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Sample records for avoiding cardiopulmonary by-pass

  1. 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

    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross......-clamping. It has been hypothesized that when coronary artery by-pass grafting is performed without the use of CPB, the rate of serious complications is reduced. METHODS/DESIGN: The trial is designed as an open, randomized, controlled, clinical trial with blinded assessment of end-points. Patients at or above 70...... years of age, referred for surgical myocardial revascularisation, are included and randomised to receive coronary artery by-pass grafting either with or without the use of CPB and aortic cross-clamping. Follow-up is performed by clinical, biochemical, electrocardiographic, and angiographic data...

  2. 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.

  3. 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

  4. Determination of pump flow rate during cardiopulmonary bypass in obese patients avoiding hemodilution.

    Science.gov (United States)

    Santambrogio, Luisa; Leva, Cristian; Musazzi, Giorgio; Bruno, Piergiorgio; Vailati, Andrea; Zecchillo, Franco; Di Credico, Germano

    2009-01-01

    During cardiopulmonary bypass the pump flow is usually set on 2.4 L/min/m(2) of body surface area (BSA) to guarantee adequate tissue perfusion without differences for patient constitutional type. The present study attempts to evaluate the adequacy of pump flow rate in obese patients, considering the ideal weight instead of the real one, avoiding the overflow side effects and hemodilution. Obese patients with body mass index (BMI) > 30 presented for cardiac surgery were randomized in two groups: in one the cardiopulmonary bypass was led traditionally, in the other, pump flow rate was calculated on ideal BMI of 25. Demographics, preoperative tests, and monitoring data were registered. Mortality at hospital discharge and 30 days after were analyzed. The pump flow rate between the groups was different (4.46 vs. 4.87; p = 0.004); there were no differences in organ perfusion (SvO(2); diuresis) and mortality, but the study group presented fewer complications and blood transfusions. The BSA is widely used as the biometric unit to normalize physiologic parameters included pump flow rate, but it is disputable if this practice is correct also in obese patients. The study group, in which pump flow rate was set on ideal BSA, presented no difference in diuresis and mixed venous saturation but fewer complications and fewer perioperative blood transfusions.

  5. 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

  6. Belief propagation decoding of quantum channels by passing quantum messages

    International Nuclear Information System (INIS)

    Renes, Joseph M

    2017-01-01

    The belief propagation (BP) algorithm is a powerful tool in a wide range of disciplines from statistical physics to machine learning to computational biology, and is ubiquitous in decoding classical error-correcting codes. The algorithm works by passing messages between nodes of the factor graph associated with the code and enables efficient decoding of the channel, in some cases even up to the Shannon capacity. Here we construct the first BP algorithm which passes quantum messages on the factor graph and is capable of decoding the classical–quantum channel with pure state outputs. This gives explicit decoding circuits whose number of gates is quadratic in the code length. We also show that this decoder can be modified to work with polar codes for the pure state channel and as part of a decoder for transmitting quantum information over the amplitude damping channel. These represent the first explicit capacity-achieving decoders for non-Pauli channels. (fast track communication)

  7. Belief propagation decoding of quantum channels by passing quantum messages

    Science.gov (United States)

    Renes, Joseph M.

    2017-07-01

    The belief propagation (BP) algorithm is a powerful tool in a wide range of disciplines from statistical physics to machine learning to computational biology, and is ubiquitous in decoding classical error-correcting codes. The algorithm works by passing messages between nodes of the factor graph associated with the code and enables efficient decoding of the channel, in some cases even up to the Shannon capacity. Here we construct the first BP algorithm which passes quantum messages on the factor graph and is capable of decoding the classical-quantum channel with pure state outputs. This gives explicit decoding circuits whose number of gates is quadratic in the code length. We also show that this decoder can be modified to work with polar codes for the pure state channel and as part of a decoder for transmitting quantum information over the amplitude damping channel. These represent the first explicit capacity-achieving decoders for non-Pauli channels.

  8. Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. Adaptation of a differential cost analysis

    Directory of Open Access Journals (Sweden)

    Massimiliano Povero

    2015-10-01

    Full Text Available BACKGROUND: A previous patient-level discrete event simulation (DES model was developed to perform an economic evaluation of GDP strategy with respect to TP in US. Aim of this supplement is provide results of the adaptations of the differential cost analysis to Belgium, Canada, France, Germany, Italy, and UK. METHODS: A Discrete Event Simulation model was developed to compare TP and GDP strategy in patients undergoing CPB. National perspective was adopted to calculate costs associated to each event while GDP strategy was exploited the introduction of Sorin Heartlink (HL Card/GDP Card and Sorin Connect (electronic data management system. RESULTS: GDP reduces the total cost with respect to traditional perfusion; furthermore the cost of GDP strategy (Sorin GDPTM Monitor and Sorin ConnectTM is completely offset by the saving in hospital stay. CONCLUSION: GDP seems to improve significantly the main outcomes related to CPB surgery, when compared to TP techniques. Additional costs due to perform GDP strategy have no impact on the total cost since completely offset by the savings in hospital cost.

  9. 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

  10. 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

  11. Video-assisted minimally invasive coronary operations without cardiopulmonary bypass : A multicenter study

    NARCIS (Netherlands)

    Benetti, F; Mariani, MA; Sani, G; Boonstra, PW; Grandjean, JG; Giomarelli, P; Toscano, M

    1996-01-01

    Objective: The need to avoid the risks associated with cardiopulmonary bypass has led to the interest in coronary operations without cardiopulmonary bypass, Patients and methods: From April 1994 to September 1995, 44 patients (mean age 63.3 +/- 10.0 years, range 43 to 83 years) were selected for

  12. Neurology of cardiopulmonary resuscitation.

    Science.gov (United States)

    Mulder, M; Geocadin, R G

    2017-01-01

    This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction. Guidance to practice evidence-based clinical care when able and thoughtful, pragmatic suggestions for care where evidence is lacking are also provided. This chapter serves as both a useful clinical guide and an updated, thorough, and state-of-the-art reference on the topic for advanced students and experienced practitioners in the field. © 2017 Elsevier B.V. All rights reserved.

  13. 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.

  14. 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...

  15. Basics of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Manjula Sarkar

    2017-01-01

    Full Text Available Cardiopulmonary bypass (CPB provides a bloodless field for cardiac surgery. It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump. Team effort between surgeon, perfusionist and anaesthesiologist is paramount for the successful use of CPB. However, it also has its share of complications and strategies to reduce these complications are the area of the current research.

  16. [Nursing process in advanced cardiopulmonary resuscitation].

    Science.gov (United States)

    Lucio Peña, Gerardo; Fuentes Leonardo, Ana María

    2002-01-01

    The process male nurse is a systematic and organized method to offer effective and efficient cares guided to the achievement of solving real problems of health, reducing the incidence and the duration. It is organized and systematic for that consists of five sequential and interrelated steps: Valuation, diagnostic, planning, execution and evaluation, in which are carried out interrelated actions, thought to maximize the long term results. The nurse process is based on the notion that the success of the cares is measured by the degree of effectiveness and the degree of satisfaction and the patient's progress. Applying this method in the Advanced Cardiac Live Support (ACLS) the identification of a cardiovascular or cardiopulmonary urgency was achieved that implies advanced treatment of the air road, defibrillation and appropriate medications to the circumstances. The ACLS challenges the nurses in charge from the patient's attention to make decisions quick low pressure and in dramatic scenes. Reason why it develops the flowing process male nurse in the advanced cardiopulmonary reanimation due to the incidence of these events in the National Institute of Cardiology Ignacio Chávez, which should guarantee the benefit of services in basic and advanced cardiopulmonary reanimation for personal with a high formation level in all the units of intensive cares and services of hospitalization in integrated form and stratified this way to avoid that it progresses to situations that cause the death or leave irreversible sequels since in the central nervous system the time it is a factor critical for the treatment of this events.

  17. 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

  18. 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.

  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. Cardiopulmonary involvement in Fabry's disease.

    Science.gov (United States)

    Koskenvuo, Juha W; Kantola, Ilkka M; Nuutila, Pirjo; Knuuti, Juhani; Parkkola, Riitta; Mononen, Ilkka; Hurme, Saija; Kalliokoski, Riikka; Viikari, Jorma S; Wendelin-Saarenhovi, Maria; Kiviniemi, Tuomas O; Hartiala, Jaakko J

    2010-04-01

    Fabry's disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A enzyme activity. Decreased enzyme activity leads to accumulation of glycosphingolipid in different tissues, including endothelial and smooth-muscle cells and cardiomyocytes. There is controversial data on cardiopulmonary involvement in Fabry's disease, because many reports are based on small and selected populations with Fabry's disease. Furthermore, the aetiology of cardiopulmonary symptoms in Fabry's disease is poorly understood. We studied cardiopulmonary involvement in seventeen patients with Fabry's disease (20-65 years, 6 men) using ECG, bicycle stress, cardiac magnetic resonance imaging, spirometry, diffusing capacity and pulmonary high-resolution computed tomography (HRCT) tests. Cardiopulmonary symptoms were compared to observed parameters in cardiopulmonary tests. Left ventricular hypertrophy (LVH) and reduced exercise capacity are the most apparent cardiac changes in both genders with Fabry's disease. ECG parameters were normal when excluding changes related to LVH. Spirometry showed mild reduction in vital capacity and forced expiratory volume in one second (FEV I), and mean values in diffusing capacity tests were within normal limits. Generally, only slight morphological pulmonary changes were detected using pulmonary HRCT, and they were not associated with changes in pulmonary function. The self-reported amount of pulmonary symptoms associated only with lower ejection fraction (P routine cardiopulmonary evaluation in Fabry's disease using echocardiography is maybe enough when integrated to counselling for aerobic exercise training.

  2. Traumatic Pancreatitis: A Rare Complication of Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Aziz, Muhammad

    2017-08-17

    An elderly gentleman was successfully revived after undergoing cardiopulmonary resuscitation (CPR) for cardiac arrest. Post CPR, the patient developed acute pancreatitis which was likely complication of inappropriately delivered chest compressions which caused further complications and resulted in the death of the patient. This case underlines the importance of quality chest compressions that includes correct placement of hands by the operator giving chest compressions to avoid lethal injuries to the receiver.

  3. 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...

  4. 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.

  5. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    Science.gov (United States)

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed.

  6. High frequency fishbone driven by passing energetic ions in tokamak plasmas

    Science.gov (United States)

    Wang, Feng; Yu, L. M.; Fu, G. Y.; Shen, Wei

    2017-05-01

    High frequency fishbone instability driven by passing energetic ions was first reported in the Princeton beta experiment with tangential neutral-beam-injection (Heidbrink et al 1986 Phys. Rev. Lett. 57 835-8). It could play an important role for ITER-like burning plasmas, where α particles are mostly passing particles. In this work, a generalized energetic ion distribution function and finite drift orbit width effect are considered to improve the theoretical model for passing particle driving fishbone instability. For purely passing energetic ions with zero drift orbit width, the kinetic energy δ {{W}k} is derived analytically. The derived analytic expression is more accurate as compared to the result of previous work (Wang 2001 Phys. Rev. Lett. 86 5286-8). For a generalized energetic ion distribution function, the fishbone dispersion relation is derived and is solved numerically. Numerical results show that broad and off-axis beam density profiles can significantly increase the beam ion beta threshold {βc} for instability and decrease mode frequency.

  7. Testing of high current by-pass diodes for the LHC magnet quench protection

    International Nuclear Information System (INIS)

    Berland, V.; Hagedorn, D.; Rodriguez-Mateos, F.

    1996-01-01

    Within the framework of the Large Hadron Collider (LHC) R and D program, CERN is performing experiments to establish the current carrying capability of irradiated diodes at liquid Helium temperatures for the superconducting magnet protection. Even if the diodes are degraded by radiation dose and neutron fluence, they must be able to support the by-pass current during a magnet quench and the de-excitation of the superconducting magnet ring. During this discharge, the current in the diode reaches a maximum value up to 13 kA and decreased with an exponential time constant of 100 s. Two sets of 75 mm wafer diameter epitaxial diodes, one irradiated and one non-irradiated, were submitted to this experiment. The irradiated diodes have been exposed to radiation in the accelerator environment up to 20 kGy and then annealed at room temperature. After the radiation exposure the diodes had shown a degradation of forward voltage of 50% which reduced to about 14% after the thermal annealing. During the long duration high current tests, one of the diodes was destroyed and the other two irradiated diodes showed a different behavior compared with non-irradiated diodes

  8. Magnesium sulphate and amiodarone prophylaxis for prevention of postoperative arrhythmia in coronary by-pass operations

    Directory of Open Access Journals (Sweden)

    Huysal Kagan

    2009-02-01

    Full Text Available Abstract Background The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations. Methods The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG. Sixty-four patients were given 3 g of magnesium sulphate (MgSO4 [20 ml = 24.32 mEq/L Mg+2] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1. Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg on first post-operative day (Group 2. After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group had 100 cc. isotonic 0.9% as placebo, during the same time periods. Results In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015. There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026. Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed. Conclusion Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this

  9. Mitigating hyperventilation during cardiopulmonary resuscitation.

    Science.gov (United States)

    Nikolla, Dhimitri; Lewandowski, Tyler; Carlson, Jestin

    2016-03-01

    Although multiple airway management and ventilation strategies have been proposed during cardiac arrest, the ideal strategy is unknown. Current strategies call for advanced airways, such as endotracheal intubation and supraglottic airways. These may facilitate hyperventilation which is known to adversely affect cardiopulmonary physiology. We provide a summary of conceptual models linking hyperventilation to patient outcomes and identify methods for mitigating hyperventilation during cardiac arrest. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Pharmacotherapy In Cardiopulmonary Resuscitation (CPR)

    OpenAIRE

    GÜNAYDIN, Berrin

    2014-01-01

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

  11. 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.

  12. Simulated Cardiopulmonary Arrests in a Hospital Setting.

    Science.gov (United States)

    Mishkin, Barbara H.; And Others

    1982-01-01

    Describes a simulated interdisciplinary role rehearsal for cardiopulmonary arrest to prepare nurses to function effectively. Includes needs analysis, program components, and responses of program participants. (Author)

  13. 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)

  14. 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

  15. 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.

  16. Combination of FVIII and by-passing agent potentiates in vitro thrombin production in haemophilia A inhibitor plasma.

    Science.gov (United States)

    Klintman, Jenny; Astermark, Jan; Berntorp, Erik

    2010-11-01

    The by-passing agents, recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (APCC), are important tools in the treatment of patients with haemophilia A and high-responding inhibitory antibodies. It has been observed clinically that in some patients undergoing immune tolerance induction the bleeding frequency decreases, hypothetically caused by a transient haemostatic effect of infused FVIII not measurable ex vivo. We evaluated how by-passing agents and factor VIII (FVIII) affect thrombin generation (TG) in vitro using plasma from 11 patients with severe haemophilia A and high titre inhibitors. Samples were spiked with combinations of APCC, rFVIIa and five different FVIII products. Combination of APCC and FVIII showed a synergistic effect in eliciting TG (Pproducts. When rFVIIa and FVIII were combined the interaction between the preparations was found to be additive. APCC and rFVIIa were then combined without FVIII, resulting in an additive effect on thrombin production. Each product separately increased TG above baseline. In conclusion, the amount of thrombin formed in vitro by adding a by-passing agent, was higher in the presence of FVIII. Our findings support the use of FVIII in by-passing therapy to optimize the haemostatic effect. © 2010 Blackwell Publishing Ltd.

  17. 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.)

  18. Updates in small animal cardiopulmonary resuscitation.

    Science.gov (United States)

    Fletcher, Daniel J; Boller, Manuel

    2013-07-01

    For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Teaching Cardiopulmonary Resuscitation in the Schools.

    Science.gov (United States)

    Carveth, Stephen W.

    1979-01-01

    Cardiopulmonary resuscitation is a key part of emergency cardiac care. It is a basic life support procedure that can be taught in the schools with the assistance of the American Heart Association. (JMF)

  20. Dynamic Cerebral Autoregulation after Cardiopulmonary Bypass

    DEFF Research Database (Denmark)

    Christiansen, Claus Behrend; Berg, Ronan M G; Plovsing, Ronni R

    2016-01-01

    Background Cerebral hemodynamic disturbances in the peri- or postoperative period may contribute to postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). We therefore examined dynamic cerebral autoregulation (d...

  1. Amitriptyline Intoxication Responded to Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Güldem Turan

    2012-04-01

    Full Text Available The most severe effects in amitriptiline intoxications are related with central nervous system and cardiovascular system. Amitriptiline intoxication especially with high doses has severe cardiac effects and can result in cardiac arrest. Most favorable responses can be achieved with efficient and prolonged cardiopulmonary resuscitation. We wanted to present a case ingested high dose of amitriptiline for attempt to suicide and responded to prolonged cardiopulmonary resuscitation.

  2. Report on soil tests of the fill used in the Ozuki by-pass, Yamaguchi Prefecture. A report on tests of the effect of water immersion on the fill (coal mine waste) used in the Ozuki by-pass

    Energy Technology Data Exchange (ETDEWEB)

    1982-01-01

    Samples of the fill (coal mine waste) used in the construction of the Ozuki by-pass were immersed in beakers of water for 15 and 30 day periods. After air drying, the particle size of the samples was measured and test of their liquid and plastic limits were carried out. The results of these tests and of the particle size measurements are reported. Immersion in water resulted in a 1.5% increase in clay content and an increase in the liquid limit. Likewise, the plasticity index increased from 4.3 to 8.3.

  3. A new step in cement plant bypass technology; Une nouvelle avancee pour les by-pass en cimenterie

    Energy Technology Data Exchange (ETDEWEB)

    Civiel, G. [Technip, 92 - Rueil-Malmaison (France)

    2001-12-01

    The demand of valorizing more and more waste fuel in cement industry results in an increase of volatile element quantities in kiln system, particularly chlorine. In 'Ciment, Betons, Platres, Chaux' no 849 May-June 2001, we made reference to the two new approaches developed by TECHNIP CL to solve the problem of the volatile elements in clinker burning lines: the raw meal curtain and the Taiheyo by-pass. The following article is focused on the second system. (author)

  4. [Prehospital thrombolysis during cardiopulmonary resuscitation].

    Science.gov (United States)

    Spöhr, F; Böttiger, B W

    2005-02-01

    Although prehospital cardiac arrest has an incidence of 40-90/100,000 inhabitants per year, there has been a lack of therapeutic options to improve the outcome of these patients. Of all cardiac arrests, 50-70% are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis has been shown to be a causal and effective therapy in patients with AMI or PE who do not suffer cardiac arrest. In contrast, experience with the use of thrombolysis during cardiac arrest has been limited. Thrombolysis during cardiopulmonary resuscitation (CPR) acts directly on thrombi or emboli causing AMI or PE. In addition, experimental studies suggest that thrombolysis causes an improvement in microcirculatory reperfusion after cardiac arrest. In-hospital and prehospital case series and clinical studies suggest that thrombolysis during CPR may cause a restoration of spontaneous circulation and survival even in patients that have been resuscitated conventionally without success. In addition, there is evidence for an improved neurological outcome in patients receiving a thrombolytic therapy during during CPR. A large randomized, double-blind multicenter trial that has started recently is expected to show if this new therapeutic option can generally improve the prognosis of patients with cardiac arrest.

  5. The Use of Tygon Tubing Sterilized by Gamma Radiation in Heart-Lung By-Pass Machines

    Energy Technology Data Exchange (ETDEWEB)

    Alladine, M. F.; Gibbons, J. R. P. [London Chest Hospital, London (United Kingdom)

    1967-09-15

    Tygon tubing is a co-polymer polyvinyl chloride. This tubing is used throughout the circuit of our heart-lung by-pass machines and had been sterilized by autoclaving or exposure to ethylene oxide gas. Tubing sterilized by autoclaving was noted to have a decrease in tensile strength and the transparency of the tubing was affected. Sterilization by ethylene oxide had the disadvantage that gas was often present in the lumen of the tube when connected to the machine. Lengths of Tygon tubing were sterilized by gamma radiation at varying radiation levels and temperatures. Bacteriological studies were done on the tubing and estimation of tensile strength carried out. We have found that a level of radiation of 2. 5 to 3. 0 Mrad at 20°C produces little or no change in tensile strength and the tubing remains bacteriologically sterile. Tygon tubing sterilized in this way has now been used in over sixty heart-lung by-pass machine operations. (author)

  6. Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla.

    Science.gov (United States)

    Fernandez, Christina M; Peyton, Jamie L; Miller, Mona; Johnson, Eric G; Kovacic, Jan P

    2013-01-01

    To describe the successful application of CPR in a geriatric chinchilla employing basic and advanced life support measures during cardiopulmonary arrest (CPA). A 13-year-old female intact chinchilla presented to a general and multispecialty referral hospital for a dental procedure. During recovery from anesthesia the patient suffered CPA and CPR was initiated. Noninvasive positive pressure mask ventilation was initiated and external chest compressions were performed. An 18-Ga needle was introduced into the medullary cavity of the right humerus as an intraosseous catheter and provided access for administration of drugs and fluids. After return of spontaneous circulation was noted mannitol was administered via the intraosseous catheter to alleviate suspected increased intracranial pressure. Clinical improvement was noted shortly after administration. Monitoring during the recovery period showed a normal sinus cardiac rhythm and a SpO₂ of 100% while on supplemental oxygen. Neurologic function continued to improve over the following hours. Oxygen therapy was provided via an oxygen cage, and administration of antimicirobials, gastrointestinal protectants, and nutritional supplementation were part of the post resuscitation care. Oxygen therapy was discontinued after 24 hours, during which time normal behaviors were observed and neurologic status was considered appropriate. The patient was discharged 48 hours after CPA. Published reports from clinical practice on the outcomes of CPR for exotic small mammals are limited. This report details the successful outcome of the use of combined basic and advanced life support measures for the provision of CPR in a chinchilla. This report also highlights the utility of an intraosseous catheter for administration of drugs and fluids novel to this species during resuscitation and recovery. To the authors' knowledge this is the first published report of successful CPR following CPA in a geriatric chinchilla. © Veterinary Emergency

  7. Are We Successful in Cardiopulmonary Resuscitation?

    Directory of Open Access Journals (Sweden)

    Nalan Kozaci

    2013-08-01

    Full Text Available Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status of judicial cases, causes and time of cardiac arrest, first observed arrest rhythm, the diseases prior to the arrest, means of arrival to emergency department, duration of cardiopulmonary resuscitation, results of cardiopulmonary resuscitation, the name of the hospitalised clinic, the existence of the operation, and outcome of the patients who underwent cardiopulmonary resuscitation in accordance with current advanced life support protocols were recorded in standard data entry form. Results: A total of 290 patients with completely accessible data were included to the study. Most of these patients were men (65.2%. The mean ages were 61 ± 19 years for men, 67 ± 14 years for women (p = 0.018. The most common diagnosis were ischemic heart disease and heart failure according to the analysis of the patient's medical history. 92 patients (31.7% were brought to the emergency department after death, and all of these patients were unsuccessful following to cardiopulmonary resuscitation. 198 patients (68.3% had cardiac arrest in the emergency department, and we determined that cardiopulmonary resuscitation application of 102 patients were successful. The most common causes of cardiac arrest were myocardial infarction and heart failure. Mostly first observed rhythm in the monitor was asystole. The response rate of cardiopulmonary resuscitation in patients with ventricular fibrillation and ventricular tachycardia was higher. Most patients were hospitalised to the

  8. 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

  9. Cardiopulmonary resuscitation in palliative care cancer patients.

    Science.gov (United States)

    Kjørstad, Odd Jarle; Haugen, Dagny Faksvåg

    2013-02-19

    The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.

  10. 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...

  11. Cryogenic Testing of High Current By-Pass Diode Stacks for the Protection of the Superconducting Magnets in the LHC

    Science.gov (United States)

    Gharib, A.; Hagedorn, D.; Della Corte, A.; Fiamozzi Zignani, C.; Turtu, S.; Brown, D.; Rout, C.

    2004-06-01

    For the protection of the LHC superconducting magnets, about 2100 specially developed by-pass diodes were manufactured by DYNEX SEMICONDUCTOR LTD (Lincoln, GB) and about 1300 of these diodes were mounted into diode stacks and submitted to tests at cryogenic temperatures. To date about 800 dipole diode stacks and about 250 quadrupole diode stacks for the protection of the superconducting lattice dipole and lattice quadrupole magnets have been assembled at OCEM (Bologna,Italy) and successfully tested in liquid helium at ENEA (Frascati, Italy). This report gives an overview of the test results obtained so far. After a short description of the test installations and test procedures, a statistical analysis is presented for test data during diode production as well as for the performance of the diode stacks during testing in liquid helium, including failure rates and degradation of the diodes.

  12. Cryogenic testing of by-pass diode stacks for the superconducting magnets of the large hadron collider at CERN

    International Nuclear Information System (INIS)

    Della Corte, A.; Catitti, A.; Chiarelli, S.; Di Ferdinando, E.; Verdini, L.; Gharib, A.; Hagedorn, D.; Turtu, S.; Basile, G. L.; Taddia, G.; Talli, M.; Viola, R.

