-diastolic volumes, pulmonary blood volume and ejection fractions. The method is well suited to clinical routine and requires only a desk calculator or a mini-computer for data handling. The cardiopulmonary parameters were measured from 70 healthy subjects with following results: cardiac index 3.46+-0.72 l/min/m 2 , stroke index 49+-9 ml/b/m 2 , right atrial blood volume 35+-13 ml/m 2 , right ventricular end-diastolic volume 76+-15 ml/m 2 , pulmonary blood volume 250+-51 ml/m 2 , left atrial blood volume 41+-15 ml/m 2 , left ventricular end-diastolic volume 75+-15 ml/m 2 , right heart ejection fraction 0.64+-0.11, left heart ejection fraction 0.66+-0.12. These values agree closely with the data accumulated from more elaborate methods. (author)

  15. Cardiopulmonary responses to exercise in moderate-to-severe obstructive sleep apnea.

    Science.gov (United States)

    Oztürk, Levent Mukadder; Metin, Gökhan; Cuhadaroğlu, Cağlar; Utkusavaş, Ayfer; Tutluoğlu, Bülent

    2005-01-01

    Information regarding the safety of maximal cardiopulmonary exercise testing (CPET) or the mechanisms of exercise limitation in obstructive sleep apnea (OSA) patients is fairly limited. In the present study, we addressed the problem of exercise capacity in moderate-to-severe OSA patients. Nineteen non-consecutive patients (three female, 16 male) with moderate-to-severe OSA and 11 age and body mass index matched control subjects (four female, seven male) underwent respiratory function tests during pre-exercise resting period and volitionally limited cardiopulmonary exercise testing on an electronically braked cycle ergometer. All participants completed CPET without any complication. Control subjects were exercise limited due to deconditioning. None of the patients revealed mechanical ventilatory limitation to exercise or had evidence of cardiac ischaemia. Five patients had no limitation to exercise. Six patients had low VO2peak, low anaerobic treshold (AT), and low peak O2 pulse, a pattern consistent with ventricular dysfunction. Six patients had low VO2peak, low AT, and peak heart rate less than 85% predicted. This pattern is consistent with exercise limitation due to peripheral vascular disease. Two patients had low VO2peak, low AT without peak oxygen pulse and peak heart rate abnormalities consistent with deconditioning. We concluded that moderate-to-severe OSA patients have impaired exercise capacity. Exercise limitation seems to originate from cardiovascular reasons namely left ventricular dysfunction and/or peripheral vascular impairment; and finally, maximal CPET can be tolerated by these patient group without serious complications.

  16. Histological changes in neonatal kidneys after cardiopulmonary bypass and deep hypothermic circulatory arrest.

    Science.gov (United States)

    Tirilomis, T; Tempes, T; Waldmann-Beushausen, R; Ballat, C; Bensch, M; Schoendube, F A

    2009-02-01

    Renal failure after open-heart surgery is a serious complication resulting in increased mortality and morbidity. The aim of the study was to find out whether different strategies for open-heart surgery would result in renal histological differences in a neonatal animal model. The renal tissue of newborn piglets was examined after mild hypothermic cardiopulmonary bypass (CPB group; n = 10), deep hypothermic circulatory arrest (DHCA group; n = 8), instrumentation without extracorporeal circulation (sham; n = 3), and the data were compared with those of normal porcine neonatal kidneys (control; n = 6). The severity of tissue damage was graded using a 4-point scoring system (0: normal morphology, 3: severe damage). Apoptotic cells and granulocytes were counted. The histological score was higher in all groups compared with controls ( P < 0.05) and higher in the CPB group compared with the DHCA group ( P < 0.05). More apoptotic cells and granulocytes were found in the CPB group compared with controls and the DHCA group ( P < 0.05). Although changes in the kidney tissue of newborn piglets are detectable after any cardiac procedure, changes are more profound after cardiopulmonary bypass with mild hypothermia.