    2002-01-01

    A dedicated facility prepared by ENEA (Italian Agency for Energy and Environment) for the cryogenic testing of by-pass diodes for the protection of the CERN Large Hadron Collider main magnets will be described. This experimental activity is in the frame of a contract awarded to OCEM, an Italian firm active in the field of electronic devices and power supplies, in collaboration with ENEA, for the manufacture and testing of all the diode stacks. In particular, CERN requests the measurement of the reverse and forward voltage diode characteristics at 300 K and 77 K, and endurance test cycles at liquid helium temperature. The experimental set-up at ENEA and data acquisition system developed for the scope will be described and the test results reported

  13. Fuel assembly outlet temperature profile influence on core by-pass flow and power distribution determination in WWER -440 reactors

    International Nuclear Information System (INIS)

    Petenyi, V.; Klucarova, K.; Remis, J.

    2003-01-01

    The in core instrumentation of the WWER-440 reactors consists of the thermocouple system and the system of self powered detectors (SPD). The thermocouple systems are positioned about 50 cm above the fuel bundle upper flow-mixing grid. The usual assumption is that, the coolant is well mixed in the Tc location, i.e. the temperature is constant through the flow cross-section area. The present evaluations by using the FLUENT 5.5.14 code reveal that, this assumption is not fulfilled. There exists a temperature profile that depends on fuel assembly geometry and on inner power profile of the fuel assembly. The paper presents the estimation of this effect and its influence on the core power distribution and the core by-pass flow determination. Comparison with measurements in Mochovce NPP will also be a part of this presentation (Authors)

  14. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

    2012-01-01

    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  15. 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.…

  16. Cardiopulmonary resuscitation: update, controversies and new advances

    Directory of Open Access Journals (Sweden)

    Alexandre C. Zago

    1999-03-01

    Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

  17. [Cardiopulmonary resuscitation: the essential of 2015 guidelines].

    Science.gov (United States)

    Maudet, Ludovic; Carron, Pierre-Nicolas; Trueb, Lionel

    2016-02-10

    Cardiopulmonary resuscitation (CPR) guidelines have been updated in October 2015. The 2010 guidelines are reaffirmed: immediate call for help via the local dispatch center, high quality CPR (frequency between 100 and 120/min, compression depth between 5 and 6 cm) and early defibrillation improve patient's survival chances. This article reviews the essential elements of resuscitation and recommended advanced measures.

  18. 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 ...

  19. 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

  20. Brain microvascular function during cardiopulmonary bypass

    International Nuclear Information System (INIS)

    Sorensen, H.R.; Husum, B.; Waaben, J.; Andersen, K.; Andersen, L.I.; Gefke, K.; Kaarsen, A.L.; Gjedde, A.

    1987-01-01

    Emboli in the brain microvasculature may inhibit brain activity during cardiopulmonary bypass. Such hypothetical blockade, if confirmed, may be responsible for the reduction of cerebral metabolic rate for glucose observed in animals subjected to cardiopulmonary bypass. In previous studies of cerebral blood flow during bypass, brain microcirculation was not evaluated. In the present study in animals (pigs), reduction of the number of perfused capillaries was estimated by measurements of the capillary diffusion capacity for hydrophilic tracers of low permeability. Capillary diffusion capacity, cerebral blood flow, and cerebral metabolic rate for glucose were measured simultaneously by the integral method, different tracers being used with different circulation times. In eight animals subjected to normothermic cardiopulmonary bypass, and seven subjected to hypothermic bypass, cerebral blood flow, cerebral metabolic rate for glucose, and capillary diffusion capacity decreased significantly: cerebral blood flow from 63 to 43 ml/100 gm/min in normothermia and to 34 ml/100 gm/min in hypothermia and cerebral metabolic rate for glucose from 43.0 to 23.0 mumol/100 gm/min in normothermia and to 14.1 mumol/100 gm/min in hypothermia. The capillary diffusion capacity declined markedly from 0.15 to 0.03 ml/100 gm/min in normothermia but only to 0.08 ml/100 gm/min in hypothermia. We conclude that the decrease of cerebral metabolic rate for glucose during normothermic cardiopulmonary bypass is caused by interruption of blood flow through a part of the capillary bed, possibly by microemboli, and that cerebral blood flow is an inadequate indicator of capillary blood flow. Further studies must clarify why normal microvascular function appears to be preserved during hypothermic cardiopulmonary bypass

  1. 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.

  2. 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.

  3. 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.

  4. Fluid distribution kinetics during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Mattias Törnudd

    2014-08-01

    Full Text Available OBJECTIVE: The purpose of this study was to examine the isovolumetric distribution kinetics of crystalloid fluid during cardiopulmonary bypass. METHODS: Ten patients undergoing coronary artery bypass grafting participated in this prospective observational study. The blood hemoglobin and the serum albumin and sodium concentrations were measured repeatedly during the distribution of priming solution (Ringer's acetate 1470 ml and mannitol 15% 200 ml and initial cardioplegia. The rate of crystalloid fluid distribution was calculated based on 3-min Hb changes. The preoperative blood volume was extrapolated from the marked hemodilution occurring during the onset of cardiopulmonary bypass. Clinicaltrials.gov: NCT01115166. RESULTS: The distribution half-time of Ringer's acetate averaged 8 minutes, corresponding to a transcapillary escape rate of 0.38 ml/kg/min. The intravascular albumin mass increased by 5.4% according to mass balance calculations. The preoperative blood volume, as extrapolated from the drop in hemoglobin concentration by 32% (mean at the beginning of cardiopulmonary bypass, was 0.6-1.2 L less than that estimated by anthropometric methods (p<0.02. The mass balance of sodium indicated a translocation from the intracellular to the extracellular fluid space in 8 of the 10 patients, with a median volume of 236 ml. CONCLUSIONS: The distribution half-time of Ringer's solution during isovolumetric cardiopulmonary bypass was 8 minutes, which is the same as for crystalloid fluid infusions in healthy subjects. The intravascular albumin mass increased. Most patients were hypovolemic prior to the start of anesthesia. Intracellular edema did not occur.

  5. 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.

  6. 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.

  7. 21 CFR 870.4280 - Cardiopulmonary prebypass filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary prebypass filter. 870.4280 Section... prebypass filter. (a) Identification. A cardiopulmonary prebypass filter is a device used during priming of... bypass. The device is not used to filter blood. (b) Classification. Class II (performance standards). ...

  8. 21 CFR 870.4200 - Cardiopulmonary bypass accessory equipment.

    Science.gov (United States)

    2010-04-01

    ... Cardiopulmonary bypass accessory equipment. (a) Identification. Cardiopulmonary bypass accessory equipment is a... mounting bracket or system-priming equipment. (b) Classification. (1) Class I. The device is classified as class I if it does not involve an electrical connection to the patient. The device is exempt from the...

  9. 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

  10. 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 Section 870.4390 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... bypass pump tubing. (a) Identification. A cardiopulmonary bypass pump tubing is polymeric tubing which is...

  11. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 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... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240...

  12. 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...

  13. Radiation Resistance and Life Time Estimates at Cryogenic Temperatures of Series Produced By-Pass Diodes for the LHC Magnet Protection

    Science.gov (United States)

    Denz, R.; Gharib, A.; Hagedorn, D.

    2004-06-01

    For the protection of the LHC superconducting magnets about 2100 specially developed by-pass diodes have been manufactured in industry and more than one thousand of these diodes have been mounted into stacks and tested in liquid helium. By-pass diode samples, taken from the series production, have been submitted to irradiation tests at cryogenic temperatures together with some prototype diodes up to an accumulated dose of about 2 kGy and neutron fluences up to about 3.0 1013 n cm-2 with and without intermediate warm up to 300 K. The device characteristics of the diodes under forward bias and reverse bias have been measured at 77 K and ambient versus dose and the results are presented. Using a thermo-electrical model and new estimates for the expected dose in the LHC, the expected lifetime of the by-pass diodes has been estimated for various positions in the LHC arcs. It turns out that for all of the by-pass diodes across the arc elements the radiation resistance is largely sufficient. In the dispersion suppresser regions of the LHC, on a few diodes annual annealing during the shut down of the LHC must be applied or those diodes may need to be replaced after some time.

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

    Directory of Open Access Journals (Sweden)

    Andréia Cristina Passaroni

    2015-04-01

    Full Text Available 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 various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies.Conclusion:Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function.

  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. Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery

    DEFF Research Database (Denmark)

    Vedel, Anne G.; Holmgaard, Frederik; Rasmussen, Lars Simon

    2016-01-01

    Background: Debilitating brain injury occurs in 1.6–5 % of patients undergoing cardiac surgery with cardiopulmonary bypass. Diffusion-weighted magnetic resonance imaging studies have reported stroke-like lesions in up to 51 % of patients after cardiac surgery. The majority of the lesions seem...... to be caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided...... by the cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. Methods/design: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients...

  17. 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.

  18. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Science.gov (United States)

    Flythe, Jennifer E.; Li, Nien-Chen; Brunelli, Steven M.; Lacson, Eduardo

    2014-01-01

    Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes). This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases) and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped) were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath) and to use the lowest effective erythropoietin stimulating agent dose. PMID:25530881

  19. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Directory of Open Access Journals (Sweden)

    Jennifer E. Flythe

    2014-01-01

    Full Text Available Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes. This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath and to use the lowest effective erythropoietin stimulating agent dose.

  20. Performance of single-pass and by-pass multi-step multi-soil-layering systems for low-(C/N)-ratio polluted river water treatment.

    Science.gov (United States)

    Wei, Cai-Jie; Wu, Wei-Zhong

    2018-09-01

    Two kinds of hybrid two-step multi-soil-layering (MSL) systems loaded with different filter medias (zeolite-ceramsite MSL-1 and ceramsite-red clay MSL-2) were set-up for the low-(C/N)-ratio polluted river water treatment. A long-term pollutant removal performance of these two kinds of MSL systems was evaluated for 214 days. By-pass was employed in MSL systems to evaluate its effect on nitrogen removal enhancement. Zeolite-ceramsite single-pass MSL-1 system owns outstanding ammonia removal capability (24 g NH 4 + -Nm -2 d -1 ), 3 times higher than MSL-2 without zeolite under low aeration rate condition (0.8 × 10 4  L m -2 .h -1 ). Aeration rate up to 1.6 × 10 4  L m -2 .h -1 well satisfied the requirement of complete nitrification in first unit of both two MSLs. However, weak denitrification in second unit was commonly observed. By-pass of 50% influent into second unit can improve about 20% TN removal rate for both MSL-1 and MSL-2. Complete nitrification and denitrification was achieved in by-pass MSL systems after addition of carbon source with the resulting C/N ratio up to 2.5. The characters of biofilms distributed in different sections inside MSL-1 system well illustrated the nitrogen removal mechanism inside MSL systems. Two kinds of MSLs are both promising as an appealing nitrifying biofilm reactor. Recirculation can be considered further for by-pass MSL-2 system to ensure a complete ammonia removal. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. 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...

  2. 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.

  3. [The systemic approach to the rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngectomy with tracheoesophageal by-pass and endoprosthetics].

    Science.gov (United States)

    Kryukov, A I; Reshetov, I V; Kozhanov, L G; Sdvizhkov, A M; Kozhanov, A L

    The objective of the present study was to enhance the effectiveness of rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngotomy with tracheoesophageal by-pass and endoprosthetics. Our experience in this field is based on the treatment of 102 patients. They were distributed by the nosological forms as follows: primary laryngeal cancer in 97 patients including T1NoMo - 8 (8.2%), T2NoMo - 63 (65%), T3NoMo - 18 (17.6%), T2N1Mo - 1 (0.9%), T4NoMo - 3 (2.9%), and T4N1M0 - 4 (3.9%), root of the tongue cancer spreading over the vestibular part of the larynx in one patient, laryngeal sarcoma in one patient, relapse of cancer following the full-dose radiotherapy and organ-sparing surgery in 3 patients. Laryngeal resection was performed in 83 patients; 19 patients underwent laryngectomy with tracheoesophageal by-pass and endoprosthetics using a domestically manufactured voice prosthesis. The systemic approach to the rehabilitation of the patients and the use of the proposed treatment algorithm made it possible to restore the function of the larynx by means of organ-sparing surgery in 79 (95.1%) of the 83 patients. The vocal function in the patients following laryngectomy with tracheoesophageal by-pass and endoprosthetics was restored in 18 (94.7%) of the 19 patients.

  4. 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.

  5. Liver laceration related to cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Halil Beydilli

    2016-06-01

    Full Text Available Cardiopulmonary resuscitation (CPR is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions. Keywords: Resuscitation complications, Emergency service, Liver laceration, Autopsy

  6. 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

  7. comparison of cardio-pulmonary responses to forward and ...

    African Journals Online (AJOL)

    GOAL REALITY

    increase quadriceps power and strength (Mackie and. Dean, 1984 ... the metabolic cost of and cardiopulmonary response to this mode of ... power and at maximal exercise. ... wind resistance ) (Fohenbach, Mader and Holloman,. 1987; Heck ...

  8. 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

  9. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.

    Science.gov (United States)

    2010-04-01

    ... bypass oxygenator. (a) Identification. A cardiopulmonary bypass oxygenator is a device used to exchange gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during open...

  10. Cardiopulmonary disease in the geriatric dog and cat

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-01-15

    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.

  11. 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...

  12. 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

  13. 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...

  14. Avoiding the Flu

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Flu Avoiding the Flu Past Issues / Fall 2009 Table of Contents Children ... should still get the 2009 H1N1 vaccine. H1N1 Flu: Who Should Be Vaccinated First The Centers for ...

  15. Helping Students Avoid Plagiarism.

    Science.gov (United States)

    Wilhoit, Stephen

    1994-01-01

    Discusses how and why college students commit plagiarism, suggesting techniques that instructors can use to help student avoid plagiarism. Instructors should define and discuss plagiarism thoroughly; discuss hypothetical cases; review the conventions of quoting and documenting material; require multiple drafts of essays; and offer responses…

  16. 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

  17. 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

  18. 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

  19. A Novel Anti-Pollution Filter for Volatile Agents During Cardiopulmonary Bypass: Preliminary Tests.

    Science.gov (United States)

    Nigro Neto, Caetano; Landoni, Giovanni; Tardelli, Maria Angela

    2017-08-01

    Concerns regarding pollution of the operating room by volatile anesthetics and effects on atmospheric ozone depletion exist. Volatile agents commonly are used during cardiopulmonary bypass to provide anesthesia independent of any supposed myocardial protective effects. The authors' aim was to create and to assess the performance of a prototype filter for volatile agents to be connected to the cardiopulmonary bypass circuit to avoid the emission of volatile agents to the operating room, and also to the environment without causing damage to the membrane oxygenator. Observational trial. University hospital. Prototype filter for volatile agents. The prototype filter was tested in a single ex vivo experiment. The main data measured during the test were pressure drop to detect interference with the performance of the oxygenator, back pressure to detect overpressure to the outlet gas jacket of the oxygenator, analysis of exhaled sevoflurane after the membrane oxygenator, and after the filter to detect any presence of sevoflurane. The prototype filter adsorbed the sevoflurane eliminated through the outlet portion of the oxygenator. During the entire test, the back pressure remained constant (4 mmHg) and pressure drop varied from 243 mmHg to 247 mmHg. The prototype filter was considered suitable to absorb the sevoflurane, and it did not cause an overpressure to the membrane oxygenator during the test. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Quality of harvested autologous platelets compared with stored donor platelets for use after cardiopulmonary bypass procedures.

    Science.gov (United States)

    Crowther, M; Ford, I; Jeffrey, R R; Urbaniak, S J; Greaves, M

    2000-10-01

    Platelet dysfunction has a major contribution in bleeding after cardiopulmonary bypass (CPB) and transfusion of platelets is frequently used to secure haemostasis. Allogeneic platelets prepared for transfusion are functionally impaired. Autologous platelets harvested preoperatively require a shorter storage time before transfusion and their use also avoids the risks associated with transfusion of allogeneic blood products. For the first time, we have compared the functional quality of autologous platelets with allogeneic platelets prepared by two methods, immediately before infusion. Platelet activation was assessed by P-selectin expression and fibrinogen binding using flow cytometry. We also monitored the effects of CPB surgery and re-infusion of autologous platelets on platelet function. Autologous platelet-rich plasma (PRP) contained a significantly lower (P platelets compared with allogeneic platelet preparations, and also contained a significantly higher (P platelets. Allogeneic platelets prepared by donor apheresis were more activated and less responsive than those produced by centrifugation of whole blood. In patients' blood, the percentage of platelets expressing P-selectin or binding fibrinogen increased significantly after CPB (P platelets responsive to in vitro agonists was decreased (P platelet activation during the procedure. The percentage of activated platelets decreased (statistically not significant) after re-infusion of autologous PRP. P-selectin expression had returned to pre-CPB levels 24 h post-operatively. Autologous platelet preparations display minimal activation, but remain responsive. Conservation of platelet function may contribute to the potential clinical benefits of autologous transfusion in cardiopulmonary bypass.

  1. Wide variation in cardiopulmonary resuscitation interruption intervals among commercially available automated external defibrillators may affect survival despite high defibrillation efficacy.

    Science.gov (United States)

    Snyder, David; Morgan, Carl

    2004-09-01

    Recent studies have associated interruptions of cardiopulmonary resuscitation imposed by automated external defibrillators (AEDs) with poor resuscitation outcome. In particular, the "hands-off" interval between precordial compressions and subsequent defibrillation shock has been implicated. We sought to determine the range of variation among current-generation AEDs with respect to this characteristic. Seven AEDs from six manufacturers were characterized via stopwatch and arrhythmia simulator with respect to the imposed hands-off interval. All AEDs were equipped with new batteries, and measurements were repeated five times for each AED. A wide variation in the hands-off interval between precordial compressions and shock delivery was observed, ranging from 5.2 to 28.4 secs, with only one AED achieving an interruption of <10 secs. Laboratory and clinical data suggest that this range of variation could be responsible for a more than two-fold variation in patient resuscitation success, an effect that far exceeds any defibrillation efficacy differences that may hypothetically exist. In addition to defibrillation waveform and dose, researchers should consider the hands-off cardiopulmonary resuscitation interruption interval between cardiopulmonary resuscitation and subsequent defibrillation shock to be an important covariate of outcome in resuscitation studies. Defibrillator design should minimize this interval to avoid potential adverse consequences on patient survival.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Examining critical care nurses' critical incident stress after in hospital cardiopulmonary resuscitation (CPR).

    Science.gov (United States)

    Laws, T

    2001-05-01

    The object of this study was to determine if critical care nurses' emotional responses to having performed cardiopulmonary resuscitation were indicative of critical incident stress. A descriptive approach was employed using a survey questionnaire of 31 critical care nurses, with supportive interview data from 18 of those participants. Analysis of the data generated from the questionnaire indicated that the respondents experienced thought intrusion and avoidance behaviour. A majority of those interviewed disclosed that they had experienced a wide range of emotional stressors and physical manifestations in response to having performed the procedure. The findings from both questionnaire and interview data were congruent with signs of critical incident stress, as described in the literature. This has been found to be detrimental to employees' mental health status and, for this reason, employers have a duty of care to minimise the risk of its occurrence and to manage problems as they arise.

  10. 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.

  11. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Bouwes Aline

    2012-08-01

    Full Text Available Abstract Background Acute posthypoxic myoclonus (PHM can occur in patients admitted after cardiopulmonary resuscitation (CPR and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP and electroencephalogram (EEG. Methods Patients with acute PHM (focal myoclonus or status myoclonus within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used. Good outcome was defined as good recovery or moderate disability after 6 months. Results Acute PHM was reported in 79/391 patients (20%. SEPs were available in 51/79 patients and in 27 of them (53% N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64% patients fulfilling criteria for a cortical origin. Nine patients (12% had a good outcome. A broad variety of drugs was used for treatment. Conclusions The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.

  12. Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations

    Directory of Open Access Journals (Sweden)

    Vidhu Bhatnagar

    2018-01-01

    Full Text Available Background: The cardiopulmonary resuscitation (CPR in prone position has been dealt with in 2010 American Heart Association (AHA guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. Aims: This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. Methods: We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. Results: No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR, CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ. Conclusion: A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

  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. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Science.gov (United States)

    2010-04-01

    ..., or tubing. 870.4210 Section 870.4210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to...

  20. 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

  1. 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.

  2. Retention of Cardiopulmonary Resuscitation Skills in Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin

    2016-01-01

    Background/Objective: For effective bystander cardiopulmonary resuscitation (CPR), retention of CPR skills after the training is central. The objective of this study was to find out how much of the CPR skills a group of Nigerian secondary school students would retain six weeks after their first exposure to the conventional CPR training. Materials…

  3. 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...

  4. 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 ...

  5. Attitude of elderly patients towards cardiopulmonary resuscitation in Greece.

    Science.gov (United States)

    Chliara, Daphne; Chalkias, Athanasios; Horopanitis, Evaggelos E; Papadimitriou, Lila; Xanthos, Theodoros

    2014-10-01

    Although researchers in several countries have investigated patients' points of view regarding cardiopulmonary resuscitation, there has been no research investigating this issue in Greece. The present study aimed at identifying the attitude of older Greek patients regarding cardiopulmonary resuscitation. One basic questionnaire consisting of 34 questions was used in order to identify patients' opinions regarding cardiopulmonary resuscitation in five different hospitals from June to November 2011. In total, 300 questionnaires were collected. Although patients' knowledge regarding cardiopulmonary resuscitation was poor, most of them would like to be resuscitated in case they suffered an in-hospital cardiac arrest. Also, they believe that they should have the right to accept or refuse treatment. However, the legal and sociocultural norms in Greece do not support patients' choice for the decision to refuse resuscitation. The influence of several factors, such as their general health status or the underlying pathology, could lead patients to give a "do not attempt resuscitation" order. The attitudes of older Greek patients regarding resuscitation are not different from others', whereas the legal and sociocultural norms in Greece do not support patient choice in end-of-life decisions, namely the decision to refuse resuscitation. We advocate the introduction of advanced directives, as well as the establishment and implementation of specific legislation regarding the ethics of resuscitation in Greece. © 2013 Japan Geriatrics Society.

  6. Myocardial injury and protection related to cardiopulmonary bypass

    NARCIS (Netherlands)

    de Hert, Stefan; Moerman, Anneliese

    2015-01-01

    During cardiac surgery with cardiopulmonary bypass, the heart is isolated from the circulation. This inevitably induces myocardial ischemia. In addition to this ischemic insult, an additional hit will occur upon reperfusion, which may worsen the extent of tissue damage and organ dysfunction. Over

  7. Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass

    NARCIS (Netherlands)

    Hensens, AG; Zeebregts, C.J.A.M.; Liem, TH; Gehlmann, H; Lacquet, LK

    Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right

  8. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    NARCIS (Netherlands)

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G

    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using

  9. PREVENTION OF BLOOD ACTIVATION DURING AND COMPLICATIONS AFTER CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    VANOEVEREN, W; WILDEVUUR, CRH

    1991-01-01

    The cardiopulmonary bypass (CPB) circuit for open heart surgery initiates a whole body inflammatory reaction (WBIR) resulting in impaired hemostasis and organ dysfunction. Impaired hemostasis appeared to be related to the activation of the contact system (factor XII), which can be inhibited by

  10. Welded tracheal stent removal in a child under cardiopulmonary bypass.

    Science.gov (United States)

    Kao, S C; Chang, W K; Pong, M W; Cheng, K W; Chan, K H; Tsai, S K

    2003-08-01

    Metallic tracheal stents have been used in the treatment of paediatric tracheomalacia for more than a decade. We describe a case in which critical airway obstruction occurred during removal of a welded tracheal stent using a rigid bronchoscope under general anaesthesia. Life-saving cardiopulmonary bypass was instituted urgently, and the welded stent was then removed successfully by directly opening the trachea.

  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. 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.

  13. Upper full arch rehabilitation with sinus by-pass with tilted implants via tapered-threaded expanders in low density bone: a clinical trial.

    Science.gov (United States)

    Andreasi Bassi, M; Andrisani, C; Lico, S; Ormanier, Z; Arcuri, C

    2016-01-01

    In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants, in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors present a case series of full-arch rehabilitations performed with this procedure named: Tilted Implant Expansion Osteotomy (TIEO). 12 patients (5 males and 7 females, average age 58.5 ± 8.1 years) with totally or partially edentulous maxilla were enrolled in this study. For each patient 4 implants were placed, the anterior implants in the area of lateral incisors or canines while, the posterior implants, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 48 cylindrical two-piece implants were placed, 24 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 6 months, the second stage surgery was performed. The cases were finalized by means of a hybrid metal-acrylic prosthesis. The post finalization follow-up was at 12 months. Survival rate was 100% since none fixtures were lost. At the one-year follow up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for full-arch rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

  14. Maxillary sinus by-pass with tilted implants via tapered-screw bone expanders in low density bone: one year follow -up of a case series.

    Science.gov (United States)

    Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors named the procedure: Tilted Implant Expansion Osteotomy (TIEO). Fifteen patients (10 females and 5 males, mean age 47.8±8.15 years) with distal edentulous maxillae were enrolled in this study. For each edentulous site 2 implants were placed, the anterior implant in the area of the most anterior missing tooth while, the posterior implant, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 34 cylindrical two-piece implants were placed, 17 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 4-6 months, the second stage surgery was performed. The cases were finalized by metal-ceramic cementable restorations with a variable number of elements, from 2 to 4, without any cantilever element. The post finalization follow-up was at 12 months. Survival rate was 100% since no fixtures were lost. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for oral rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

  15. 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.

  16. Surgical treatment of Wolff-Parkinson-White syndrome: epicardial approach without the use of cardiopulmonary bypass.

    Science.gov (United States)

    Graffigna, A; Pagani, F; Vigano, M

    1993-03-01

    Epicardial dissection without the use of cardiopulmonary bypass (CPB) was performed in 88 patients (56 males and 32 females, mean age 31.9 years). With intraoperative epicardial mapping, 101 accessory pathways were detected, with multiple pathways in 11 patients. CPB was avoided in all but one patient due to frequent onset of atrial fibrillation with rapid ventricular rate. Surgical ablation was successful in 86 patients (97.6%). Three patients required multiple surgical procedures because of persistence of conduction along a component of the original pathway. All but two patients were discharged without antiarrhythmic medication; these two patients were given quinidine therapy because of atrial fibrillation, but had normal early and late electrophysiological studies. Surgical ablation of Kent bundles by the epicardial approach for the treatment of Wolff-Parkinson-White syndrome can be achieved without the use of CPB. Optimal and steady exposure of the area are mandatory for the procedure, and dissection is eased by avoidance of heparin required for CPB.

  17. A Cardiopulmonary Bypass Based Blood Management Strategy in Adult Cardiac Surgery.

    Science.gov (United States)

    Budak, Ali Baran; McCusker, Kevin; Gunaydin, Serdar

    2017-10-24

    Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open-heart surgical procedures. Efforts should be made to decrease or completely avoid transfusions to avoid these negative reactions. Our coronary artery bypass grafting database was reviewed retrospectively and a total of 243 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) were studied in a 12-month period (January-December 2016) after the implementation of the new program, and compared with 275 patients of the previous 12-month period.All the staff involved in the care of the patients were educated about the risks and benefits of blood transfusions and the new transfusion guidelines in a 45-min training. We revised our guidelines for transfusions based on the STS. A transfusion log was created. Reduction in IV fluid volume was targeted. CPB circuitry was redesigned to achieve significantly less prime volume. Results: The proportion of patients transfused with red blood cells was 56% (n =154) in the control group and reduced by 26.8% in the study group (29.2%; 71 patients; P conservation group.  Conclusion: These findings, in addition to risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in adult cardiac operations.

  18. Use of Aerial high resolution visible imagery to produce large river bathymetry: a multi temporal and spatial study over the by-passed Upper Rhine

    Science.gov (United States)

    Béal, D.; Piégay, H.; Arnaud, F.; Rollet, A.; Schmitt, L.

    2011-12-01

    Aerial high resolution visible imagery allows producing large river bathymetry assuming that water depth is related to water colour (Beer-Bouguer-Lambert law). In this paper we aim at monitoring Rhine River geometry changes for a diachronic study as well as sediment transport after an artificial injection (25.000 m3 restoration operation). For that a consequent data base of ground measurements of river depth is used, built on 3 different sources: (i) differential GPS acquisitions, (ii) sounder data and (iii) lateral profiles realized by experts. Water depth is estimated using a multi linear regression over neo channels built on a principal component analysis over red, green and blue bands and previously cited depth data. The study site is a 12 km long reach of the by-passed section of the Rhine River that draws French and German border. This section has been heavily impacted by engineering works during the last two centuries: channelization since 1842 for navigation purposes and the construction of a 45 km long lateral canal and 4 consecutive hydroelectric power plants of since 1932. Several bathymetric models are produced based on 3 different spatial resolutions (6, 13 and 20 cm) and 5 acquisitions (January, March, April, August and October) since 2008. Objectives are to find the optimal spatial resolution and to characterize seasonal effects. Best performances according to the 13 cm resolution show a 18 cm accuracy when suspended matters impacted less water transparency. Discussions are oriented to the monitoring of the artificial reload after 2 flood events during winter 2010-2011. Bathymetric models produced are also useful to build 2D hydraulic model's mesh.

  19. Determinants of Aggressive Tax Avoidance

    OpenAIRE

    Herbert, Tanja

    2015-01-01

    This thesis consists of three essays examining determinants of aggressive tax avoidance. The first essay “Measuring the Aggressive Part of International Tax Avoidance”, co-authored with Prof. Dr. Michael Overesch, proposes a new measure that isolates the additional or even aggressive part in international tax avoidance and analyzes the determinants of aggressive tax avoidance of multinational enterprises. The second essay “Capital Injections and Aggressive Tax Planning - Can Banks Have It All...

  20. Predictors of avoiding medical care and reasons for avoidance behavior.

    Science.gov (United States)

    Kannan, Viji Diane; Veazie, Peter J

    2014-04-01

    Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.

  1. 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.

  2. 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.

  3. Strategy analysis of cardiopulmonary resuscitation training in the community

    OpenAIRE

    Wang, Jin; Ma, Li; Lu, Yuan-Qiang

    2015-01-01

    Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest. This appreciation produced immense efforts by professional organizations to train laypeople for CPR skills. However, the rate of CPR training is low and varies widely across communities. Several strategies are used in order to improve the rate of CPR training and are performed in some advanced countries. The Chinese CPR training in communities could gain enlightenment from them.

  4. 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...

  5. Comparison of cardiopulmonary resuscitation techniques using video camera recordings.

    OpenAIRE

    Mann, C J; Heyworth, J

    1996-01-01

    OBJECTIVE--To use video recordings to compare the performance of resuscitation teams in relation to their previous training in cardiac resuscitation. METHODS--Over a 10 month period all cardiopulmonary resuscitations carried out in an accident and emergency (A&E) resuscitation room were videotaped. The following variables were monitored: (1) time to perform three defibrillatory shocks; (2) time to give intravenous adrenaline (centrally or peripherally); (3) the numbers and grade of medical an...

  6. Disseminated intravascular and intracardiac thrombosis after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Deepak K Tempe

    2017-01-01

    Full Text Available Massive intracardiac and intravascular thrombosis is a rare complication following cardiopulmonary bypass (CPB. Most of the cases of the disseminated thrombosis have been reported in patients undergoing complex cardiac surgeries and those receiving antifibrinolytic agents during CPB. We report the occurrence of disseminated intravascular and intracardiac thrombosis after CPB in a patient undergoing mitral valve replacement in which no antifibrinolytic agent was used. The possible pathophysiology and management of the patient is discussed.

  7. 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.

  8. 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.

  9. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    International Nuclear Information System (INIS)

    O'Neill, John M.; McBride, Kieran D.

    2001-01-01

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000

  10. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, John M.; McBride, Kieran D

    2001-04-01

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

  11. Cardiopulmonary metastrongyloidosis of dogs and cats contribution to diagnose

    Directory of Open Access Journals (Sweden)

    Ilić Tamara

    2017-01-01

    Full Text Available Background. In the last fifteen years on the European continent and also worldwide, the prevalence of cardiopulmonary metastrongyloidosis in dogs and cats has increased significantly, especially cases involving those parasites which are the most important for veterinary practice (Angiostrongylus vasorum, Aelurostrongylus abstrusus and Crenosoma vulpis. Scope and Approach. The aim of this study is to present a detailed clinical-parasitological approach to highlight the importance of these helminths, and to display the newest findings concerning the diagnostic possibilities in dogs and cats Key Findings and Conclusions. The effects of global warming, vector range shift, the frequent transportation and movement of animals to other epizootic areas, as well as the intensification of merchandise transportation and movement of people are just some of the potential factors which could impact the dynamics of incidence, upkeep and spread of cardiopulmonary nematodoses in carnivores. For the timely implementation of effective treatment of sick animals, it essential to accurately diagnose these parasitoses. Accurate, timely diagnosis can, in the end, significantly contribute to the prognostic course of disease in infected carnivores. Cardiopulmonary metastrongyloidoses in dogs and cats have great clinical-parasitological significance because of their high degree of pathogenicity, their spread outside endemic areas, the difficulties encountered in establishing their diagnosis, and the fact that they represent a potential danger to human health. [Project of the Serbian ministry of education, science and technological development

  12. 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…

  13. Cigarette tax avoidance and evasion.

    Science.gov (United States)

    Stehr, Mark

    2005-03-01

    Variation in state cigarette taxes provides incentives for tax avoidance through smuggling, legal border crossing to low tax jurisdictions, or Internet purchasing. When taxes rise, tax paid sales of cigarettes will decline both because consumption will decrease and because tax avoidance will increase. The key innovation of this paper is to compare cigarette sales data to cigarette consumption data from the Behavioral Risk Factor Surveillance System (BRFSS). I show that after subtracting percent changes in consumption, residual percent changes in sales are associated with state cigarette tax changes implying the existence of tax avoidance. I estimate that the tax avoidance response to tax changes is at least twice the consumption response and that tax avoidance accounted for up to 9.6% of sales between 1985 and 2001. Because of the increase in tax avoidance, tax paid sales data understate the level of smoking and overstate the drop in smoking. I also find that the level of legal border crossing was very low relative to other forms of tax avoidance. If states have strong preferences for smoking control, they must pair high cigarette taxes with effective policies to curb smuggling and other forms of tax avoidance or employ alternative policies such as counter-advertising and smoking restrictions.

  14. European cardiovascular nurses' and allied professionals' knowledge and practical skills regarding cardiopulmonary resuscitation.

    Science.gov (United States)

    Pettersen, Trond R; Mårtensson, Jan; Axelsson, Åsa; Jørgensen, Marianne; Strömberg, Anna; Thompson, David R; Norekvål, Tone M

    2018-04-01

    Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training. Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

  15. 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.

  16. The Effects of Normothermic and Hypothermic Cardiopulmonary Bypass Upon Defibrillation Energy Requirements and Transmyocardial Impedance

    National Research Council Canada - National Science Library

    Martin, David

    1993-01-01

    .... To evaluate these questions we studied the effect of controlled hypothermia upon defibrillation energy requirements and transcardiac impedance in a canine model of cardiopulmonary bypass in which 26...

  17. Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

    Science.gov (United States)

    López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

    2018-03-01

    To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

  18. 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

  19. A survey on training in pediatric cardiopulmonary resuscitation in Latin America, Spain, and Portugal.

    Science.gov (United States)

    López-Herce, Jesús; Carrillo, Angel

    2011-09-01

    To determine how training in pediatric cardiopulmonary resuscitation is provided in the Iberoamerican countries. Survey. Latin America, Spain, and Portugal. Experts in pediatric cardiopulmonary resuscitation education. A questionnaire was sent to experts in pediatric cardiopulmonary resuscitation training in 21 countries in Latin America, Spain, and Portugal; we received 15 replies. Pediatric cardiopulmonary resuscitation training is not included in medical undergraduate or nursing training in any of these countries and pediatric residents receive systematic cardiopulmonary resuscitation training in only four countries. Basic pediatric life support courses, pediatric advanced life support courses, and pediatric cardiopulmonary resuscitation instructors courses are given in 13 of 15, 14 of 15, and 11 of 15 respondent countries, respectively. Course duration and the number of hours of practical training were variable: basic life support, 5 hrs (range, 4-8 hrs); practical training, 4 hrs (range, 2-5 hrs); advanced life support, 18 hrs (range, 10-30 hrs); and practical training, 14 hrs (range, 5-18 hrs). Only nine countries (60%) had a national group that organized pediatric cardiopulmonary resuscitation training. Thirteen countries (86.6%) had fewer than five centers offering pediatric cardiopulmonary resuscitation training. Respondents considered the main obstacles to the expansion of training in pediatric cardiopulmonary resuscitation to be the shortage of instructors (28.5%), students' lack of financial resources (21.4%), and deficiencies in educational organization (21.4%). Pediatric cardiopulmonary resuscitation training is not uniform across the majority of Iberoamerican countries, with poor organization and little institutional involvement. National groups should be created in each country to plan and coordinate pediatric cardiopulmonary resuscitation training and to coordinate with other Iberoamerican countries.

  20. 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.

  1. Who participates in tax avoidance?

    OpenAIRE

    Alstadsæter, Annette; Jacob, Martin

    2013-01-01

    This paper analyzes the sources of heterogeneity in legal tax avoidance strategies across individuals. Three conditions are required for a taxpayer to participate in tax avoidance: incentive, access, and awareness. Using rich Swedish administrative panel data with a unique link between corporate and individual tax returns, we analyze individual participation in legal tax planning around the 2006 Swedish tax reform. Our results suggest that closely held corporations are utilized to facilitate ...

  2. 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.

  3. 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

    2013-01-01

    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 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. PMID:25371337

  4. The opinion of health professionals regarding the presence of relatives during cardiopulmonary resucitation.

    Science.gov (United States)

    Asencio-Gutiérrez, J M; Reguera-Burgos, I

    The latest recommendations from the American Heart Association and the European Resuscitation Council invite allowance for the presence of relatives (PR) during cardiopulmonary resuscitation (CPR) as an extra measure of family care. To discover the opinion of health professionals on the PR during CPR. Cross-sectional observational study through an online survey in Spain, based on a non-probability sample (n=315). 45% consider that the PR during CPR is not demanded by users. 64% value the implementation of this practice in a negative or a very negative way. 45% believe that the practice would avoid the feeling of abandonment that is instilled in the relatives, this being the most widely perceived potential benefit. 30% do not believe that it can help reduce the anxiety of relatives. The majority remarked that PR would cause situations of violence, psychological harm in witnesses, and more mistakes during care. 48% feel prepared to perform the role of companion. Most professionals perceive more risks than benefits, and are not in favour of allowing PR due to a paternalistic attitude, and fear of the reactions that could be presented to the team. Extra-hospital emergency personnel seems to be the group most open to allowing this practice. Most professionals do not feel fully prepared to perform the role of companion. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Meyborg, Matthias; Abdi-Tabari, Zila; Hoffmeier, Andreas; Engelbertz, Christiane; Lüders, Florian; Freisinger, Eva; Malyar, Nasser M; Martens, Sven; Reinecke, Holger

    2016-05-01

    In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Does Cardiopulmonary Resuscitation Cause Rib Fractures in Children? A Systematic Review

    Science.gov (United States)

    Maguire, Sabine; Mann, Mala; John, Nia; Ellaway, Bev; Sibert, Jo R.; Kemp, Alison M.

    2006-01-01

    Background: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in…

  7. 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...

  8. Ketamine has no effect on oxygenation indices following elective coronary artery bypass grafting under cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Parthasarathi Gayatri

    2011-01-01

    Full Text Available Cardiopulmonary bypass is known to elicit systemic inflammatory response syndrome and organ dysfunction. This can result in pulmonary dysfunction and deterioration of oxygenation after cardiac surgery and cardiopulmonary bypass. Previous studies have reported varying results on anti-inflammatory strategies and oxygenation after cardiopulmonary bypass. Ketamine administered as a single dose at induction has been shown to reduce the pro-inflammatory serum markers in patients undergoing cardiopulmonary bypass. Therefore we investigated if ketamine can result in better oxygenation in these patients. This was a prospective randomized blinded study. Eighty consecutive adult patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass were included in the study. Patients were divided into two groups. Patients in ketamine group received 1mg/kg of ketamine intravenously at induction of anesthesia. Control group patients received an equal volume of saline. All patients received standard anesthesia, operative and postoperative care.Paired t test and independent sample t test were used to compare the inter-group and between group oxygenation indices respectively. Oxygenation index and duration of ventilation were analyzed. Deterioration of oxygenation index was noted in both the groups after cardiopulmonary bypass. However, there was no significant difference in the oxygenation index at various time points after cardiopulmonary bypass or the duration of ventilation between the two groups. This study shows that the administered as a single dose at induction does not result in better oxygenation after cardiopulmonary bypass.

  9. 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 ...

  10. Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea

    Directory of Open Access Journals (Sweden)

    Stokes NR

    2016-05-01

    Full Text Available Natalie R Stokes,1 Brett W Dietz,1 Jackson J Liang2 1Perelman School of Medicine, University of Pennsylvania, 2Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USAAbstract: Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP and N-terminal prohormone (NT-proBNP, mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.Keywords: cardiopulmonary, emergency, heart failure, troponin, BNP, galectin 3, MR-proANP, MR-proADM

  11. 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.

  12. 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.

  13. [2018 National consensus on cardiopulmonary resuscitation training in China].

    Science.gov (United States)

    Wang, Lixiang; Meng, Qingyi; Yu, Tao

    2018-05-01

    To promote the technical training and scientific popularization of cardiopulmonary resuscitation (CPR) in China, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association combined with the Science Popularization Branch of the Chinese Medical Association wrote "2018 National consensus on cardiopulmonary resuscitation training in China". The formation was based on the general outline about "2016 National consensus on cardiopulmonary resuscitation in China", and to implement the important strategies included the "three pre" policy, prevention, precognition, and pre-warning, before the cardiac arrest (CA); the "three modernization" methods, standardized, diversified and individualized, during the CA; and the "three life" strategies, the rebirth, the extra and the extended, after the CA; and also combined with the concrete National conditions and clinical practice of China area. The document summarized the evidence of published science about CPR training till now, and recommend the establishment of "the CPR Training Triangle" according to the Chinese National conditions. The bases of the triangle were system, training and person, the core of which was CPR science. The main contents were: (1) The "three training" policy for CPR training: the cultivation of a sound system, which included professional credibility, extensive mobilization and continuous driving force, and the participation of the whole people and continuous improvement; the cultivation of scientific guidelines, which included scientific content, methods and thinking; and the cultivation of a healthy culture, which included the enhancement of civic quality, education of rescue scientifically, and advocate of healthy life. (2) The "three training" program of CPR training: training professional skills, which included standard, multiple, and individual skills; training multidimensional, which included time, space, and human; and training flexible, including problem, time

  14. Education Strategies Through Simulation For Training In Cardiopulmonary Resuscitation Treatment

    Directory of Open Access Journals (Sweden)

    Regimar Carla Machado

    2017-01-01

    Full Text Available Theoretical and reflective study based on scientific literature and critical analysis of authors related to teaching strategies through simulation for training in cardiopulmonary resuscitation (CPR. Current teaching methodologies CPR involve realistic simulation strategies and simulations in virtual environments, but the first method provides the best results, allowing proactivity of individuals in their teaching-learning process and bringing them the experience of a life threatening situation. It is noteworthy that health professionals need to be able to assist a victim in cardiac arrest, but even  existing effective teaching methodologies to enable them in this subject, is not fully applicable in the Brazilian context of health education.

  15. Digital subtraction cardiopulmonary angiography using FCR (Fuji computed radiography)

    International Nuclear Information System (INIS)

    Tanimura, Shigeo; Tomoyasu, Hiroshi; Banba, Jiro; Masaki, Mikio; Kanno, Yukio; Abe, Kazuo

    1987-01-01

    Digital subtraction cardiopulmonary angiography using FCR was performed on 46 patients including lung cancer, mediastinal tumor, giant bullous formation and others. The images of digital subtraction for pulmonary artery, pulmonary vein and thoracic aorta were studied by comparing to the conventional pulmonary angiogram. Good images of pulmonary artery due to digital subtraction were obtained in 80 % of the 45 cases. This method needed only half volume of contrast media compared to the conventional for obtaining good images and thus reduced side effect. Therefore this method seems to be an usefull pre-operative examination in various chest diseases, especially in case of lung cancer. (author)

  16. 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

  17. 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.

  18. Cardiopulmonary function and oxygen delivery during total liquid ventilation.

    Science.gov (United States)

    Tsagogiorgas, Charalambos; Alb, Markus; Herrmann, Peter; Quintel, Michael; Meinhardt, Juergen P

    2011-10-01

    Total liquid ventilation (TLV) with perfluorocarbons has shown to improve cardiopulmonary function in the injured and immature lung; however there remains controversy over the normal lung. Hemodynamic effects of TLV in the normal lung currently remain undetermined. This study compared changes in cardiopulmonary and circulatory function caused by either liquid or gas tidal volume ventilation. In a prospective, controlled study, 12 non-injured anesthetized, adult New Zealand rabbits were primarily conventionally gas-ventilated (CGV). After instrumentation for continuous recording of arterial (AP), central venous (CVP), left artrial (LAP), pulmonary arterial pressures (PAP), and cardiac output (CO) animals were randomized into (1) CGV group and (2) TLV group. In the TLV group partial liquid ventilation was initiated with instillation of perfluoroctylbromide (12 ml/kg). After 15 min, TLV was established for 3 hr applying a volume-controlled, pressure-limited, time-cycled ventilation mode using a double-piston configured TLV. Controls (CGV) remained gas-ventilated throughout the experiment. During TLV, heart rate, CO, PAP, MAP, CVP, and LAP as well as derived hemodynamic variables, arterial and mixed venous blood gases, oxygen delivery, PVR, and SVR did not differ significantly compared to CGV. Liquid tidal volumes suitable for long-term TLV in non-injured rabbits do not significantly impair CO, blood pressure, and oxygen dynamics when compared to CGV. Copyright © 2011 Wiley-Liss, Inc.

  19. 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

  20. 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.

  1. Knowledge of Guidelines for Cardiopulmonary Resuscitation among Brazilian Medical Students

    Directory of Open Access Journals (Sweden)

    Felipe Scipião Moura

    Full Text Available ABSTRACT Introduction Sudden death is a substantial public health problem, representing a major cause of mortality worldwide. Suitable initial care is essential for a good prognosis of these patients. Objectives To assess the knowledge of the 2010 guidelines for cardiopulmonary resuscitation (CPR among medical students in their final year of undergraduate training. Methods This was a cross-sectional study with a sample of 217 medical students enrolled in the sixth year of accredited medical schools in Brazil. A structured questionnaire with 27 items was used to record the sociodemographic characteristics of the participants and to assess their knowledge base of the 2010 ILCOR guidelines for CPR. Results Only fifty (23.04% out of 217 students achieved results considered as satisfactory in the written evaluation. The average score obtained was 56.74% correct answers. Seventeen percent of the students had never performed CPR maneuvers and 83.80% had never performed cardioversion or defibrillation. Conclusions The knowledge base of medical students regarding cardiopulmonary resuscitation is low. Considering these medical students are in their final year of medical school, this study reveals a worrisome scenario.

  2. Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea.

    Science.gov (United States)

    Stokes, Natalie R; Dietz, Brett W; Liang, Jackson J

    2016-01-01

    Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP) and N-terminal prohormone (NT-proBNP), mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.

  3. 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

  4. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Popov Aron-Frederik

    2010-11-01

    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  5. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Science.gov (United States)

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

    2016-03-01

    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  6. Home-based mobile cardio-pulmonary rehabilitation consultant system.

    Science.gov (United States)

    Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

    2011-01-01

    Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

  7. 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.

  8. 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.

  9. Avoiding Complications with MPFL Reconstruction.

    Science.gov (United States)

    Smith, Marvin K; Werner, Brian C; Diduch, David R

    2018-05-12

    To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.

  10. Avoidant personality disorder: current insights

    OpenAIRE

    Lampe,Lisa; Malhi,Gin

    2018-01-01

    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 t...

  11. Pathogen avoidance by insect predators

    OpenAIRE

    Meyling, Nicolai V.; Ormond, Emma; Roy, Helen E.; Pell, Judith K.

    2008-01-01

    Insects can detect cues related to the risk of attack by their natural enemies. Pathogens are among the natural enemies of insects and entomopathogenic fungi attack a wide array of host species. Evidence documents that social insects in particular have adapted behavioural mechanisms to avoid infection by fungal pathogens. These mechanisms are referred to as 'behavioural resistance'. However, there is little evidence for similar adaptations in non-social insects. We have conducted experime...

  12. 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

  13. 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)

  14. 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.

  15. 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.

  16. Cardiopulmonary resuscitation knowledge and skills of registered nurses in Botswana.

    Science.gov (United States)

    Rajeswaran, Lakshmi; Ehlers, Valerie J

    2014-01-01

    In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations. The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills. A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple-choice questionnaire and checklist were used to collect data. All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted. The significantly low levels of registered nurses’ CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses

  17. 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

    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...... 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...... of CPR skills may be beneficial to ensure high-quality learning outcome.Author Disclosures: C. Hansen: None. S.E. Rasmussen: None. M.A. Nebsbjerg: None. M. Stærk: None. B. Løfgren: None....

  18. [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.

  19. 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.

  20. [Problem-based learning in cardiopulmonary resuscitation: basic life support].

    Science.gov (United States)

    Sardo, Pedro Miguel Garcez; Dal Sasso, Grace Terezinha Marcon

    2008-12-01

    Descriptive and exploratory study, aimed to develop an educational practice of Problem-Based Learning in CPR/BLS with 24 students in the third stage of the Nursing Undergraduate Course in a University in the Southern region of Brazil. The study used the PBL methodology, focused on problem situations of cardiopulmonary arrest, and was approved by the CONEP. The methodological strategies for data collection, such as participative observation and questionnaires to evaluate the learning, the educational practices and their methodology, allowed for grouping the results in: students' expectations; group activities; individual activities; practical activities; evaluation of the meetings and their methodology. The study showed that PBL allows the educator to evaluate the academic learning process in several dimensions, functioning as a motivating factor for both the educator and the student, because it allows the theoretical-practical integration in an integrated learning process.

  1. 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.

  2. 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

    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...... 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...... 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...