  17. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR)

    Science.gov (United States)

    Hilberman, M; Kutner, J; Parsons, D; Murphy, D J

    1997-12-01

    Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated.

  18. Exercise Affects Cardiopulmonary Function in Patients with Chronic Kidney Disease: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Hongchang Yang

    2017-01-01

    Full Text Available This study aimed to comprehensively assess the effects of exercise on cardiopulmonary function indices in patients with chronic kidney disease (CKD. A literature review was performed by searching literatures in PubMed and Embase before June 2016. Studies were selected based on predefined inclusion and exclusion criteria, followed by data extraction and a quality assessment of the included studies using the Cochrane Collaboration’s tool. Correlations between exercise and cardiopulmonary function indices [pulse wave velocity, respiratory exchange ratio, and peak oxygen uptake (VO2 peak] were then evaluated using mean differences and 95% confidence intervals. All meta-analyses were conducted using R 3.12 software. Finally, five eligible studies involving 179 CKD patients were included. After intervention, a heterogeneity test showed that the VO2 peak values of the treatment group were greater than those of the control group, whereas no significant differences were found for the other indices. However, a sensitivity analysis showed inconsistent results both before and after intervention. Thus, we concluded that exercise might play an important role in improving the VO2 peak values in CKD patients. Additional studies are needed to verify this conclusion.

  19. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Science.gov (United States)

    Burkhardt, Joshua N.; Glick, Joshua E.; Terndrup, Thomas E.

    2014-01-01

    Introduction The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (μ=117 vs. 94, p<0.001). Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (μ=86% vs. 72%, p<0.01). No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest. PMID:25035744

  20. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Directory of Open Access Journals (Sweden)

    Joshua N. Burkhardt

    2014-07-01

    Full Text Available Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results: Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (µ=117 vs. 94, p<0.001. Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (µ=86% vs. 72%, p<0.01. No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion: Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

  1. Inviting family to be present during cardiopulmonary resuscitation: Impact of education.

    Science.gov (United States)

    Dwyer, Trudy; Friel, Deborah

    2016-01-01

    Encouraging and permitting family members to stay together during cardiopulmonary resuscitation benefits the patient, family and staff. Health care professionals (HCP) attitudes and experiences are documented as barriers to initiating family presence during cardiopulmonary resuscitation (FPDR). The aim of this pilot study was to explore the influence of education on changing HCPs attitudes and intent to provide families with the option to be present at the next cardiac arrest. A purposive sample of 29 HCP from an acute care hospital participated in this quasi-experimental study. 18 of the original 29 HCP completed both the education package and the post-test questionnaire. The majority of participants in this study had previous experience with FPDR (62%) and supported FPDR (69%). While participants had slightly more positive attitudes towards FPDR post education, this change was not significant (p = 0.79). Similarly, participation in education did not change participants concerns about safety issues or increase participant's intention to invite a family member to be present at the next cardiac arrest. The majority of participants strongly supported the development of a dedicated family support person. Education has limited impact on change participant's attitudes or intentions to invite family to be present at the next cardiac arrest. Copyright © 2015. Published by Elsevier Ltd.

  2. Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

    Directory of Open Access Journals (Sweden)

    Clairton Marcos Citolino Filho

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

  3. Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals

    Directory of Open Access Journals (Sweden)

    Thoren Ann-Britt

    2011-01-01

    Full Text Available Abstract Background D-CPR (Defibrillator Cardiopulmonary Resuscitation is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR. Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators. The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR. Methods Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention. Results There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P P Conclusion Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.