  3. Oral Triiodothyronine for Infants and Children Undergoing Cardiopulmonary Bypass.

    Science.gov (United States)

    Marwali, Eva M; Boom, Cindy E; Budiwardhana, Novik; Fakhri, Dicky; Roebiono, Poppy S; Santoso, Anwar; Sastroasmoro, Sudigdo; Slee, April; Portman, Michael A

    2017-08-01

    This study evaluated the efficacy and safety of oral triiodothyronine (T3; Tetronine, Dalim BioTech, Korea) for infants and children undergoing cardiopulmonary bypass in an Indonesian population. We performed a single-center, randomized, double-blind, and placebo-controlled trial in children aged 3 years and younger undergoing congenital heart disease operations with cardiopulmonary bypass. We administered oral T3 (1 μg/kg per body weight/dose) or placebo (saccharum lactis) by nasogastric tube every 6 hours for 60 hours after induction of anesthesia. The primary end point, time to extubation, was compared with Cox regression. The modified intention-to-treat group included 101 placebo and 104 treated patients. The stratified log-rank test did not show a significant treatment difference (p = 0.061) for time to extubation, but after adjustment for age, the nutritional Z score, and Aristotle surgical complexity, the hazard ratio was 1.33 (95% confidence interval, 1.00 to 1.76; p = 0.049). The effect of T3 was stronger in the strata aged 5 months and younger (hazard ratio, 1.86; 95% confidence interval 1.02 to 3.39; p = 0.043). Median intubation time was 47.3 hours for the placebo and 32.1 hours for the T3 group in aged 5 months and younger. Adverse events rates, including arrhythmia, were similar between groups, although sepsis was more frequent with placebo. Oral T3 supplementation may shorten time to extubation in children undergoing congenital heart disease operations, particularly infants aged 5 months or younger. Administration is relatively safe, simple and inexpensive. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. Revolving back to the basics in cardiopulmonary resuscitation.

    Science.gov (United States)

    Roppolo, L P; Wigginton, J G; Pepe, P E

    2009-05-01

    Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a ''revolution'' in resuscitation medicine in terms of ''coming full circle'' to the 1960s when basic CPR was first developed. Recent data have indicated the need for minimally-interrupted chest compressions with an accompanying emphasis toward removing rescue ventilation altogether in sudden cardiac arrest, at least in the few minutes after a sudden unheralded collapse. In other studies, transient delays in defibrillation attempts and ALS interventions are even recommended so that basic CPR can be prioritized to first restore and maintain better coronary artery perfusion. New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.

  6. Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system

    NARCIS (Netherlands)

    Huybregts, Rien A. J. M.; Morariu, Aurora M.; Rakhorst, Gerhard; Spiegelenberg, Stefan R.; Romijn, Hans W. A.; de Vroege, Roel; van Oeveren, Willem

    Background. Transient, subclinical myocardial, renal, intestinal, and hepatic tissue injury and impaired homeostasis is detectable even in low-risk patients undergoing conventional cardiopulmonary bypass (CPB). Small extracorporeal closed circuits with low priming volumes and optimized perfusion

  7. Potential of photoplethysmography to guide pulse checks during cardiopulmonary resuscitation : observations in an animal study

    NARCIS (Netherlands)

    Wijshoff, R.W.C.G.R.; Sar, van der T.; Aarts, R.M.; Woerlee, P.H.; Noordergraaf, G.J.

    2013-01-01

    Introduction: Detecting return of spontaneous circulation (ROSC) via palpation during cardiopulmonary resuscitation (CPR) is challenging and often time-consuming, which can negatively impact outcome. Non-invasive ROSC detection could reduce compression pauses and thereby improve outcome. We

  8. Knowledge and preferences regarding cardiopulmonary resuscitation : A survey among older patients

    NARCIS (Netherlands)

    Zijlstra, Trudy J.; Leenman-Dekker, Sonja J.; Oldenhuis, Hilbrand K. E.; Bosveld, Henk E. P.; Berendsen, Annette J.

    Objective: Survival rates following cardiopulmonary resuscitation (CPR) are low for older people, and are associated with a high risk of neurological damage. This study investigated the relationship between the preferences, knowledge of survival chances, and characteristics among older people

  9. An Up-To-Date View of Cardiopulmonary Resusciation Instruction in Colleges and Universities

    Science.gov (United States)

    Winkelman, Jack L.

    1977-01-01

    Cardiopulmonary resuscitation instruction can and should be included as part of first aid and emergency care courses in colleges and universities. Close working relationships with voluntary health organizations that sponsor such courses should be established. (MJB)

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

    Science.gov (United States)

    Al-Naji, Ali; Chahl, Javaan

    2018-03-20

    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.

  11. 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

  12. 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.

  13. Is the use of albumin in colloid prime solution of cardiopulmonary bypass circuit justified?

    NARCIS (Netherlands)

    Boks, RH; van Herwerden, LA; Takkenberg, JJM; van Oeveren, W; Gu, YJ; Wijers, MJ; Bogers, AJJC

    Background. Albumin in the priming solution precoats the surface of the cardiopulmonary bypass circuit, supposedly causing delayed adsorption of fibrinogen and reduced activation and adhesion of platelets. This action may result in lower transoxygenator resistance. Because our institution uses a

  14. 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.

  15. 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.

  16. Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass : the role of hemodilution

    NARCIS (Netherlands)

    Koning, Nick J.; de lange, Fellery; Vonk, Alexander B. A.; Ahmed, Yunus; van den Brom, Charissa E.; Bogaards, Sylvia; van Meurs, Matijs; Jongman, Rianne M.; Schalkwijk, Casper G.; Begieneman, Mark P. V.; Niessen, Hans W.; Baufreton, Christophe; Boer, Christa

    2016-01-01

    Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue

  17. 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.

  18. Mechanism of avoiding little rip

    OpenAIRE

    ZHAI Xianghua; XI Ping

    2014-01-01

    The scalar phantom field Φ leads to various catastrophic fates of the universe including big rip,little rip and other future singularity depending on the choice of its potential.For example,little rip stems from a quadratic potential in general relativity.We suggest a new mechanism to avoid little rip in the 1/R gravity.The phantom field with different potentials,including quadratic,cubic and quantic potentials are studied via numerical calculation in the 1/R gravity with R2 correction.T...

  19. Basic and advanced paediatric cardiopulmonary resuscitation - guidelines of the Australian and New Zealand Resuscitation Councils 2010.

    Science.gov (United States)

    Tibballs, James; Aickin, Richard; Nuthall, Gabrielle

    2012-07-01

    Guidelines for basic and advanced paediatric cardiopulmonary resuscitation (CPR) have been revised by Australian and New Zealand Resuscitation Councils. Changes encourage CPR out-of-hospital and aim to improve the quality of CPR in-hospital. Features of basic CPR include: omission of abdominal thrusts for foreign body airway obstruction; commencement with chest compression followed by ventilation in a ratio of 30:2 or compression-only CPR if the rescuer is unwilling/unable to give expired-air breathing when the victim is 'unresponsive and not breathing normally'. Use of automated external defibrillators is encouraged. Features of advanced CPR include: prevention of cardiac arrest by rapid response systems; restriction of pulse palpation to 10 s to diagnosis cardiac arrest; affirmation of 15:2 compression-ventilation ratio for children and for infants other than newly born; initial bag-mask ventilation before tracheal intubation; a single direct current shock of 4 J/kg for ventricular fibrillation (VF) and pulseless ventricular tachycardia followed by immediate resumption of CPR for 2 min without analysis of cardiac rhythm and avoidance of unnecessary interruption of continuous external cardiac compressions. Monitoring of exhaled carbon dioxide is recommended to detect non-tracheal intubation, assess quality of CPR, and to help match ventilation to reduced cardiac output. The intraosseous route is recommended if immediate intravenous access is impossible. Amiodarone is strongly favoured over lignocaine for refractory VF and adrenaline over atropine for severe bradycardia, asystole and pulseless electrical activity. Family presence at resuscitation is encouraged. Therapeutic hypothermia is acceptable after resuscitation to improve neurological outcome. Extracorporeal circulatory support for in-hospital cardiac arrest may be used in equipped centres. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal

  20. S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB).

    Science.gov (United States)

    Varrica, Alessandro; Satriano, Angela; Gavilanes, Antonio D W; Zimmermann, Luc J; Vles, Hans J S; Pluchinotta, Francesca; Anastasia, Luigi; Giamberti, Alessandro; Baryshnikova, Ekaterina; Gazzolo, Diego

    2017-11-28

    S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO 2 ). We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B assessment were collected at six monitoring time-points: before the surgical procedure (T0), after sternotomy but before CPB (T1), at the end of the cross-clamp CPB phase (T2), at the end of CPB (T3), at the end of the surgical procedure (T4), at 24 h postsurgery (T5). In the CHDc group, S100B multiples of median (MoM) were significantly higher (p  .05, for all) were found at T2, T3, T5. Linear regression analysis showed a positive correlation between S100B MoM at T3 and PaO 2 (R = 0.84; p < .001). The present data showing higher hypoxia/hyperoxia-mediated S100B concentrations in CHDc infants suggest that CHDc are more prone to perioperative brain stress/damage and suggest the usefulness of further investigations to detect the "optimal" PaO 2 target in order to avoid the side effects associated with reoxygenation during CPB.

  1. A nutritional and metabolic assessment of a cardiopulmonary bypass technique without donor blood

    OpenAIRE

    東,良平

    1993-01-01

    A nutritional and metabolic assessment of a cardiopulmonary bypass technique without donor blood was made in 23 patients undergoing open heart surgery (non-donor blood group). For comparison, 14 patients receiving cardiopulmonary bypass with donor blood prime (donor blood group) were also evaluated. 1)Serum transferrin level showed significantly more rapid recovery in the non-donor blood group compared to the donor blood group on the 7th post operative day. 2)Total protein, serum albumin, arm...

  2. Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care.

    Science.gov (United States)

    Lasa, Javier J; Jain, Parag; Raymond, Tia T; Minard, Charles G; Topjian, Alexis; Nadkarni, Vinay; Gaies, Michael; Bembea, Melania; Checchia, Paul A; Shekerdemian, Lara S; Thiagarajan, Ravi

    2018-02-01

    Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorporeal cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. None. Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extracorporeal membrane oxygenation cannulation "most of the time" by 58% of respondents and 94% report using afterload reducing/antihypertensive agents "some" to "most of the time" after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common

  3. New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

    OpenAIRE

    Pranskūnas, Andrius; Dobožinskas, Paulius; Pilvinis, Vidas; Pranskūnienė, Živilė; Jasinskas, Nedas; Stašaitis, Kęstutis; Vaitkaitienė, Eglė; Vaitkaitis, Dinas

    2010-01-01

    Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life supp...

  4. Cardiopulmonary response during whole-body vibration training in patients with severe COPD

    OpenAIRE

    Rainer Gloeckl; Petra Richter; Sandra Winterkamp; Michael Pfeifer; Christoph Nell; Jeffrey W. Christle; Klaus Kenn

    2017-01-01

    Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1?s: 38?8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle...

  5. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas

    2016-01-01

    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... perfusion with normothermic oxygenated blood during cardiopulmonary bypass appears to improve postoperative oxygenation in patients with COPD undergoing cardiac surgery. Pulmonary artery perfusion with hypothermic HTK solution does not seem to improve postoperative oxygenation. TRIAL REGISTRATION NUMBER...

  6. Reversibility of cardiopulmonary impairment after laparoscopic repair of large hiatal hernia

    Directory of Open Access Journals (Sweden)

    Emanuele Asti

    2015-01-01

    Full Text Available Giant hiatus hernia with or without intrathoracic gastric volvulus often presents with symptoms suggestive of both cardiac and pulmonary compression. Cardiopulmonary impairment may be reversible in these patients by laparoscopic crural repair and fundoplication as shown in this case report. Cardiac magnetic resonance and the cardiopulmonary exercise test may help selecting patients for surgery. These preliminary findings led us to start a prospective study using this multimodality diagnostic approach.

  7. 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.

  8. 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

  9. 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.

  10. Correlation of femoral artery vs radial artery pressures with central pressure after cardiopulmonary bypass in children

    International Nuclear Information System (INIS)

    Yaseen, R.; Memon, H.

    2008-01-01

    To assess the effectiveness of femoral and radial arterial lines on the correlation of peripheral and central mean arterial blood pressure in children after discontinuation of cardiopulmonary bypass. Fifty children scheduled for cardiac surgery with cardiopulmonary bypass were included in the study. After approval from the hospital ethics committee and informed consent. 50 children undergoing cardiac surgical procedures with cardiopulmonary bypass were randomly assigned to two different groups. In Group- A (RAP, n-2) a radial arterial line and in Group-B (FAP, n-25) a femoral arterial line was used to monitor the blood pressure. Simultaneous mean peripheral arterial pressure and mean central aortic pressure were recorded before cardiopulmonary bypass and 5 mins after separation from the cardiopulmonary bypass. The correlation of mean peripheral arterial pressure (radial and femoral) versus mean aortic pressure were compared. The data was recorded as Mean +- SD and P-value. The ages of children ranged from 4-12 years and their weight from 14.1-28.5 kg. In all of them following cardiopulmonary bypass, aortic pressure correlates better with femoral arterial pressure (p<0.001). The radial arterial line readings under estimated central aortic pressure when compared to femoral arterial line readings. Aortic pressure readings correlate better with femoral arterial pressure than radial arterial pressure in children. (author)

  11. Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease.

    Science.gov (United States)

    Wallen, M P; Hall, A; Dias, K A; Ramos, J S; Keating, S E; Woodward, A J; Skinner, T L; Macdonald, G A; Arena, R; Coombes, J S

    2017-10-01

    Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta-blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing. To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease. This was a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. All participants remained on their usual beta-blocker dose and timing prior to the test. Variables measured during cardiopulmonary exercise testing included the ventilatory threshold, peak oxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and the ventilatory equivalents for carbon dioxide slope. Participants taking beta-blockers (n = 28) had a lower ventilatory threshold (P advanced liver disease taking beta-blockers compared to those not taking the medication. This may incorrectly risk stratify patients on beta-blockers and has implications for patient management before and after liver transplantation. The oxygen uptake efficiency slope was not influenced by beta-blockers and may therefore be a better measure of cardiopulmonary performance in this patient population. © 2017 John Wiley & Sons Ltd.

  12. 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.

  13. Measurement properties of maximal cardiopulmonary exercise tests protocols in persons after stroke: A systematic review.

    Science.gov (United States)

    Wittink, Harriet; Verschuren, Olaf; Terwee, Caroline; de Groot, Janke; Kwakkel, Gert; van de Port, Ingrid

    2017-11-21

    To systematically review and critically appraise the literature on measurement properties of cardiopulmonary exercise test protocols for measuring aerobic capacity, VO2max, in persons after stroke. PubMed, Embase and Cinahl were searched from inception up to 15 June 2016. A total of 9 studies were identified reporting on 9 different cardiopulmonary exercise test protocols. VO2max measured with cardiopulmonary exercise test and open spirometry was the construct of interest. The target population was adult persons after stroke. We included all studies that evaluated reliability, measurement error, criterion validity, content validity, hypothesis testing and/or responsiveness of cardiopulmonary exercise test protocols. Two researchers independently screened the literature, assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and extracted data on measurement properties of cardiopulmonary exercise test protocols. Most studies reported on only one measurement property. Best-evidence synthesis was derived taking into account the methodological quality of the studies, the results and the consistency of the results. No judgement could be made on which protocol is "best" for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.

  14. 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.

  15. Collision avoidance in robotic environments

    International Nuclear Information System (INIS)

    Kreifeldt, J.G.

    1984-01-01

    A generalized approach to the problem of collision avoidance in robotic environments is presented. This approach transforms the three dimensional but dynamic real-world changing geometric space of the robot in its environment into a multidimensional but static space such that any possible geometric arrangement of the robotic space becomes a point in hyperspace. Major advantages of this approach include clarification of and potential solution to the basic problem of finding optimized, collision free movements from an initial to a final configuration. A major disadvantage of the approach is related to computational and data storage problems. However these latter are technically solvable while the clarification of the control and guidance problem gained through the transformational approach and its general elucidation power remain prime conceptual tools for the problem of robot design and operation

  16. 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

  17. Improvement in recuperative gas cycles by means of a heat generator partly by-passing the recuperator. Application to open and closed cycles and to various kinds of energy

    International Nuclear Information System (INIS)

    Tilliette, Z.P.; Pierre, B.

    1979-01-01

    A particular arrangement applicable to open or closed recuperative gas cycles and consisting of a heat generator partly by-passing the low pressure side of the recuperator is proven to enhance advantages of gas cycles for energy production. The cogeneration of both power with a high efficiency owing to the recuperator and high temperature process heat becomes possible and economically attractive. Furthermore, additional possibilities appear for power generation by combined gas and steam or ammonia cycles. In any case the overall utilization coefficient of the primary energy is increased and the combined production of low or medium temperature heat can also be improved. The great operation flexibility of the system for combined energy generation is worth being emphasized: the by-pass arrangement involves no significant change in the operation conditions of the main turbocompressor as the heat output varies. Applications of this arrangement are made to: - open and closed gas cycle, power plants; - fossil, nuclear and solar energies. The overall heat conversion efficiency is tentatively estimated in order to appreciate the energy conversion capability of the investigated power plants

  18. Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

    Directory of Open Access Journals (Sweden)

    Dr. Nagla Hamdi Kamal Khalil El- Meanawi

    2015-08-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

  19. Avoidant/Restrictive Food Intake Disorder

    Science.gov (United States)

    ... Eating Disorder Bulimia Nervosa Pica Rumination Disorder Avoidant/restrictive food intake disorder is characterized by eating very little food and/or avoiding eating certain foods. People with this disorder eat ...

  20. Resuscitation after prolonged cardiac arrest: role of cardiopulmonary bypass and systemic hyperkalemia.

    Science.gov (United States)

    Liakopoulos, Oliver J; Allen, Bradley S; Buckberg, Gerald D; Hristov, Nikola; Tan, Zhongtuo; Villablanca, J Pablo; Trummer, Georg

    2010-06-01

    The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF). Thirty-one pigs (34 +/- 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging. Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB. Ventricular fibrillation persisted more than 10 minutes in 13 of 20 pigs, and animals were treated either with repeated defibrillation (6 of 13 pigs) or with a potassium bolus (7 of 13 pigs) to induce transient cardiac arrest. Overall survival at 24 hours was 84% with cardiopulmonary resuscitation (100% of pigs with hypotension; 71% in CPB-VF < 10 minutes). Despite CPB, fatal myocardial failure occurred after VF duration of more than 10 minutes in all pigs treated with electrical defibrillation, whereas hyperkalemia allowed 100% cardioversion and 86% survival. Biochemical variables remained elevated in all groups. Similarly, severe brain injury was present in all animals as confirmed by neurologic deficit score (197 +/- 10) and magnetic resonance imaging. Emergency CPB after prolonged cardiac arrest improves survival and allows systemic hyperkalemia to convert intractable VF, but fails to reduce neurologic damage. 2010 The Society of Thoracic

  1. Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

    Science.gov (United States)

    Hoyme, Derek B; Atkins, Dianne L

    2017-02-01

    To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was $1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Video quality of 3G videophones for telephone cardiopulmonary resuscitation.

    Science.gov (United States)

    Tränkler, Uwe; Hagen, Oddvar; Horsch, Alexander

    2008-01-01

    We simulated a cardiopulmonary resuscitation (CPR) scene with a manikin and used two 3G videophones on the caller's side to transmit video to a laptop PC. Five observers (two doctors with experience in emergency medicine and three paramedics) evaluated the video. They judged whether the manikin was breathing and whether they would give advice for CPR; they also graded the confidence of their decision-making. Breathing was only visible from certain orientations of the videophones, at distances below 150 cm with good illumination and a still background. Since the phones produced a degradation in colours and shadows, detection of breathing mainly depended on moving contours. Low camera positioning produced better results than having the camera high up. Darkness, shaking of the camera and a moving background made detection of breathing almost impossible. The video from the two 3G videophones that were tested was of sufficient quality for telephone CPR provided that camera orientation, distance, illumination and background were carefully chosen. Thus it seems possible to use 3G videophones for emergency calls involving CPR. However, further studies on the required video quality in different scenarios are necessary.

  3. Trainers’ Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training

    Directory of Open Access Journals (Sweden)

    M. Mäkinen

    2016-01-01

    Full Text Available Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers’ attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D, Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N=185 focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree. Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse’s Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation. Cronbach’s alphas were 0.92–0.51. Statistics were Student’s t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p<0.01. Participants scoring high on Hesitation scale (p<0.01 were less confident about their Nurse’s Role (p<0.01 and Nontechnical Skills (p<0.01. Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Extracorporeal Cardiopulmonary Resuscitation Among Patients with Structurally Normal Hearts.

    Science.gov (United States)

    Conrad, Stephanie J; Bridges, Brian C; Kalra, Yuvraj; Pietsch, John B; Smith, Andrew H

    Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria. Median age was 16 years. Overall survival to hospital discharge was 32%. Conditional logistic regression demonstrated an independent survival benefit among smaller patients, patients with a lower partial pressure of carbon dioxide (PaCO2) on cannulation, and those with a shorter duration from intubation to eCPR cannulation. A diagnosis of sepsis was independently associated with a nearly threefold increase in odds of mortality, whereas the diagnosis of myocarditis portended a more favorable outcome. Neurologic complications, pulmonary hemorrhage, disseminated intravascular coagulation, CPR, pH less than 7.20, and hyperbilirubinemia after eCPR cannulation were independently associated with an increase in odds of mortality. When utilizing eCPR in patients with structurally normal hearts, a diagnosis of sepsis is independently associated with mortality, whereas a diagnosis of myocarditis is protective. Neurologic complications and pulmonary hemorrhage while on extracorporeal membrane oxygenation (ECMO) are independently associated with mortality.

  10. High-quality cardiopulmonary resuscitation: current and future directions.

    Science.gov (United States)

    Abella, Benjamin S

    2016-06-01

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

  11. Regional Cerebral Oximetry During Cardiopulmonary Resuscitation: Useful or Useless?

    Science.gov (United States)

    Genbrugge, Cornelia; Dens, Jo; Meex, Ingrid; Boer, Willem; Eertmans, Ward; Sabbe, Marc; Jans, Frank; De Deyne, Cathy

    2016-01-01

    Approximately 375,000 people annually experience sudden cardiac arrest (CA) in Europe. Most patients who survive the initial hours and days after CA die of postanoxic brain damage. Current monitors, such as electrocardiography and end-tidal capnography, provide only indirect information about the condition of the brain during cardiopulmonary resuscitation (CPR). In contrast, cerebral near-infrared spectroscopy provides continuous, noninvasive, real-time information about brain oxygenation without the need for a pulsatile blood flow. It measures transcutaneous cerebral tissue oxygen saturation (rSO2). This information could supplement currently used monitors. Moreover, an evolution in rSO2 monitoring technology has made it easier to assess rSO2 in CA conditions. We give an overview of the literature regarding rSO2 measurements during CPR and the current commercially available devices. We highlight the feasibility of cerebral saturation measurement during CPR, its role as a quality parameter of CPR, predictor of return of spontaneous circulation (ROSC) and neurologic outcome, and its monitoring function during transport. rSO2 is feasible in the setting of CA and has the potential to measure the quality of CPR, predict ROSC and neurologic outcome, and monitor post-CA patients during transport. The literature shows that rSO2 has the potential to serve multiple roles as a neuromonitoring tool during CPR and also to guide neuroprotective therapeutic strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. 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)

  13. 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.

  14. Cardiopulmonary bypass considerations for pediatric patients on the ketogenic diet.

    Science.gov (United States)

    Melchior, R W; Dreher, M; Ramsey, E; Savoca, M; Rosenthal, T

    2015-07-01

    There is a population of children with epilepsy that is refractory to anti-epileptic drugs. The ketogenic diet, a high-fat, low-carbohydrate regimen, is one alternative treatment to decrease seizure activity. Special considerations are required for patients on the ketogenic diet undergoing cardiopulmonary bypass (CPB) to prevent exposure to glucose substrates that could alter ketosis, increasing the risk of recurrent seizures. A 2-year-old, 9 kilogram male with a history of infantile spasms with intractable epilepsy, trisomy 21 status post tetralogy of Fallot repair, presented to the cardiac operating room for closure of a residual atrial septal defect. All disciplines of the surgical case minimized the use of carbohydrate-containing and contraindicated medications. Changes to the standard protocol and metabolic monitoring ensured the patient maintained ketosis. All disciplines within cardiac surgery need to be cognizant of patients on the ketogenic diet and prepare a modified protocol. Future monitoring considerations include thromboelastography, electroencephalography and continuous glucose measurement. Key areas of focus with this patient population in the cardiac surgical theater are to maintain a multidisciplinary approach, alter the required CPB prime components, address cardiac pharmacological concerns and limit any abnormal hematological occurrences. © The Author(s) 2014.

  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 already in Egypt 5,000 years ago?].

    Science.gov (United States)

    Ocklitz, A

    1997-06-06

    In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

  17. [Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass].

    Science.gov (United States)

    Uji, Makiko; Terada, Yuki; Noguchi, Teruo; Nishida, Takaya; Hasuwa, Kyoko; Shinohara, Kozue; Kumano, Hotaka; Ishimura, Naoko; Nishiwada, Makoto

    2012-08-01

    Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period. The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit. For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1). Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.

  18. The Global Attack on Tax Avoidance

    OpenAIRE

    Franck, Gustav Grønborg; Runchel, Daniel Theis; Mac, Martin Tuannhien; Ahmed, Jahanzeeb; Bang, Lars Seneca

    2015-01-01

    The issue of tax avoidance has been subject for recommended regulations by the G20 countries in collaboration with OECD. We examine the usefulness of market failure theory to explain the economic and political issues of tax avoidance. We test our hypothesis using theory through a deductive approach incorporating content analysis to find convergence(s) between tax avoidance methods identified and the efforts of the G20 BEPS action plan to respond to those methods. The issue of tax avoidance...