  4. The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass.

    Science.gov (United States)

    Maslow, Andrew D; Stearns, Gary; Butala, Parag; Batula, Parag; Schwartz, Carl S; Gough, Jeffrey; Singh, Arun K

    2006-07-01

    Hypotension occurs during cardiopulmonary bypass (CPB), in part because of induction of the inflammatory response, for which nitric oxide and guanylate cyclase play a central role. In this study we examined the hemodynamic effects of methylene blue (MB), an inhibitor of guanylate cyclase, administered during cardiopulmonary bypass (CPB) to patients taking angiotensin-converting enzyme inhibitors. Thirty patients undergoing cardiac surgery were randomized to receive either MB (3 mg/kg) or saline (S) after institution of CPB and cardioplegic arrest. CPB was managed similarly for all study patients. Hemodynamic data were assessed before, during, and after CPB. The use of vasopressors was recorded. All study patients experienced a similar reduction in mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) with the onset of CPB and cardioplegic arrest. MB increased MAP and SVR and this effect lasted for 40 minutes. The saline group demonstrated a persistently reduced MAP and SVR throughout CPB. The saline group received phenylephrine more frequently during CPB, and more norepinephrine after CPB to maintain a desirable MAP. The MB group recorded significantly lower serum lactate levels despite equal or greater MAP and SVR. In conclusion, administration of MB after institution of CPB for patients taking angiotensin-converting enzyme inhibitors increased MAP and SVR and reduced the need for vasopressors. Furthermore, serum lactate levels were lower in MB patients, suggesting more favorable tissue perfusion.

  5. An integrative review: instructional strategies to improve nurses' retention of cardiopulmonary resuscitation priorities.

    Science.gov (United States)

    Sullivan, Nancy

    2015-04-01

    Recognizing and responding to a cardiac arrest in the hospital setting is a high stress, high anxiety event for all healthcare providers. It requires the performance of several basic, but extremely important cardiopulmonary resuscitation (CPR) skills and response priorities. If not executed correctly and in a timely manner, a bad outcome may result. Poor retention of cardiopulmonary resuscitation skills and priorities is well documented in the literature. An integrative review of the evidence was conducted to answer the question, "Is there a more effective training method to improve nurses' retention of CPR priorities during an in hospital cardiac arrest as compared to traditional American Heart Association training? "This review evaluated high fidelity and low fidelity simulation training, online or computer-based training and video instruction as potential teaching strategies focusing on CPR priorities. The role of deliberate practice is discussed. The strongest evidence suggests that a teaching plan employing brief, frequent, repetitive or deliberate practice used in collaboration with low fidelity or high fidelity simulation may be a potential strategy to improve nurses' retention of CPR priorities over time.

  6. Induction and recovery characteristics and cardiopulmonary effects of sevoflurane and isoflurane in bald eagles.

    Science.gov (United States)

    Joyner, Priscilla H; Jones, Michael P; Ward, Daniel; Gompf, Rebecca E; Zagaya, Nancy; Sleeman, Jonathan M

    2008-01-01

    To compare induction and recovery characteristics and cardiopulmonary effects of isoflurane and sevoflurane in bald eagles. Animals-17 healthy adult bald eagles. Anesthesia was induced with isoflurane or sevoflurane delivered in oxygen via a facemask in a crossover design with 4 weeks between treatments. Eagles were intubated, allowed to breathe spontaneously, and instrumented for cardiopulmonary measurements. Time to induction, extubation, and recovery, as well as smoothness of recovery, were recorded. Administration of sevoflurane resulted in a significantly quicker recovery, compared with isoflurane. Temperature, heart rate, and respiratory rate significantly decreased over time, whereas systolic (SAP), diastolic (DAP), and mean arterial blood pressure (MAP) significantly increased over time with each treatment. Temperature, heart rate, SAP, DAP, and MAP were significantly higher with isoflurane. Blood pH significantly decreased, whereas PaCO(2) significantly increased over time with each treatment. Bicarbonate and total carbon dioxide concentrations significantly increased over time with each treatment; however, there was a significant time-treatment interaction. The PaO(2) and arterial oxygen saturation increased over time with isoflurane and decreased over time with sevoflurane with a significant time-treatment interaction. Six eagles developed cardiac arrhythmias with isoflurane, as did 4 with sevoflurane anesthesia. Isoflurane and sevoflurane administration resulted in smooth, rapid induction of and recovery from anesthesia similar to other species. Isoflurane administration resulted in tachycardia, hypertension, and more arrhythmias, compared with sevoflurane. Sevoflurane was associated with fewer adverse effects and may be particularly beneficial in compromised bald eagles.