  19. Tax Avoidance, Welfare Transfers, and Asset Prices

    OpenAIRE

    Denis Gorea

    2013-01-01

    Does tax avoidance have any implications for financial markets? This paper quantifies the general equilibrium implications of tax avoidance by setting up an incomplete markets production economy model in which households pay capital gains taxes and have access to tax avoidance technologies provided by financial institutions. I find that changes in the level of tax avoidance have disproportionate effects on different groups of agents and generally benefit the old, wealthy and high income house...

  20. 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…

  1. 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

  2. Earthworm avoidance of silver nanomaterials over time

    DEFF Research Database (Denmark)

    Mariyadas, Jennifer; Amorim, Mónica J B; Jensen, John

    2018-01-01

    Avoidance behaviour offers a highly relevant information as it reveals the ability to avoid (or not) possible toxic compounds in the field, hence it provides information on reasons for the presence/absence in the field. The earthworm Eisenia fetida was used to study avoidance behaviour to four si...... exposure durations and showed a continuous higher avoidance with time (based on EC50 values). The AgNMs avoidance was in the order NM300Ksoil solution fraction that correlated with EC50 across materials....

  3. 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%, pscreening 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.

  4. 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.

  5. A multimedia intervention on cardiopulmonary resuscitation and advance directives.

    Science.gov (United States)

    Yamada, R; Galecki, A T; Goold, S D; Hogikyan, R V

    1999-09-01

    To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. Prospective randomized controlled, single blind study of educational interventions. General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

  6. 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.

  7. Effect of dyad training on medical students' cardiopulmonary resuscitation performance.

    Science.gov (United States)

    Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

    2017-03-01

    We investigated the effects of dyadic training on medical students' resuscitation performance during cardiopulmonary resuscitation (CPR) training.We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills.Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022).Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance.

  8. Effect of dyad training on medical students’ cardiopulmonary resuscitation performance

    Science.gov (United States)

    Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

    2017-01-01

    Abstract We investigated the effects of dyadic training on medical students’ resuscitation performance during cardiopulmonary resuscitation (CPR) training. We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills. Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022). Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance. PMID:28353555

  9. 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

  10. 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.

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

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    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

  12. 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.

  13. 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.

  14. Elimination of Gaseous Microemboli from Cardiopulmonary Bypass using Hypobaric Oxygenation

    Science.gov (United States)

    Gipson, Keith E.; Rosinski, David J.; Schonberger, Robert B.; Kubera, Cathryn; Mathew, Eapen S.; Nichols, Frank; Dyckman, William; Courtin, Francois; Sherburne, Bradford; Bordey, Angelique F; Gross, Jeffrey B.

    2014-01-01

    Background Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits following cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. Methods Variable subatmospheric pressures were applied to 100% oxygen sweep gas in standard hollow fiber microporous membrane oxygenators to oxygenate and denitrogenate blood. GME were quantified using ultrasound while air embolism from the surgical field was simulated experimentally. We assessed end organ tissues in swine postoperatively using light microscopy. Results Variable sweep gas pressures allowed reliable oxygenation independent of CO2 removal while denitrogenating arterial blood. Hypobaric oxygenation produced dose-dependent reductions of Doppler signals produced by bolus and continuous GME loads in vitro. Swine were maintained using hypobaric oxygenation for four hours on CPB with no apparent adverse events. Compared with current practice standards of O2/air sweep gas, hypobaric oxygenation reduced GME volumes exiting the oxygenator (by 80%), exiting the arterial filter (95%), and arriving at the aortic cannula (∼100%), indicating progressive reabsorption of emboli throughout the CPB circuit in vivo. Analysis of brain tissue suggested decreased microvascular injury under hypobaric conditions. Conclusions Hypobaric oxygenation is an effective, low-cost, common sense approach that capitalizes on the simple physical makeup of GME to achieve their near-total elimination during CPB. This technique holds great potential for limiting end-organ damage and improving outcomes in a variety of patients undergoing extracorporeal circulation. PMID:24206970

  15. Knowledge and Attitude of Radiology Technologists Towards Cardiopulmonary Resuscitation

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    Behroozi

    2015-04-01

    Full Text Available Background The number of casualties and critically ill patients referred to radiology departments increased during the past decade, which caused the risk of cardiac arrest in radiology departments to increase considerably. Objectives The current study aimed to evaluate the knowledge and attitude of radiology technologists regarding Cardiopulmonary Resuscitation (CPR. Patients and Methods After approval a cross sectional study was designed. Ninety five radiology technologists (male and female were selected in four tertiary referral hospitals in Ahvaz, Iran. Accordingly, 87 radiologic technologists of which agreed to participate in the study. The researchers developed a questionnaire. The questionnaire consisted of three distinct sections including demographic data, attitude, and technical knowledge questions. Reliability of the technical knowledge questions were evaluated using Cronbach’s alpha (76%. Data collection was performed using interview method. Results Of the total 87 questionnaires, one was incomplete. None of the participants had attended a training program since employment. The average scores of attitude towards CPR and technical knowledge were 80 ± 8.9 and 8.8 ± 2.3, respectively. A correlation was observed between age and work experience (r = 0.866, P ≤ 0.0001, age and technical knowledge (r = 0.380, P ≤ 0.0001, work experience and technical knowledge (r = 0.317, P = 0.003, and attitude and technical knowledge (r = 0.397, P ≤ 0.0001. Also a correlation was observed between work experience and attitude (r = 0.385, P ≤ 0.0001. No significant difference was observed between male and female subjects’ technical knowledge (P ≥ 0.05 and attitude (P ≥ 0.05. Conclusions It can be concluded that, although the attitude of participants towards CPR was positive in general, their technical knowledge was poor. This finding should urge decision-makers to consider delivering in-service training courses to radiology technologists

  16. [Coronary artery bypass grafting without use of cardiopulmonary bypass].

    Science.gov (United States)

    Mujanović, Emir; Bergsland, Jacob; Hadziselimović, Mehdin; Softić, Muniba; Azabagic, Azur; Stanimirović-Mujanović, Sanja; Kabil, Emir

    2002-01-01

    Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5.77% vs. 21.15%). The mortality rate was reduced in patients operated without CPB (0.00% vs. 5.76%). There were reduced need for transfusion in patients operated without CPB (0.28 vs. 1.11 units of blood). The average time spent on respirators was shorter in patients operated without CPB (1.50 vs. 4.76 hours). The average time of total hospitalisation was also shorter in patients operated withouth CPB (6.53 vs. 8.13 days). In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care and the total hospitalisation time is also less.

  17. 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. 

  18. Intratracheal Milrinone Bolus Administration During Acute Right Ventricular Dysfunction After Cardiopulmonary Bypass.

    Science.gov (United States)

    Gebhard, Caroline Eva; Desjardins, Georges; Gebhard, Cathérine; Gavra, Paul; Denault, André Y

    2017-04-01

    To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass. Retrospective analysis. Single-center study. The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass. After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube. RV function improvement, as indicated by decreasing pulmonary artery pressure and changes of RV waveforms, was observed in all 7 patients. Adverse effects of tMil included dynamic RV outflow tract obstruction (2 patients) and a decrease in systemic mean arterial pressure (1 patient). tMil may be an effective, rapid, and easily applicable therapeutic alternative to inhaled milrinone for the treatment of acute RV failure during cardiac surgery. However, sufficiently powered clinical trials are needed to confirm these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. 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

    BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is common and is associated with increased mortality. We wanted to investigate if the arterial pressure or the use of norepinephrine during cardiopulmonary bypass were associated with AKI. METHODS: A retrospective analysis of patients who...... 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...

  20. Blood utilization in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass.

    Science.gov (United States)

    Wesley, Mark C; Yuki, Koichi; Daaboul, Dima G; Dinardo, James A

    2011-07-01

    Neonates and infants undergoing cardiac surgery with cardiopulmonary bypass are exposed to multiple blood products from different donors. The volume of the bypass circuit is often as large as the patient's total blood volume and asanguineous bypass primes are unusual. As a result, blood products are required for the cardiopulmonary bypass prime and are often used to treat the postbypass dilutional coagulopathy. We review clot formation and strength, cardiopulmonary bypass prime considerations, assessment of postbypass coagulopathy, component therapy use, ultrafiltration techniques, and use of antifibrinolytic medications. A combined approach including techniques to minimize the prime volume, utilization of ultrafiltration, administration of antifibrinolytics during surgery, and the proper treatment of the dilutional coagulopathy can limit the transfusion requirements.

  1. 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.

  2. 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.

  3. 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

  4. Combined Psoas Compartment-Sciatic Block in a Pediatric Patient with High-Risk Cardiopulmonary

    Directory of Open Access Journals (Sweden)

    Levent Þahin

    2013-03-01

    Full Text Available There is high potential for complications in cardiopulmonary high-risk patients with valvular heart disease at perioperative period. The operation was planned due to pathological fracture of the femoral shaft of a nine year old male patient weighing 26 kilograms. He had 3o tricuspid insufficiency, 3o mitral insufficiency and pulmonary hypertension in preoperative evaluation. Sciatic nerve block and psoas compartment block was performed to patient for anesthesia and analgesia. In conclusion we think that combined psoas compartment-sciatic nerve block may be a good alternative to other methods of anesthesia in high-risk pediatric patients with cardiopulmonary perspective in lower-extremity surgery.

  5. 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.

  6. Global and regional changes of cardiopulmonary blood volume under continuous work load

    International Nuclear Information System (INIS)

    Hoeck, A.; Schuerch, P.; Freundlieb, C.; Vyska, K.; Kunz, N.; Feinendegen, L.E.; Hollmann, W.

    1980-01-01

    The present study describes a method for the continuous determination of global and regional stress-induced alterations of cardiopulmonary blood volumes in normals, trained athletes and patients with latent cardiac insufficiency. In contrast to normals and athletes there is an increase of the total cardiac blood volume in the cardiac patients. There are also significant differences in blood volume changes of the left lung between normals and athletes on the one hand and the cardiac patients on the other. The method is simple and non-hazardous; it permits the observation of the obviously different adaptation of the cardiopulmonary system during exercise in normals, athletes and cardiac patients. (orig.) [de

  7. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.

    Science.gov (United States)

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy

    2015-10-15

    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  8. [Comparison of cardiopulmonary endurance and muscular fitness in teenagers between Hong Kong and inland cities].

    Science.gov (United States)

    Hong, Y; Chan, K; Wang, Y

    1997-01-01

    A study on the data of the physique investigated in teenagers was carried out between Hong Kong and inland cities to compare their cardiopulmonary endurance and muscular fitness. Results revealed that cardiopulmonary endurance in school teenagers of both sex at different ages in inland cities was better than that in Hong Kong. Muscular strength and endurance of sports performance of teenagers, except for standing long jump, in Hong Kong were weaker than that in inland cities. It suggests that attention should be paid to the involvement of teenagers in physical education with the increase of people's living standard.

  9. Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey.

    Science.gov (United States)

    Son, Jeong Woo; Ryoo, Hyun Wook; Moon, Sungbae; Kim, Jong-Yeon; Ahn, Jae Yun; Park, Jeong Bae; Seo, Kang Suk; Kim, Jong Kun; Kim, Yun Jeong

    2017-06-01

    Bystander cardiopulmonary resuscitation (CPR) is an important factor associated with improved survival rates and neurologic prognoses in cases of out-of-hospital cardiac arrest. We assessed how factors related to CPR education including timing of education, period from the most recent education session, and content, affected CPR willingness. In February 2012, trained interviewers conducted an interview survey of 1,000 Daegu citizens through an organized questionnaire. The subjects were aged ≥19 years and were selected by quota sampling. Their social and demographic characteristics, as well as CPR and factors related to CPR education, were investigated. Chi-square tests and multivariate logistic regression analyses were used to evaluate how education-related factors affected the willingness to perform CPR. Of total 1,000 cases, 48.0% were male. The multivariate analyses revealed several factors significantly associated with CPR willingness: didactic plus practice group (adjusted odds ratio [AOR], 3.38; 95% confidence interval [CI], 2.3 to 5.0), group with more than four CPR education session (AOR, 7.68; 95% CI, 3.21 to 18.35), interval of less than 6 months from the last CPR education (AOR, 4.47; 95% CI 1.29 to 15.52), and education with automated external defibrillator (AOR, 5.98; 95% CI 2.30 to 15.53). The following were associated with increased willingness to perform CPR: practice sessions and automated electrical defibrillator training in public CPR education, more frequent CPR training, and shorter time period from the most recent CPR education sessions.

  10. Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: a cross-sectional survey of Victorians.

    Science.gov (United States)

    Bray, Janet E; Smith, Karen; Case, Rosalind; Cartledge, Susie; Straney, Lahn; Finn, Judith

    2017-04-01

    To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  11. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.

    Science.gov (United States)

    Sakamoto, Tetsuya; Morimura, Naoto; Nagao, Ken; Asai, Yasufumi; Yokota, Hiroyuki; Nara, Satoshi; Hase, Mamoru; Tahara, Yoshio; Atsumi, Takahiro

    2014-06-01

    A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR). Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively. In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. 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

  13. 2010 Survey on cell phone use while performing cardiopulmonary bypass.

    Science.gov (United States)

    Smith, T; Darling, E; Searles, B

    2011-09-01

    Cell phone use in the U.S. has increased dramatically over the past decade and text messaging among adults is now mainstream. In professions such as perfusion, where clinical vigilance is essential to patient care, the potential distraction of cell phones may be especially problematic. However, the extent of this as an issue is currently unknown. Therefore, the purpose of this study was to (1) determine the frequency of cell phone use in the perfusion community, and (2) to identify concerns and opinions among perfusionists regarding cell phone use. In October 2010, a link to a 19-question survey (surveymonkey.com) was posted on the AmSECT (PerfList) and Perfusion.com (PerfMail) forums. There were 439 respondents. Demographic distribution is as follows; Chief Perfusionist (30.5%), Staff Perfusionist (62.0%), and Other (7.5%), with age ranges of 20-30 years (14.2%), 30-40 years (26.5%), 40-50 years (26.7%), 50-60 years (26.7%), >60 years (5.9%). The use of a cell phone during the performance of cardiopulmonary bypass (CPB) was reported by 55.6% of perfusionists. Sending text messages while performing CPB was acknowledged by 49.2%, with clear generational differences detected when cross-referenced with age groups. For smart phone features, perfusionists report having accessed e-mail (21%), used the internet (15.1%), or have checked/posted on social networking sites (3.1%) while performing CPB. Safety concerns were expressed by 78.3% who believe that cell phones can introduce a potentially significant safety risk to patients. Speaking on a cell phone and text messaging during CPB are regarded as "always an unsafe practice" by 42.3% and 51.7% of respondents, respectively. Personal distraction by cell phone use that negatively affected performance was admitted by 7.3%, whereas witnessing another perfusionist distracted with phone/text while on CPB was acknowledged by 33.7% of respondents. This survey suggests that the majority of perfusionists believe cell phones raise

  14. Cardiopulmonary Resuscitation Training Rates 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.

    2014-01-01

    Context Bystander cardiopulmonary resuscitation (CPR) improves the likelihood of surviving out-of-hospital cardiac arrest (OHCA), yet treatment rates differ by a community’s racial and income composition. Objective To determine if CPR training differs by the race and income of communities across the United States (U.S.). Design, Setting, and Participants We analyzed county-level CPR training rates from 2010–2011 using CPR training data from the American Heart Association, the American Red Cross, and the Health and Safety Institute. We utilized multivariable logistic regression models to examine the association of annual adult CPR training rates with a county’s proportion of black residents and median household income (categorized as tertiles), as well as other demographic, geographic, and healthcare characteristics. Main Outcome Measure CPR training rate. Results From 07/01/2010–06/30/2011, 13.1 million persons in 3143 U.S. counties received CPR training. The median county training rate ranged from 0.00%–1.29% (median=0.51%) in the lower tertile, 1.29%–4.07% (median=2.39%) in the middle tertile, and >4.07% (median=6.81%) in the upper tertile. Counties that were most likely to have CPR training rates in the lower tertile included those with a higher proportion of rural (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.10, 1.15 per 5 percentage point [PP] change), black (OR 1.09, 95% CI 1.06, 1.13 per 5 PP change), and Hispanic residents (OR 1.06, 95% CI 1.02, 1.11 per 5 PP change); those with a lower median household income (OR 1.18, 95% CI 1.04, 1.34 per $10,000 decrease); those with a higher median age (OR 1.28, 95% CI 1.04, 1.53 per 10 year change); and those located in the South. Conclusions Counties with a higher proportion of rural, black, Hispanic, and lower income residents had lower CPR training rates. Differences in CPR training by race and income may contribute to recognized disparities in bystander CPR treatment and OHCA survival, and

  15. Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Magura Stephen

    2012-11-01

    Full Text Available Abstract Background Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills. Methods The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. Results Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two did not have a significant effect

  16. Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

    Science.gov (United States)

    2012-01-01

    Background Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills. Methods The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. Results Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two) did not have a significant effect on any outcomes

  17. Emotional Impact of Cardiopulmonary Resuscitation Training on High School Students

    Directory of Open Access Journals (Sweden)

    Abdullah Alismail

    2018-01-01

    Full Text Available BackgroundThe American Heart Association (AHA has implemented several programs to educate the public about cardiopulmonary resuscitation (CPR. A common issue in bystander CPR is the fear of hurting the victim. As a result, the victim may not receive CPR in time. The purpose of this study was to measure the emotional impact of CPR training on high school students using two approved AHA courses.MethodsA total of 60 students participated in this study. These students had a mean age of 15.4 ± 1.2 years old and were selected from a high school in Southern California. Subjects were divided into two groups, Basic Life Support (BLS (n1 = 31 and Hands-Only™ CPR (n2 = 29. Emotional impacts were assessed by having each subject answer a questionnaire based on given scenarios before and after their training session.ResultsThere was a significant difference in both groups when comparing positive-emotion scores before and after the training (BLS: 30.3 ± 6.0 vs. 34.5 ± 6.7, p < 0.001; Hands-Only 27.9 ± 5.0 vs. 32.1 ± 6.5, p < 0.001. In addition, both groups showed significant reductions in negative-emotion scores (BLS: 29.2 ± 6.7 vs. 23.7 ± 6.5, p < 0.001 and Hands-Only: 26.8 ± 6.1vs. 24.8 ± 7.7, p = 0.05.ConclusionOur results indicate that the AHA programs have positive effects on students’ emotional response. We recommend that future studies include an in-depth study design that probes the complexity of students’ emotions after completing an AHA session.

  18. 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

  19. 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.

  20. A Demonstration of Approach and Avoidance Conflicts

    Science.gov (United States)

    Terry, W. Scott

    2010-01-01

    Choosing between 2 unpleasant alternatives (Would you rather be less intelligent or less attractive?) is more difficult than choosing between two desirable options (Would you rather be more intelligent or more attractive?). Here I describe a classroom demonstration of avoidance-avoidance conflicts. Students make a series of approach-approach and…

  1. 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.

  2. Higher threat avoidance costs reduce avoidance behaviour which in turn promotes fear extinction in humans.

    Science.gov (United States)

    Rattel, Julina A; Miedl, Stephan F; Blechert, Jens; Wilhelm, Frank H

    2017-09-01

    Theoretical models specifying the underlying mechanisms of the development and maintenance of anxiety and related disorders state that fear responses acquired through classical Pavlovian conditioning are maintained by repeated avoidance behaviour; thus, it is assumed that avoidance prevents fear extinction. The present study investigated behavioural avoidance decisions as a function of avoidance costs in a naturalistic fear conditioning paradigm. Ecologically valid avoidance costs - manipulated between participant groups - were represented via time-delays during a detour in a gamified computer task. After differential acquisitions of shock-expectancy to a predictive conditioned stimulus (CS+), participants underwent extinction where they could either take a risky shortcut, while anticipating shock signaled by the CS+, or choose a costly avoidance option (lengthy detour); thus, they were faced with an approach-avoidance conflict. Groups with higher avoidance costs (longer detours) showed lower proportions of avoiders. Avoiders gave heightened shock-expectancy ratings post-extinction, demonstrating 'protecting from extinction', i.e. failure to extinguish. Moreover, there was an indirect effect of avoidance costs on protection from extinction through avoidance behaviour. No moderating role of trait-anxiety was found. Theoretical implications of avoidance behaviour are discussed, considering the involvement of instrumental learning in the maintenance of fear responses. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution

    Energy Technology Data Exchange (ETDEWEB)

    Pope III, C.A.; Burnett, R.T.; Thun, M.J.; Calle, E.E.; Krewski, D.; Ito, K.; Thurston, G.D. [Brigham Young University, Provo, UT (United States)

    2003-03-06

    A study was conducted to the relationship between long-term exposure to fine particulate air pollution and all-cause, lung cancer, and cardiopulmonary mortality. Vital status and cause of death data were collected by the American Cancer Society as part of the Cancer Prevention II study, an ongoing prospective mortality study, which enrolled approximately 1.2 million adults in 1982. Participants completed a questionnaire detailing individual risk factor data (age, sex, race, weight, height, smoking history, education, marital status, diet, alcohol consumption, and occupational exposures). The risk factor data for approximately 500 000 adults were linked with air pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data through December 31, 1998. Fine particulate and sulfur oxide-related pollution were found to be associated with all-cause, lung cancer, and cardiopulmonary mortality. Each 10-{mu}g/m{sup 3} elevation in fine particulate air pollution was associated with approximately a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality, respectively. Measures of coarse particle fraction and total suspended particles were not consistently associated with mortality. It was concluded that long-term exposure to combustion-related fine particulate air pollution is an important environmental risk factor for cardiopulmonary and lung cancer mortality. 31 refs., 5 figs., 2 tabs.

  4. Treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Ruijter, Barry J.; van Putten, Michel J. A. M.; Horn, Janneke; Blans, Michiel J.; Beishuizen, Albertus; van Rootselaar, Anne-Fleur; Hofmeijer, Jeannette

    2014-01-01

    Electroencephalographic (EEG) status epilepticus is described in 10 to 35% of patients with postanoxic encephalopathy after successful cardiopulmonary resuscitation and is associated with case fatality rates of 90 to 100%. It is unclear whether these EEG patterns represent a condition to be treated

  5. A Pilot Study of Flipped Cardiopulmonary Resuscitation Training: Which Items Can Be Self-Trained?

    Science.gov (United States)

    Van Raemdonck, Veerle; Aerenhouts, Dirk; Monsieurs, Koen; De Martelaer, Kristine

    2017-01-01

    Objective: This study evaluated self-trained basic life support (BLS) skills acquired from an e-learning platform to design a complementary in-class training approach. Design: In total, 41 students (15-17 years, 29 men) participated in a pilot study on self-training in BLS. After 6 weeks, a compression-only cardiopulmonary resuscitation (CPR) test…

  6. A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students.

    Science.gov (United States)

    Onan, Arif; Simsek, Nurettin; Elcin, Melih; Turan, Sevgi; Erbil, Bülent; Deniz, Kaan Zülfikar

    2017-11-01

    Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training. Copyright © 2017 Elsevier Ltd. All rights reserved.

  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. Understanding the Impact of Cardiopulmonary Resuscitation Training on Participants' Perceived Confidence Levels

    Science.gov (United States)

    Nordheim, Shawn M.

    2013-01-01

    This pre-experimental, participatory action research study investigated the impact of Cardiopulmonary Resuscitation (CPR) training on participants' perceived confidence and willingness to initiate CPR. Parents of seventh and eighth grade students were surveyed. Parent participants were asked to watch the American Heart Association's Family and…

  9. 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

  10. A Curriculum-Based Health Service Program in Hypertension, Diabetes, Venereal Diseases and Cardiopulmonary Resuscitation

    Science.gov (United States)

    Coker, Samuel T.; Janer, Ann L.

    1978-01-01

    Special screening and education courses in hypertension, diabetes, venereal disease, and cardiopulmonary resuscitation were added as electives at the Auburn University School of Pharmacy. Applied learning experiences for students and services to the community are achieved. Course goals and content and behavioral objectives in each area are…

  11. 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.

  12. Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Gyllenborg, Tore; Granfeldt, Asger; Lippert, Freddy

    2017-01-01

    BACKGROUND: Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM: To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OH...

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

    Science.gov (United States)

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

    2004-12-01

    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, electrocardiography, and echocardiography. Exercise capacity was measured using a maximal exercise test on a bicycle ergometer and an expired gas analysis system. Muscle strength in shoulder abductors, hip flexors, ankle dorsal flexor, and grip strength were measured. All results were compared with reference values. Cardiopulmonary function at rest was within normal ranges, but when it was compared with normal height for age and sex, vital capacities were reduced. Mean absolute and relative VO 2 peak were respectively -1.17 (+/- 0.67) and -1.41 (+/- 1.52) standard deviations lower compared with reference values ( P exercise tolerance and muscle strength were significantly reduced in patients with OI, which might account for their increased levels of fatigue during activities of daily living.

  14. Triiodothyronine supplementation and cytokines during cardiopulmonary bypass in infants and children.

    Science.gov (United States)

    Priest, James R; Slee, April; Olson, Aaron K; Ledee, Dolena; Morrish, Fionnuala; Portman, Michael A

    2012-10-01

    The Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study demonstrated a shortened time to extubation in children younger than 5 months old undergoing cardiopulmonary bypass for congenital heart surgery with triiodothyronine supplementation. Cardiopulmonary bypass precipitates a systemic inflammatory response that affects recovery, and triiodothyronine is related to cytokine mediators of inflammation. We sought to investigate the preoperative cytokine levels by age and relationship to the triiodothyronine levels and to examine the effect of the cytokine levels on the time to extubation. We measured 6 cytokines at preoperative time 0 and 6 and 24 hours after crossclamp removal in 76 subjects. The preoperative cytokine levels were related to both the triiodothyronine levels and the patient age. The postoperative cytokine levels were predictive of the triiodothyronine levels at 6, 12, 24, and 72 hours. Preoperative CCL4 was associated with an increased chance of early extubation. Inclusion of the cytokines did not change the relationship of triiodothyronine to the time to extubation, and the postoperative course of interleukin-6 was independently associated with a decreased chance of early extubation. The preoperative and postoperative cytokine levels, in particular, interleukin-1β, showed complex time-dependent relationships with triiodothyronine. The data suggest that cytokine-mediated suppression of triiodothyronine plays an important role in determining the clinical outcome after cardiopulmonary bypass. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. 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.

  16. Cardiopulmonary resuscitation: state of the art in 2011 | Möhr ...

    African Journals Online (AJOL)

    Failure to recognise the signs of sudden cardiac arrest or impending cardiac arrest will lead to delayed intervention. Cardiopulmonary resuscitation (CPR) must be initiated without delay, irrespective of the level of skill of the caregiver. The 2010 CPR guidelines emphasise the importance of chest compressions, which have ...

  17. 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

  18. 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 resuscitation training.

  19. 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.

  20. 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.

  1. 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

  2. The effect of extracorporeal life support on the brain: cardiopulmonary bypass.

    Science.gov (United States)

    Jonas, Richard A

    2005-02-01

    This article reviews the mechanisms of brain injury associated with cardiopulmonary bypass. These include embolic injury of both a gaseous and particulate nature as well as global hypoxic ischemic injury. Ischemic injury can result from problems associated with venous drainage or with arterial inflow including a steal secondary to systemic to pulmonary collateral vessels. Modifications in the technique of cardiopulmonary bypass have reduced the risk of global hypoxic/ischemic injury. Laboratory and clinical studies have demonstrated that perfusion hematocrit should be maintained above 25% and preferably above 30%. Perfusion pH is also critically important, particularly when hypothermia is employed. An alkaline pH can limit cerebral oxygen delivery by inducing cerebral vasoconstriction as well as shifting oxyhemoglobin dissociation leftwards. If deep hypothermia is employed, it is critically important to add carbon dioxide using the so-called "pH stat" strategy. Oxygen management during cardiopulmonary bypass is also important. Although there is currently enthusiasm for using air rather than pure oxygen, ie, adding nitrogen, this does introduce a greater risk of gaseous nitrogen emboli since nitrogen is much less soluble than oxygen. The use of pure oxygen in conjunction with CO2 to apply the pH stat strategy is recommended. Many of the lessons learned from studies focusing on brain protection during cardiopulmonary bypass can be applied to the patient being supported with extracorporeal membrane oxygenation.

  3. 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)

  4. Increased concentrations of L-lactate in the rectal lumen in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Perner, A; Jørgensen, V L; Poulsen, T D

    2005-01-01

    Gut ischaemia may contribute to morbidity in patients after cardiopulmonary bypass (CPB), but little is known about the metabolic state of the large bowel in such patients. Therefore we estimated the concentrations of L-lactate and Pco(2) in rectal mucosa in patients undergoing cardiac surgery...

  5. Fatal air embolism during cardiopulmonary bypass : analysis of an incident and prevention measures

    NARCIS (Netherlands)

    van der Zee, Michiel P.; Koene, Bart M.; Mariani, Massimo A.

    Air embolism is a life-threatening complication during cardiopulmonary bypass. We present a case of a patient who suffered an air embolism during coronary bypass surgery, despite standard safety features and procedures. The patient died 3 days after surgery due to massive cerebral oedema. This case

  6. 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...

  7. Influence of cardiopulmonary bypass on the interaction of recombinant factor VIIa with activated platelets

    DEFF Research Database (Denmark)

    Kjalke, M.; Runge, M.; Rojkjaer, R.

    2009-01-01

    Recombinant factor VIIa (rFVIIa) interacts preferentially with coated platelets characterized by a high exposure of phosphatidyl serine (PS), FV, FVIII, FIX, and FX binding, and fibrinogen. Cardiopulmonary bypass (CPB) is known to impair platelet function. In this study, the influence of CPB...

  8. The impact of heparin-coated circuits on hemodynamics during and after cardiopulmonary bypass

    NARCIS (Netherlands)

    de Vroege, R; Huybregts, R; van Oeveren, W; van Klarenbosch, J; Linley, G; Mutlu, J; Jansen, E; Hack, E; Eijsman, L; Wildevuur, C

    This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused

  9. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Toft, P; Tønnesen, Else Kirstine; Zülow, I

    1997-01-01

    Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open...

  10. 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...

  11. 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,

  12. The routine use of fresh frozen plasma in operations with cardiopulmonary bypass is not justified

    NARCIS (Netherlands)

    Consten, E. C.; Henny, C. P.; Eijsman, L.; Dongelmans, D. A.; van Oers, M. H.

    1996-01-01

    BACKGROUND: The negative influence of cardiopulmonary bypass on hemostasis has been documented. Although abnormalities in platelet function are reported as the major cause of postoperative blood loss related to this hemostasis defect, fresh frozen plasma is often used in operations with

  13. Effect of dexamethasone on perioperative renal function impairment during cardiac surgery with cardiopulmonary bypass

    NARCIS (Netherlands)

    Loef, BG; Henning, RH; Epema, AH; Rietman, GW; van Oeveren, W; Navis, GJ; Ebels, T

    2004-01-01

    Background. In cardiac surgery with cardiopulmonary bypass (CPB), corticosteroids are administered to attenuate the physiological changes caused by the systemic inflammatory response. The effects of corticosteroids on CPB-associated renal damage have not been documented. The purpose of this study

  14. 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.

  15. 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.

  16. Treatment of electroencephalopgraphic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Ruijter, Barry Johannes; van Putten, Michel Johannes Antonius Maria; Horn, J.; Blans, M.J.; Beishuizen, A.; van Rootselaar, A.F.; Hofmeijer, Jeannette

    2014-01-01

    Abstract Background Electroencephalographic (EEG) status epilepticus is described in 10 to 35% of patients with postanoxic encephalopathy after successful cardiopulmonary resuscitation and is associated with case fatality rates of 90 to 100%. It is unclear whether these EEG patterns represent a

  17. 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

  18. Home continuous positive airway pressure for cardiopulmonary indications in infants and children.

    Science.gov (United States)

    Al-Iede, Montaha; Kumaran, Radhagini; Waters, Karen

    2018-04-30

    A number of reports exist regarding the use of continuous positive airway pressure (CPAP) to manage obstructive sleep apnoea (OSA) in children, which we term 'conventional CPAP'. In contrast, there are few reports of home CPAP use for other indications, which we have grouped under the term 'cardiopulmonary'. The aims of this study were to (1) document cardiopulmonary indications for CPAP use in a cohort of infants and children, and (2) evaluate its effectiveness in this group. Hospital records were reviewed for 645 patients who were commenced on long-term CPAP over a 10-year period at a single-tertiary hospital (Children's Hospital at Westmead). This study evaluated the group where the primary indication for CPAP was not OSA ('cardiopulmonary CPAP'). Data evaluated included: demographics, diagnoses, indications for CPAP, hours of use (compliance) and sleep study results at baseline and on CPAP. Of 645 children, 148 (23%) used home CPAP for cardiopulmonary indications; and 130 (87.8%) of these were included. For this group, mean age at CPAP initiation was 18.6 ± 33.6 months (range one week to 16.8 years). Cardiopulmonary indications for CPAP use included: primary airway diseases 65 (50%), chronic lung diseases 33 (25.4%), congenital heart disease (CHD) 20 (15.4%), and both CHD and airway malacia 12 (9.2%). All sleep study variables improved on CPAP relative to the diagnostic sleep study (p 4 h/night). Interstitial lung diseases and other cardiorespiratory disorders, often of congenital origin, can be effectively treated with home CPAP whether they are associated with OSA or not. Sleep studies demonstrated improved gas exchange, sleep and reduced work of breathing with CPAP use. Copyright © 2018 Elsevier B.V. All rights reserved.

  19. Does lying in the recovery position increase the likelihood of not delivering cardiopulmonary resuscitation?

    Science.gov (United States)

    Freire-Tellado, Miguel; Navarro-Patón, Rubén; Pavón-Prieto, Maria Del Pilar; Fernández-López, Marta; Mateos-Lorenzo, Javier; López-Fórneas, Ivan

    2017-06-01

    Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p=0.006 (OR 6.571) detected breathing arrest within 2min. The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Effect of hormone replacement on exercise cardiopulmonary reserve and recovery performance in subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    M.R.M. Mainenti

    2010-11-01

    Full Text Available Subclinical hypothyroidism (SH patients present cardiopulmonary, vascular and muscle dysfunction, but there is no consensus about the benefits of levothyroxine (L-T4 intervention on cardiopulmonary performance during exercise. The aim of the present study was to investigate the effects of L-T4 on cardiopulmonary exercise reserve and recovery in SH patients. Twenty-three SH women, 44 (40-50 years old, were submitted to two ergospirometry tests, with an interval of 6 months of normalization of thyroid-stimulating hormone (TSH levels (L-T4 replacement group or simple observation (TSH = 6.90 μIU/mL; L-T4 = 1.02 ng/dL. Patients with TSH >10 μIU/mL were excluded from the study to assure that they would receive treatment in this later stage of SH. Twenty 30- to 57-year-old women with no thyroid dysfunction (TSH = 1.38 μIU/mL; L-T4 = 1.18 ng/dL were also evaluated. At baseline, lower values of gas exchange ratio reserve (0.24 vs 0.30; P < 0.05 were found for SH patients. The treated group presented greater variation than the untreated group for pulmonary ventilation reserve (20.45 to 21.60 L/min; median variation = 5.2 vs 25.09 to 22.45 L/min; median variation = -4.75, respectively and for gas exchange ratio reserve (0.19 to 0.27; median variation = 0.06 vs 0.28 to 0.18; median variation = -0.08, respectively. There were no relevant differences in cardiopulmonary recovery for either group at baseline or after follow-up. In the sample studied, L-T4 replacement improved exercise cardiopulmonary reserve, but no modification was found in recovery performance after exercise during this period of analysis.

  1. Quality of intraoperative autologous blood withdrawal used for retransfusion after cardiopulmonary bypass.

    Science.gov (United States)

    Flom-Halvorsen, Hanne I; Øvrum, Eivind; Øystese, Rolf; Brosstad, Frank

    2003-09-01

    Intraoperative autologous blood withdrawal protects the pooled blood from the deleterious effects of cardiopulmonary bypass. Following reinfusion after cardiopulmonary bypass, the fresh autologous blood contributes to less coagulation abnormalities and reduces postoperative bleeding and the need for allogeneic blood products. However, few data have been available concerning the quality and potential activation of fresh blood stored at room temperature in the operating room. Forty coronary artery bypass grafting patients undergoing a consistent intraoperative and postoperative autotransfusion protocol had a median of 1,000 mL of autologous blood withdrawn before cardiopulmonary bypass. After heparinization the blood was drained from the venous catheter via venous cannula into standard blood bags and stored in the operating room until termination of cardiopulmonary bypass. Samples for hemostatic and inflammatory markers were taken from the pooled blood immediately before it was returned to the patient. There was some activation of platelets in the stored autologous blood, as measured by an increase of beta-thromboglobulin. Indications of thrombin formation, as assessed by plasma levels of thrombin-antithrombin complex and prothrombin fragment 1.2 were not seen, and there was no fibrinolytic activity. The red blood cells remained intact, indicated by the absence of plasma free hemoglobin. As for the inflammatory response, the levels of the terminal complement complex remained stable, and the cytokines tumor necrosis factor-alpha and interleukin 6 levels were not increased during storage. The complement activation products increased minimally, but remained within normal ranges. Except for slight activation of platelets, there was no indication of coagulation, hemolysis, fibrinolysis, or immunologic activity in the autologous blood after approximately 1 hour of operating room storage. The autologous blood was preserved in a condition of high quality, and retransfusion

  2. A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests.

    Science.gov (United States)

    Walsh, Órla; Lydon, Sinéad; O'Connor, Paul

    2017-12-01

    Paediatric cardiopulmonary arrest (CPA) survival rates are strongly linked to the training of the doctors responding to the event. This study sought to characterise the level of experience in managing CPAs among paediatric trainees and to investigate the nontechnical (NTS) required to effectively lead a paediatric CPA team. A mixed-methods research design was used. For the quantitative phase, a questionnaire was developed to assess training, confidence, and experiences related to CPA management. During the qualitative phase, 17 paediatric trainees participated in a series of critical incident technique (CIT) interviews to explore the NTS used during the management of paediatric CPAs. A total of 56 of 131 (37.1% response rate) trainees responded to the preparedness questionnaire. A total of 48.2% of respondents expressed low confidence in their skill as a team leader during the management of a CPA. The CIT interviews highlighted deficiencies in specific NTS (identifying options, prioritising, and identifying and utilising resources). Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS. What is Known • Levels of preparedness to be a paediatric cardiopulmonary arrests team member/leader are generally lower than desirable. • The importance of nontechnical skills to the effective performance of adult cardiopulmonary arrests teams has been identified. What is New • Levels of preparedness to be a cardiopulmonary arrests team member were higher than reported in US studies. • There is a need for greater training in cardiopulmonary arrest management which includes a focus on key nontechnical skills to include identifying options, prioritising, identifying and utilising resources.

  3. 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.

  4. Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement.

    Science.gov (United States)

    Lopez-Jimenez, Francisco; Kramer, Valerie Carroll; Masters, Barbara; Stuart, Patricia Mickey W; Mullooly, Cathy; Hinshaw, Ling; Haas, Linda; Warwick, Kathy

    2012-01-01

    Diabetes mellitus is a highly prevalent condition in patients participating in cardiopulmonary rehabilitation. However, research and subsequent guidelines specifically applicable to patients with diabetes, participating in cardiopulmonary rehabilitation, are limited. Recognizing this limitation, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) initiated this statement, with the goal of developing a template that incorporated recommendations provided in the AACVPR Core Components and the American Association of Diabetes Educators 7 Self-Care Behaviors. This statement describes key processes regarding evaluation, interventions, and expected outcomes in each of the core components for the management of patients with diabetes in a cardiopulmonary rehabilitation program.

  5. Cardiopulmonary functional capacity and the role of exercise in improving maximal oxygen consumption in women with PCOS.

    Science.gov (United States)

    Lenarcik, Agnieszka; Bidzińska-Speichert, Bozena

    2010-01-01

    Polycystic ovary syndrome (PCOS) is one of the most common reproductive disorder in premenopausal women and is frequently accompanied by the presence of cardiovascular risk factors. It has also been recognized that PCOS women are characterized by cardiopulmonary impairment. Reduced cardiopulmonary functional capacity and the autonomic dysfunction associated with abnormal heart rate recovery might be responsible for the increased cardiovascular risk in patients with PCOS. Exercise training has beneficial effects on cardiopulmonary functional capacity and reduces the risk of cardiovascular disease in PCOS women.

  6. 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

  7. Ecology: avoidance of disease by social lobsters.

    Science.gov (United States)

    Behringer, Donald C; Butler, Mark J; Shields, Jeffrey D

    2006-05-25

    Transmissible pathogens are the bane of social animals, so they have evolved behaviours to decrease the probability of infection. There is no record, however, of social animals avoiding diseased individuals of their own species in the wild. Here we show how healthy, normally gregarious Caribbean spiny lobsters (Panulirus argus) avoid conspecifics that are infected with a lethal virus. Early detection and avoidance of infected, though not yet infectious, individuals by healthy lobsters confers a selective advantage and highlights the importance of host behaviour in disease transmission among natural populations.

  8. Toddlers at the Table: Avoiding Power Struggles

    Science.gov (United States)

    ... Search English Español Toddlers at the Table: Avoiding Power Struggles KidsHealth / For Parents / Toddlers at the Table: ... common concerns into opportunities to teach healthy eating habits. Most Toddlers Are Picky Eaters Many toddlers express ...

  9. 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 ...

  10. 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...

  11. 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...

  12. Foods to Avoid or Limit during Pregnancy

    Science.gov (United States)

    ... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... during pregnancy Foods to avoid or limit during pregnancy E-mail to a friend Please fill in ...

  13. 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.

  14. 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...

  15. 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 ...

  16. ADVERTISING AVOIDANCE PADA IKLAN DI MEDIA TELEVISI

    OpenAIRE

    Indah Dwi Pratama; Ujang Sumarwan; Hari Wijayanto

    2016-01-01

    One factor that can interfere with the absorption rate of viewers on television advertisement is advertising avoidance which shows the difference between the number of viewers who watch advertisement programs and the number of viewers who watch television programs. The factors that affect advertising avoidance include the demography of the viewers (gender, age, area of residence, and social economic status, or SES), advertising attributes (the television stations, order of ads, genre of the p...

  17. 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.

  18. Sinkhole Avoidance Routing in Wireless Sensor Networks

    Science.gov (United States)

    2011-05-09

    COVERED (From- To) 09-05-2011 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Sinkhole Avoidance Routing in Wireless Sensor Networks 5b . GRANT NUMBER . 5c...reliability of wireless sensor networks. 15. SUBJECT TERMS wireless sensor networks, sinkhole attack, routing protocol 16. SECURITY CLASSIFICATION...Include area code) Standard Form 298 (Rev. 8/98) Prescribed by ANSI Std . Z39.18 1 Sinkhole Avoidance Routing in Wireless Sensor Networks MIDN 1/C

  19. Pathological demand avoidance: Exploring the behavioural profile.

    OpenAIRE

    O Nions, E.; Viding, E.; Greven, C. U.; Ronald, A.; Happé, F.

    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 avoidance is thought to share aspects of social impairment with autism spectrum disorders, but autism spectrum disorder-appropriate strategies, such as routine and repetition, ...

  20. 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.

  1. Neurological complications are avoidable during CABG.

    Science.gov (United States)

    Haider, Zulfiqar; Jalal, Anjum; Alamgir, Asif Rashid; Rasheed, Irfan

    2018-01-01

    To review the incidence of stroke in patients undergoing CABG and the impact of a preventive strategy adopted at tertiary care unit of cardiac surgery. The data of all patients who underwent isolated CABG (N= 722) from July 2016 to August 2017 at Faisalabad Institute of Cardiology was retrieved for this retrospective study. All operations were done on cardiopulmonary bypass and cold blood cardioplegia. Numeric data was summarized as Mean ± Standard Deviation while categoric variables were summarized into frequency and percentage. Mean age of patients was 53.83±8.8 years. Mean Parsonnet and Logistic EuroScore were 4.3±3.2 and 3.3±0.9 respectively. Forty nine patients (6.78%) had significant carotid artery disease. Mean number of grafts was 2.8±0.82. Diabetes was present in 27.8% patients. Neurological complications were noticed in 14 patients (1.94%) who included 12 permanent paralyses. Further subgroup analysis revealed that 67 patients who were operated by single clamp technique remained free of neurological complications. This is clinically remarkable finding but due to small population size it is statistically non- significant. The incidence of neurological complications can be reduced significantly by adopting the appropriate preventing measures. Use of Single Clamp technique may be the reasons of such a low incidence of stroke in this study.

  2. 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

  3. Early-Life Persistent Vitamin D Deficiency Alters Cardiopulmonary Responses to Particulate Matter-Enhanced Atmospheric Smog in Adult Mice

    Science.gov (United States)

    This study demonstrates that early-life persistent vitamin D deficiency alters the cardiopulmonary response to smog in mice and may increase risk of adverse effects. Early life nutritional deficiencies can lead to increased cardiovascular susceptibility to environme...

  4. 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.

  5. ADVERTISING AVOIDANCE PADA IKLAN DI MEDIA TELEVISI

    Directory of Open Access Journals (Sweden)

    Indah Dwi Pratama

    2016-01-01

    Full Text Available One factor that can interfere with the absorption rate of viewers on television advertisement is advertising avoidance which shows the difference between the number of viewers who watch advertisement programs and the number of viewers who watch television programs. The factors that affect advertising avoidance include the demography of the viewers (gender, age, area of residence, and social economic status, or SES, advertising attributes (the television stations, order of ads, genre of the program, and advertising sector, and competition (DayPart. The study attempted to measure the level of advertising avoidance in Indonesia and its relation to various factors that influence it by using the secondary data generated by Nielsen Audience Measurement Indonesia through Television Audience Measurement (TAM. The methods utilized consisted of the t-test independent sample, one way ANOVA, Tukey, Kruskal Wallis, and Dunn Bonferoni. The result showed that the level of advertising avoidance in Indonesia reached by 23%, with relatively similar results to the other studies in various countries. The hypothesis test results also showed a significant relationship between the advertising avoidance and demographic variables, advertising attributes, and competitions affecting this avoidance. On one hand, the findings of the study are expected to be useful for the advertisers to plan their advertisements on television so that they become more effective and efficient. On the other hand, television stations can utilize these findings as a development strategy to expand their audience segmentation and to accommodate the needs of the advertisers more optimally.Keywords: advertising avoidance, television advertisement, TAM, ANOVA, Tukey

  6. Key conclusions from AVOID Work Stream One

    Science.gov (United States)

    Warren, Rachel

    2010-05-01

    AVOID work stream (WS1)one has produced emission scenarios that simulate potential future global emission pathways for greenhouse gases during the 21st century. The study explored the influence of three key features of such pathways: (1) the year in which emissions peak globally, (2) the rate of emission reduction, and (3) the minimum level to which emissions are eventually reduced. It examined the resultant climate change, climate change impacts and economic implications using computer simulations. Avoided impacts, carbon taxes and GDP change increase throughout the 21st century in the models. AVOID-WS1 showed that in the absence of climate policy it is very likely that global mean temperatures would exceed 3 degrees and there are evens chances that the temperature would rise by 4 degrees relative to pre-industrial times. Scenarios that peak emissions in 2016 were more effective at constraining temperatures to below 3 degrees than those that peaked in 2030: one ‘2016' scenario achieved a probability of 45% of avoiding breaching of a 2 degree threshold. Scenarios peaking in 2030 were inconsistent with constraining temperatures to below 2 degrees. Correspondingly, scenarios that peak in 2030 are more effective at avoiding climate impacts than scenarios that peak in 2016, for all sectors that we studied. Hence the date at which emissions peak is more important than the rate of subsequent emissions reduction in determining the avoided impacts. Avoided impacts increase with time, being negligible in the 2030s, significant by the 2050s and large by the 2080s. Finally, the choice of GCM influences the magnitude of the avoided impacts strongly, so that the uncertainties in our estimates of avoided impacts for each scenario are larger than the difference between the scenarios. Our economic analysis is based on models which differ greatly in the assumptions that they make, but generally show that the date at which emissions peak is a stronger driver of induced GDP changes

  7. Harm avoidance and disability in old age.

    Science.gov (United States)

    Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A

    2006-01-01

    The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

  8. 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.

  9. 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

  10. 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.

  11. Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

    Science.gov (United States)

    Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas

    2011-02-01

    We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

  12. Cardiopulmonary measurements in dogs undergoing gastropexy without gastrectomy for correction of gastric dilatation-volvulus.

    Science.gov (United States)

    Wagner, A E; Dunlop, C I; Chapman, P L

    1999-08-15

    To measure cardiopulmonary variables, including cardiac index, in dogs with naturally acquired gastric dilatation-volvulus (GDV). Prospective clinical study. 6 dogs with GDV. In addition to typical medical and surgical management of GDV, the dorsal metatarsal and pulmonary arteries and right atrium of the dogs were catheterized to obtain cardiopulmonary measurements before and during anesthesia and surgery. All dogs underwent gastropexy but none required gastrectomy. Mean cardiac index and mean arterial blood pressure for this small population of dogs with GDV were not significantly different from those reported for clinically normal awake or anesthetized dogs. Dogs with naturally acquired GDV without gastric necrosis may not have the classic characteristics, including decreased cardiac index and hypotension, of hypovolemic circulatory shock.

  13. 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.

  14. Myxedema Coma with Reversible Cardiopulmonary Failure: a Rare Entity in 21St Century.

    Science.gov (United States)

    Dhakal, Prajwal; Pant, Manisha; Acharya, Pranab Sharma; Dahal, Sumit; Bhatt, Vijaya Raj

    2015-09-01

    Myxedema coma, a rare entity in 21st century in developed nations, is a decompensated phase of hypothyroidism with high mortality rates. We describe a young woman with myxedema, who developed respiratory failure, congestive heart failure and significant pericardial effusion, some of the uncommon manifestations. Decreased cardiac contractility can result in cardiomyopathy and heart failure. As illustrated by this case, myxedema can also result in significant pericardial effusion due to increased vascular permeability. Myxedema can further be complicated by alveolar hypoventilation and respiratory failure secondary to the lack of central drive as well as respiratory muscle weakness. Prompt therapy with thyroid hormone replacement, glucocorticoid therapy, aggressive supportive care and management of the precipitating event can save lives and reverse the cardiopulmonary symptoms, as in our patient. Hence, physicians should have a high index of suspicion for myxedema coma in patients with unexplained cardiopulmonary failure. Our report is, therefore, aimed at bringing awareness about the rare but fatal manifestations of myxedema coma.