  7. Transition of intestinal fatty acid-binding protein on hypothermic circulatory arrest with cardiopulmonary bypass.

    Science.gov (United States)

    Kano, Hiroya; Takahashi, Hiroaki; Inoue, Takeshi; Tanaka, Hiroshi; Okita, Yutaka

    2017-04-01

    Intestinal fatty acid-binding protein (I-FABP) is increasingly employed as a highly specific marker of intestinal necrosis. However, the value of this marker associated with cardiovascular surgery with hypothermic circulatory arrest is unclear. The aim of this study was to measure serum I-FABP levels and provide the transition of I-FABP levels with hypothermic circulatory arrest to help in the management of intestinal perfusion. From August 2011 to September 2013, 33 consecutive patients who had aortic arch surgery with hypothermic circulatory arrest or heart valve surgery performed were enrolled in the study. Twenty patients had aortic surgery with hypothermic (23-29°C) circulatory arrest and 13 patients had heart valve surgery with cardiopulmonary bypass (33°C). I-FABP levels increased, both in patients undergoing aortic surgery with hypothermic circulatory arrest and heart valve surgery with cardiopulmonary bypass, reaching peak levels shortly after the administration of protamine. I-FABP levels in patients with aortic surgery were significantly higher with circulatory arrest. They reached peak levels immediately after recirculation and there was a significant drop at the end of surgery (parrest than in patients with heart valve surgery. However, no postoperative reperfusion injury occurred in the intestinal tract due to the use of hypothermic organ protection. Plasma I-FABP monitoring could be a valuable method for finding an intestinal ischemia in patients with cardiovascular surgery.

  8. Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation.

    Science.gov (United States)

    Matsumoto, Cal S; Kaufman, Stuart S; Girlanda, Raffaele; Little, Cheryl M; Rekhtman, Yuliya; Raofi, Vandad; Laurin, Jaqueline M; Shetty, Kirti; Fennelly, Erin M; Johnson, Lynt B; Fishbein, Thomas M

    2008-10-15

    Cardiopulmonary resuscitation (CPR) of a person destined to become an organ donor has been associated with overall poor donor quality, especially for the intestinal donor, as splanchnic vasoconstriction that is intended to preserve coronary and cerebral blood flow may result in clinically relevant intestinal ischemia. Outcomes of recipients who receive intestine grafts that have suffered CPR are unknown. We sought to analyze our clinical experience in using intestinal grafts from donors who suffered cardiopulmonary arrest and resuscitation and to evaluate the outcome of recipients of organs coming from resuscitated donors when compared with recipients of nonresuscitated donors. We retrospectively analyzed the donor and recipient charts of all of our intestinal transplants with regard to the performance of donor CPR. Sixty-seven intestinal transplants were performed in 65 patients from November 2003 to December 2007. Twelve donors (18%) were identified as having suffered cardiac arrest and subsequent CPR. Mean duration of CPR was 19.3+/-12.7 min. Terminal laboratory profiles of CPR donors and non-CPR donors were similar. Of the 12 resuscitated grafts, two were used for multivisceral, one for a modified multivisceral, seven for liver-intestine, and two for isolated intestinal transplant. There were no significant differences in outcome parameters such as operative time, blood use, ventilation days, length of stay, time to enteral independence, rejection, enteric bacteremia, and survival between the 12 resuscitated grafts and the 55 nonresuscitated grafts. A donor history of cardiac arrest should not automatically exclude the use of the intestine graft for transplantation.