  15. A Transient Dopamine Signal Represents Avoidance Value and Causally Influences the Demand to Avoid

    Science.gov (United States)

    Pultorak, Katherine J.; Schelp, Scott A.; Isaacs, Dominic P.; Krzystyniak, Gregory

    2018-01-01

    Abstract While an extensive literature supports the notion that mesocorticolimbic dopamine plays a role in negative reinforcement, recent evidence suggests that dopamine exclusively encodes the value of positive reinforcement. In the present study, we employed a behavioral economics approach to investigate whether dopamine plays a role in the valuation of negative reinforcement. Using rats as subjects, we first applied fast-scan cyclic voltammetry (FSCV) to determine that dopamine concentration decreases with the number of lever presses required to avoid electrical footshock (i.e., the economic price of avoidance). Analysis of the rate of decay of avoidance demand curves, which depict an inverse relationship between avoidance and increasing price, allows for inference of the worth an animal places on avoidance outcomes. Rapidly decaying demand curves indicate increased price sensitivity, or low worth placed on avoidance outcomes, while slow rates of decay indicate reduced price sensitivity, or greater worth placed on avoidance outcomes. We therefore used optogenetics to assess how inducing dopamine release causally modifies the demand to avoid electrical footshock in an economic setting. Increasing release at an avoidance predictive cue made animals more sensitive to price, consistent with a negative reward prediction error (i.e., the animal perceives they received a worse outcome than expected). Increasing release at avoidance made animals less sensitive to price, consistent with a positive reward prediction error (i.e., the animal perceives they received a better outcome than expected). These data demonstrate that transient dopamine release events represent the value of avoidance outcomes and can predictably modify the demand to avoid. PMID:29766047

  16. 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...

  17. Combined Psoas Compartment-Sciatic Block in a Pediatric Patient with High-Risk Cardiopulmonary

    OpenAIRE

    Levent Þahin

    2013-01-01

    There is high potential for complications in cardiopulmonary high-risk patients with valvular heart disease at perioperative period. The operation was planned due to pathological fracture of the femoral shaft of a nine year old male patient weighing 26 kilograms. He had 3o tricuspid insufficiency, 3o mitral insufficiency and pulmonary hypertension in preoperative evaluation. Sciatic nerve block and psoas compartment block was performed to patient for anesthesia and analgesia. In conclusion we...

  18. 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...

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

    OpenAIRE

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

    2016-01-01

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

  20. 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...

  1. 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...

  2. 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.

  3. 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

  4. 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.

  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

    -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...... echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important...

  6. 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...

  7. ELEMENTAL ANALYSIS OF RESPIRABLE TIRE PARTICLES AND ASSESSMENT OF CARDIO-PULMONARY TOXICITY IN RATS

    Science.gov (United States)

    Elemental Analysis of Respirable Tire Particles and Assessment of Cardio-pulmonary Toxicity in RatsR.R. Gottipolu, PhD1, E. Landa, PhD2, J.K. McGee, MS1, M.C. Schladweiler, BS1, J.G. Wallenborn, MS3, A.D. Ledbetter, BS1, J.E. Richards, MS1 and U.P. Kodavanti, PhD1. 1NHEER...

  8. Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT.

    Science.gov (United States)

    Passen, Edward; Feng, Zekun

    2015-01-01

    Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  9. 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 ...

  10. An avoidance layer in hierarchical process control

    International Nuclear Information System (INIS)

    De Callatay, A.

    1994-01-01

    A project of layered software architecture is proposed: a safety-critical real-time non-stop simple kernel system includes a layer avoiding threatening actions from operators or programs in other control systems. Complex process-control applications (such as fuzzy systems) are useful for the smooth operation of the system, optimum productivity, efficient diagnostics, and safe management of degraded modes of operation. Defects in these complex process-control applications do not have an impact on safety if their commands have first to be accepted by a safety-critical module. The development, testing, and certification of complex applications computed in the outside layers can be made simpler and less expensive than for those in the kernel. Avoidance systems use rule-base systems having negative fuzzy conditions and actions. Animal and human behaviour cannot be explained without active avoidance

  11. 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.

  12. Engaging Math-Avoidant College Students

    Directory of Open Access Journals (Sweden)

    M. Paul Latiolais

    2009-07-01

    Full Text Available This paper is an informal, personal account of how we, as two college teachers, became interested in math anxiety, decided to explore it amongst students at our institution in order to inform our teaching, and became convinced that the massive problem is math avoidance. We tried discussion groups, but few students attended, although those that did made useful suggestions. Thus informed, we designed an innovative course, Confronting College Mathematics as a Humanities course with the possibility of credit toward the math requirement, but it was undersubscribed in its first offering and had to be canceled. How can we get college students who avoid math to break through the barrier of math avoidance? We have now begun to explore a new approach: Second Life, where students can engage math—and quantitative literacy—virtually, and anonymously.

  13. Smoking, activity level and exercise test outcomes in a young population sample without cardiopulmonary disease.

    Science.gov (United States)

    Vozoris, N T; O'donnell, D E

    2015-01-01

    Whether reduced activity level and exercise intolerance precede the clinical diagnosis of cardiopulmonary disorders in smokers is not known. We examined activity level and exercise test outcomes in a young population-based sample without overt cardiopulmonary disease, differentiating by smoking history. This was a multiyear cross-sectional study using United States National Health and Nutrition Examination Survey data from 1999-2004. Self-reported activity level and incremental exercise treadmill testing were obtained on survey participants ages 20-49 years, excluding individuals with cardio-pulmonary disease. Three thousand seven hundred and one individuals completed exercise testing. Compared to never smokers, current smokers with >10 pack years reported significantly higher odds of little or no recreation, sport, or physical activity (adjusted OR 1.62; 95% CI 1.12-2.35). Mean perceived exertion ratings (Borg 6-20) at an estimated standardized workload were significantly greater among current smokers (18.3-18.6) compared to never (17.3) and former smokers (17.9) (psmoking abstinence was associated with significantly lower likelihood of low estimated peak oxygen uptake categorization (psmoking cessation, these results set the stage for future studies that examine mechanisms of activity restriction in young smokers and the utility of measures of activity restriction in the earlier diagnosis of smoking-related diseases.

  14. Cardiopulmonary Resuscitation in Resource-limited Health Systems-Considerations for Training and Delivery.

    Science.gov (United States)

    Friesen, Jason; Patterson, Dean; Munjal, Kevin

    2015-02-01

    In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result from CPR training in low- and middle-income countries (LMICs). It is determined that for many health care systems, CPR training may have financial and ethically-deleterious, unintended consequences. Evidence shows Basic Life Support (BLS) skills training in a community is an effective intervention to improve public health. But, health care systems with limited resources should include CPR training only after considering the full implications of that intervention.

  15. 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 or not 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.

  16. Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

    Science.gov (United States)

    Gabbott, David; Smith, Gary; Mitchell, Sarah; Colquhoun, Michael; Nolan, Jerry; Soar, Jasmeet; Pitcher, David; Perkins, Gavin; Phillips, Barbara; King, Ben; Spearpoint, Ken

    2005-07-01

    The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

  17. 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.

  18. 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.

  19. Information Dilemmas and Blame-Avoidance Strategies

    DEFF Research Database (Denmark)

    Erik, Baekkeskov; Rubin, Olivier

    2017-01-01

    from day one about 2009 H1N1 flu. To explore why, this article links crisis information dilemmas to blame avoidance concepts from democratic political theories. We argue that greater Chinese transparency about infectious disease response reflects evolution in blame avoidance, from heavy reliance...... on information control to insulating leaders by using technical experts and agencies as 'lightning rods.' In 2003, the Chinese strategy of information containment and secrecy backfired, and the Chinese leadership eventually received blame at home and internationally for crisis mismanagement. In 2009, China put...... in place public health specialists and institutions as responsible for H1N1 information and responses, thereby insulating the top-tier leadership....

  20. 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

  1. 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

  2. Employer Attitudes towards Peak Hour Avoidance

    NARCIS (Netherlands)

    Vonk Noordegraaf, D.M.; Annema, J.A.

    2012-01-01

    Peak Hour Avoidance is a relatively new Dutch mobility management measure. To reduce congestion frequent car drivers are given a financial reward for reducing the proportion of trips that they make during peak hours on a specific motorway section. Although previous studies show that employers are

  3. Employer attitudes towards peak hour avoidance

    NARCIS (Netherlands)

    Noordegraaf, D.M.V.; Annema, J.A.

    2012-01-01

    Peak Hour Avoidance is a relatively new Dutch mobility management measure. To reduce congestion frequent car drivers are given a financial reward for reducing the proportion of trips that they make during peak hours on a specific motorway section. Although previous studies show that employers are

  4. 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

  5. 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

  6. 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…

  7. ALUMINUM AVOIDANCE BY MUCUNA-PRURIENS

    NARCIS (Netherlands)

    HAIRIAH, K; VANNOORDWIJK, M; STULEN, [No Value; KUIPER, PJC

    The hypothesis was tested that the avoidance of acid subsoil by the velvet bean Mucuna pruriens is based on a mechanism acting on the whole root system rather than on individual roots. In a split-root experiment with circulating nutrient solution the growth of plants with Al-containing (+/+) or

  8. 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 ...

  9. Hydrofluoric acid on dentin should be avoided.

    NARCIS (Netherlands)

    Loomans, B.A.C.; Mine, A.; Roeters, F.J.M.; Opdam, N.J.M.; Munck, J. De; Huysmans, M.C.D.N.J.M.; Meerbeek, B. Van

    2010-01-01

    Hydrofluoric acid can be used for intra-oral repair of restorations. Contamination of tooth substrate with hydrofluoric acid cannot always be avoided. OBJECTIVES: To investigate the bonding effectiveness to hydrofluoric acid contaminated dentin by, micro-tensile bond strength testing, SEM and TEM.

  10. 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)

  11. 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.

  12. Traveler's guide to avoiding infectious diseases

    Science.gov (United States)

    ... to-date information, please visit the Centers for Disease Control and Prevention's (CDC) website -- www.cdc.gov/zika . To prevent getting the Zika virus, take steps to avoid mosquito bites. Sexual transmission of the virus can be prevented by using condoms ...

  13. An Examination of Avoided Costs in Utah

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan

    2005-01-07

    The Utah Wind Working Group (UWWG) believes there are currently opportunities to encourage wind power development in the state by seeking changes to the avoided cost tariff paid to qualifying facilities (QFs). These opportunities have arisen as a result of a recent renegotiation of Pacificorp's Schedule 37 tariff for wind QFs under 3 MW, as well as an ongoing examination of Pacificorp's Schedule 38 tariff for wind QFs larger than 3 MW. It is expected that decisions made regarding Schedule 38 will also impact Schedule 37. Through the Laboratory Technical Assistance Program (Lab TAP), the UWWG has requested (through the Utah Energy Office) that LBNL provide technical assistance in determining whether an alternative method of calculating avoided costs that has been officially adopted in Idaho would lead to higher QF payments in Utah, and to discuss the pros and cons of this method relative to the methodology recently adopted under Schedule 37 in Utah. To accomplish this scope of work, I begin by summarizing the current method of calculating avoided costs in Utah (per Schedule 37) and Idaho (the ''surrogate avoided resource'' or SAR method). I then compare the two methods both qualitatively and quantitatively. Next I present Pacificorp's four main objections to the use of the SAR method, and discuss the reasonableness of each objection. Finally, I conclude with a few other potential considerations that might add value to wind QFs in Utah.

  14. 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

  15. 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.

  16. Learn to Avoid or Overcome Leadership Obstacles

    Science.gov (United States)

    D'Auria, John

    2015-01-01

    Leadership is increasingly recognized as an important factor in moving schools forward, yet we have been relatively random in how we prepare and support them. Four obstacles often block or diminish their effectiveness. Avoiding or overcoming each of these requires an underlying set of skills and knowledge that we believe can be learned and…

  17. PENGARUH CORPORATE GOVERNANCE TERHADAP TAX AVOIDANCE

    Directory of Open Access Journals (Sweden)

    Nuralifmida Ayu Annisa

    2012-05-01

    Full Text Available This study aims to find out how the influence of the corporate governance of tax avoidanceactivity in companies listed on Indonesia Stock Exchange in 2008. The samples are publiclytraded company listed on the Indonesia Stock Exchange in 2008 as many as 200 companies. Thisstudy uses data analysis and regression analysis of the elements of corporate governance and taxavoidance. The results of this study show that the elements of corporate governance that consist ofaudit quality and audit committee significantly influence the activity of tax avoidance as measuredusing proxy book tax gap. Other results show that the tax avoidance activity as measured withproxy book tax gap are not affected significantly by institutional ownership and board ofcommissioners. Limitation of this study is not to use each type of industries as control variable socan’t identify the direct effect from type of industry on tax avoidance. Another limitation of thisstudy is use corporate governance’s proxy separately, so it can’t capture the full effect ofcorporate governance. Keywords:corporate governance, ownership structure, board of commissioners, audit committee,tax avoidance, book tax gap.

  18. Avoidance: From threat encounter to action execution

    NARCIS (Netherlands)

    Arnaudova, I.

    2015-01-01

    Every day we encounter many threats to survival: a car speeding on a small street or an angry neighbor carrying an axe. Mostly, people go through their days not worrying that their chance of survival might be small. They avoid many dangers without even thinking about them (e.g., looking at both

  19. 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.

  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...

  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. 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...

  3. Myopic Regret Avoidance: Feedback Avoidance and Learning in Repeated Decision Making

    Science.gov (United States)

    Reb, Jochen; Connolly, Terry

    2009-01-01

    Decision makers can become trapped by "myopic regret avoidance" in which rejecting feedback to avoid short-term "outcome regret" (regret associated with counterfactual outcome comparisons) leads to reduced learning and greater long-term regret over continuing poor decisions. In a series of laboratory experiments involving repeated choices among…

  4. A collision avoidance model for two-pedestrian groups: Considering random avoidance patterns

    Science.gov (United States)

    Zhou, Zhuping; Cai, Yifei; Ke, Ruimin; Yang, Jiwei

    2017-06-01

    Grouping is a common phenomenon in pedestrian crowds and group modeling is still an open challenging problem. When grouping pedestrians avoid each other, different patterns can be observed. Pedestrians can keep close with group members and avoid other groups in cluster. Also, they can avoid other groups separately. Considering this randomness in avoidance patterns, we propose a collision avoidance model for two-pedestrian groups. In our model, the avoidance model is proposed based on velocity obstacle method at first. Then grouping model is established using Distance constrained line (DCL), by transforming DCL into the framework of velocity obstacle, the avoidance model and grouping model are successfully put into one unified calculation structure. Within this structure, an algorithm is developed to solve the problem when solutions of the two models conflict with each other. Two groups of bidirectional pedestrian experiments are designed to verify the model. The accuracy of avoidance behavior and grouping behavior is validated in the microscopic level, while the lane formation phenomenon and fundamental diagrams is validated in the macroscopic level. The experiments results show our model is convincing and has a good expansibility to describe three or more pedestrian groups.

  5. Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature.

    Science.gov (United States)

    Hamilton, Rosemary

    2005-08-01

    This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest. Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization. A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review. One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards. Resuscitation training should be based on in-hospital scenarios and current evidence

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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...

  15. UV Impacts Avoided by the Montreal Protocol

    Science.gov (United States)

    Newman, Paul; McKenzie, Richard

    2010-01-01

    Temporal and geographical variabilities in the future "World Expected" UV environment are compared with the "World Avoided", which would have occurred without the Montreal Protocol on protection of the ozone layer and its subsequent amendments and adjustments. Based on calculations of clear-sky UV irradiances, the effects of the Montreal Protocol have been hugely beneficial to avoid the health risks, such as skin cancer, which are associated with high UV, while there is only a small increase in health risks, such as vitamin D deficiency, that are associated with low UV. However, interactions with climate change may lead to changes in cloud and albedo, and possibly behavioural changes which could also be important.

  16. Milrinone, a phosphodiesterase III inhibitor, prevents reduction of jugular bulb saturation during rewarming from hypothermic cardiopulmonary bypass.

    Science.gov (United States)

    Iritakenishi, T; Hayashi, Y; Yamanaka, H; Kamibayashi, T; Ueda, K; Mashimo, T

    2012-01-01

    Inadequate cerebral oxygen balance during cardiopulmonary bypass may cause neuropsychological dysfunction. Milrinone, a phosphodiesterase III inhibitor, augments cerebral blood flow by direct vasodilatation. We conducted a prospective, randomized study in patients undergoing cardiac surgery with cardiopulmonary bypass to clarify the clinical efficacy of milrinone in the imbalance of cerebral oxygen supply and demand during the rewarming period of cardiopulmonary bypass. This is a prospective, randomized and placebo-controlled study. After anesthesia, a 5.5 F fiberoptic oximeter catheter was inserted into the right jugular bulb retrogradely for monitoring the jugular venous oxyhemoglobin saturation (SjO(2)). Patients were randomly assigned to two groups, one receiving a continuous infusion of milrinone, 0.5 µg/kg/min during hypothermic cardiopulmonary bypass, and the other receiving saline as control. Milrinone significantly prevented the reduction of the jugular venous oxyhemoglobin saturation at 10 minutes from the start of rewarming compared with the control group, but did not do so from 10 to 20 minutes after rewarming. Milrinone suppresses the reduction of SjO(2) and improves the balance of cerebral oxygen supply and demand during the early rewarming period of hypothermic cardiopulmonary bypass.

  17. Online Learning of Commission Avoidant Portfolio Ensembles

    OpenAIRE

    Uziel, Guy; El-Yaniv, Ran

    2016-01-01

    We present a novel online ensemble learning strategy for portfolio selection. The new strategy controls and exploits any set of commission-oblivious portfolio selection algorithms. The strategy handles transaction costs using a novel commission avoidance mechanism. We prove a logarithmic regret bound for our strategy with respect to optimal mixtures of the base algorithms. Numerical examples validate the viability of our method and show significant improvement over the state-of-the-art.

  18. Detect and Avoid (DAA) Automation Maneuver Study

    Science.gov (United States)

    2017-02-01

    GUY A. FRENCH JOSEPH C. PRICE, MAJ, USAF Work Unit Manager Acting Chief, Supervisory Control and Cognition Branch Supervisory Control and Cognition...19a. NAME OF RESPONSIBLE PERSON (Monitor) a. REPORT Unclassified b. ABSTRACT Unclassified c. THIS PAGE Unclassified Guy French 19b. TELEPHONE...the ability to detect and safely avoid other aircraft in flight ( Cook & Davis, 2013). In order to increase UAS flight safety and support UAS

  19. 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.

  20. Avoiding Local Optima with Interactive Evolutionary Robotics

    Science.gov (United States)

    2012-07-09

    the top of a flight of stairs selects for climbing ; suspending the robot and the target object above the ground and creating rungs between the two will...REPORT Avoiding Local Optimawith Interactive Evolutionary Robotics 14. ABSTRACT 16. SECURITY CLASSIFICATION OF: The main bottleneck in evolutionary... robotics has traditionally been the time required to evolve robot controllers. However with the continued acceleration in computational resources, the

  1. 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...

  2. Functional neuroimaging of avoidance habits in OCD

    Science.gov (United States)

    Gillan, Claire M; Apergis-Schoute, Annemieke M; Morein-Zamir, Sharon; Urcelay, Gonzalo P; Sule, Akeem; Fineberg, Naomi A; Sahakian, Barbara J; Robbins, Trevor W

    2016-01-01

    Objective The goal of this study was to determine the neural correlates of excessive habit formation in obsessive-compulsive disorder (OCD). We aimed to (i) test for neurobiological convergence with the known pathophysiology of OCD and (ii) infer, based on abnormalities in brain activation, whether these habits arise from dysfunction in the goal-directed or habit system. Method Thirty-seven OCD patients and 33 controls learned to avoid shocks while undergoing a functional Magnetic Resonance Imaging (fMRI) scan. Following 4 blocks of training, we tested if the avoidance response had become a habit by removing the threat of shock and measuring continued avoidance. We tested for task-related differences in brain activity in 3 ROIs, the caudate, putamen and medial orbitofrontal cortex at a statistical threshold of phabit formation in OCD patients, which was associated with hyper-activation in the caudate. Activation in this region was also associated with subjective ratings of increased urge to perform habits. The OCD group, as a whole, showed hyper-activation in the medial orbitofrontal cortex (mOFC) during the acquisition of avoidance, however this did not relate directly to habit formation. Conclusions OCD patients exhibited excessive habits that were associated with hyper-activation in a key region implicated in the pathophysiology of OCD, the caudate nucleus. Prior studies suggest that this region is important for goal-directed behavior, suggesting that habit-forming biases in OCD may be a result of impairments in this system, rather than differences in the build up of stimulus-response habits themselves. PMID:25526600

  3. 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

  4. Granting silence to avoid wireless collisions

    KAUST Repository

    Choi, Jung Il; Jain, Mayank; Kazandjieva, Maria A.; Levis, Philip

    2010-01-01

    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.

  5. 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.

  6. Acute carbon dioxide avoidance in Caenorhabditis elegans.

    Science.gov (United States)

    Hallem, Elissa A; Sternberg, Paul W

    2008-06-10

    Carbon dioxide is produced as a by-product of cellular respiration by all aerobic organisms and thus serves for many animals as an important indicator of food, mates, and predators. However, whether free-living terrestrial nematodes such as Caenorhabditis elegans respond to CO2 was unclear. We have demonstrated that adult C. elegans display an acute avoidance response upon exposure to CO2 that is characterized by the cessation of forward movement and the rapid initiation of backward movement. This response is mediated by a cGMP signaling pathway that includes the cGMP-gated heteromeric channel TAX-2/TAX-4. CO2 avoidance is modulated by multiple signaling molecules, including the neuropeptide Y receptor NPR-1 and the calcineurin subunits TAX-6 and CNB-1. Nutritional status also modulates CO2 responsiveness via the insulin and TGFbeta signaling pathways. CO2 response is mediated by a neural circuit that includes the BAG neurons, a pair of sensory neurons of previously unknown function. TAX-2/TAX-4 function in the BAG neurons to mediate acute CO2 avoidance. Our results demonstrate that C. elegans senses and responds to CO2 using multiple signaling pathways and a neural network that includes the BAG neurons and that this response is modulated by the physiological state of the worm.

  7. 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.

  8. Knowing and avoiding plagiarism during scientific writing.

    Science.gov (United States)

    Kumar, P Mohan; Priya, N Swapna; Musalaiah, Svvs; Nagasree, M

    2014-09-01

    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.

  9. 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

  10. 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.

  11. 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

  12. 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...

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

    Directory of Open Access Journals (Sweden)

    Laurel S. Morris

    Full Text Available Background: 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. Methods: 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. Results: 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. 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

  14. A Crowd Avoidance Method Using Circular Avoidance Path for Robust Person Following

    Directory of Open Access Journals (Sweden)

    Kohei Morishita

    2017-01-01

    Full Text Available A life-support service robot must avoid both static and dynamic obstacles for working in a real environment. Here, a static obstacle means an obstacle that does not move, and a dynamic obstacle is the one that moves. Assuming the robot is following a target person, we discuss how the robot avoids a crowd through which the target person passes and arrives at the target position. The purpose of this paper is to propose a crowd avoidance method that makes a robot to be able to avoid both static and dynamic obstacles. The method uses the surface points of the obstacles to form an avoidance region, and the robot moves along the edge of the region. We conducted experiments assuming various situations such that the robot was blocked, there was a wide gap in the crowd, or a person in the crowd yielded for the robot to pass through. As an experimental result, it was confirmed the robot could avoid the crowd even when the obstacles were aligned in an “inverted wedge” shape.

  15. 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.

  16. Assessment of nurses’ cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana

    Science.gov (United States)

    2018-01-01

    Background Nurses are usually the first to identify the need for and initiate cardiopulmonary resuscitation (CPR) on patients with cardiopulmonary arrest in the hospital setting. Cardiopulmonary resuscitation has been shown to reduce in-hospital deaths when received from adequately trained health care professionals. Aim We aimed to investigate nurses’ retention of CPR knowledge and skills at district hospitals in Botswana. Methods A quantitative, quasi-experimental study was conducted at three hospitals in Botswana. A pre-test, intervention, post-test, and a re-test after 6 months were utilised to determine the retention of CPR knowledge and skills. Non-probability, convenience sampling technique was used to select 154 nurses. The sequences of the test were consistent with the American Heart Association’s 2010 basic life support (BLS) guidelines for health care providers. Data were analysed to compare performance over time. Results This study showed markedly deficient CPR knowledge and skills among registered nurses in the three district hospitals. The pre-test knowledge average score (48%) indicated that the nurses did not know the majority of the BLS steps. Only 85 nurses participated in the re-evaluation test at 6 months. While a 26.4% increase was observed in the immediate post-test score compared with the pre-test, the performance of the available participants dropped by 14.5% in the re-test 6 months after the post-test. Conclusion Poor CPR knowledge and skills among registered nurses may impede the survival and management of cardiac arrest victims. Employers and nursing professional bodies in Botswana should encourage and monitor regular CPR refresher courses. PMID:29781687

  17. Assessment of nurses' cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana.

    Science.gov (United States)

    Rajeswaran, Lakshmi; Cox, Megan; Moeng, Stoffel; Tsima, Billy M

    2018-04-12

     Nurses are usually the first to identify the need for and initiate cardiopulmonary resuscitation (CPR) on patients with cardiopulmonary arrest in the hospital setting. Cardiopulmonary resuscitation has been shown to reduce in-hospital deaths when received from adequately trained health care professionals.  We aimed to investigate nurses' retention of CPR knowledge and skills at district hospitals in Botswana.  A quantitative, quasi-experimental study was conducted at three hospitals in Botswana. A pre-test, intervention, post-test, and a re-test after 6 months were utilised to determine the retention of CPR knowledge and skills. Non-probability, convenience sampling technique was used to select 154 nurses.The sequences of the test were consistent with the American Heart Association's 2010 basic life support (BLS) guidelines for health care providers. Data were analysed to compare performance over time.  This study showed markedly deficient CPR knowledge and skills among registered nurses in the three district hospitals. The pre-test knowledge average score (48%) indicated that the nurses did not know the majority of the BLS steps. Only 85 nurses participated in the re-evaluation test at 6 months. While a 26.4% increase was observed in the immediate post-test score compared with the pre-test, the performance of the available participants dropped by 14.5% in the re-test 6 months after the post-test.  Poor CPR knowledge and skills among registered nurses may impede the survival and management of cardiac arrest victims. Employers and nursing professional bodies in Botswana should encourage and monitor regular CPR refresher courses.