  9. Cardio-pulmonary fitness test by ultra-short heart rate variability.

    Science.gov (United States)

    Aslani, Arsalan; Aslani, Amir; Kheirkhah, Jalal; Sobhani, Vahid

    2011-10-01

    It is known that exercise induces cardio-respiratory autonomic modulation. The aim of this study was to assess the cardio-pulmonary fitness by ultra-short heart rate variability. Study population was divided into 3 groups: Group-1 (n = 40) consisted of military sports man. Group-2 (n = 40) were healthy age-matched sedentary male subjects with normal body mass index [BMI = 19 - 25 kg/m(2)). Group-3 (n = 40) were healthy age-matched obese male subjects [BMI > 29 kg/m(2)). Standard deviation of normal-to-normal QRS intervals (SDNN) was recorded over 15 minutes. Bruce protocol treadmill test was used; and, maximum oxygen consumption (VO(2)max) was calculated. WHEN THE STUDY POPULATION WAS DIVIDED INTO QUARTILES OF SDNN (FIRST QUARTILE: 60 and 100 and 140 msec), progressive increase was found in VO(2)max; and, SDNN was significantly linked with estimated VO(2)max. In conclusion, the results of this study demonstrate that exercise training improves cardio-respiratory autonomic function (and increases heart rate variability). Improvement in cardio-respiratory autonomic function seems to translate into a lower rate of long term mortality. Ultra-short heart rate variability is a simple cardio-pulmonary fitness test which just requires 15 minutes, and involves no exercise such as in the treadmill or cycle test.

  10. Phenotyping Exercise Limitation in Systemic Sclerosis: The Use of Cardiopulmonary Exercise Testing.

    Science.gov (United States)

    Boutou, Afroditi K; Pitsiou, Georgia G; Siakka, Panagiota; Dimitroulas, Theodoros; Paspala, Asimina; Sourla, Evdokia; Chavouzis, Nikolaos; Garyfallos, Alexandros; Argyropoulou, Paraskevi; Stanopoulos, Ioannis

    2016-01-01

    Exercise impairment is a common symptom of systemic sclerosis (SSc), a disorder which is frequently complicated by cardiopulmonary involvement. This study's aims were: (a) to define the prevalence and the potential causes of limited exercise capacity and (b) to study potential differences in clinical, radiological and functional characteristics and blood serology among SSc patients with exercise limitation of different etiology. Prospectively collected data on SSc patients who had conducted full lung function testing, blood serology, thorax high-resolution computed tomography, Doppler echocardiogram and a maximal cardiopulmonary exercise testing (CPET) were retrospectively analyzed. Using a CPET algorithm, patients were characterized as having normal or subnormal exercise capacity (N), respiratory limitation (RL), left ventricular dysfunction (LVD) or pulmonary vasculopathy (PV). Group comparisons were conducted using either one-way ANOVA or the Kruskal-Wallis test. A p value present in 32.1%, LVD in 25.6% and RL in 10.2%, while 32.1% of the patients constituted the N group. The presence of antisclero-70 antibodies, low anaerobic threshold and low peak exercise capacity measures could discriminate LVD from the other groups. Low end-tidal carbon dioxide pressure and its change from rest to anaerobic threshold could discriminate between the PV, LVD and N groups, while respiratory restriction along with ventilatory inefficiency indices could differentiate the RL group from the rest. The combined evaluation of CPET gas exchange patterns with baseline measurements could discriminate the causes of exercise limitation among SSc patients. © 2016 S. Karger AG, Basel.

  11. Human Biomechanical and Cardiopulmonary Responses to Partial Gravity – A Systematic Review

    Science.gov (United States)

    Richter, Charlotte; Braunstein, Bjoern; Winnard, Andrew; Nasser, Mona; Weber, Tobias

    2017-01-01

    The European Space Agency has recently announced to progress from low Earth orbit missions on the International Space Station to other mission scenarios such as exploration of the Moon or Mars. Therefore, the Moon is considered to be the next likely target for European human space explorations. Compared to microgravity (μg), only very little is known about the physiological effects of exposure to partial gravity (μg astronauts' health during future missions in partial gravity. The initial search generated 1,323 publication hits. Out of these 1,323 publications, 43 studies were included into the present analysis and relevant data were extracted. None of the 43 included studies investigated long-term effects. Studies investigating the immediate effects of partial gravity exposure reveal that cardiopulmonary parameters such as heart rate, oxygen consumption, metabolic rate, and cost of transport are reduced compared to 1 g, whereas stroke volume seems to increase with decreasing gravity levels. Biomechanical studies reveal that ground reaction forces, mechanical work, stance phase duration, stride frequency, duty factor and preferred walk-to-run transition speed are reduced compared to 1 g. Partial gravity exposure below 0.4 g seems to be insufficient to maintain musculoskeletal and cardiopulmonary properties in the long-term. To compensate for the anticipated lack of mechanical and metabolic stimuli some form of exercise countermeasure appears to be necessary in order to maintain reasonable astronauts' health, and thus ensure both sufficient work performance and mission safety. PMID:28860998

  12. A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data.

    Science.gov (United States)

    Serrano, Carlos; Rocha e Silva, Mauricio

    2010-04-01

    Research in the field of cardiopulmonary disease in Brazil has been very active in recent decades. The combination of PUBMED, SCieLO, open access and online searching has provided a significant increase in the visibility of Brazilian journals. This newly acquired international visibility has in turn resulted in the appearance of more original research reports in the Brazilian scientific press. This review is intended to highlight part of this work for the benefit of the readers of "Clinics." We searched through PUBMED for noteworthy articles published in Brazilian medical journals included in the Journal of Citation Reports of the Institute of Scientific Information to better expose them to our readership. The following journals were examined: "Arquivos Brasileiros de Cardiologia," "Arquivos Brasileiros de Endocrinologia e Metabologia," "Brazilian Journal of Medical and Biological Reviews," "Jornal Brasileiro de Pneumologia," "Jornal de Pediatria," "Revista Brasileira de Cirurgia Cardiovascular," "Revista da Associação Médica Brasileira," Revista da Escola de Enfermagem U.S.P." and "São Paulo Medical Journal." These journals publish original investigations in the field of cardiopulmonary disease. The search produced 71 references, which are briefly examined.

  13. A review of cardiopulmonary research in brazilian medical journals: clinical, surgical and epidemiological data

    Directory of Open Access Journals (Sweden)

    Carlos Serrano

    2010-01-01

    Full Text Available Research in the field of cardiopulmonary disease in Brazil has been very active in recent decades. The combination of PUBMED, SCieLO, open access and online searching has provided a significant increase in the visibility of Brazilian journals. This newly acquired international visibility has in turn resulted in the appearance of more original research reports in the Brazilian scientific press. This review is intended to highlight part of this work for the benefit of the readers of "Clinics." We searched through PUBMED for noteworthy articles published in Brazilian medical journals included in the Journal of Citation Reports of the Institute of Scientific Information to better expose them to our readership. The following journals were examined: "Arquivos Brasileiros de Cardiologia," "Arquivos Brasileiros de Endocrinologia e Metabologia," "Brazilian Journal of Medical and Biological Reviews," "Jornal Brasileiro de Pneumologia," "Jornal de Pediatria," "Revista Brasileira de Cirurgia Cardiovascular," "Revista da Associação Médica Brasileira," Revista da Escola de Enfermagem U.S.P." and "São Paulo Medical Journal." These journals publish original investigations in the field of cardiopulmonary disease. The search produced 71 references, which are briefly examined.

  14. [Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery].