  18. 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.

  19. 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.

  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. Influenece of the CPRmeter on angular position of elbows and generated forces during cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Karolina Kopacz

    2017-10-01

    Full Text Available Objectives: It is commonly known that ergonomics in emergency medical services (EMS is very important. Emergency medical services workers are exposed to different conditions and they should perform a variety of tasks. Material and Methods: The aim of the work has been to analyze the angular position of elbows and forces generated by the upper limbs during cardiopulmonary resuscitation with and without the CPRmeter based on feedback technology. Ten male paramedics and 10 male non-paramedics, in a kneeling position, performed cardiopulmonary resuscitation (CPR on an Ambu Megacode manikin placed on the ground. Measurements were taken after 1 min and 4 min following the beginning of the trial. The angular position of the elbows was evaluated with a BTS Smart DX 7000 motion capture system. Kistler platforms 9286BA were used for measuring forces. Results: In the paramedic group, one statistically significant difference was observed in the mean difference between maximal and minimal right elbow angle in the 1st min without the device vs. the mean difference in the 4th min without the device. In the paramedic group, a 25% force decrease was observed after 4 min of resuscitation in trials without the CPRmeter in comparison to the 1st min. In trials with the CPRmeter, the force parameters were similar in the 1st and 4th min and more stable. No statistically significant differences were noticed in the control group. Conclusions: The CPRmeter has influence on the magnitude of the forces applied by the upper limbs and on the optimization of the rescuer effort during cardiopulmonary resuscitation. The CPRmeter had no influence on the position of the upper part of the kinematic chain. Int J Occup Med Environ Health 2017;30(6:909–916

  2. Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

    Science.gov (United States)

    Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

    2004-01-01

    INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

  3. Cardiopulmonary response during whole-body vibration training in patients with severe COPD

    Directory of Open Access Journals (Sweden)

    Rainer Gloeckl

    2017-03-01

    Full Text Available Several studies in patients with chronic obstructive pulmonary disease (COPD have shown that whole-body vibration training (WBVT has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE/carbon dioxide production (V′CO2: 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236. Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min−1 to 1060±160 mL·min−1 with WBVT and 988±124 mL min−1 without WBV (p=0.093. However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068, heart rate (109±13 bpm versus 110±15 bpm, p=0.513 or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279. Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD.

  4. Cardiopulmonary response during whole-body vibration training in patients with severe COPD.

    Science.gov (United States)

    Gloeckl, Rainer; Richter, Petra; Winterkamp, Sandra; Pfeifer, Michael; Nell, Christoph; Christle, Jeffrey W; Kenn, Klaus

    2017-01-01

    Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation ( V E)/carbon dioxide production ( V' CO 2 ): 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min -1 to 1060±160 mL·min -1 with WBVT and 988±124 mL min -1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD.

  5. 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.

  6. Gender comparison of psychophysical forces, cardiopulmonary, and muscle metabolic responses during a simulated cart pushing task.

    Science.gov (United States)

    Maikala, Rammohan V; Ciriello, Vincent M; Dempsey, Patrick G; O'Brien, Niall V

    2010-10-01

    The purpose was to compare psychophysiological responses between healthy male and female workers during dynamic pushing. Using a psychophysical approach, 27 participants chose an acceptable force that they could push over a 7.6m distance at a frequency of 1 push per min on a treadmill. On a separate day, cardiopulmonary (e.g., whole-body oxygen uptake, heart rate, ventilation volume) and muscle metabolic measurements (change in muscle blood volume [ΔtHb] and Tissue Oxygenation Index [TOI]) from the right and left gastrocnemius muscles were collected simultaneously while participants pushed the previously chosen acceptable force on the treadmill at a similar frequency and distance for 2h. Results showed no significant difference between men and women for integrated force exerted on the instrumented treadmill handle and cardiopulmonary responses. In contrast, women demonstrated 45.7% lower ΔtHb but 3.6% higher TOI in the gastrocnemius region as compared to men, suggesting a lower hemoglobin concentration in women and high venous oxygen saturation during pushing. When ΔtHb and TOI were corrected for both body mass and pushing force, the disparity in gender was retained, implying an increased muscle oxygen saturation per force development in women than men during pushing. In the left gastrocnemius region, ΔtHb was 60% lower and TOI was 5.7% higher in women than men, suggesting an uneven muscle loading during pushing. Overall, the gender similarity in cardiopulmonary responses versus disparity in muscle metabolic responses suggest the importance of evaluating human performance during physical work at both whole-body and localized muscle levels. Copyright © 2010 Elsevier B.V. All rights reserved.

  7. Impact of mean arterial pressure on sublingual microcirculation during cardiopulmonary bypass - secondary outcome from a randomised clinical trial

    DEFF Research Database (Denmark)

    Holmgaard, Frederik; Vedel, Anne G; Ravn, Hanne Berg

    2018-01-01

    . METHODS: Thirty-six cardiac surgery patients undergoing coronary artery bypass grafting were included and randomised to either low (40-50 mmHg) or high (70-80 mmHg) mean arterial pressure during cardiopulmonary bypass. Sidestream Dark Field video images were recorded from the sublingual mucosa. Recordings...... were analysed in a blinded fashion to quantify microcirculatory variables. RESULTS: Mean arterial pressure during cardiopulmonary bypass in the low target group was 45.0 mmHg (SD 5.3) vs. 67.2 mmHg (SD 8.9) in the high target group. We found no significant difference between the two groups......OBJECTIVE: In this substudy of a randomised, clinical trial, we explored the sublingual microcirculation during cardiac surgery at two different levels of blood pressure. We hypothesised that a higher mean arterial pressure during cardiopulmonary bypass would cause higher Microvascular Flow Index...

  8. Effects of current inhalation exposure methods on cardiopulmonary function of immature dogs

    International Nuclear Information System (INIS)

    Mauderly, J.A.; Muggenburg, B.A.; Lay, J.C.

    1976-01-01

    Approximately 9% of 84 3-mo-old dogs exposed to inhalation of radioactive aerosols have experienced respiratory failure during exposure. A study was conducted to evaluate effects of exposure on cardiopulmonary function of immature dogs. Results indicate that the combination of nose breathing and breathing into the aerosol delivery cone quadrupled breathing effort of 3-mo-old dogs. Excitement exacerbated a failure to maintain adequate alveolar ventilation and resulted in CO 2 retention and acidosis. General anesthesia and use of an endotracheal tube alleviated problems due to nasal airflow resistance and behaviorally-related increases in ventilatory requirement

  9. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Toft, P; Tønnesen, Else Kirstine; Zülow, I

    1997-01-01

    Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open-heart...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p open-heart as well as abdominal operations. Thus CPB...

  10. Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Gebreegziabher Gebremedhn E

    2017-01-01

    Full Text Available Endale Gebreegziabher Gebremedhn,1 Gebremedhn Berhe Gebregergs,2 Bernard Bradley Anderson,3,† Vidhya Nagaratnam1 1Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, 2Department of Public Health, Bahir Dar College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, 3Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia †Dr Bernard Bradley Anderson passed away on January 2, 2014 Background: Cardiopulmonary resuscitation (CPR is an emergency procedure used to treat victims following cardiopulmonary arrest. Graduate health professionals at the University of Gondar Teaching Hospital manage many trauma and critically ill patients. The chance of survival after cardiopulmonary arrest may be increased with sufficient attitude and skill levels. The study aimed to assess the attitude and skill levels of graduate health professionals in performing CPR.Methods: A hospital-based cross-sectional study was conducted from May 1 to 30, 2013, at the University of Gondar Teaching Hospital. The mean attitude and skill scores were compared for sex, original residence, and department of the participants using Student’s t-test and analysis of variance (Scheffe’s test. P-values <0.05 were considered to be statistically significant.Results: Of the 506 graduates, 461 were included in this study with a response rate of 91.1%. The mean attitude scores of nurse, interns, health officer, midwifery, anesthesia, and psychiatric nursing graduates were 1.15 (standard deviation [SD] =1.67, 8.21 (SD =1.24, 7.2 (SD =1.49, 6.69 (SD =1.83, 8.19 (SD =1.77, and 7.29 (SD =2.01, respectively, and the mean skill scores were 2.34 (SD =1.95, 3.77 (SD =1.58, 1.18 (SD =1.52, 2.16 (SD =1.93, 3.88 (SD =1.36, and 1.21 (SD =1.77, respectively.Conclusion and recommendations: Attitude and skill level of graduate health professionals with regard

  11. Growth Hormone Improves Cardiopulmonary Capacity and Body Composition in Children With Growth Hormone Deficiency.

    Science.gov (United States)

    Capalbo, Donatella; Barbieri, Flavia; Improda, Nicola; Giallauria, Francesco; Di Pietro, Elisa; Rapacciuolo, Antonio; Di Mase, Raffaella; Vigorito, Carlo; Salerno, Mariacarolina

    2017-11-01

    Growth hormone deficiency (GHD) in children may be associated with early cardiovascular risk factors and alterations in left ventricular (LV) structure and function; data on cardiopulmonary functional capacity are lacking. Aim of the study was to evaluate the effect of GHD and growth hormone (GH) therapy on cardiopulmonary functional capacity, left and right cardiac structure and function, and body composition in children and adolescents. Prospective, case-control study. Twenty-one untrained GHD children (11.3 ± 0.8 years) underwent cardiopulmonary exercise testing, echocardiography and dual-energy x-ray absorptiometry, before and after 12 months of GH therapy. Twenty-one controls matched for sex, pubertal status, body mass index, and physical activity (PA) were evaluated at baseline and after 1 year. At baseline, GHD patients showed reduced LV mass (LVM; 63.32 ± 7.80 vs 80.44 ± 26.29 g/m2, P = 0.006), peak oxygen consumption (VO2peak; 22.92 ± 4.80 vs 27.48 ± 6.71 mL/Kg/min, P = 0.02), peak workload (80.62 ± 29.32 vs 103.76 ± 36.20 W, P = 0.02), and O2 pulse (4.93 ± 1.30 vs 7.67 ± 2.93 mL/beat, P = 0.0003), compared with controls. GHD patients also exhibited lower lean body mass (LBM 65.36 ± 7.84% vs 76.13 ± 8.23%, P controls. GH therapy resulted in a significant increase of LVM (72.01 ± 15.88, P = 0.03), VO2peak (26.80 ± 4.97; P = 0.01), peak workload (103.67 ± 32.24, P = 0.001), O2 pulse (6.64 ± 1.68, P = 0.0007), and LBM (75.36 ± 7.59%, P = 0.0001), with a reduction in FM (22.62 ± 7.73%, P = 0.001). No difference was found in either left or right ventricular function. Our results suggest that cardiac structure, body composition and cardiopulmonary functional capacity are impaired in children with untreated GHD and can be restored after short-term GH replacement therapy. Copyright © 2017 Endocrine Society

  12. 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.

  13. Prognostic Usefulness of Cardiopulmonary Exercise Testing for Managing Patients With Severe Aortic Stenosis

    DEFF Research Database (Denmark)

    Le, Van D; Jensen, Gunnar V; Kjøller-Hansen, Lars

    2017-01-01

    The approach to managing asymptomatic or questionably symptomatic patients for aortic stenosis is difficult. We aimed to determine whether cardiopulmonary exercise testing (CPET) is prognostically useful in such patients. Patients judged asymptomatic or questionably symptomatic for aortic stenosis...... with aortic valve area index managed conservatively provided they had either (group 1) normal peak oxygen consumption and peak oxygen pulse (>83% and >95% of the predicted values, respectively) or (group 2) subnormal peak oxygen consumption or peak...... oxygen pulse but with CPET data pointing to pathologies other than hemodynamic compromise from aortic stenosis. Increase in systolic blood pressure events included cardiac death or hospitalization with heart...

  14. 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.

  15. 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.

  16. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Toft, P; Tønnesen, Else Kirstine; Zülow, I

    1997-01-01

    Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p ... was associated with increased expression of the adhesion molecule CD11a/CD18 on lymphocytes, while the expression of activation molecules on lymphocytes was unchanged....

  17. Autologous blood transfusion in open heart surgeries under cardio-pulmonary bypass - Clinical appraisal

    Directory of Open Access Journals (Sweden)

    B. Sartaj Hussain

    2017-01-01

    Full Text Available Autologous blood withdrawal before instituting cardiopulmonary bypass (CPB protects the platelets, preserve red cell mass and reduce allogeneic transfusion requirements. Ideal condition for autologous blood donation is elective cardiac surgery where there is a high probability of blood transfusion. The purpose of this study was to assess the role of preoperative autologous blood donation in cardiac surgeries. Out of 150 patients registered, 50 cases were excluded on the basis of hemoglobin content ( [J Med Allied Sci 2017; 7(1.000: 48-54

  18. 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.

  19. Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

    DEFF Research Database (Denmark)

    Toft, P; Nielsen, C H; Tønnesen, Else Kirstine

    1998-01-01

    Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... during cardiopulmonary bypass was observed. The percentage of CD11a-positive granulocytes increased from 30% pre-operatively to 75% following cardiopulmonary bypass, while CD44-positive granulocytes increased from 5% to 13%. Despite the extent of the changes, these were not significant. The oxidative...... to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play...

  20. Avoiding Plagiarism in Writing a Research Paper

    Directory of Open Access Journals (Sweden)

    Majid Wajdi

    2018-03-01

    Full Text Available This paper discusses how to avoid plagiarism in a research paper. Avoiding plagiarism is part of a scientific writing ethic that always stated in any publication. Every writer should pay attention to their papers submitted to a journal or a scientific forum that they are free from unethical conduct. Writing a research paper needs overall accuracy especially in avoiding plagiarism in the paper that is to be published in a journal or to be presented at a certain scientific meeting, seminar or symposium. It is based on writers’ experience as a paper writer as well as a journal reviewer. The first application that the writers use is ‘checker’, a Mac computer application, used to check spelling and grammar. It assists the writers to check how misspelling and an ungrammatical inaccuracy in the writers’ papers. The second free application is ‘plagiarism checker’. Checking originality of a paper is essential and it is not too difficult to do today. It is freely accessible that plagiarism checker can be used to check how original the paper is. By visiting “Google” then write down ‘plagiarism checker’, it will appear ‘smallseatools’ and then the writers could choose and check how original the paper is. This application is freely accessed and helps immensely to check how original a paper is and how far a paper is free from plagiarism. The unoriginal phrase will be underlined and marked red and finally will be shown how inimitable the paper is. Plagiarism scan report which consists of the date of the report, plagiarism status, total words and total characters can be downloaded.

  1. Colostomy closure: how to avoid complications.

    Science.gov (United States)

    Bischoff, Andrea; Levitt, Marc A; Lawal, Taiwo A; Peña, Alberto

    2010-11-01

    Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung's disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Based on

  2. Precision Landing and Hazard Avoidance Doman

    Science.gov (United States)

    Robertson, Edward A.; Carson, John M., III

    2016-01-01

    The Precision Landing and Hazard Avoidance (PL&HA) domain addresses the development, integration, testing, and spaceflight infusion of sensing, processing, and GN&C functions critical to the success and safety of future human and robotic exploration missions. PL&HA sensors also have applications to other mission events, such as rendezvous and docking. Autonomous PL&HA builds upon the core GN&C capabilities developed to enable soft, controlled landings on the Moon, Mars, and other solar system bodies. Through the addition of a Terrain Relative Navigation (TRN) function, precision landing within tens of meters of a map-based target is possible. The addition of a 3-D terrain mapping lidar sensor improves the probability of a safe landing via autonomous, real-time Hazard Detection and Avoidance (HDA). PL&HA significantly improves the probability of mission success and enhances access to sites of scientific interest located in challenging terrain. PL&HA can also utilize external navigation aids, such as navigation satellites and surface beacons. Advanced Lidar Sensors High precision ranging, velocimetry, and 3-D terrain mapping Terrain Relative Navigation (TRN) TRN compares onboard reconnaissance data with real-time terrain imaging data to update the S/C position estimate Hazard Detection and Avoidance (HDA) Generates a high-resolution, 3-D terrain map in real-time during the approach trajectory to identify safe landing targets Inertial Navigation During Terminal Descent High precision surface relative sensors enable accurate inertial navigation during terminal descent and a tightly controlled touchdown within meters of the selected safe landing target.

  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. Avoiding object by robot using neural network

    International Nuclear Information System (INIS)

    Prasetijo, D.W.

    1997-01-01

    A Self controlling robot is necessary in the robot application in which operator control is difficult. Serial method such as process on the computer of van newman is difficult to be applied for self controlling robot. In this research, Neural network system for robotic control system was developed by performance expanding at the SCARA. In this research, it was shown that SCARA with application at Neural network system can avoid blocking objects without influence by number and density of the blocking objects, also departure and destination paint. robot developed by this study also can control its moving by self

  5. Common pitfalls to avoid during workover operations

    International Nuclear Information System (INIS)

    Byars, R.R.

    1994-01-01

    Remedial well work has been, and will continue to be, an integral part of oil company operations. More than 16,000 workover operations were performed during 1993 in the US. The economic impact from workover operations is usually immediate due to flowlines, tank batteries and other equipment being in place and ready for service prior to the workover. Similarly, problems encountered during workover operations contribute an immediate negative impact to project economics. Guidelines for common mistake avoidance are presented. They will be especially helpful for those individuals not well trained in workover preparation and supervision

  6. 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.

  7. 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

  8. Deterministic LOCA avoidance by gravity effect

    Energy Technology Data Exchange (ETDEWEB)

    Harms, A A [McMaster Univ., Hamilton, ON (Canada)

    1996-12-31

    A novel concept for an intrinsically safe reactor, called the Pellet Suspension Reactor (PSR), has vertical fuel tubes in which fuel, in the form of micro-pellets, is suspended by an upwardly flowing liquid or (preferably) gas coolant. Then, in the event of a primary pump failure, the fuel pellets fall down into a divergent conical annulus which is surrounded by ordinary water; the divergent geometry of this catchment ensures nuclear subcriticality, and the annulus will ensure decay-heat removal by packed-bed conduction. Thus melting of the fuel is avoided, and no emergency shut-down or emergency cooling provisions are required. 7 refs., 1 tab., 1 fig.

  9. Collision Avoidance for Airport Traffic Concept Evaluation

    Science.gov (United States)

    Jones, Denise R.; Prinzel, Lawrence J., III; Otero, Sharon D.; Barker, Glover D.

    2009-01-01

    An initial Collision Avoidance for Airport Traffic (CAAT) concept for the Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate the initial concept for an aircraft-based method of conflict detection and resolution (CD&R) in the TMA focusing on conflict detection algorithms and alerting display concepts. This paper gives an overview of the CD&R concept, simulation study, and test results.

  10. 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

  11. 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.

  12. 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.

  13. Prolonged Activated Clotting Time after Protamine Administration Does Not Indicate Residual Heparinization after Cardiopulmonary Bypass in Pediatric Open Heart Surgery.

    Science.gov (United States)

    Yamamoto, Tomohiro; Wolf, Hans-Gerd; Sinzobahamvya, Nicodème; Asfour, Boulos; Hraska, Victor; Schindler, Ehrenfried

    2015-08-01

    In open heart surgery, heparinization is commonly neutralized using an empirical heparin:protamine ratio ranging between 1:1 and 1:1.5. However, these ratios may result in protamine overdose that should be avoided for its negative side effects on the coagulation system. This study aimed to indicate the appropriate treatment for prolonged activated clotting time (ACT) after protamine administration following cardiopulmonary bypass (CPB) in pediatric open heart surgery by investigating the underlying reasons for it. Twenty-seven children (open heart surgery were included. Heparin was administered only before CPB (400 IU/kg) and in the pump priming volume for CPB (2,000 IU) and was neutralized by 1:1 protamine after CPB. The blood heparin concentration was measured using anti-Xa assay. ACT and blood concentrations of heparin, coagulation factors, thrombin-antithrombin complex, and prothrombin fragment 1 + 2 were assessed. A rotational thromboelastometry (ROTEM; Tem International GmbH, München, Bayern, Germany) was used to confirm the coagulation status and residual heparin after protamine administration. Anti-Xa assay showed that there is no residual heparin in the blood after 1:1 protamine administration. Nevertheless, ACT (128.89 ± 3.09 seconds before heparin administration) remained prolonged (177.14 ± 5.43 seconds at 10 minutes after protamine, 182.00 ± 5.90 seconds at 30 minutes after protamine). The blood concentrations of coagulation factors were significantly lower than those before heparin administration (p < 0.01). The low FIBTEM MCF of ROTEM (4.43 ± 0.32 mm) at 10 minutes after protamine indicated low fibrinogen concentration. Prolonged ACT after heparin neutralization by 1:1 protamine administration does not necessarily indicate residual heparin, but low blood concentrations of coagulation factors should be considered as a reason as well. Accordingly, supply of coagulation factors instead of additional protamine should be

  14. Survey on Air Pollution and Cardiopulmonary Mortality in Shiraz from 2011 to 2012: An Analytical-Descriptive Study

    Directory of Open Access Journals (Sweden)

    Mansooreh Dehghani

    2014-01-01

    Conclusions: Air pollution can aggravate chronic cardiopulmonary disease. In the current study, one of the most important air pollutants in Shiraz was the PM 10 component. Mechanical processes, such as wind blowing from neighboring countries, is the most important parameter increasing PM 10 in Shiraz to alarming conditions. The average monthly variation in PSI values of air pollutants such as NO 2 , CO, and SO 2 were lower than standard limits. Moreover, there was no significant correlation between the average monthly variation in PSI of NO 2 , CO, PM 10, and SO 2 and the number of those expired from cardiopulmonary disease in Shiraz.

  15. 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.

  16. Avoiding humiliations in the clinical encounter.

    Science.gov (United States)

    Malterud, Kirsti; Hollnagel, Hanne

    2007-06-01

    To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.

  17. Shape optimization of self-avoiding curves

    Science.gov (United States)

    Walker, Shawn W.

    2016-04-01

    This paper presents a softened notion of proximity (or self-avoidance) for curves. We then derive a sensitivity result, based on shape differential calculus, for the proximity. This is combined with a gradient-based optimization approach to compute three-dimensional, parameterized curves that minimize the sum of an elastic (bending) energy and a proximity energy that maintains self-avoidance by a penalization technique. Minimizers are computed by a sequential-quadratic-programming (SQP) method where the bending energy and proximity energy are approximated by a finite element method. We then apply this method to two problems. First, we simulate adsorbed polymer strands that are constrained to be bound to a surface and be (locally) inextensible. This is a basic model of semi-flexible polymers adsorbed onto a surface (a current topic in material science). Several examples of minimizing curve shapes on a variety of surfaces are shown. An advantage of the method is that it can be much faster than using molecular dynamics for simulating polymer strands on surfaces. Second, we apply our proximity penalization to the computation of ideal knots. We present a heuristic scheme, utilizing the SQP method above, for minimizing rope-length and apply it in the case of the trefoil knot. Applications of this method could be for generating good initial guesses to a more accurate (but expensive) knot-tightening algorithm.

  18. Avoidable cost of alcohol abuse in Canada.

    Science.gov (United States)

    Rehm, Jürgen; Patra, Jayadeep; Gnam, William H; Sarnocinska-Hart, Anna; Popova, Svetlana

    2011-01-01

    To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree. Copyright © 2010 S. Karger AG, Basel.

  19. Avoided operating costs in thermal generating systems

    International Nuclear Information System (INIS)

    Chowdhury, N.; Billinton, R.; Gupta, R.

    1995-01-01

    A simple and straightforward technique was developed to assess avoided system operating costs associated with non-utility generation (NUG). The technique was based on optimum loading configurations of the committed units both before and after the inclusion of NUG energy. The salient features of the technique were presented in this paper. Assessment of avoided operating cost with deterministic and probabilistic criteria were explained. A time differentiated price system was adopted in the algorithms to reflect the different value placed on purchased price by a utility at different times of the day. The algorithms show the utility effects of dispatchable and non-dispatchable NUG energies. The IEEE Reliability Test System (RTS) was utilized for numerical analysis. Results were illustrated. It was found that sensitivity studies similar to those performed on the IEEE-RTS could be utilized to determine the amount of energy and the time period during which utilities and NUGs can maximize their economic benefits. 7 refs., 5 figs., 1 tab

  20. Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival.

    Science.gov (United States)

    Vukmir, R B

    2004-05-01

    This study correlated the effect of witnessing a cardiac arrest and instituting bystander CPR (ByCPR), as a secondary end point in a study evaluating the effect of bicarbonate on survival. This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using chi(2) with Pearson correlation and odds ratio where appropriate. The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest-a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (ptwo minutes (p = 0.3752). Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.