    Science.gov (United States)

    Mainenti, Míriam R M; Teixeira, Patrícia F S; Oliveira, Fátima P; Vaisman, Mário

    2007-12-01

    In order to identify the characteristics of subclinical hypothyroidism (SH) during physical stress and its recovery, 15 SH patients and 16 healthy women were compared by a treadmill cardiopulmonary test. Means of variables were analyzed by the Mann-Whitney U test. Patients obtained lower values for peak expired fraction of O2 (14.90+/-1.05 x 16+/-1.14%; p = 0.014); systolic blood pressure variation (34.33+/-17.92 x 52.50+/-17.22; p = 0.009); exercise duration (8.83+/-2.91 x 14.5+/-5.63 min; p = 0.0005), maximal test load (11.6+/-4.22 x 18.94+/-5.45%; p = 0.0004), as well as tendencies in gas exchange ratio and peak heart rate. Between the first and the third recovery minutes, there was a reduction of only 0.71 mmHg in the diastolic blood pressure, whereas there was a 5.33-mmHg reduction to control group (p = 0.0009) (slower recovery of patients). It is presumable that SH may cause cardiopulmonary dysfunctions, with higher sensibility to the parameters previously cited.

  15. Cardiopulmonary exercise testing is well tolerated in people with Alzheimer-related cognitive impairment.

    Science.gov (United States)

    Billinger, Sandra A; Vidoni, Eric D; Greer, Colby S; Graves, Rasinio S; Mattlage, Anna E; Burns, Jeffrey M

    2014-09-01

    To retrospectively assess whether cardiopulmonary exercise testing would be well tolerated in individuals with Alzheimer disease (AD) compared with a nondemented peer group. We retrospectively reviewed 575 cardiopulmonary exercise tests (CPETs) in individuals with and without cognitive impairment caused by AD. University medical center. Exercise tests (N=575) were reviewed for nondemented individuals (n=340) and those with AD-related cognitive impairment (n=235). Not applicable. The main outcome measure for this study was reporting the reason for CPET termination. The hypothesis reported was formulated after data collection. We found that in cognitively impaired individuals, CPETs were terminated because of fall risk more often, but that overall test termination was infrequent-5.5% versus 2.1% (P=.04) in peers without cognitive impairment. We recorded 6 cardiovascular and 7 fall risk events in those with AD, compared with 7 cardiovascular and 0 fall risk events in those without cognitive impairment. Our findings support using CPETs to assess peak oxygen consumption in older adults with cognitive impairment caused by AD. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Cardiopulmonary Resuscitation Training for Medical Students in Anesthesiology Rotation in Ardabil Medical University (Iran

    Directory of Open Access Journals (Sweden)

    Kh Isazadehfar

    2009-11-01

    Full Text Available Background and purpose: Cardiopulmonary resuscitation (CPR training for undergraduate medical students has been noted to be poor in the past. Attempts have been made The aim of this study is to determine effect of CPR training in the anesthetic ward to improve knowledge and practice undergraduate medical student of CPR.Methods: A 12 month Educational experimental study with self control was done on all undergraduate medical student (n=30 at the medical university of Ardabil in 2006-2007. During I month of program allthis students have undergone CPR training including basic life support (BLS , advanced cardiac life support (ACLS and practical skills. Data were collected via questionnaire, demographic, pre/post knowledge and practice.Results: After training the acceptable score (good and very good about knowledge of BLS, ACLS and practical skill significantly increased %6.7 to %50 (p=0.0001 , %13.3 to %53.4 (p=0.001 and %3.3 to %100 (p=0.001 respectively. A significant relationship between knowledge of ACLS and practical skills was shown (p=0.005.Conclusion: The CPR training course in anesthetic ward leads to a significant increased in skills and knowledge. Adding this course to undergraduate curriculum of medical students especially in operaticallywards (e.g. Anesthetic ward is essential.Keywords: CARDIOPULMONARY RESUSCITATION; TRAINING; BASIC LIFE SUPPORT; ADVANCED CARDIAC LIFE SUPPORT

  17. Use of the cardiopulmonary flow index to evaluate cardiac function in thoroughbred horses

    International Nuclear Information System (INIS)

    Guthrie, A.J.; Killeen, V.M.; Grosskopf, J.F.W.

    1991-01-01

    The ratio of the cardiopulmonary blood volume to stroke volume is called the cardiopulmonary flow index (CPFI). The CPFI can be determined indirectly from the simultaneous recording of a radiocardiogram and an electrocardiogram. The CPFI and cardiac output were measured simultaneously in horses that were diagnosed as having cardiac disease. The results obtained from these subjects were compared with those from control animals and significant differences were found between the mean CPFI of the control horses and those with macroscopically visible myocardial fibrosis on post mortem examination. No significant differences were found between the means of the cardiac output measured in either of the groups of horses. The effect of pharmacological acceleration of the heart rate on the CPFI was also studied. Significant differences were found between the mean CPFI and the slopes of the regression lines of CPFI on heart rate of the control and principal groups of horses. These differences were greatest at heart rates near to the resting heart rates of the individuals. The CPFI was found to be a more sensitive measure of cardiac function than cardiac output, in the horses. 16 refs., 2 figs., 2 tabs

  18. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

    Directory of Open Access Journals (Sweden)

    Kambiz Alizadeh

    2014-02-01

    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  19. Noninvasive measurement of cardiopulmonary blood volume: evaluation of the centroid method

    International Nuclear Information System (INIS)

    Fouad, F.M.; MacIntyre, W.J.; Tarazi, R.C.

    1981-01-01

    Cardiopulmonary blood volume (CPV) and mean pulmonary transit time (MTT) determined by radionuclide measurements (Tc-99m HSA) were compared with values obtained from simultaneous dye-dilution (DD) studies (indocyanine green). The mean transit time was obtained from radionuclide curves by two methods: the peak-to-peak time and the interval between the two centroids determined from the right and left-ventricular time-concentration curves. Correlation of dye-dilution MTT and peak-to-peak time was significant (r = 0.79, p < 0.001), but its correlation with centroid-derived values was better (r = 0.86, p < 0.001). CPV values (using the centroid method for radionuclide technique) correlated significantly with values derived from dye-dilution curves (r = 0.74, p < 0.001). Discrepancies between the two were greater the more rapid the circulation (r = 0.61, p < 0.01), suggesting that minor inaccuracies of dye-dilution methods, due to positioning or delay of the system, can become magnified in hyperkinetic conditions. The radionuclide method is simple, repeatable, and noninvasive, and it provides simultaneous evaluation of pulmonary and systemic hemodynamics. Further, calculation of the ratio of cardiopulmonary to total blood volume can be used as an index of overall venous distensibility and relocation of intravascular blood volume

  20. Ship Collision Avoidance by Distributed Tabu Search

    Directory of Open Access Journals (Sweden)

    Dong-Gyun Kim

    2015-03-01

    Full Text Available More than 90% of world trade is transported by sea. The size and speed of ships is rapidly increasing in order to boost economic efficiency. If ships collide, the damage and cost can be astronomical. It is very difficult for officers to ascertain routes that will avoid collisions, especially when multiple ships travel the same waters. There are several ways to prevent ship collisions, such as lookouts, radar, and VHF radio. More advanced methodologies, such as ship domain, fuzzy theory, and genetic algorithm, have been proposed. These methods work well in one-on-one situations, but are more difficult to apply in multiple-ship situations. Therefore, we proposed the Distributed Local Search Algorithm (DLSA to avoid ship collisions as a precedent study. DLSA is a distributed algorithm in which multiple ships communicate with each other within a certain area. DLSA computes collision risk based on the information received from neighboring ships. However, DLSA suffers from Quasi-Local Minimum (QLM, which prevents a ship from changing course even when a collision risk arises. In our study, we developed the Distributed Tabu Search Algorithm (DTSA. DTSA uses a tabu list to escape from QLM that also exploits a modified cost function and enlarged domain of next-intended courses to increase its efficiency. We conducted experiments to compare the performance of DLSA and DTSA. The results showed that DTSA outperformed DLSA.